Neil Osterweil

ATLANTA – Men with intermediate-risk prostate cancer fared just as well over the long term with 8 weeks as with 28 weeks of neoadjuvant androgen suppression before receiving concomitant androgen suppression and radiation, said Dr. Thomas M. Pisansky at the annual meeting of the American Society for Radiation Oncology.

Based on follow-up data from the RTOG 9910 trial, 10-year disease-specific survival rates were virtually identical for the two groups at 95% and 96%. Further, 10-year biochemical failure rates were exactly the same at 27%. Nor were there any significant differences in either locoregional progression at 10 years (6% vs. 4%) or in distant metastases (6% in each group).

Neil Osterweil/IMNG Medical Media

"In 10-years of follow-up, the disease-specific survival of men treated in either fashion is extraordinarily high," said Dr. Pisansky, principal investigator for the trial, and a professor of radiation oncology at the Mayo Clinic in Rochester, Minn.

"It’s quite clear to us: The recommendation is that the preradiotherapy neoadjuvant androgen suppression need last no longer than 8 weeks. When you combine the preradiotherapy with the concurrent radiotherapy/androgen suppression, it need last no more than 16 weeks," he said at a media briefing before his presentation of the data in plenary session.

A radiation oncologist who was not involved in the study commented that it reinforces the importance of optimizing therapeutic regimens.

"From personal experience, when you shorten treatment, patients at least perceive that their quality of life is better," said Dr. Bruce G. Haffty, a radiation oncologist at the Cancer Institute of New Jersey in New Brunswick, and ASTRO president-elect.

Dr. Haffty moderated the briefing at which Dr. Pisansky discussed his data.

The investigators enrolled men with intermediate-risk prostate cancer into the trial, with accrual ranging from February 2000 through May 2004. The participants were randomly assigned to receive either 8 weeks (752 men) or 28 weeks (737 men) of neoadjuvant total androgen suppression with a luteinizing hormone-releasing-hormone analog and nonsteroidal antiandrogen. All patients then received radiation therapy of 70.2 Gy divided into 39 fractions with doses to the seminal vesicles and pelvic nodes as needed, concurrent with 8 additional weeks of total androgen suppression.

After a median follow-up of 8.7 years for all patients and 9.3 years for all survivors, 3% of all patients had died from prostate cancer. There were 30 prostate cancer deaths in the 8-week arm, and 24 in the 28-week arm, a difference that was not significant. Biochemical failures, defined as at least a 2 ng/dL rise in prostate specific antigen [PSA] from the PSA nadir), occurred in 192 of 752 patients assigned to 8 weeks neoadjuvant suppression, and in 185 of 737 assigned to 28 weeks.

Late radiation toxicities of grade 2 or greater occurred in 10% of patients in the 8-week arm, and in 8% of those in the 28-week arm. Sexual adverse events of grade 2 or greater occurred in 8% and 17%, respectively.

The evidence indicates that "there is little room for improvement in disease-specific survival and overall survival," and that studies seeking to show further benefit would be difficult to accomplish, Dr. Pisansky said.

He noted that as with breast cancer, there is likely to be a shift away from survival outcomes toward decreasing biochemical failure rates, reducing need for secondary therapies, and toward establishing an ideal radiation therapy dose.

The study was supported by grants from the National Cancer Institute. Dr. Pisansky and Dr. Haffty reported having no relevant conflicts of interest.

ATLANTA – Men with intermediate-risk prostate cancer fared just as well over the long term with 8 weeks as with 28 weeks of neoadjuvant androgen suppression before receiving concomitant androgen suppression and radiation, said Dr. Thomas M. Pisansky at the annual meeting of the American Society for Radiation Oncology.

Based on follow-up data from the RTOG 9910 trial, 10-year disease-specific survival rates were virtually identical for the two groups at 95% and 96%. Further, 10-year biochemical failure rates were exactly the same at 27%. Nor were there any significant differences in either locoregional progression at 10 years (6% vs. 4%) or in distant metastases (6% in each group).

Neil Osterweil/IMNG Medical Media

"In 10-years of follow-up, the disease-specific survival of men treated in either fashion is extraordinarily high," said Dr. Pisansky, principal investigator for the trial, and a professor of radiation oncology at the Mayo Clinic in Rochester, Minn.

"It’s quite clear to us: The recommendation is that the preradiotherapy neoadjuvant androgen suppression need last no longer than 8 weeks. When you combine the preradiotherapy with the concurrent radiotherapy/androgen suppression, it need last no more than 16 weeks," he said at a media briefing before his presentation of the data in plenary session.

A radiation oncologist who was not involved in the study commented that it reinforces the importance of optimizing therapeutic regimens.

"From personal experience, when you shorten treatment, patients at least perceive that their quality of life is better," said Dr. Bruce G. Haffty, a radiation oncologist at the Cancer Institute of New Jersey in New Brunswick, and ASTRO president-elect.

Dr. Haffty moderated the briefing at which Dr. Pisansky discussed his data.

The investigators enrolled men with intermediate-risk prostate cancer into the trial, with accrual ranging from February 2000 through May 2004. The participants were randomly assigned to receive either 8 weeks (752 men) or 28 weeks (737 men) of neoadjuvant total androgen suppression with a luteinizing hormone-releasing-hormone analog and nonsteroidal antiandrogen. All patients then received radiation therapy of 70.2 Gy divided into 39 fractions with doses to the seminal vesicles and pelvic nodes as needed, concurrent with 8 additional weeks of total androgen suppression.

After a median follow-up of 8.7 years for all patients and 9.3 years for all survivors, 3% of all patients had died from prostate cancer. There were 30 prostate cancer deaths in the 8-week arm, and 24 in the 28-week arm, a difference that was not significant. Biochemical failures, defined as at least a 2 ng/dL rise in prostate specific antigen [PSA] from the PSA nadir), occurred in 192 of 752 patients assigned to 8 weeks neoadjuvant suppression, and in 185 of 737 assigned to 28 weeks.

Late radiation toxicities of grade 2 or greater occurred in 10% of patients in the 8-week arm, and in 8% of those in the 28-week arm. Sexual adverse events of grade 2 or greater occurred in 8% and 17%, respectively.

The evidence indicates that "there is little room for improvement in disease-specific survival and overall survival," and that studies seeking to show further benefit would be difficult to accomplish, Dr. Pisansky said.

He noted that as with breast cancer, there is likely to be a shift away from survival outcomes toward decreasing biochemical failure rates, reducing need for secondary therapies, and toward establishing an ideal radiation therapy dose.

The study was supported by grants from the National Cancer Institute. Dr. Pisansky and Dr. Haffty reported having no relevant conflicts of interest.

ATLANTA – Men with intermediate-risk prostate cancer fared just as well over the long term with 8 weeks as with 28 weeks of neoadjuvant androgen suppression before receiving concomitant androgen suppression and radiation, said Dr. Thomas M. Pisansky at the annual meeting of the American Society for Radiation Oncology.

Based on follow-up data from the RTOG 9910 trial, 10-year disease-specific survival rates were virtually identical for the two groups at 95% and 96%. Further, 10-year biochemical failure rates were exactly the same at 27%. Nor were there any significant differences in either locoregional progression at 10 years (6% vs. 4%) or in distant metastases (6% in each group).

Neil Osterweil/IMNG Medical Media

"In 10-years of follow-up, the disease-specific survival of men treated in either fashion is extraordinarily high," said Dr. Pisansky, principal investigator for the trial, and a professor of radiation oncology at the Mayo Clinic in Rochester, Minn.

"It’s quite clear to us: The recommendation is that the preradiotherapy neoadjuvant androgen suppression need last no longer than 8 weeks. When you combine the preradiotherapy with the concurrent radiotherapy/androgen suppression, it need last no more than 16 weeks," he said at a media briefing before his presentation of the data in plenary session.

A radiation oncologist who was not involved in the study commented that it reinforces the importance of optimizing therapeutic regimens.

"From personal experience, when you shorten treatment, patients at least perceive that their quality of life is better," said Dr. Bruce G. Haffty, a radiation oncologist at the Cancer Institute of New Jersey in New Brunswick, and ASTRO president-elect.

Dr. Haffty moderated the briefing at which Dr. Pisansky discussed his data.

The investigators enrolled men with intermediate-risk prostate cancer into the trial, with accrual ranging from February 2000 through May 2004. The participants were randomly assigned to receive either 8 weeks (752 men) or 28 weeks (737 men) of neoadjuvant total androgen suppression with a luteinizing hormone-releasing-hormone analog and nonsteroidal antiandrogen. All patients then received radiation therapy of 70.2 Gy divided into 39 fractions with doses to the seminal vesicles and pelvic nodes as needed, concurrent with 8 additional weeks of total androgen suppression.

