Now they can live longer thanks to a new minimally invasive treatment that involves inserting an artificial valve that takes over the work of the diseased valve. The University of Florida is among a limited number of facilities around the country initially approved to offer the procedure.

“It’s exciting — this technology opens an option for patients who otherwise do not have a repair option,” said cardiologist Dr. Anthony A. Bavry, an assistant professor in the UF College of Medicine’s department of medicine. “Previously we had to treat these patients with medications, and unfortunately many did not do well. This is a big change.”

The new valve replacement technique, called transcatheter aortic valve replacement, or TAVR, was approved by the U.S. Food and Drug Administration in November 2011. Medical practices approved to perform the procedure had to demonstrate high levels of expertise and collaboration in cardiology and surgery, as well as high-quality facilities for conducting the procedure and collecting data for patient care and monitoring.

Bavry and Dr. R. David Anderson, director of interventional cardiology at UF, will team with thoracic and cardiovascular surgeons Dr. Thomas M. Beaver, and Dr. Charles T. Klodell, to do the procedure at UF&Shands, the University of Florida Academic Health Center. Working in such multidisciplinary teams streamlines and speeds patient evaluation and decisions about the best course of action.

“You have both a surgeon and a cardiologist seeing a patient, reviewing the data and making the best decision about how to treat,” Bavry said.

Among the elderly, severe aortic stenosis is the most common abnormality of the heart valves. But up to one-third of such patients are considered ineligible for surgery. They are instead given medicines to control heart rate and blood pressure, and their heart volume is monitored in order to head off congestive heart failure. Medical treatments ease symptoms but do not prolong life.

In the new TAVR procedure, the artificial valve — framed by a stent and wrapped around a balloon — is transported up to the aortic valve via a large catheter in the leg. The new valve is then anchored into position inside the diseased valve by inflation of the balloon. Placement of the stent is monitored with X-ray and ultrasound imaging.

Patients’ survival chances improve with the new technique. In clinical trials involving 700 patients, treatment with the new procedure cut the death rate nearly in half after one year of having the implanted device, compared with medical therapy alone.

“This is one of the best things that has happened in the last 10 years in interventional cardiology,” said Dr. Samir Kapadia, an interventional cardiologist at the Cleveland Clinic who is one of the leaders in clinical trials of the new technique. “Procedurally, it’s like a miracle — patients are sick, you do the critical part of the valve replacement in 15 to 30 seconds and all of a sudden the heart starts working more efficiently. It has changed the way we do things and has provided treatment options for lots of people who did not have an option before.”

The procedure has also been compared with traditional open surgery in patients who were operable but had a high risk of dying if they did have surgery. After a year, patient outcomes were comparable to those of surgery patients. Additional studies are being carried out to see how the procedure works among patients who are at lower risk of death if they have surgery.

The UF team has begun evaluating patients to see who might be good candidates for the procedure. Tests include chest CT scans, cardiac catheterization and EKGs. They are also reaching out to physicians whose patients might benefit.

Research continues on new ways to insert the valve, as well as on new types of valves, including one that can be repositioned after it has been placed inside the body.

Now, researchers from the University of Florida and elsewhere have identified a new drug that can serve as a “bridge” during that time when patients have to stop taking blood thinners, minimizing both the risk of a heart attack and the risk of excessive bleeding during surgery. The findings appeared Wednesday in the Journal of the American Medical Association.

“This could be a way to satisfy an unmet need and solve a huge clinical problem for millions of patients,” said the study’s lead author, Dr. Dominick Angiolillo, an associate professor of medicine and medical director of the UF Cardiovascular Research Program at the UF College of Medicine-Jacksonville.

Patients who have stents — small mesh tubes that help open up the arteries — must take aspirin or other blood-thinning medication for at least one year after implantation of the devices. But a problem arises if a patient requires open heart surgery during that year.

The patient must stop taking blood thinners five to seven days before surgery to avoid severe bleeding during surgery. But stopping the medication increases heart attack risk. The need for a short-term “bridge” between traditional medication and heart surgery came to national attention when former President Bill Clinton had a mild heart attack in 2004 and needed bypass surgery. Clinton had to wait six days for surgery because he had been taking aspirin and clopidogrel, commercially sold as Plavix.

Angiolillo and colleagues conducted a two-year international clinical trial to determine whether an experimental intravenous blood-thinning drug called cangrelor can keep patients in good health during the presurgery period in which they stop taking traditional oral medication. The trial was funded by The Medicines Company, which manufactures cangrelor.

The researchers determined the appropriate dosage of the drug then administered it to half of the 210 patients in the study. The other half were given a placebo, which did not contain the drug. Neither patients nor physicians knew to which group a patient was assigned until surgery was needed.

The researchers found that cangrelor can effectively thin the blood to keep heart attack risk low without increasing the risk of major bleeding during surgery. Some cases of minor, non-life threatening bleeding occurred among patients on cangrelor. Because the blood-thinning effects of cangrelor are not as long lasting as for traditional medications such as aspirin and clopidogrel, the risk of heavy bleeding is reduced.

“This is a very important scientific first step that really helps us understand what to do with people who are awaiting surgical procedures and are on medications that raise their bleeding risk,” said Dr. Deepak L. Bhatt, an associate professor of medicine at Harvard Medical School, who is not affiliated with the current study but has also conducted research on cangrelor.

Further studies are needed before cangrelor can be used in widespread clinical practice.

The study, sponsored by St. Jude Medical Inc., tested the safety and effectiveness of a constant current DBS device developed by St. Jude Medical to manage the symptoms of Parkinson’s disease. The device aimed to reduce tremors, improve the slowness of movement, decrease the motor disability of the disease and reduce involuntary movements called dyskinesia, which are a common side effect of Parkinson’s drugs.

After treatment, analysis of 136 patient diaries revealed longer periods of effective symptom control — known as “on time” — without involuntary movements. “On time” for patients who received stimulation increased by an average of 4.27 hours compared with an increase of 1.77 hours in the group without stimulation. Patients also noted overall improvements in the quality of their daily activities, mobility, emotional state, social support and physical comfort.

