Ginkgo Evaluation of Memory Study

The dietary supplement Ginkgo biloba was found to be ineffective in reducing the development of dementia and Alzheimer's disease in older people, according to a study published in the "Journal of the American Medical Association"{1}. Researchers led by Stephen T. DeKosky, M.D., formerly of the University of Pittsburgh, vice president and dean of the School of Medicine at the University of Virginia in Charlottesville, conducted the trial known as the Ginkgo Evaluation of Memory (GEM) study at four clinical sites over the course of 8 years. GEM is the largest clinical trial ever to evaluate ginkgo's effect on the occurrence of dementia.

This research was co-funded by five components of the National Institutes of Health (NIH): National Center for Complementary and Alternative Medicine (NCCAM); National Institute on Aging (NIA); National Heart, Lung, and Blood Institute; National Institute of Neurological Disorders and Stroke, and the Office of Dietary Supplements.

"We have made enormous progress in understanding the basic mechanisms involved in Alzheimer's disease, and we continue to pursue a vigorous program to translate what we know into the development and testing of new potential therapies for this devastating disease," said Richard Hodes, M.D., director of the NIA. "However, it is disappointing that the dietary supplement tested in this study had no effect in preventing Alzheimer's disease."

GEM enrolled 3,069 participants age 75 or older with normal cognition or mild cognitive impairment. Those with dementia were excluded from participation. After extensive medical and neuropsychological screening, participants were randomly assigned to receive twice-daily doses of either 120 milligrams of ginkgo extract or an identical-appearing placebo. The 240 milligrams daily dose of ginkgo was selected based on current dosage recommendations and prior clinical studies indicating possible effectiveness at this dose. The products used in the study were supplied by Schwabe Pharmaceuticals, a German company.

"According to the 2007 National Health Interview Survey, ginkgo is one of the top 10 natural products used by Americans," said Richard L. Nahin, Ph.D., M.P.H., acting director of the Division of Extramural Research at NCCAM. "It is important to conduct studies and build the scientific evidence base regarding botanical supplements through rigorous research, such as the GEM trial."

The study was conducted primarily to determine if ginkgo would decrease the incidence of all types of dementia and, more specifically, reduce the incidence of Alzheimer's disease. Secondarily, the study evaluated ginkgo for its effects on overall cognitive decline, functional disability, incidence of cardiovascular disease and stroke, and total mortality. The primary endpoint was the diagnosis of dementia as determined by an expert panel of clinicians using standard criteria for diagnosis. The patients with a diagnosis of dementia underwent magnetic resonance imaging scans to determine their dementia type.

"The results of this study confirm the importance of randomized trials in the development of new therapies for dementia and Alzheimer's disease and in determining therapeutic benefit not only for conventional therapies but also complementary therapies like ginkgo," said Dr. DeKosky, principal investigator on the GEM study. "If older patients are considering using ginkgo for preventing dementia, I urge them to speak with their health care providers about the results of this study and work together to create the best treatment plan."

Study participants were followed for an average of approximately 6 years (maximum of just over 7 years). During the study, 523 participants were diagnosed with dementia, 246 in the placebo group and 277 in the ginkgo group. Thus, ginkgo showed no overall effect for reducing all types of dementia or Alzheimer's disease. In addition, in analyzing safety data, the GEM study did not find significant adverse effects from ginkgo, in particular there was no evidence for increased bleeding risk in persons taking ginkgo.

Cognitive status was known for more than 93 percent of all participants at the end of the trial and 60 percent of active participants were taking their assigned study medication. There was no difference in adherence to taking medication between the ginkgo group and the placebo group.

"While this study revealed that ginkgo does not have an effect on reducing dementia in the study populationi it does provide us with important information about how to design and conduct large dementia prevention trials in older adults" said Dr. Jeff Williamson, a geriatrician and principal investigator of the GEM Clinical Coordinating Center at Wake Forest University. "Future analyses will provide us with additional information on ginkgo's possible effects on cardiovascular disease, cancer, depression and other age-related conditions. We are especially grateful to the more than 3,000 older adults who dedicated many hours to helping us answer the important questions addressed by GEMS."