After a median follow-up of 8.7 years for all patients and 9.3 years for all survivors, 3% of all patients had died from prostate cancer. There were 30 prostate cancer deaths in the 8-week arm, and 24 in the 28-week arm, a difference that was not significant. Biochemical failures, defined as at least a 2 ng/dL rise in prostate specific antigen [PSA] from the PSA nadir), occurred in 192 of 752 patients assigned to 8 weeks neoadjuvant suppression, and in 185 of 737 assigned to 28 weeks.

Late radiation toxicities of grade 2 or greater occurred in 10% of patients in the 8-week arm, and in 8% of those in the 28-week arm. Sexual adverse events of grade 2 or greater occurred in 8% and 17%, respectively.

The evidence indicates that "there is little room for improvement in disease-specific survival and overall survival," and that studies seeking to show further benefit would be difficult to accomplish, Dr. Pisansky said.

He noted that as with breast cancer, there is likely to be a shift away from survival outcomes toward decreasing biochemical failure rates, reducing need for secondary therapies, and toward establishing an ideal radiation therapy dose.

The study was supported by grants from the National Cancer Institute. Dr. Pisansky and Dr. Haffty reported having no relevant conflicts of interest.

ATLANTA – In patients undergoing radiation therapy for locally advanced non–small cell lung cancer, quality-of-life scores were more predictive of overall survival than were tumor stage or performance status, Dr. Benjamin Movsas reported at the annual meeting of the American Society for Radiation Oncology.

Among patients in the RTOG 0617 trial, every baseline increase of 10 points on a validated lung cancer quality-of-life scale was associated with a 14% reduction in the risk of death. In multivariate analysis, neither performance status nor tumor stage significantly predicted overall survival, whereas quality-of-life scores did, said Dr. Movsas, chairman of radiation oncology at the Henry Ford Health System in Detroit.

Neil Osterweil/IMNG Medical Media

Results of the RTOG 0617 trial, reported at the 2011 ASTRO annual meeting, indicated that higher radiation doses did not improve overall survival. At 1 year, median overall survival was 81% for patients randomized to treatment with standard-dose (60-Gy) radiation and 70.4% for those who received high-dose (74-Gy) radiation. The respective median survival rates were 21.7 months and 20.7 months (P = .02).

The high-dose arm of the study was stopped in June 2011 when a planned interim analysis showed that the radiation comparison had crossed the prespecified boundary for futility.

"Why was the survival actually lower in patients who received the higher dose of radiation? When we look at the toxicity, as scored by the physicians, there were few if any differences," Dr. Movsas noted in a press briefing prior to his presentation of the data in a plenary session.

To answer that question, researchers looked at patient-reported quality-of-life data from RTOG 0617, which was collected at baseline, 3 months from the start of treatment, and again at 12 months using the FACT-TOI (Functional Assessment of Cancer Therapy–Trial Outcome Index). The index comprises items touching on physical and functional well-being, as well as a lung cancer subscale. Clinically meaningful changes are a point change of 2 or more on each of the subscales, and a point change of 5 or more on the overall scale.

Patients who received the higher radiation dose had clinically meaningful declines in quality-of-life scores on the lung cancer subscale at 3 months compared with baseline. The decrease was 46% among patients in the high-dose arm and 31% in the standard-dose arm (P = .024). At 12 months, however, the changes over baseline were not significantly different at 39% and 36%, respectively.

"Beyond the radiation level, the baseline quality of life also predicted for survival, as well as in multivariate analysis," Dr. Movsas said.

Although the study was not randomized by treatment type, intensity-modulated radiation therapy (IMRT) was used in 41% of patients who received the 60-Gy dose and who completed quality-of-life evaluations, and in 44% of patients who received 74 Gy and completed the evaluations. The remaining patients in each group received 3D conformal radiation therapy.

Significantly more patients with stage IIIB disease and larger gross tumor volumes were treated with IMRT. Nonetheless, there was a trend at 3 months toward a smaller decline in quality of life at 3 months (43% for 3D vs. 31% for IMRT; P = .06) and a significant difference at 12 months (47% vs. 23%; P = .005).

Neil Osterweil/IMNG Medical Media

"Despite few differences in provider-reported toxicity between the arms, the patient-reported outcomes help tell us at least part of the rest of the story by showing significantly worse quality of life on the high-dose arm at 3 months, confirming the quality-of-life hypothesis," Dr. Movsas said.

The finding "raises the intriguing question of whether the decline in quality of life on the high-dose arm may help account for the survival decrement in this arm over time," he added.

The researchers are also looking at other factors that might account for the survival difference, including the volume of the heart irradiated and local failure rates.

A radiation oncologist who was not involved in the study said that it emphasizes the importance of collecting and analyzing patient-outcomes data.

Although the study’s primary endpoint showed that dose escalation did not improve outcomes, "we find out as a secondary analysis that patients who received intensity-modulated radiation therapy, which spares normal tissues, had a better quality of life," said Dr. Bruce G. Haffty, a radiation oncologist at the Cancer Institute of New Jersey in New Brunswick, and ASTRO president-elect.

Dr. Haffty moderated the briefing in which Dr. Movsas discussed his data.

RTOG 0617 was supported by the National Cancer Institute. Dr. Movsas disclosed departmental research support from Varian and Philips. Dr. Haffty reported having no relevant disclosures.

ATLANTA – In patients undergoing radiation therapy for locally advanced non–small cell lung cancer, quality-of-life scores were more predictive of overall survival than were tumor stage or performance status, Dr. Benjamin Movsas reported at the annual meeting of the American Society for Radiation Oncology.

Among patients in the RTOG 0617 trial, every baseline increase of 10 points on a validated lung cancer quality-of-life scale was associated with a 14% reduction in the risk of death. In multivariate analysis, neither performance status nor tumor stage significantly predicted overall survival, whereas quality-of-life scores did, said Dr. Movsas, chairman of radiation oncology at the Henry Ford Health System in Detroit.

Neil Osterweil/IMNG Medical Media

Results of the RTOG 0617 trial, reported at the 2011 ASTRO annual meeting, indicated that higher radiation doses did not improve overall survival. At 1 year, median overall survival was 81% for patients randomized to treatment with standard-dose (60-Gy) radiation and 70.4% for those who received high-dose (74-Gy) radiation. The respective median survival rates were 21.7 months and 20.7 months (P = .02).

The high-dose arm of the study was stopped in June 2011 when a planned interim analysis showed that the radiation comparison had crossed the prespecified boundary for futility.

"Why was the survival actually lower in patients who received the higher dose of radiation? When we look at the toxicity, as scored by the physicians, there were few if any differences," Dr. Movsas noted in a press briefing prior to his presentation of the data in a plenary session.

To answer that question, researchers looked at patient-reported quality-of-life data from RTOG 0617, which was collected at baseline, 3 months from the start of treatment, and again at 12 months using the FACT-TOI (Functional Assessment of Cancer Therapy–Trial Outcome Index). The index comprises items touching on physical and functional well-being, as well as a lung cancer subscale. Clinically meaningful changes are a point change of 2 or more on each of the subscales, and a point change of 5 or more on the overall scale.

Patients who received the higher radiation dose had clinically meaningful declines in quality-of-life scores on the lung cancer subscale at 3 months compared with baseline. The decrease was 46% among patients in the high-dose arm and 31% in the standard-dose arm (P = .024). At 12 months, however, the changes over baseline were not significantly different at 39% and 36%, respectively.

"Beyond the radiation level, the baseline quality of life also predicted for survival, as well as in multivariate analysis," Dr. Movsas said.

Although the study was not randomized by treatment type, intensity-modulated radiation therapy (IMRT) was used in 41% of patients who received the 60-Gy dose and who completed quality-of-life evaluations, and in 44% of patients who received 74 Gy and completed the evaluations. The remaining patients in each group received 3D conformal radiation therapy.

Significantly more patients with stage IIIB disease and larger gross tumor volumes were treated with IMRT. Nonetheless, there was a trend at 3 months toward a smaller decline in quality of life at 3 months (43% for 3D vs. 31% for IMRT; P = .06) and a significant difference at 12 months (47% vs. 23%; P = .005).