“I think it is safe to say since dopamine treatment emerged in the 1960s, DBS has been the single biggest symptomatic breakthrough for Parkinson patients who have experienced the fluctuations associated with levodopa therapy,” said Dr. Michael S. Okun, first author of the study, administrative director of the UF College of Medicine’s Center for Movement Disorders and Neurorestoration, and the National Medical Director for the National Parkinson Foundation. “This study validates the use of mild electrical currents delivered to specific brain structures in order to improve Parkinson’s disease in select patients with advanced symptoms, and additionally, it explored a new stimulation paradigm. Future improvements in devices and the delivery systems for DBS will hopefully provide exciting new opportunities for Parkinson’s sufferers.”

Only patients who have had Parkinson’s disease for five years or more were included in the study. They were randomly assigned to a control group that delayed the onset of stimulation for three months, or a group whose stimulation began shortly after surgery. All patients were followed for 12 months.

The deep brain stimulation procedure involves surgeons implanting small electrodes into an area of the patient’s brain that controls movement. The electrodes are connected to a device precisely programmed to use mild electrical current to modulate problematic brain signals that result in movement problems.

Today’s voltage-controlled DBS devices deliver pulses of current that vary slightly with surrounding tissue changes. The DBS devices tested in this study are intended to provide more accurate delivery and control of the electrical pulses.

“We are committed to driving research that will provide solutions for physicians and their patients whose needs are currently unmet,” said Rohan Hoare, president of St. Jude Medical Neuromodulation Division. “These results are significant as they offer evidence that stimulation with the Libra constant current system enabled patients to have better motor control and an improvement in their quality of life when compared to the control group.”

The U.S. Food and Drug Administration approved the use of DBS for Parkinson’s disease in 2002. At least 500,000 people in the United States suffer from Parkinson’s with about 50,000 new cases reported annually, according to the National Institute of Neurological Disorders and Stroke. These numbers are expected to increase as the average age of the population rises.

“The study answered some very important questions concerning cognition and mood with lead implantation (alone) versus implantation with stimulation. It also refutes the hypothesis that DBS increases depressive symptoms,” said Dr. Gordon H. Baltuch, a professor of neurosurgery in the Perelman School of Medicine at the University of Pennsylvania and a study author. “The group’s results also showed a decrease in the infection rate to 4 percent from previously published 10 percent. It shows that American neurosurgeons and neurologists with their industry partners are improving the safety of this procedure and working in a collaborative fashion.”

Comparable with other large DBS studies, the most common serious adverse event revealed was infection, which occurred in five patients. Likewise, some participants also reported an increase in the occurrence of slurred speech, known as dysarthria.

“Technology is on the move, and we expect to see continued improvements to DBS approaches, equipment and materials,” said Okun, who is also affiliated with UF’s McKnight Brain Institute. “DBS has set the bar high for the development of new therapies for advanced Parkinson’s disease patients. DBS will be the standard of care gene therapy and other cell-based therapies that are now being conceived will be measured against, and this will hopefully translate into significant improvements in what we can offer our patients.”

In addition to UF and Penn, research was conducted at centers affiliated with Baylor College of Medicine, Columbia University Medical Center, Lahey Clinic, Loma Linda University Medical Center, the Medical College of Wisconsin, Mount Sinai Medical Center, Oakwood Hospital and Health Systems, Texas Health Presbyterian, Rush University Medical Center, the University of Miami, the University of Rochester and the University of Virginia Health Systems.

Writing in the November issue of the Journal of Pain, a multi-institutional team of researchers including scientists with the University of Florida College of Dentistry, revealed the results of the Orofacial Pain Prospective Evaluation and Risk Assessment study, or OPPERA.

One of the largest clinical investigations into the causes of what are technically known as temporomandibular joint disorders, or TMD, researchers hope the discoveries may lead to new methods of diagnosing and treating facial pain conditions, and predicting who will be susceptible to them.

“A major benefit of the OPPERA study is the comprehensive evaluation of demographic, clinical, biological, sensory and psychosocial factors that may contribute to increased risk of TMD,” said Roger Fillingim, a professor of community dentistry and behavioral science at the UF College of Dentistry and the principal investigator for the UF OPPERA site. “It is important to assess variables across these multiple biopsychosocial domains in order to fully reflect the complexity of chronic pain development and persistence.”

Temporomandibular joint disorders, sometimes referred to as TMJ, produce pain that radiates from the jaw and surrounding muscles, restricting jaw movement and causing considerable suffering. Although the disorders vary in duration and severity, for some people the pain becomes a permanent feature of their lives. Estimates suggest more than 10 million people are affected by TMD disorders, according to the National Institute of Dental and Craniofacial Research.

Researchers, led by William Maixner, of the University of North Carolina at Chapel Hill School of Dentistry, followed 3,200 initially pain-free individuals aged 18 to 44 for three to five years, comparing the initially pain-free individuals with 185 people who had long-standing, chronic TMD.

They found chronic TMD becomes more frequent with increasing age in women, but not in men. Early studies indicated women’s greatest risk occurred during early childbearing years and decreased thereafter.

In addition, a wide range of biological and psychological factors appear to contribute to the condition. Compared with pain-free individuals, people with TMD were much more sensitive to mildly painful sensations, they were more aware of body sensations and they experienced greater heart rate increases during mild physical and psychological stress.

Researchers believe the findings provide evidence that chronic TMD is at least partially linked to a person’s perception of and ability to suppress pain, which is determined by the body’s physiological regulatory systems.

Researchers also identified new and important genetic factors that appear to be linked to chronic TMD. Several genes, including some known to influence stress response, psychological well-being and inflammation were identified and may result in new targets for drugs to treat temporomandibular joint disorders and related chronic pain conditions.

The longitudinal study builds on earlier work by members of the multi-university research team, which designed a broad conceptual model to determine the condition’s causes.