The GEM results will prove useful in determining how many participants are needed in future trials to provide clinically significant measures on outcomes such as occurrence of dementia. Future analysis of this study may also identify subgroups of these participants who may be at greater risk for developing dementia.

Data analysis for the trial was overseen by the University of Washington, Seattle and the four GEM institutions that participated in this study were

* University of Pittsburgh
* Wake Forest University, Winston-Salem, N.C.
* Johns Hopkins University, Baltimore, Md.
* University of California, Davis

The National Center for Complementary and Alternative Medicine's mission is to explore complementary and alternative medical practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals. For additional information, call NCCAM's Clearinghouse toll free at 1-888-644-6226, or visit the NCCAM Web site at www.nccam.nih.gov.

The National Institutes of Health (NIH) -- The Nation's Medical Research Agency -- includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.


REFERENCE:
{1} DeKosky ST, Williamson JD, Fitzpatrick AL, et al. Ginkgo biloba for Prevention of Dementia. "Journal of the American Medical Association". 2008 300(19): 2253-2262.

Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update

This research report from the AARP Public Policy Institute provides updates of state and national data on the economic value of family caregivers and their effects on the health and LTC systems.

Policy recommendations at both the federal and state levels are offered to prevent family caregivers from being overwhelmed by the demands placed upon them and to fund more services and supports for them.

http://www.aarp.org/research/housing-mobility/caregiving/i13_caregiving.html

Guideline for Alzheimer's Disease Management

Prepared by the California Workgroup on Guidelines for Alzheimer's Disease Management. There are two versions of the guidelines, designed primarily for primary care practitioners and clinicians working with people with Alzheimer's and their families.

The guidelines are hosted on the California Council of the Alzheimer’s Association website. This Association is affiliated with the national Alzheimer’s Association and is the vehicle for California’s five chapters to advance statewide public policy issues. The Council identifies and influences issues that demonstrate a direct, positive link to people living with Alzheimer’s disease and other dementia disorders and their families. Through the leadership of the California Council families drive policy decisions that impact persons with dementia, their families and caregivers.


http://www.caalz.org/Guidelines.htm

Well-being of Older People in Ageing Societies

Rising human longevity in recent times pose new challenges to policy-makers worldwide, particularly in maintaining the financial sustainability of old age pension systems.

Individuals planning for retirement also face critical challenges: they need to safeguard against risks of falling into poverty during an increasing longer duration of retirement.

This book provides new insights into how with ageing factors such as ill health and disability become ever more important in determining the personal well-being of older people, and these factors have financial implications not captured by an analysis of pension income alone.

Another important policy implication arising from this book is the extent to which people are exposed to income risks in their retirement. While individuals and governments already safeguard against such hazards, this research shows that these measures will need to be strengthened further in light of the increasingly longer time spent in the post-retirement phase of life and in view of greater reliance by retirees on diverse and potentially volatile sources of income.

http://www.euro.centre.org/detail.php?xml_id=1356

The Baby Boomer's Handbook on Helping Parent's Receive Care for Memory Problems

This book contains tips and information on helping parents or families seek care for memory problems and includes:

• a 15 point Dementia-Risk Inventory
• Q and A on talking to parents about dementia
• ten benefits for the parent in recognizing dementia early
• twelve warning signs of dementia
• ten commandments to dementia prevention

http://www.alzbrain.org/pdf/handouts/a%20bABY%20BOOMER's%20guide%20to%20dealing%20with%20memory%20problems%20in%20their%20parents.pdf

Age-Related Disease Study

The National Eye Institute (NEI), part of the National Institutes of Health (NIH), announces the release of more than 10 years of data collected during the Age-Related Eye Disease Study (AREDS), which looked at the progression of age-related macular degeneration and age-related cataract in 4,757 adults aged 55 to 80.

Researchers around the world can apply for access to this complete set of medical history records and clinical trial results as well as select genetic information to gain a better understanding of two complicated vision conditions that affect aging adults.

The public, open-access AREDS data can be viewed on the dbGaP website at http://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?study_id=phs000001.v2.p1.