Neil Osterweil/IMNG Medical Media

"Despite few differences in provider-reported toxicity between the arms, the patient-reported outcomes help tell us at least part of the rest of the story by showing significantly worse quality of life on the high-dose arm at 3 months, confirming the quality-of-life hypothesis," Dr. Movsas said.

The finding "raises the intriguing question of whether the decline in quality of life on the high-dose arm may help account for the survival decrement in this arm over time," he added.

The researchers are also looking at other factors that might account for the survival difference, including the volume of the heart irradiated and local failure rates.

A radiation oncologist who was not involved in the study said that it emphasizes the importance of collecting and analyzing patient-outcomes data.

Although the study’s primary endpoint showed that dose escalation did not improve outcomes, "we find out as a secondary analysis that patients who received intensity-modulated radiation therapy, which spares normal tissues, had a better quality of life," said Dr. Bruce G. Haffty, a radiation oncologist at the Cancer Institute of New Jersey in New Brunswick, and ASTRO president-elect.

Dr. Haffty moderated the briefing in which Dr. Movsas discussed his data.

RTOG 0617 was supported by the National Cancer Institute. Dr. Movsas disclosed departmental research support from Varian and Philips. Dr. Haffty reported having no relevant disclosures.

ATLANTA – In patients undergoing radiation therapy for locally advanced non–small cell lung cancer, quality-of-life scores were more predictive of overall survival than were tumor stage or performance status, Dr. Benjamin Movsas reported at the annual meeting of the American Society for Radiation Oncology.

Among patients in the RTOG 0617 trial, every baseline increase of 10 points on a validated lung cancer quality-of-life scale was associated with a 14% reduction in the risk of death. In multivariate analysis, neither performance status nor tumor stage significantly predicted overall survival, whereas quality-of-life scores did, said Dr. Movsas, chairman of radiation oncology at the Henry Ford Health System in Detroit.

Neil Osterweil/IMNG Medical Media

Results of the RTOG 0617 trial, reported at the 2011 ASTRO annual meeting, indicated that higher radiation doses did not improve overall survival. At 1 year, median overall survival was 81% for patients randomized to treatment with standard-dose (60-Gy) radiation and 70.4% for those who received high-dose (74-Gy) radiation. The respective median survival rates were 21.7 months and 20.7 months (P = .02).

The high-dose arm of the study was stopped in June 2011 when a planned interim analysis showed that the radiation comparison had crossed the prespecified boundary for futility.

"Why was the survival actually lower in patients who received the higher dose of radiation? When we look at the toxicity, as scored by the physicians, there were few if any differences," Dr. Movsas noted in a press briefing prior to his presentation of the data in a plenary session.

To answer that question, researchers looked at patient-reported quality-of-life data from RTOG 0617, which was collected at baseline, 3 months from the start of treatment, and again at 12 months using the FACT-TOI (Functional Assessment of Cancer Therapy–Trial Outcome Index). The index comprises items touching on physical and functional well-being, as well as a lung cancer subscale. Clinically meaningful changes are a point change of 2 or more on each of the subscales, and a point change of 5 or more on the overall scale.

Patients who received the higher radiation dose had clinically meaningful declines in quality-of-life scores on the lung cancer subscale at 3 months compared with baseline. The decrease was 46% among patients in the high-dose arm and 31% in the standard-dose arm (P = .024). At 12 months, however, the changes over baseline were not significantly different at 39% and 36%, respectively.

"Beyond the radiation level, the baseline quality of life also predicted for survival, as well as in multivariate analysis," Dr. Movsas said.

Although the study was not randomized by treatment type, intensity-modulated radiation therapy (IMRT) was used in 41% of patients who received the 60-Gy dose and who completed quality-of-life evaluations, and in 44% of patients who received 74 Gy and completed the evaluations. The remaining patients in each group received 3D conformal radiation therapy.

Significantly more patients with stage IIIB disease and larger gross tumor volumes were treated with IMRT. Nonetheless, there was a trend at 3 months toward a smaller decline in quality of life at 3 months (43% for 3D vs. 31% for IMRT; P = .06) and a significant difference at 12 months (47% vs. 23%; P = .005).

Neil Osterweil/IMNG Medical Media

"Despite few differences in provider-reported toxicity between the arms, the patient-reported outcomes help tell us at least part of the rest of the story by showing significantly worse quality of life on the high-dose arm at 3 months, confirming the quality-of-life hypothesis," Dr. Movsas said.

The finding "raises the intriguing question of whether the decline in quality of life on the high-dose arm may help account for the survival decrement in this arm over time," he added.

The researchers are also looking at other factors that might account for the survival difference, including the volume of the heart irradiated and local failure rates.

A radiation oncologist who was not involved in the study said that it emphasizes the importance of collecting and analyzing patient-outcomes data.

Although the study’s primary endpoint showed that dose escalation did not improve outcomes, "we find out as a secondary analysis that patients who received intensity-modulated radiation therapy, which spares normal tissues, had a better quality of life," said Dr. Bruce G. Haffty, a radiation oncologist at the Cancer Institute of New Jersey in New Brunswick, and ASTRO president-elect.

Dr. Haffty moderated the briefing in which Dr. Movsas discussed his data.

RTOG 0617 was supported by the National Cancer Institute. Dr. Movsas disclosed departmental research support from Varian and Philips. Dr. Haffty reported having no relevant disclosures.

ATLANTA – Five common radiation therapy practices are not adequately supported by evidence and may not be the best choice for many patients, radiation oncology experts said at the annual meeting of the American Society for Radiation Oncology (ASTRO).

The evidence-based recommendations on radiation therapy for breast cancer, prostate cancer, and bone metastases are part of the national "Choosing Wisely" campaign, which is aimed at improving the quality of care by reducing or eliminating overuse of tests and procedures. This campaign is about "removal of waste to improve quality and safety, and doing no harm to patients," said Daniel Wolfson, executive vice president and chief operating officer of the American Board of Internal Medicine (ABIM) Foundation, which is leading the Choosing Wisely campaign.

Medical societies in various disciplines have released recommendations geared toward individual clinical disciplines, and now it’s ASTRO’s turn, said Dr. Michael L. Steinberg, chairman of ASTRO’s board of directors, in a briefing announcing the guidelines. "The list serves only as a starting point for a detailed conversation between a patient and physician, and to ensure patient-centered care, which is a core principle of ASTRO."

The five recommendations are:

• Don’t initiate whole-breast radiotherapy as a part of breast conservation therapy in women aged 50 years and older with early-stage invasive breast cancer without considering shorter treatment schedules.

"We’ve known for years that whole-breast radiation improves local control and improves survival, and has cosmetic advantages over mastectomy," Dr. Steinberg said. In recent years, however, randomized clinical trials have demonstrated that shorter courses of therapy – less than 4 weeks, compared with 5 weeks for conventionally fractionated radiation – produce equivalent tumor control and cosmetic outcomes.

• Don’t initiate management of patients who have low-risk prostate cancer without discussing active surveillance.

Patients with low-risk prostate cancer should discuss "reasonable management options" with their physicians, including active surveillance. With this recommendation, ASTRO is "reinforcing the shared decision-making model," Dr. Steinberg said.

• Don’t routinely use extended fractionation schemes (more than 10 fractions) for palliation of bone metastases.

Patients with bone metastases may derive equivalent pain relief from 30 Gy in 10 fractions, 20 Gy over 5 fractions, or even a single 8-Gy fraction, studies suggest. The single-fraction option is more convenient for patients, but it may be associated with a marginally higher need for retreatment of the same site. Patients who are not ambulatory, have transportation problems, or a limited prognosis may be good candidates for the single-fraction option, the guidelines say.

• Don’t routinely recommend proton-beam therapy for prostate cancer outside of a prospective clinical trial or registry.

"There is no clear evidence that proton-beam therapy for prostate cancer offers any clinical advantage over other forms of definitive radiation therapy. Clinical trials are necessary to establish a possible advantage of this expensive therapy," the Choosing Wisely guidelines state.

At ASTRO 2012, investigators reported that men who receive proton-beam radiotherapy for prostate cancer have modestly better bowel function in the short term than do those who receive conformal or intensity-modulated radiation, but the effect is transient. In addition, proton-beam therapy is estimated to cost about 70% more than external-beam radiotherapy for the treatment of prostate cancer.

• Don’t routinely use intensity-modulated radiation therapy (IMRT) to deliver whole-breast radiotherapy as part of breast conservation therapy.