“The OPPERA conceptual model proposes that measures of pain sensitivity and psychosocial functioning, both of which are influenced by life experiences as well as genetics, are related to future development of TMD,” Fillingim said. “While the OPPERA conceptual model was developed initially to explain risk for developing TMD, it can be more broadly applied and may help explain the reasons some people develop many different chronic pain conditions.”

The research team will publish additional findings and insights as they continue to analyze the study data.

The National Institute of Dental and Craniofacial Research-funded study was conducted across four study sites, including UF, UNC-Chapel Hill, UF, the University of Maryland at Baltimore, the University of Buffalo and Battelle Memorial Institute.

The initial conceptual model of TMD causation was developed by Maixner, Luda Diachenko, Gary Slade, at UNC-Chapel Hill and Fillingim at UF.

Other study investigators include Eric Bair, and Shad Smith, from UNC; Ronald Dubner, and Joel D. Greenspan, from the University of Maryland; Richard Ohrbach, at the University of Buffalo; and Charles Knott with Battelle Memorial Institute, who served as the director of the Data Coordination Center.

The findings, from a national clinical trial conducted by University of Florida researchers and colleagues, was published online in The New England Journal of Medicine online on Wednesday.

Against expectations, the short-term risk of stroke and related death was twice as high in some cases for patients whose diseased arteries were widened via balloon angioplasty and stent insertion, compared with patients who received medical therapy alone.

Although the 30-day risk of stroke for the stenting patients is concerning, long-term results could be more favorable, the researchers said.

“Five years from now, who will be doing better — the patients who are being medically managed, or those who received a stent?” said study co-author Dr. Michael F. Waters, director of the Shands at UF Stroke Program, who along with Dr. Brian L. Hoh, the William Merz associate professor of neurological surgery in the College of Medicine, led the UF portion of the trial.

The study will have a substantial impact on clinical practice and research, the researchers said, because it is the first randomized stroke trial to pit stenting against nonsurgical treatment for symptomatic intracranial atherosclerosis, a type of stroke caused by artery blockage in the brain. Early results clearly show that intensive medical management is key to improving health, the researchers said.

“This study provides an answer to a longstanding question by physicians — what to do to prevent a devastating second stroke in a high-risk population. Although technological advances have brought intracranial stenting into practice, we have now learned that when tested in a large group this particular device did not lead to a better health outcome,” said Dr. Walter Koroshetz, deputy director of the NIH National Institute of Neurological Disorders and Stroke, which funded the clinical trial.

Every 40 seconds, someone in the U.S. has a stroke. Stroke is the fourth leading cause of death and a leading cause of disability in the U.S. Almost 800,000 people a year have a new or recurring stroke, according to the American Heart Association. With higher than average rates of stroke and related deaths, parts of the southeastern U.S. are together termed the “Stroke Belt.”

Patients with the type of stroke known as symptomatic intracranial atherosclerosis do not respond well to existing treatments. One-quarter of those patients have another stroke within 12 months, and the risk of additional strokes continues in subsequent years. Doctors are unsure what the best course of treatment is.

To find out, the UF researchers and colleagues launched a clinical trial, nicknamed SAMMPRIS, at 50 sites around the country, including at the Medical University of South Carolina, the lead site. The study recruited 451 participants age 30 to 80 who had at least 70 percent narrowing in the arteries in the brain, and had experienced symptoms within the previous 30 days. UF recruited the second-highest number of patients among all sites, through its stroke program, which has been designated a Comprehensive Stroke Center by the Agency for Health Care Administration.

Patients in one group were randomly assigned to receive intensive management involving smoking cessation and medications for blood pressure, cholesterol, diabetes and blood-clot prevention. A second group of patients had that same medical treatment but also had balloon angioplasty and stent implantation into the affected brain artery to improve blood flow.

Almost 15 percent of patients who received stents had a stroke or died within 30 days of enrolling in the study, compared with just under 6 percent of patients in the medical therapy group. The stark difference between the groups persisted almost a year, by which time about 21 percent of patients who had received stents had had negative effects, compared with 12 percent in the medical group.

The researchers initially thought that patients who received stents would have fared better, given the successful use of similar procedures in clinical practice at the Shands at UF Stroke Program and other medical centers.

But the striking difference between the two patient groups prompted the study’s independent safety monitoring body to call off new recruitment. The researchers will, however, continue to monitor previously enrolled patients for the next two years.
It’s not unusual for surgical patients to have more complications at first, the researchers said. That’s because the invasiveness of surgery poses an inherent risk regardless of the illness being treated.

“The real question is, is there a benefit to patients over the long term,” said study co-author and co-principal investigator Hoh, who is an associate professor of radiology and neuroscience in the UF College of Medicine. “If you think about it, when people are concerned about stroke, it’s not just their first month that matters, so we’re waiting to see what the longer-term results will be.”

Over time, improvement of stent design and honing of surgical techniques could help improve outcomes for patients.

“This is certainly not the final say on managing this disease,” Waters said. “This is another piece of the puzzle that helps to guide our hand.”

Previous research has been mostly based on error-prone self-reports of physical activity rather than actual measurements. Now, University of Florida researchers and colleagues have used laboratory-based methods to objectively measure the amount of energy older adults use up as they go about their daily activities, and linked that to cognitive performance.

The researchers found that older adults who expend relatively high amounts of energy in their daily activities are substantially less likely to become cognitively impaired than those who exert less energy. The findings are published in the July 25 issue of the Archives of Internal Medicine.

“There are millions and millions of people who don’t exercise, but we’re beginning to understand that a lot of these people do a lot during the day, and they are likely to accumulate more energy expenditure during the day than others who go out and exercise,” said study co-author Todd Manini, an assistant professor in the department of aging and geriatric research at the University of Florida College of Medicine and the UF Institute on Aging. “These studies are starting to shed light on the fact that accumulating activity during the day can potentially provide health benefits.”

A growing body of research points to the promise of physical activity as a way to prevent or even treat cognitive impairment. But to figure out what types of activities are necessary, and how much, researchers need better estimates of energy spent in various activities.