Researchers can find a link to the application for controlled access to individual-level data on the same site.

Source: National Eye Institute (NEI)

Finding Rosa: A Mother with Alzheimer's, a Daughter in Search of the Past

A moving account of one woman’s journey into the realm of her mother’s dementia.When her mother, Rosa, begins to show signs of Alzheimer’s, Caterina Edwards embarks on a complex journey—all at once geographical, intellectual, and emotional—that turns out to be a journey in search of the past and of home. As Rosa loses her memory and her sense of herself, Edwards travels to Istria, now part of Croatia, to get at the truth of her mother’s past.

For ordering information, go to the following link:

http://www.dmpibooks.com/book/9781553653899

Aging and Caring at the Intersection of Work and Home Life

This book looks at the boundaries of care by looking at private and public help, professional and personal help and paid and unpaid caregivers. It captures and conceptualizes the complexity of the intersection of work and home life as it relates to the provision of assistance and support to older relatives in a variety of "care work" contexts.

Readers of this volume will gain a deeper understanding of issues of care provision amongst "networks" of careers and helpers, and of the particular dynamics of care when it is episodic or framed by constrains of space and time as a result of geography.

Source: Gerontologyarena.com

Consumer Direction of Personal Assistance Services in Medicaid: A Review of Four State Programs

With a shift towards providing long-term services and supports in the community, policy interest in Medicaid consumer direction of personal assistance services (CD-PAS) has grown. Although overall enrollment in these programs is small, 42 states offered consumer direction in Medicaid in 2006. These programs allow Medicaid beneficiaries control over hiring, scheduling, training and paying of personal care attendants. The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured has produced two new reports examining Medicaid’s role in providing CD-PAS in four states: California, Colorado, New York and Virginia.

http://www.kff.org/medicaid/kcmu032408pkg.cfm

Oseltamivir, Amantadine and Zanamivir for the Prophylaxis of Influenza

This technology appraisal contains a series of documents providing guidance to the NHS on the use of oseltamivir, amantadine and zanamivir for the prophylaxis of influenza.

This guidance is produced by the National Institute for Health and Clinical Excellence (NICE). Technology appraisals produced by NICE have been developed by a team of experts aiming to produce guidance for both the NHS and patients on medicines, medical equipment and clinical procedures based on evidence of clinical and cost effectiveness.

Made available in September 2008, this appraisal includes practice guidelines, a patient-oriented leaflet, and background information.

http://www.nice.org.uk/guidance/index.jsp?action=byID&o=12060

Estrogen and progestogen use in postmenopausal women: July 2008 position statement of The North American Menopause Society.

This links to a summary of the recently updated guideline from the North American Menopause Society.

http://www.guideline.gov/summary/summary.aspx?doc_id=12713&nbr=6584&ss=6&xl=999

Alzheimer's Disease: Unraveling the Mystery

he National Institute on Aging today released a new edition of Alzheimer's Disease: Unraveling the Mystery, an illustrated, 80-page book written for people with Alzheimer's disease (AD), their families, health care professionals, students, and others with an interest in the disease.

This update to the 2003 edition of Unraveling the Mystery helps readers understand AD, its impact on individuals and society, and research advances to prevent or diminish the effects of the disease. The new edition:

• describes the basics of the healthy brain;
  
• focuses on changes that occur in a brain affected by AD;
  
• highlights findings from recent NIA-funded research into the causes of AD, new developments in diagnosis, and the search for new treatments; and
  
• addresses issues of concern to AD caregivers and families.

The book also includes a glossary, a comprehensive list of organizations offering more information, and a list of recommended reading.

To view, download, or order copies of Alzheimer's Disease: Unraveling the Mystery, go to: www.nia.nih.gov/Alzheimers/Publications/Unraveling, or call NIA's Alzheimer's Disease Education and Referral (ADEAR) Center at 1-800-438-4380.

Mental Stimulation and Lifelong Learning Activities

Elderhostel has issued a research report on "Mental Stimulation and Lifelong Learning Activities
in the 55+ Population" available at:

http://news.aarp.org/UM/T.asp?A910.52852.7112.7.2978658