"Clinical trials have suggested lower rates of skin toxicity after using modern 3D conformal techniques relative to older methods of 2D planning. In these trials, the term ‘IMRT’ has generally been applied to describe methods that are more accurately defined as field-in-field 3D conformal radiotherapy. While IMRT may be of benefit in select cases where the anatomy is unusual, its routine use has not been demonstrated to provide significant clinical advantage," the guidelines note.

The cost difference between 3D conformal radiotherapy and IMRT for whole-breast radiotherapy is approximately $7,000, according to Dr. Steinberg.

"These are not ‘never do this’ recommendations, these are ‘engage the patient in the shared-decision paradigm’ guidelines, because there may be patients that are better treated with, let’s say, IMRT [for whole-breast radiotherapy]," he said.

Asked whether the Choosing Wisely guidelines in radiation oncology and other disciplines might be used by insurers to justify denying reimbursement for certain procedures, Mr. Wolfson said that "we haven’t seen that, and whether it comes to be will be the question, but we would sharply criticize that [approach]."

ATLANTA – Five common radiation therapy practices are not adequately supported by evidence and may not be the best choice for many patients, radiation oncology experts said at the annual meeting of the American Society for Radiation Oncology (ASTRO).

The evidence-based recommendations on radiation therapy for breast cancer, prostate cancer, and bone metastases are part of the national "Choosing Wisely" campaign, which is aimed at improving the quality of care by reducing or eliminating overuse of tests and procedures. This campaign is about "removal of waste to improve quality and safety, and doing no harm to patients," said Daniel Wolfson, executive vice president and chief operating officer of the American Board of Internal Medicine (ABIM) Foundation, which is leading the Choosing Wisely campaign.

Medical societies in various disciplines have released recommendations geared toward individual clinical disciplines, and now it’s ASTRO’s turn, said Dr. Michael L. Steinberg, chairman of ASTRO’s board of directors, in a briefing announcing the guidelines. "The list serves only as a starting point for a detailed conversation between a patient and physician, and to ensure patient-centered care, which is a core principle of ASTRO."

The five recommendations are:

• Don’t initiate whole-breast radiotherapy as a part of breast conservation therapy in women aged 50 years and older with early-stage invasive breast cancer without considering shorter treatment schedules.

"We’ve known for years that whole-breast radiation improves local control and improves survival, and has cosmetic advantages over mastectomy," Dr. Steinberg said. In recent years, however, randomized clinical trials have demonstrated that shorter courses of therapy – less than 4 weeks, compared with 5 weeks for conventionally fractionated radiation – produce equivalent tumor control and cosmetic outcomes.

• Don’t initiate management of patients who have low-risk prostate cancer without discussing active surveillance.

Patients with low-risk prostate cancer should discuss "reasonable management options" with their physicians, including active surveillance. With this recommendation, ASTRO is "reinforcing the shared decision-making model," Dr. Steinberg said.

• Don’t routinely use extended fractionation schemes (more than 10 fractions) for palliation of bone metastases.

Patients with bone metastases may derive equivalent pain relief from 30 Gy in 10 fractions, 20 Gy over 5 fractions, or even a single 8-Gy fraction, studies suggest. The single-fraction option is more convenient for patients, but it may be associated with a marginally higher need for retreatment of the same site. Patients who are not ambulatory, have transportation problems, or a limited prognosis may be good candidates for the single-fraction option, the guidelines say.

• Don’t routinely recommend proton-beam therapy for prostate cancer outside of a prospective clinical trial or registry.

"There is no clear evidence that proton-beam therapy for prostate cancer offers any clinical advantage over other forms of definitive radiation therapy. Clinical trials are necessary to establish a possible advantage of this expensive therapy," the Choosing Wisely guidelines state.

At ASTRO 2012, investigators reported that men who receive proton-beam radiotherapy for prostate cancer have modestly better bowel function in the short term than do those who receive conformal or intensity-modulated radiation, but the effect is transient. In addition, proton-beam therapy is estimated to cost about 70% more than external-beam radiotherapy for the treatment of prostate cancer.

• Don’t routinely use intensity-modulated radiation therapy (IMRT) to deliver whole-breast radiotherapy as part of breast conservation therapy.

"Clinical trials have suggested lower rates of skin toxicity after using modern 3D conformal techniques relative to older methods of 2D planning. In these trials, the term ‘IMRT’ has generally been applied to describe methods that are more accurately defined as field-in-field 3D conformal radiotherapy. While IMRT may be of benefit in select cases where the anatomy is unusual, its routine use has not been demonstrated to provide significant clinical advantage," the guidelines note.

The cost difference between 3D conformal radiotherapy and IMRT for whole-breast radiotherapy is approximately $7,000, according to Dr. Steinberg.

"These are not ‘never do this’ recommendations, these are ‘engage the patient in the shared-decision paradigm’ guidelines, because there may be patients that are better treated with, let’s say, IMRT [for whole-breast radiotherapy]," he said.

Asked whether the Choosing Wisely guidelines in radiation oncology and other disciplines might be used by insurers to justify denying reimbursement for certain procedures, Mr. Wolfson said that "we haven’t seen that, and whether it comes to be will be the question, but we would sharply criticize that [approach]."

ATLANTA – Five common radiation therapy practices are not adequately supported by evidence and may not be the best choice for many patients, radiation oncology experts said at the annual meeting of the American Society for Radiation Oncology (ASTRO).

The evidence-based recommendations on radiation therapy for breast cancer, prostate cancer, and bone metastases are part of the national "Choosing Wisely" campaign, which is aimed at improving the quality of care by reducing or eliminating overuse of tests and procedures. This campaign is about "removal of waste to improve quality and safety, and doing no harm to patients," said Daniel Wolfson, executive vice president and chief operating officer of the American Board of Internal Medicine (ABIM) Foundation, which is leading the Choosing Wisely campaign.

Medical societies in various disciplines have released recommendations geared toward individual clinical disciplines, and now it’s ASTRO’s turn, said Dr. Michael L. Steinberg, chairman of ASTRO’s board of directors, in a briefing announcing the guidelines. "The list serves only as a starting point for a detailed conversation between a patient and physician, and to ensure patient-centered care, which is a core principle of ASTRO."

The five recommendations are:

• Don’t initiate whole-breast radiotherapy as a part of breast conservation therapy in women aged 50 years and older with early-stage invasive breast cancer without considering shorter treatment schedules.

"We’ve known for years that whole-breast radiation improves local control and improves survival, and has cosmetic advantages over mastectomy," Dr. Steinberg said. In recent years, however, randomized clinical trials have demonstrated that shorter courses of therapy – less than 4 weeks, compared with 5 weeks for conventionally fractionated radiation – produce equivalent tumor control and cosmetic outcomes.

• Don’t initiate management of patients who have low-risk prostate cancer without discussing active surveillance.

Patients with low-risk prostate cancer should discuss "reasonable management options" with their physicians, including active surveillance. With this recommendation, ASTRO is "reinforcing the shared decision-making model," Dr. Steinberg said.

• Don’t routinely use extended fractionation schemes (more than 10 fractions) for palliation of bone metastases.

Patients with bone metastases may derive equivalent pain relief from 30 Gy in 10 fractions, 20 Gy over 5 fractions, or even a single 8-Gy fraction, studies suggest. The single-fraction option is more convenient for patients, but it may be associated with a marginally higher need for retreatment of the same site. Patients who are not ambulatory, have transportation problems, or a limited prognosis may be good candidates for the single-fraction option, the guidelines say.

• Don’t routinely recommend proton-beam therapy for prostate cancer outside of a prospective clinical trial or registry.

"There is no clear evidence that proton-beam therapy for prostate cancer offers any clinical advantage over other forms of definitive radiation therapy. Clinical trials are necessary to establish a possible advantage of this expensive therapy," the Choosing Wisely guidelines state.

At ASTRO 2012, investigators reported that men who receive proton-beam radiotherapy for prostate cancer have modestly better bowel function in the short term than do those who receive conformal or intensity-modulated radiation, but the effect is transient. In addition, proton-beam therapy is estimated to cost about 70% more than external-beam radiotherapy for the treatment of prostate cancer.

• Don’t routinely use intensity-modulated radiation therapy (IMRT) to deliver whole-breast radiotherapy as part of breast conservation therapy.

"Clinical trials have suggested lower rates of skin toxicity after using modern 3D conformal techniques relative to older methods of 2D planning. In these trials, the term ‘IMRT’ has generally been applied to describe methods that are more accurately defined as field-in-field 3D conformal radiotherapy. While IMRT may be of benefit in select cases where the anatomy is unusual, its routine use has not been demonstrated to provide significant clinical advantage," the guidelines note.