“That’s going to be a hard question to answer until we can get objective answers about physical activity,” said Kirk Erickson, an assistant professor in the department of psychology and the Center for the Neural Basis of Cognition at the University of Pittsburgh. “If we’re going to translate this research into a clinical setting, we need to provide a quantifiable metric or number for how much physical activity to get.” Erickson was not involved in the current study.

Previous studies have relied heavily on study participants to tell researchers how physically active they were.

“With self-report, we hear what people think they are getting, but it might not be accurate, and doesn’t tell us about energy expenditure the way that objective measures do,” said Erickson, whose imaging studies have shown that one year of participation in modest amounts of exercise can reverse Alzheimer’s-related atrophy in parts of the brain involved in memory formation.

In the new study, the research team, led by scientists at the Heart and Stroke Foundation Centre in Toronto, and at the University of California, San Francisco, moved a step closer to reliably identifying just how much energy people expend.

The researchers studied almost 200 older adults who on average were 75 years old to figure out how much energy people burn during daily activities. First, they calculated the total amount of energy used for the day, then subtracted the basic amount of energy the body needs while at rest.

Participants drank so-called “heavy” water, which has a slight chemical difference from regular water. That allowed researchers to track the body’s consumption of oxygen molecules over time and use that to calculate the number of calories burned.

To find out how much energy a person used while at rest, the researchers used a method called calorimetry to determine the levels of carbon dioxide in the breath.

For comparison, the researchers also collected self-reported activity data.

To assess cognitive function, patients were tested on memory, concentration, orientation, language and other categories.

The more energy spent, the lower the likelihood of cognitive impairment, the researchers found. Patients with the highest levels of activity energy expenditure were 90 percent less likely to become cognitively impaired than those with the lowest levels of expenditure.

The findings are consistent with what other researchers have found, but Manini and colleagues went a step beyond by pointing out the shortcomings associated with using self-reported activity.

Self-reports are highly biased because people might report participating in more activity than they actually do — or they might forget to mention something they did. Self-reports also often focus on sports-like activities and fail to capture movements such as walking around the house or pottering about in the garden.

The link between the onset of cognitive impairment and energy expenditure was stronger when laboratory measurements were used to measure activity than when self-report data was used. In addition, the relationship between the amount of energy spent and the amount of decline experienced was more pronounced for laboratory methods than for self-reports, possibly because of more accurate recording of low-intensity activity.

“The strength of the study was that the researchers didn’t have to just ask people how much physical activity they got — they could actually measure it,” Erickson said.

News stories have long touted resveratrol as a cure for various diseases and a preventative against aging.

”We’re all looking for an anti-aging cure in a pill, but it doesn’t exist. But what does exist shows promise of lessening many of the scourges and infirmities of old age,” said UF exercise psychologist Heather Hausenblas, one of the researchers involved in the study.

A comprehensive review of human clinical research on resveratrol has found it has “anti-aging, anti-carcinogenic, anti-inflammatory and antioxidant properties,” but more research of its benefits is needed, she said.

The study, which appeared online this week in Molecular Nutrition and Food Research, examined results gleaned from thousands of laboratory studies with enzymes, cultured cells and laboratory animals. It was conducted by Hausenblas and fellow researchers James Smoliga of Marywood University and Joseph Baur of the University of Pennsylvania School of Medicine. Their review aimed to examine the current state of knowledge of the effects of resveratrol on humans and to use this information to guide much needed future human clinical trials.

Despite numerous clinical studies on resveratrol’s tonic effects on animals, there is little evidence that it benefits human health. That’s because “there haven’t been many studies on humans,” Hausenblas said.

However, she points out, for years many scientists have thought that a link between resveratrol and human health exists. The French people, for example, enjoy low levels of cardiovascular disease, even though their diets are rich in saturated fats and oils. Some researchers think the reason for this paradox lies in France’s national drink — red wine, which is the most important dietary source of resveratrol. The UF review, said Hausenblas, shows that the resveratrol has considerable potential to improve health and prevent chronic disease in humans. However, further research examining the long-term health effects of resveratrol is much needed.

Exactly how resveratrol works isn’t yet fully understood. Correlating factors such as metabolism, the chemical interplay of molecules, genetics, exercise, age, dosage, and many others all play a role.

Among resveratrol’s most intriguing aspects is how it functions as an antioxidant. Oxidation is a natural chemical process in living tissues that results in a transfer of electrons. When this happens, groups of atoms are formed called “free radicals” that can cause cell damage which in turn provides a pathway for diseases. Antioxidants, however, suppress free radicals. “It’s not so easy to say resveratrol is the main factor,” Hausenblas said. “It’s one piece of the overall puzzle that reduces the free radicals.”

The UF study also reveals that resveratrol’s contribution to good health promises to be widespread. Various clinical trials, for example, indicate that this polyphenol — an antibiotic substance produced by plants as a defense against microorganisms — prevents the growth of some cancers in mice, inhibits enzymes that cause inflammation, shrinks tumors and increases blood flow, thus reducing cardiovascular diseases. In many cases, it also extends the life of obese animals. Some evidence also shows that resveratrol could one day be used to help regulate insulin sensitivity in diabetic patients.

Hausenblas and her colleagues think research that explores resveratrol’s potential to alleviate human infirmities will become increasingly more important as the nation’s 76 million baby boomers undergo the aging process. One trial under way at UF’s College of Medicine in the Institute on Aging examines the effect resveratrol may have on the physical and cognitive skills on older people.

Reporting on the largest stroke rehabilitation study ever conducted in the United States, researchers, including a team from the University of Florida, also revealed that patients continue to make strides in their therapy up to one year after a stroke, longer than typically expected.

“For individuals who have suffered a stroke, the findings of this trial offer good news for improving walking within the first year post-stroke through intense physical therapy interventions,” said Andrea Behrman, co-principal investigator and an associate professor in the department of physical therapy at the University of Florida College of Public Health and Health Professions. “For therapists and physicians, the study informs us of the merit of two rehabilitation strategies for improving walking — one via practice of walking and the other via strengthening and balance training — and who will benefit and when to deliver the intervention.”

The Locomotor Experience Applied Post-Stroke, or LEAPS, trial included more than 400 patients who were randomly assigned to a treadmill training group two or six months after their stroke, or to a home-based therapy program. The National Institute of Neurological Disorders and Stroke provided primary funding for the study.

Participants in the walking training group practiced walking using a treadmill with a device providing partial body-weight support, also known as locomotor training, in a clinic setting. The home-based exercise therapy program was supervised by a physical therapist and focused on flexibility, range of motion, strength and balance.

At the one-year mark, 52 percent of all the study participants had made significant improvements in their walking ability. Both the walking training and exercise program patients had similar improvements in walking speed, motor recovery, balance, social participation and quality of life. But the exercise program may save on health-care costs and promote treatment adherence: Only 3 percent of patients in the home-based therapy dropped out of the study while 13 percent discontinued the locomotor training.

Pamela W. Duncan, the study’s principal investigator and a professor at Duke University School of Medicine, told the NINDS, “We were pleased to see that stroke patients who had a home physical therapy exercise program improved just as well as those who did the locomotor training. The home physical therapy program is more convenient and pragmatic. Usual care should incorporate more intensive exercise programs that are easily accessible to patients to improve walking, function and quality of life.”

The research team found that patients in the group who began the therapy six months after their stroke also improved their walking. This finding challenges the widely held belief that patients can only make gains in their rehabilitation within the first few months of a stroke, the researchers say.

“More than 4 million stroke survivors experience difficulty walking. Rigorously comparing available physical therapy treatments is essential to determine which is best,’’ said Dr. Walter Koroshetz, deputy director of NINDS. “The results of this study show that the more expensive, high-tech therapy was not superior to intensive home strength and balance training, but both were better than lower intensity physical therapy.”

Along with Behrman, Katherine Sullivan, an associate professor of clinical physical therapy at the University of Southern California served as a co-principal investigator of the study. UF researchers on the team included Samuel Wu, an associate professor in the department of biostatistics, Dr. Stephen Nadeau, a professor in the departments of neurology and clinical and health psychology, and Dorian Rose, a research assistant professor in the department of physical therapy. Nadeau and Rose also hold appointments at the Malcom Randall Veterans Affairs Medical Center in Gainesville, Fla.

Hurricane season begins June 1 and preparations can take a little longer and require a bit more attention to detail for older adults and their caregivers, said UF’s Linda Bobroff, a family, youth and community sciences professor who helped update a guide that outlines exactly how to become prepared. Bobroff, who specializes in food and nutrition, is part of UF’s Institute of Food and Agricultural Sciences.

The guide, called Disaster Planning Tips for Older Adults, is available at http://edis.ifas.ufl.edu/fy620.

The guide is intended for anyone planning for disaster, but includes special recommendations that apply especially to older adults.

For example, the guide notes that everyone in hurricane-prone areas needs, ideally, a two-week supply of drinking water — one gallon per person, per day, and even more if you have pets.

The guide notes that because older adults become dehydrated more easily, it’s a good idea to store more water than recommended. It also suggests that planners make sure that the jugs aren’t too heavy. For those who choose not to buy storage containers or bottled water, a sanitized two-liter plastic soda bottle might be a better option than gallon jugs. Caps should be easily removed by someone with arthritis.

Everyone needs a three- to five-day nonperishable food supply, the guide says, but for older adults, dietary needs such as low sodium or high fiber foods should be considered. Smaller cans of food that can be eaten at one meal or as a snack are helpful, because older adults are more vulnerable to foodborne illness. Ensuring that you have a can opener an older person can easily operate is a lifesaver, the guide suggests.

It’s vital for families to talk about disaster scenarios well before they happen, Bobroff said, because if a family has already decided what to do in an emergency, it can save precious time that would otherwise be spent debating whether or not to go and haggling over what to bring.

“You have to talk about it,” she said. “Just knowing that if the roof blows off, or if we start to get flooded, we’re leaving — having the plan already mapped out helps.”

Carolyn Wilken, a UF associate professor emeritus, and Emily Minton, program coordinator for UF’s Elder Nutrition and Food Safety Program, also contributed to the update.

For more information on preparing for disasters, visit the Extension Disaster Education Network (EDEN) at http://eden.lsu.edu/Pages/default.aspx.

So says Dr. Marco Pahor, director of the University of Florida Institute on Aging, in an editorial Wednesday, May 4, in the Journal of the American Medical Association. Pahor’s paper accompanies an analysis of multiple clinical trials that examined the effect of exercise and physical activity on the control of blood glucose levels.

“Cumulative work over the past few decades provides solid evidence for public policymakers to consider structured physical activity and exercise programs as worthy of insurance reimbursement,” Pahor said.

A host of studies have linked exercise programs with improved health measures related to blood pressure, lipid levels — including cholesterol and triglycerides — cardiovascular events, cognition, physical performance, premature death and quality of life. People who take part in programs that contain both aerobic and resistance training are likely to get the greatest benefit, compared with people who do only resistance exercises.

The study that Pahor’s editorial accompanied, conducted by Daniel Umpierre, of the Hospital de Clinicas de Porto Alegre, Brazil, and colleagues, compared the association between physical activity advice and structured exercise programs, respectively, and markers of diabetes.

Analyses of interventions to promote physical exercise in adults have found that compared with no intervention, exercise programs are cost-effective and have the potential to improve survival rates and health-related quality of life.

Some insurance providers already include a fitness benefit for members, such as monthly membership at certain fitness centers or access to personal trainers or exercise classes at reduced cost. Use of such health plan-sponsored club benefits by older adults has been linked to slower increases in total health care costs.

In one study, older adults who visited a health club two or more times a week over two years incurred $1,252 less in health-care costs in the second year than those who visited a health club less than once a week. Programs among people with lower incomes can also pay off, because people in that group are otherwise more likely to forego health-promoting physical activity because of economic constraints or safety concerns.

“People are willing to invest in improved health, but if you have a fixed amount of resources then you want to choose where you get the most health for the dollar,” said Erik Groessl, an assistant professor of family and preventive medicine at the University of California, San Diego, and director of the UCSD Health Services Research Center. Groessl was not involved in the current analysis.