The cost difference between 3D conformal radiotherapy and IMRT for whole-breast radiotherapy is approximately $7,000, according to Dr. Steinberg.

"These are not ‘never do this’ recommendations, these are ‘engage the patient in the shared-decision paradigm’ guidelines, because there may be patients that are better treated with, let’s say, IMRT [for whole-breast radiotherapy]," he said.

Asked whether the Choosing Wisely guidelines in radiation oncology and other disciplines might be used by insurers to justify denying reimbursement for certain procedures, Mr. Wolfson said that "we haven’t seen that, and whether it comes to be will be the question, but we would sharply criticize that [approach]."

BOSTON – Women who complain about cognitive problems after menopause might have increases rather than decreases in volume of certain brain regions, reported investigators at the Alzheimer’s Association International Conference 2013.

Brain imaging studies of 48 women in the early years of menopause showed that those with subjective cognitive complaints had significantly greater volumes in certain regions of the brain than did noncomplainers, including the right posterior cingulate gyrus (P less than .04), the right transverse temporal cortex (P less than .03), The left caudal middle frontal gyrus, and the right paracentral gyrus (P less than .05 for both), said Lilia Zurkovsky, Ph.D., a postdoctoral fellow from the Center for Cognitive Medicine at Vanderbilt University Medical Center in Nashville, Tenn.

The findings appear to run counter to those of another study (Neurology 2006;12:67: 834-42) showing that older adults with cognitive complaints had smaller volumes in temporal and frontal areas, compared with healthy age-matched controls, Dr. Zurkovsky acknowledged. She noted, however, that her group studied postmenopausal women in their 50s and 60s, whereas the earlier study included men. In addition, the mean age for each group in that study was above 70 years.

Combined with recent findings pointing to subjective cognitive and/or memory complaints as possible early signs of Alzheimer’s disease, the studies hint at a possible pattern of change as women age.

"If we look at all the data together, it would seem as though in early middle age, 50- to 60-year old individuals with complaints may be having some sort of compensatory mechanism. That’s speculation; all we know is that they have this increase in volume before they have a decrease in volume as shown by other papers," Dr. Zurkovsky said.

She and her colleagues scanned the participants with T1-weight magnetic resonance imaging with a 3 Tesla magnet, and measured cognitive complaints with the Cognitive Complaint Index (CCI) and five surveys with 120 total questions about the individual’s perceptions of cognitive abilities since menopause.

Brain changes in healthy postmenopausal women were the focus of a second, unrelated study also reported at AAIC2013.

Australian investigators followed participants in the Womens Healthy Ageing Project, a longitudinal study of the menopausal transition among cognitively normal women. The investigators looked at MRI brain scans conducted in 2002 and 2012, and brain-amyloid imaging studies with 18-F florbetaben positron emission tomography (FBB-PET). Florbetaben is an investigational amyloid imaging agent, similar to florbetapir (Amyvid).

They found that among the 26 women who had both FBB-PET and the two MRI scans spaced a decade apart, a significant decline was found over time in hippocampal volume, but not in gray matter volume. There was also a nonsignificant trend correlating higher levels of FBB uptake, as measured by a standardized uptake value ratio (SUVR) with greater declines in hippocampal volume.

"Those who were in the higher tertile of florbetaben SUVR have had an 18%-19% decrement in hippocampal volume over that 10-year period," said lead author Paul Yates, Ph.D., a neuroscientist and imaging research fellow at Austin Health in Heidelberg, Australia.

Although these findings are preliminary and the changes observed were at the trend level only, they suggest that people with intermediate levels of uptake of an amyloid imaging agent might be at increased risk for Alzheimer’s disease, he said.

Dr. Zurkovsky’s study is supported by funding from the National Institute on Aging, Vanderbilt University, and the University of Vermont, Burlington. Dr. Yates’s study is supported by the National Ageing Research Institute at the University of Melbourne, with additional support from Bayer and Piramal Imaging. Neither Dr. Zurkovsky nor Dr. Yates reported having financial disclosures.

BOSTON – Women who complain about cognitive problems after menopause might have increases rather than decreases in volume of certain brain regions, reported investigators at the Alzheimer’s Association International Conference 2013.

Brain imaging studies of 48 women in the early years of menopause showed that those with subjective cognitive complaints had significantly greater volumes in certain regions of the brain than did noncomplainers, including the right posterior cingulate gyrus (P less than .04), the right transverse temporal cortex (P less than .03), The left caudal middle frontal gyrus, and the right paracentral gyrus (P less than .05 for both), said Lilia Zurkovsky, Ph.D., a postdoctoral fellow from the Center for Cognitive Medicine at Vanderbilt University Medical Center in Nashville, Tenn.

The findings appear to run counter to those of another study (Neurology 2006;12:67: 834-42) showing that older adults with cognitive complaints had smaller volumes in temporal and frontal areas, compared with healthy age-matched controls, Dr. Zurkovsky acknowledged. She noted, however, that her group studied postmenopausal women in their 50s and 60s, whereas the earlier study included men. In addition, the mean age for each group in that study was above 70 years.

Combined with recent findings pointing to subjective cognitive and/or memory complaints as possible early signs of Alzheimer’s disease, the studies hint at a possible pattern of change as women age.

"If we look at all the data together, it would seem as though in early middle age, 50- to 60-year old individuals with complaints may be having some sort of compensatory mechanism. That’s speculation; all we know is that they have this increase in volume before they have a decrease in volume as shown by other papers," Dr. Zurkovsky said.

She and her colleagues scanned the participants with T1-weight magnetic resonance imaging with a 3 Tesla magnet, and measured cognitive complaints with the Cognitive Complaint Index (CCI) and five surveys with 120 total questions about the individual’s perceptions of cognitive abilities since menopause.

Brain changes in healthy postmenopausal women were the focus of a second, unrelated study also reported at AAIC2013.

Australian investigators followed participants in the Womens Healthy Ageing Project, a longitudinal study of the menopausal transition among cognitively normal women. The investigators looked at MRI brain scans conducted in 2002 and 2012, and brain-amyloid imaging studies with 18-F florbetaben positron emission tomography (FBB-PET). Florbetaben is an investigational amyloid imaging agent, similar to florbetapir (Amyvid).

They found that among the 26 women who had both FBB-PET and the two MRI scans spaced a decade apart, a significant decline was found over time in hippocampal volume, but not in gray matter volume. There was also a nonsignificant trend correlating higher levels of FBB uptake, as measured by a standardized uptake value ratio (SUVR) with greater declines in hippocampal volume.

"Those who were in the higher tertile of florbetaben SUVR have had an 18%-19% decrement in hippocampal volume over that 10-year period," said lead author Paul Yates, Ph.D., a neuroscientist and imaging research fellow at Austin Health in Heidelberg, Australia.

Although these findings are preliminary and the changes observed were at the trend level only, they suggest that people with intermediate levels of uptake of an amyloid imaging agent might be at increased risk for Alzheimer’s disease, he said.

Dr. Zurkovsky’s study is supported by funding from the National Institute on Aging, Vanderbilt University, and the University of Vermont, Burlington. Dr. Yates’s study is supported by the National Ageing Research Institute at the University of Melbourne, with additional support from Bayer and Piramal Imaging. Neither Dr. Zurkovsky nor Dr. Yates reported having financial disclosures.

BOSTON – Women who complain about cognitive problems after menopause might have increases rather than decreases in volume of certain brain regions, reported investigators at the Alzheimer’s Association International Conference 2013.

Brain imaging studies of 48 women in the early years of menopause showed that those with subjective cognitive complaints had significantly greater volumes in certain regions of the brain than did noncomplainers, including the right posterior cingulate gyrus (P less than .04), the right transverse temporal cortex (P less than .03), The left caudal middle frontal gyrus, and the right paracentral gyrus (P less than .05 for both), said Lilia Zurkovsky, Ph.D., a postdoctoral fellow from the Center for Cognitive Medicine at Vanderbilt University Medical Center in Nashville, Tenn.

The findings appear to run counter to those of another study (Neurology 2006;12:67: 834-42) showing that older adults with cognitive complaints had smaller volumes in temporal and frontal areas, compared with healthy age-matched controls, Dr. Zurkovsky acknowledged. She noted, however, that her group studied postmenopausal women in their 50s and 60s, whereas the earlier study included men. In addition, the mean age for each group in that study was above 70 years.

Combined with recent findings pointing to subjective cognitive and/or memory complaints as possible early signs of Alzheimer’s disease, the studies hint at a possible pattern of change as women age.