Group training or walking programs, for example, can be cost-effective, sustainable forms of physical activity that don’t require expensive health care professionals or equipment. But more costly interventions that yield dramatic results might also be worth the expense.

With respect to type 2 diabetes, Medicare reimburses for approved self-management education and medical nutrition therapy programs. But no specific reimbursement is given for any physical activity or exercise program, despite evidence that such programs can help improve health and cut costs.

Questions remain as to what format reimbursable exercise and physical activity programs should take, what population group should be targeted, and at what stage of life or health status would a lifestyle intervention be most cost-effective to implement.

Various studies, including the UF Institute on Aging Lifestyle Interventions and Independence for Elders, or LIFE study, are aimed at answering those questions through randomized controlled trials that can provide data about the efficacy and cost-effectiveness of structured activity programs with respect to a range of health outcomes. Funded by the National Institute on Aging, the LIFE study is the largest of its kind to examine physical activity and health education as a way to prevent mobility disability among older adults, and accounts for the largest federal award to the University of Florida.

The institute will break ground on May 26 for a 40,000-square-foot complex within UF’s new $45 million, 120,000-square-foot Clinical and Translational Research Building, which will serve as headquarters for this research and others aimed at speeding scientific discoveries to patients.

“There is a lot of evidence that physical activity works, and I think it’s time to start putting it into practice more widely,” Groessl said.

The foremost obstacle is that the most promising preventive strategies are being tested in patients firmly in the grip of Alzheimer’s disease — the ones least likely to be helped.

The approach would be similar to testing statins — drugs widely used to prevent heart disease — in patients who are already in cardiac arrest, according to Dr. Todd Golde, director of the University of Florida College of Medicine’s Center for Translational Research in Neurodegenerative Disease.

With Dr. Edward Koo of the University of California, San Diego, and Dr. Lon S. Schneider of the Keck School of Medicine at the University of Southern California, Golde pointed to a lack of alignment between studies in human volunteers, which focus on treatment, and preclinical laboratory studies, which are aimed at prevention.

“If we do the right types of clinical studies, we have the ability to move toward prevention, which would have a huge impact on this disease,” said Golde, a professor in the department of neuroscience at UF’s McKnight Brain Institute. “But we have to overcome our ‘prevention versus treatment’ dilemma. We already have more than 5 million people affected, and half of people in nursing homes, or more, have Alzheimer’s disease. As society ages, we are just going to continue to see Alzheimer’s drain the economy and the quality of human life.”

Without medical breakthroughs, a projected 7.7 million patients in the U.S. will have Alzheimer’s by 2030, according to the Alzheimer’s Association. That number will grow to between 11 million and 16 million by 2050.

Researchers say solving the treatment-prevention problem will require the development of biomarkers — substances in the body that point to a disease — to identify patients before they show the symptoms associated with Alzheimer’s. With biomarkers, it may be possible to test Alzheimer’s drugs in pre-symptomatic volunteers.

“The dilemma is, can you treat people as if they have Alzheimer’s if they do not?” said Koo, co-director of the Shiley-Marcos Alzheimer’s Disease Research Center at UC San Diego. “That’s the catch-22.”

Most proposed Alzheimer’s disease therapies target so-called “brain plaques” — proteins that clog the spaces between brain cells. Experimental models suggest that therapies targeting these proteins, known as amyloid beta-peptide, may be effective.

Approximately 90 experimental therapies intended to slow or stop the progression of the disease are under way, many of them targeting Alzheimer’s hallmark brain plaques, according to the Alzheimer’s Association. The problem is the strategies are likely to be much less effective when tested in patients who are already experiencing confusion, memory loss or personality changes.

But simply placing more emphasis on prevention has its own complications, the researchers say. To date, no drug candidates have been found to be effective at prevention or suitably safe enough for a patient to take for a lifetime.

And even if such a drug were found, clinical testing would take well more than a decade and cost pharmaceutical companies millions of dollars. If the drug were successful — and there is no guarantee — the company’s patent would expire before it had a chance to recover its expenses.

“It is important to find ways to ensure that the commercial sector will invest in prevention trials that may take 10 years or more to complete,” Koo said.

The authors said they are not the first to point out misalignment between clinical and preclinical studies, or summarize current therapeutics, or critique how trials are conducted.

But by presenting the issues in a comprehensive way, they hope to spur discussion among members of the research community, pharmaceutical companies and regulatory bodies to address the challenges.

“What we’ve done is collect those points and suggest what has to happen to help patients who are suffering from this awful disease,” Golde said.

Now, for the first time in mammals, researchers at the University of Florida and colleagues at the University of Wisconsin have sleuthed out the role of a key player in the process, using age-related hearing loss as an example. The protein in question, called Sirt3, could provide a new target for anti-aging drug therapies. The findings are reported in the Nov. 24 issue of the journal Cell.

The researchers found that when Sirt3 is absent, caloric restriction loses its anti-aging powers. They uncovered details of how the protein, an enzyme found primarily in mitochondria — the energy-producing centers of cells — wards off cell death by maintaining an environment that combats destructive chemicals.

“Knocking it out seems to be very negative for mitochondrial function and allows the accumulation of oxidative stress and damage to neurons and other cells,” said Christiaan Leeuwenburgh, one of the study’s senior authors who is chief of the biology of aging division in the UF College of Medicine department of aging and geriatric research and a member of the UF Institute on Aging. “That’s an important clue about the role that Sirt3 plays in protecting cells from age-related damage.”

Age-related hearing loss is the most common sensory disorder among the elderly, affecting more than 40 percent of people older than 65 and projected to affect 28 million Americans by 2030, according to the Department of Health and Human Services.

The disorder is marked by the death of sensory hair and nerve cells in the inner ear. While those cells are long-lived, they do not regenerate, so their demise means permanent loss of hearing. But all is not lost, since the environment in which those cells reside can be remodeled over time as damaged organelles such as mitochondria get replaced. Caloric restriction helps to rescue those damaged cells by reducing oxidative damage.