"If we look at all the data together, it would seem as though in early middle age, 50- to 60-year old individuals with complaints may be having some sort of compensatory mechanism. That’s speculation; all we know is that they have this increase in volume before they have a decrease in volume as shown by other papers," Dr. Zurkovsky said.

She and her colleagues scanned the participants with T1-weight magnetic resonance imaging with a 3 Tesla magnet, and measured cognitive complaints with the Cognitive Complaint Index (CCI) and five surveys with 120 total questions about the individual’s perceptions of cognitive abilities since menopause.

Brain changes in healthy postmenopausal women were the focus of a second, unrelated study also reported at AAIC2013.

Australian investigators followed participants in the Womens Healthy Ageing Project, a longitudinal study of the menopausal transition among cognitively normal women. The investigators looked at MRI brain scans conducted in 2002 and 2012, and brain-amyloid imaging studies with 18-F florbetaben positron emission tomography (FBB-PET). Florbetaben is an investigational amyloid imaging agent, similar to florbetapir (Amyvid).

They found that among the 26 women who had both FBB-PET and the two MRI scans spaced a decade apart, a significant decline was found over time in hippocampal volume, but not in gray matter volume. There was also a nonsignificant trend correlating higher levels of FBB uptake, as measured by a standardized uptake value ratio (SUVR) with greater declines in hippocampal volume.

"Those who were in the higher tertile of florbetaben SUVR have had an 18%-19% decrement in hippocampal volume over that 10-year period," said lead author Paul Yates, Ph.D., a neuroscientist and imaging research fellow at Austin Health in Heidelberg, Australia.

Although these findings are preliminary and the changes observed were at the trend level only, they suggest that people with intermediate levels of uptake of an amyloid imaging agent might be at increased risk for Alzheimer’s disease, he said.

Dr. Zurkovsky’s study is supported by funding from the National Institute on Aging, Vanderbilt University, and the University of Vermont, Burlington. Dr. Yates’s study is supported by the National Ageing Research Institute at the University of Melbourne, with additional support from Bayer and Piramal Imaging. Neither Dr. Zurkovsky nor Dr. Yates reported having financial disclosures.

BOSTON – Cognitively normal adults who learn that they are at high risk for developing Alzheimer’s disease do not, as some clinicians fear, spiral downward into depression, anxiety, or distress, investigators reported at the Alzheimer’s Association International Conference 2013.

An analysis of data from three randomized trials testing the effects of genetic testing disclosure found that that cognitively normal adults who learned that they were homozygous for the high-risk apolipoprotein E epsilon-4 allele (APOE epsilon-4) had a spike in test-specific distress score until about 6 months after learning the results but returned to levels similar to those of heterozygous carriers, reported Dr. Jason Karlawish, professor of medicine at the University of Pennsylvania, Philadelphia, and his colleagues.

However, both homozygous and heterozygous APOE epsilon-4 carriers had more test-specific distress than did carriers of other APOE alleles, noted coauthor Leo B. Waterston of Harvard Medical School, Boston.

Neil Osterweil/IMNG Medical Media

"While there is no question that learning that you’re at higher risk causes some test-specific distress, this further validates that there is no long-term, sustained psychological distress," Dr. Karlawish said in an interview.

People who learned that they were at high risk for developing Alzheimer’s disease (AD) were significantly more like to adopt putative AD risk-reducing behaviors, such as dietary changes, exercise, and medication or vitamin supplementation, he said.

The authors looked at participants in three Risk Evaluation and Education for Alzheimer’s Disease (REVEAL) trial cohorts. The REVEAL study is a series of multicenter trials looking at the effects of APOE genotyping.

They pooled data from three randomized REVEAL trials on a total of 648 patients, identifying 399 (62%) participants who were negative for the epsilon-4 allele, 221 (34%) who were heterozygous carriers of the epsilon-4 allele, and 28 (4%) who were epsilon-4 homozygotes.

They found that epsilon-4 homozygotes and heterozygotes had significantly higher mean test-specific distress levels, compared with noncarriers (P less than .0001), but there were no significant differences between the two epsilon-4–positive groups.

Asked at 1-year follow-up how they perceived their risk for AD, 64% of heterozygous carriers and 72% of homozygous carriers rated their risk as high or very high, a difference that was not significant. In contrast, about half of all noncarriers rated their risk as average and about 15% rated it as high, but none rated their risk as very high.

There were no significant differences in mean depression scores on the Center for Epidemiologic Studies Depression Scale.

Nearly two-thirds (61%) of homozygous carriers reported dietary changes at 12 months, compared with 34% of heterozygous carriers and 27% of noncarriers. Homozygotes also were more likely to report increases in exercise (58% vs. 39% and 28%, respectively), and to take medication and/or vitamins to try to stave off AD (58% vs. 38% and 27%, P less than .001 for all comparisons).

Dr. Karlawish noted that, although there were only 28 participants who carried both copies of the epsilon-4 allele, analysis of individual participants suggested that the data across this group were uniform and not skewed by outliers. He also noted that the distribution of APOE alleles in the study mirrored that of the population at large.

Mr. Waterston said that they are currently mailing follow-up surveys to participants and hope to continue with long-term follow-up.

The research was supported by grants from the National Institutes of Health. Dr. Karlawish and Mr. Waterston reported having no financial disclosures.

BOSTON – Cognitively normal adults who learn that they are at high risk for developing Alzheimer’s disease do not, as some clinicians fear, spiral downward into depression, anxiety, or distress, investigators reported at the Alzheimer’s Association International Conference 2013.

An analysis of data from three randomized trials testing the effects of genetic testing disclosure found that that cognitively normal adults who learned that they were homozygous for the high-risk apolipoprotein E epsilon-4 allele (APOE epsilon-4) had a spike in test-specific distress score until about 6 months after learning the results but returned to levels similar to those of heterozygous carriers, reported Dr. Jason Karlawish, professor of medicine at the University of Pennsylvania, Philadelphia, and his colleagues.

However, both homozygous and heterozygous APOE epsilon-4 carriers had more test-specific distress than did carriers of other APOE alleles, noted coauthor Leo B. Waterston of Harvard Medical School, Boston.

Neil Osterweil/IMNG Medical Media

"While there is no question that learning that you’re at higher risk causes some test-specific distress, this further validates that there is no long-term, sustained psychological distress," Dr. Karlawish said in an interview.

People who learned that they were at high risk for developing Alzheimer’s disease (AD) were significantly more like to adopt putative AD risk-reducing behaviors, such as dietary changes, exercise, and medication or vitamin supplementation, he said.

The authors looked at participants in three Risk Evaluation and Education for Alzheimer’s Disease (REVEAL) trial cohorts. The REVEAL study is a series of multicenter trials looking at the effects of APOE genotyping.

They pooled data from three randomized REVEAL trials on a total of 648 patients, identifying 399 (62%) participants who were negative for the epsilon-4 allele, 221 (34%) who were heterozygous carriers of the epsilon-4 allele, and 28 (4%) who were epsilon-4 homozygotes.

They found that epsilon-4 homozygotes and heterozygotes had significantly higher mean test-specific distress levels, compared with noncarriers (P less than .0001), but there were no significant differences between the two epsilon-4–positive groups.

Asked at 1-year follow-up how they perceived their risk for AD, 64% of heterozygous carriers and 72% of homozygous carriers rated their risk as high or very high, a difference that was not significant. In contrast, about half of all noncarriers rated their risk as average and about 15% rated it as high, but none rated their risk as very high.

There were no significant differences in mean depression scores on the Center for Epidemiologic Studies Depression Scale.

Nearly two-thirds (61%) of homozygous carriers reported dietary changes at 12 months, compared with 34% of heterozygous carriers and 27% of noncarriers. Homozygotes also were more likely to report increases in exercise (58% vs. 39% and 28%, respectively), and to take medication and/or vitamins to try to stave off AD (58% vs. 38% and 27%, P less than .001 for all comparisons).

Dr. Karlawish noted that, although there were only 28 participants who carried both copies of the epsilon-4 allele, analysis of individual participants suggested that the data across this group were uniform and not skewed by outliers. He also noted that the distribution of APOE alleles in the study mirrored that of the population at large.

Mr. Waterston said that they are currently mailing follow-up surveys to participants and hope to continue with long-term follow-up.

The research was supported by grants from the National Institutes of Health. Dr. Karlawish and Mr. Waterston reported having no financial disclosures.

BOSTON – Cognitively normal adults who learn that they are at high risk for developing Alzheimer’s disease do not, as some clinicians fear, spiral downward into depression, anxiety, or distress, investigators reported at the Alzheimer’s Association International Conference 2013.

An analysis of data from three randomized trials testing the effects of genetic testing disclosure found that that cognitively normal adults who learned that they were homozygous for the high-risk apolipoprotein E epsilon-4 allele (APOE epsilon-4) had a spike in test-specific distress score until about 6 months after learning the results but returned to levels similar to those of heterozygous carriers, reported Dr. Jason Karlawish, professor of medicine at the University of Pennsylvania, Philadelphia, and his colleagues.

However, both homozygous and heterozygous APOE epsilon-4 carriers had more test-specific distress than did carriers of other APOE alleles, noted coauthor Leo B. Waterston of Harvard Medical School, Boston.

Neil Osterweil/IMNG Medical Media

"While there is no question that learning that you’re at higher risk causes some test-specific distress, this further validates that there is no long-term, sustained psychological distress," Dr. Karlawish said in an interview.

People who learned that they were at high risk for developing Alzheimer’s disease (AD) were significantly more like to adopt putative AD risk-reducing behaviors, such as dietary changes, exercise, and medication or vitamin supplementation, he said.

The authors looked at participants in three Risk Evaluation and Education for Alzheimer’s Disease (REVEAL) trial cohorts. The REVEAL study is a series of multicenter trials looking at the effects of APOE genotyping.

They pooled data from three randomized REVEAL trials on a total of 648 patients, identifying 399 (62%) participants who were negative for the epsilon-4 allele, 221 (34%) who were heterozygous carriers of the epsilon-4 allele, and 28 (4%) who were epsilon-4 homozygotes.

They found that epsilon-4 homozygotes and heterozygotes had significantly higher mean test-specific distress levels, compared with noncarriers (P less than .0001), but there were no significant differences between the two epsilon-4–positive groups.

Asked at 1-year follow-up how they perceived their risk for AD, 64% of heterozygous carriers and 72% of homozygous carriers rated their risk as high or very high, a difference that was not significant. In contrast, about half of all noncarriers rated their risk as average and about 15% rated it as high, but none rated their risk as very high.

There were no significant differences in mean depression scores on the Center for Epidemiologic Studies Depression Scale.

Nearly two-thirds (61%) of homozygous carriers reported dietary changes at 12 months, compared with 34% of heterozygous carriers and 27% of noncarriers. Homozygotes also were more likely to report increases in exercise (58% vs. 39% and 28%, respectively), and to take medication and/or vitamins to try to stave off AD (58% vs. 38% and 27%, P less than .001 for all comparisons).

Dr. Karlawish noted that, although there were only 28 participants who carried both copies of the epsilon-4 allele, analysis of individual participants suggested that the data across this group were uniform and not skewed by outliers. He also noted that the distribution of APOE alleles in the study mirrored that of the population at large.

Mr. Waterston said that they are currently mailing follow-up surveys to participants and hope to continue with long-term follow-up.

The research was supported by grants from the National Institutes of Health. Dr. Karlawish and Mr. Waterston reported having no financial disclosures.

BOSTON – Older adults with type 2 diabetes who were taking metformin had a significantly lower 5-year risk for dementia than did peers who were taking other oral antidiabetic agents, investigators reported at the Alzheimer’s Association International Conference 2013.

A retrospective study of nearly 15,000 adults aged 55 years and older who started on single-agent drug therapy for type 2 diabetes between 1999 and 2001 showed that 5 years after starting therapy, patients who started on metformin had a 23% lower 5-year risk for dementia compared with patients who started on a thiazolidinedione (TZD) such as rosiglitazone (Avandia), reported Rachel Whitmer, Ph.D., an investigator in the research division of Kaiser Permanente Northern California, Oakland.

Metformin users also had a 20% lower risk for any dementia compared with those on a sulfonylurea such as glyburide. Among patients with a diabetes duration of less than 5 years, metformin users had a 40% lower dementia risk than did sulfonylurea users, and among those with a diabetes duration of at least 10 years, the risk for metformin users was 19% lower.

It is estimated that 12%-25% of people over age 65 have type 2 diabetes, putting them at about a 50% increase in risk for dementia, compared with nondiabetic people of the same age.  - Dr. Rachel Whitmer

The differences between the drug types held up after adjustment for race, sex, education, and hemoglobin A_1c (HbA_1c) levels, Dr. Whitmer said.

It is estimated that 12%-25% of people over age 65 have type 2 diabetes, putting them at about a 50% increase in risk for dementia, compared with nondiabetic people of the same age. Nearly all elderly patients with type 2 diabetes will be started on some antidiabetic agent at some point, she noted.

"A lot of work out there [indicates] that insulin, and specifically insulin resistance, may play a role in Alzheimer’s disease, and there has been some nice work from animal models and cell-culture studies looking at metformin specifically," Dr. Whitmer said.

Metformin appears to lessen neuronal insulin resistance and is associated with neurogenesis. In addition, because it is associated with reduced risk of myocardial infarction and stroke, metformin may protect against vascular dementias, she added.

Dr. Whitmer and her colleagues delved into the Kaiser Permanente database to identify 14,891 patients aged 55 years and up with no history of dementia who were started on new diabetes pharmacotherapy between October 1999 and November 2001.

In all, 9.9% of patients in the sample were diagnosed with dementia during 5 years of follow-up, including 9.5% of 8,528 patients on metformin, 19.9% of 3,383 patients on a sulfonylurea, 9.8% of 2,095 patients on a TZD, and 11.1% of 905 patients on insulin.

In multivariate models adjusting for age, race, education, and diabetes duration, metformin was associated with a hazard ratio (HR) for any dementia of 0.77, compared with a TZD. Neither sulfonylureas nor insulin was associated with a significant reduction in risk. When glycemic control (HbA_1c) was added to the model, metformin remained significantly better (HR, 0.84) at protecting against dementia, whereas the other agents were not significantly better than a TZD.

Similarly, in a model with sulfonylureas as the referent, metformin was significantly better, with adjusted HRs of 0.79 and 0.80 in models without and with HbA_1c, respectively.

An analysis of effect by dementia subtype also showed significant benefit for metformin vs. sulfonylurea for protection against Alzheimer’s disease (HR, 0.70) and vascular dementia (HR, 0.75).

The investigators plan to examine relationships between dose and dementia, and to look at the effects of combination therapies.

The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, and by Kaiser Permanente. Dr. Whitmer is employed by Kaiser Permanente Northern California.

BOSTON – Older adults with type 2 diabetes who were taking metformin had a significantly lower 5-year risk for dementia than did peers who were taking other oral antidiabetic agents, investigators reported at the Alzheimer’s Association International Conference 2013.

A retrospective study of nearly 15,000 adults aged 55 years and older who started on single-agent drug therapy for type 2 diabetes between 1999 and 2001 showed that 5 years after starting therapy, patients who started on metformin had a 23% lower 5-year risk for dementia compared with patients who started on a thiazolidinedione (TZD) such as rosiglitazone (Avandia), reported Rachel Whitmer, Ph.D., an investigator in the research division of Kaiser Permanente Northern California, Oakland.

Metformin users also had a 20% lower risk for any dementia compared with those on a sulfonylurea such as glyburide. Among patients with a diabetes duration of less than 5 years, metformin users had a 40% lower dementia risk than did sulfonylurea users, and among those with a diabetes duration of at least 10 years, the risk for metformin users was 19% lower.

It is estimated that 12%-25% of people over age 65 have type 2 diabetes, putting them at about a 50% increase in risk for dementia, compared with nondiabetic people of the same age.  - Dr. Rachel Whitmer

The differences between the drug types held up after adjustment for race, sex, education, and hemoglobin A_1c (HbA_1c) levels, Dr. Whitmer said.

It is estimated that 12%-25% of people over age 65 have type 2 diabetes, putting them at about a 50% increase in risk for dementia, compared with nondiabetic people of the same age. Nearly all elderly patients with type 2 diabetes will be started on some antidiabetic agent at some point, she noted.

"A lot of work out there [indicates] that insulin, and specifically insulin resistance, may play a role in Alzheimer’s disease, and there has been some nice work from animal models and cell-culture studies looking at metformin specifically," Dr. Whitmer said.

Metformin appears to lessen neuronal insulin resistance and is associated with neurogenesis. In addition, because it is associated with reduced risk of myocardial infarction and stroke, metformin may protect against vascular dementias, she added.