Having previously shown that restricting the diet induces expression of the protein Sirt3 in the inner ear, the researchers now show that Sirt3 aids caloric restriction by combating some of the chemical changes that play a major role in the process of aging.

The enzyme belongs to a class of compounds called sirtuins that are known to have anti-aging effects in lower organisms including yeast and flies. Until now, however, there wasn’t clear evidence that the effect extends to mammals.

“This is a major step in terms of understanding aging retardation by dietary restriction — it doesn’t work without Sirt3,” said Shinichi Someya, first author of the paper and an assistant scientist in genetics and medical genetics at the University of Wisconsin-Madison.

In normal mice, lowering calorie intake to 75 percent of a regular diet reduced hearing loss, but in Sirt3-deficient mice, dietary restriction had no such effect. Further, after caloric restriction, mice lacking Sirt3 lost more cellular structures vital for hearing — sensory hair and nerve cells in the ear — than did normal mice on a similarly restricted diet.

Corresponding with that observation, the researchers found that while caloric restriction reduced oxidative damage to DNA in inner ear cells in normal mice, it did not have that effect in mice that lacked Sirt3.

Closer examination revealed that Sirt3 regulates a mitochondria-based defense mechanism called the glutathione antioxidant system, via which caloric restriction works to help maintain the appropriate chemical balance needed to keep sopping up damaging oxygen-containing chemicals as they appear.

Effects seen in the ear were also observed in brain and liver tissue, suggesting that Sirt3 might have a role well beyond age-related hearing loss, and a potential benefit in cardiovascular and neurological diseases.

“They’ve taken it all the way from the physiological level down to the molecular level,” said S. Michal Jazwinski, a professor of medicine and biochemistry at Tulane University and director of the Tulane Center for Aging, who was not involved in the study. “This may be something that is generally operable in other tissues as well, and may explain the overall caloric restriction effect.”

The new findings identify Sirt3 as a target around which to focus anti-aging therapeutic efforts, including investigating ways to activate its production in the body.

“We’re now finally identifying the major genes involved in the action of caloric restriction, and this provides new opportunities for the development of therapies that may be able to provide the benefits of caloric restriction,” said Tomas Prolla, a professor of genetics and medical genetics at the University of Wisconsin-Madison, who led the research team.

The findings could ultimately help shorten the national liver transplant waiting list by allowing the use of livers donated by older adults.

“If we can improve the function and health of livers, and increase donations from seniors, then we can significantly improve the success rate of transplantations,” said Jae-Sung Kim, an assistant professor of surgery in the UF College of Medicine, and a member of the UF Institute on Aging, who led the research team.

Kim presented the findings Sunday during the American Association for the Studies of Liver Diseases, in Boston.

The liver performs many vital and complex jobs, including turning food into usable nutrients and removing toxins from the body. But just as the brain and muscles lose function as people age, the liver also becomes less resilient. Because of that, liver surgery in elderly patients is often unsuccessful, and livers donated by older adults are frequently unusable because of increased risk of failure or poor function. Recipients who do get livers from old donors often need a new transplant within a year.

Surgery to remove portions of the liver or transplant the entire organ involves the clamping off of blood vessels, temporarily depriving the organ of blood flow and oxygen. Suddenly restoring blood and oxygen after surgery causes stress-related damage known as ischemia/reperfusion injury. Older livers have great difficulty recovering from the injury, whereas younger livers rebound readily.

Existing treatments have not made a substantial difference in how patients fare after transplantation, partly because liver injury mechanisms are not well-understood.

UF researchers were interested in a process by which the body removes damaged cellular components, and which has a potential role in aging.

In particular, they looked at the clearing away of damaged mitochondria, the energy centers of cells. That helps cells optimize performance in a number of ways, including preventing the formation of toxic chemicals, maintaining appropriate levels of energy production and recycling nutrients.

In laboratory studies, Kim and colleagues found that disruption of this cellular cleanup is linked to the inability of aged livers to recover from surgery-related stress. They discovered an age-related decrease in levels of one of the main proteins, called Atg4B, that orchestrates the process.

“This work, for the first time, gets into the mechanism of why livers from older animals are more prone to injury from ischemia/reperfusion than those from young animals,” said Dr. John Lemasters, a professor of biochemistry and molecular biology and of pharmaceutical sciences at the Medical University of South Carolina who was not involved in the study.

The researchers used gene therapy to replenish the depleted protein and observed liver function afterward in liver transplant mouse models whose ages correspond to those of people in their late 20s to early 30s, and in their 80s.

The approach reduced mitochondrial dysfunction and promoted recovery after ischemia/reperfusion injury, boosting the performance of livers from old animals beyond that of normal middle-aged animals. In untreated aged livers, mitochondrial levels were at nearly zero after injury, whereas 80 percent of the mitochondria in treated livers were functional. Cells in the treated livers also were much more resilient; only 30 percent died compared with 80 percent in untreated livers — a more than two-fold improvement.

“This is a new strategy to improve liver function after ischemia/reperfusion injury, which might be important in liver surgery, and in organ storage and preservation for transplantation,” Lemasters said.

Kim and collaborators, including Christiaan Leeuwenburgh, a professor and chief of the biology of aging division in the department of aging and geriatric research and a member of the UF Institute on Aging, hope the findings will make their way into clinical applications. They are now testing various pharmaceuticals to see which can mimic the observed results with genetic manipulation, with minimal side effects.

“The basic mechanisms discovered here will lead to the next step in helping transplant surgeons find tools and ways to spur some of the pathways that are failing, and allow organs from older individuals to be successfully transplanted,” Leeuwenburgh said.

In fact, the blood pressure range considered normal — less than 120 systolic and less than 80 diastolic — may actually be risky for those with a combined diagnosis of diabetes and coronary artery disease, report University of Florida researchers from the International Verapamil SR-Trandolapril study, known as INVEST.

Optimum systolic blood pressure levels should be between 130 and 140 for patients coping with the diabetes-heart disease combination, according to Rhonda Cooper-DeHoff, an associate professor of pharmacy and medicine at UF.

Efforts to reduce systolic blood pressure to below 130 did not offer any additional benefit to patients with diabetes and coronary artery disease, compared with reduction of systolic blood pressure to between 130 and less than 140.

“Sustained blood pressure lower than 120 is considered optimal for healthy people,” Cooper-DeHoff said. “But, our data show that for these patients with diabetes, the range may actually cause an increased risk for heart attack, stroke and death.”

As many as two out of three adults with diabetes have high blood pressure. Blood pressure greater than 140 is still associated with a nearly 50 percent increase in cardiovascular risk in these patients.

“While lowering blood pressure to less than 140 is very important, based on our data and data recently published by others, it is now clear that in patients with diabetes, it is not necessary, and may be harmful to lower blood pressure too much,” Cooper-DeHoff said.

In addition, the study for the first time reveals that this group of patients had an increased risk for death when their blood pressure was controlled to lower than 115 systolic — the range recommended as normal by the American Heart Association.

The findings in the Journal of American Medical Association formalize a report Cooper-DeHoff made at the American College of Cardiology’s 59th annual scientific session earlier this spring.

Heart disease or stroke is the top cause of death for people with diabetes, affecting more than 60 percent of patients, according to the AHA. High blood pressure, common in diabetes, doubles the risk of cardiovascular disease.

The INVEST study is the first to evaluate the effects of blood pressure-lowering in diabetic patients diagnosed with coronary artery disease. Researchers analyzed data collected from 6,400 patients from fall 1997 to spring 2003. The patients, who were 50 or older, were recruited from more than 850 sites in 14 countries.

The researchers further consulted the national death index for U.S.-enrolled patients for an additional five years to compare death rates of patients based on their blood pressure category ranging from tightly controlled to non-controlled hypertension.

Abbott Laboratories provided funding for INVEST. Cooper-DeHoff also received support from a National Institutes of Health career development award.

Alzheimer’s patients can appear withdrawn and apathetic, symptoms often attributed to memory problems or difficulty finding the words to communicate.

A new University of Florida study found that they may also have a decreased ability to experience emotions; that is, they do not feel emotions as deeply as their healthy peers. This finding in a small group of patients may be useful for doctors assessing whether Alzheimer’s patients are clinically depressed.

The study, published online in the spring issue of the Journal of Neuropsychiatry & Clinical Neurosciences, suggests that when Alzheimer’s patients are asked to place an emotional value on pictures, they measure the pleasant images as less pleasant and the negative scenes as less negative compared with a control group of normal elderly people. This emotional flatness could be incorrectly interpreted as a symptom of depression.

“We found that the Alzheimer’s patients as a rule tend to go more toward the middle,” said Dr. Kenneth Heilman, senior author of the paper and a professor of neurology at the College of Medicine and UF’s McKnight Brain Institute. “They don’t feel as positive toward the positive pictures or as negative toward the negative ones. They’re not depressed, but their emotional experience appears to be flattened.”

Further research is needed, but the findings could be valuable for clinicians trying to learn whether a patient is depressed as well as for families concerned about a loved one’s apparent indifference.

The study presented seven patients with Alzheimer’s disease pictures of positive and negative scenes, such as babies and spiders, and asked them to rate each picture. Patients recorded their emotional reaction to the picture by marking on a piece of paper with a happy face on one and a sad face on the other. The closer their mark was to either emoticon, the stronger they felt.

Most of the time they placed their mark in the appropriate direction, said Heilman, who is also director of the UF Cognitive and Memory Disorders Program.

“For a puppy, they wouldn’t rate it as high (as the control group members did), but they would put it more toward the happy face, showing that they appear to understand the picture,” he said. “But they also made more inconsistent markings than the normal control group, such as when being shown a spider putting their mark toward the happy face.”

The study’s authors proposed several reasons for why the Alzheimer’s patients show a flattened affect.

Previous studies reveal that such symptoms of Alzheimer’s are caused by deterioration of neural systems, Heilman said.

“Even in its early stages, Alzheimer’s destroys the areas of the brain that produce chemical neurotransmitters such as norepinephrine, which is essential for experiencing fear and anger,” he said. “If we prescribed medication to patients that replace or increase these neurotransmitters, maybe they would better experience emotions.”

Misinterpreting the images or not understanding the meaning of some pictures — a comprehension disorder — could have skewed the results, but the volunteers were given a naming test to minimize this possibility. Though Alzheimer’s patients often suffer from depression, researchers ruled it out as a cause for lower emotional response based on yearly face-to-face evaluations conducted throughout the study.

The Alzheimer’s Association estimates 5.1 million Americans age 65 and older suffer from Alzheimer’s disease, a number that is expected to rise to 13.5 million by 2050 if treatments are not improved.

“One important implication of this work is that when an Alzheimer’s patient appears emotionally blunted, the clinician or caregiver should not assume the patient is depressed and automatically treat with antidepressants, as other organic factors could be at work,” said Dr. Todd Feinberg, a professor of clinical neurology and psychiatry at Beth Israel Medical Center in New York, who did not participate in the research.

The findings also bring new understanding to families of Alzheimer’s patients.

“Caregivers also should be helped to understand that it is not ‘their fault’ if a loved one seems emotionally indifferent to them,” Feinberg said.

Heilman and his colleagues used a more thorough approach to distinguish depression from Alzheimer’s symptoms, said Dr. Yonas Geda, an associate professor of neurology and psychiatry at the Mayo Clinic College of Medicine in Rochester, Minn., who reviewed the study. In larger studies, thoroughness is sacrificed in favor of large sample size by using questionnaires of 10 or 20 questions answered by caregivers or patients themselves.

“Unlike questionnaire-based studies, Heilman and his colleagues’ study raises serious questions about potential neurobiological issues to account for the observed behavior,” Yonas said. “Can we replicate this thorough face-to-face evaluation in a larger sample size? Perhaps computers and technology may help us to administer a rigorous evaluation that Heilman’s team did on a larger sample size.”

Yonas also suggested that futures studies use neuroimaging techniques along with the picture test to probe a little more into the mechanism of experiencing emotion.