Dr. Whitmer and her colleagues delved into the Kaiser Permanente database to identify 14,891 patients aged 55 years and up with no history of dementia who were started on new diabetes pharmacotherapy between October 1999 and November 2001.

In all, 9.9% of patients in the sample were diagnosed with dementia during 5 years of follow-up, including 9.5% of 8,528 patients on metformin, 19.9% of 3,383 patients on a sulfonylurea, 9.8% of 2,095 patients on a TZD, and 11.1% of 905 patients on insulin.

In multivariate models adjusting for age, race, education, and diabetes duration, metformin was associated with a hazard ratio (HR) for any dementia of 0.77, compared with a TZD. Neither sulfonylureas nor insulin was associated with a significant reduction in risk. When glycemic control (HbA_1c) was added to the model, metformin remained significantly better (HR, 0.84) at protecting against dementia, whereas the other agents were not significantly better than a TZD.

Similarly, in a model with sulfonylureas as the referent, metformin was significantly better, with adjusted HRs of 0.79 and 0.80 in models without and with HbA_1c, respectively.

An analysis of effect by dementia subtype also showed significant benefit for metformin vs. sulfonylurea for protection against Alzheimer’s disease (HR, 0.70) and vascular dementia (HR, 0.75).

The investigators plan to examine relationships between dose and dementia, and to look at the effects of combination therapies.

The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, and by Kaiser Permanente. Dr. Whitmer is employed by Kaiser Permanente Northern California.

BOSTON – Older adults with type 2 diabetes who were taking metformin had a significantly lower 5-year risk for dementia than did peers who were taking other oral antidiabetic agents, investigators reported at the Alzheimer’s Association International Conference 2013.

A retrospective study of nearly 15,000 adults aged 55 years and older who started on single-agent drug therapy for type 2 diabetes between 1999 and 2001 showed that 5 years after starting therapy, patients who started on metformin had a 23% lower 5-year risk for dementia compared with patients who started on a thiazolidinedione (TZD) such as rosiglitazone (Avandia), reported Rachel Whitmer, Ph.D., an investigator in the research division of Kaiser Permanente Northern California, Oakland.

Metformin users also had a 20% lower risk for any dementia compared with those on a sulfonylurea such as glyburide. Among patients with a diabetes duration of less than 5 years, metformin users had a 40% lower dementia risk than did sulfonylurea users, and among those with a diabetes duration of at least 10 years, the risk for metformin users was 19% lower.

It is estimated that 12%-25% of people over age 65 have type 2 diabetes, putting them at about a 50% increase in risk for dementia, compared with nondiabetic people of the same age.  - Dr. Rachel Whitmer

The differences between the drug types held up after adjustment for race, sex, education, and hemoglobin A_1c (HbA_1c) levels, Dr. Whitmer said.

It is estimated that 12%-25% of people over age 65 have type 2 diabetes, putting them at about a 50% increase in risk for dementia, compared with nondiabetic people of the same age. Nearly all elderly patients with type 2 diabetes will be started on some antidiabetic agent at some point, she noted.

"A lot of work out there [indicates] that insulin, and specifically insulin resistance, may play a role in Alzheimer’s disease, and there has been some nice work from animal models and cell-culture studies looking at metformin specifically," Dr. Whitmer said.

Metformin appears to lessen neuronal insulin resistance and is associated with neurogenesis. In addition, because it is associated with reduced risk of myocardial infarction and stroke, metformin may protect against vascular dementias, she added.

Dr. Whitmer and her colleagues delved into the Kaiser Permanente database to identify 14,891 patients aged 55 years and up with no history of dementia who were started on new diabetes pharmacotherapy between October 1999 and November 2001.

In all, 9.9% of patients in the sample were diagnosed with dementia during 5 years of follow-up, including 9.5% of 8,528 patients on metformin, 19.9% of 3,383 patients on a sulfonylurea, 9.8% of 2,095 patients on a TZD, and 11.1% of 905 patients on insulin.

In multivariate models adjusting for age, race, education, and diabetes duration, metformin was associated with a hazard ratio (HR) for any dementia of 0.77, compared with a TZD. Neither sulfonylureas nor insulin was associated with a significant reduction in risk. When glycemic control (HbA_1c) was added to the model, metformin remained significantly better (HR, 0.84) at protecting against dementia, whereas the other agents were not significantly better than a TZD.

Similarly, in a model with sulfonylureas as the referent, metformin was significantly better, with adjusted HRs of 0.79 and 0.80 in models without and with HbA_1c, respectively.

An analysis of effect by dementia subtype also showed significant benefit for metformin vs. sulfonylurea for protection against Alzheimer’s disease (HR, 0.70) and vascular dementia (HR, 0.75).

The investigators plan to examine relationships between dose and dementia, and to look at the effects of combination therapies.

The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, and by Kaiser Permanente. Dr. Whitmer is employed by Kaiser Permanente Northern California.

BOSTON – Older adults with type 2 diabetes who were taking metformin had a significantly lower 5-year risk for dementia than did peers who were taking other oral antidiabetic agents, investigators reported at the Alzheimer’s Association International Conference 2013.

A retrospective study of nearly 15,000 adults aged 55 years and older who started on single-agent drug therapy for type 2 diabetes between 1999 and 2001 showed that 5 years after starting therapy, patients who started on metformin had a 23% lower 5-year risk for dementia compared with patients who started on a thiazolidinedione (TZD) such as rosiglitazone (Avandia), reported Rachel Whitmer, Ph.D., an investigator in the research division of Kaiser Permanente Northern California, Oakland.

Metformin users also had a 20% lower risk for any dementia compared with those on a sulfonylurea such as glyburide. Among patients with a diabetes duration of less than 5 years, metformin users had a 40% lower dementia risk than did sulfonylurea users, and among those with a diabetes duration of at least 10 years, the risk for metformin users was 19% lower.

It is estimated that 12%-25% of people over age 65 have type 2 diabetes, putting them at about a 50% increase in risk for dementia, compared with nondiabetic people of the same age.  - Dr. Rachel Whitmer

The differences between the drug types held up after adjustment for race, sex, education, and hemoglobin A_1c (HbA_1c) levels, Dr. Whitmer said.

It is estimated that 12%-25% of people over age 65 have type 2 diabetes, putting them at about a 50% increase in risk for dementia, compared with nondiabetic people of the same age. Nearly all elderly patients with type 2 diabetes will be started on some antidiabetic agent at some point, she noted.

"A lot of work out there [indicates] that insulin, and specifically insulin resistance, may play a role in Alzheimer’s disease, and there has been some nice work from animal models and cell-culture studies looking at metformin specifically," Dr. Whitmer said.

Metformin appears to lessen neuronal insulin resistance and is associated with neurogenesis. In addition, because it is associated with reduced risk of myocardial infarction and stroke, metformin may protect against vascular dementias, she added.

Dr. Whitmer and her colleagues delved into the Kaiser Permanente database to identify 14,891 patients aged 55 years and up with no history of dementia who were started on new diabetes pharmacotherapy between October 1999 and November 2001.

In all, 9.9% of patients in the sample were diagnosed with dementia during 5 years of follow-up, including 9.5% of 8,528 patients on metformin, 19.9% of 3,383 patients on a sulfonylurea, 9.8% of 2,095 patients on a TZD, and 11.1% of 905 patients on insulin.

In multivariate models adjusting for age, race, education, and diabetes duration, metformin was associated with a hazard ratio (HR) for any dementia of 0.77, compared with a TZD. Neither sulfonylureas nor insulin was associated with a significant reduction in risk. When glycemic control (HbA_1c) was added to the model, metformin remained significantly better (HR, 0.84) at protecting against dementia, whereas the other agents were not significantly better than a TZD.

Similarly, in a model with sulfonylureas as the referent, metformin was significantly better, with adjusted HRs of 0.79 and 0.80 in models without and with HbA_1c, respectively.

An analysis of effect by dementia subtype also showed significant benefit for metformin vs. sulfonylurea for protection against Alzheimer’s disease (HR, 0.70) and vascular dementia (HR, 0.75).

The investigators plan to examine relationships between dose and dementia, and to look at the effects of combination therapies.

The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, and by Kaiser Permanente. Dr. Whitmer is employed by Kaiser Permanente Northern California.

BOSTON – Older adults with type 2 diabetes who were taking metformin had a significantly lower 5-year risk for dementia than did peers who were taking other oral antidiabetic agents, investigators reported at the Alzheimer’s Association International Conference 2013.

A retrospective study of nearly 15,000 adults aged 55 years and older who started on single-agent drug therapy for type 2 diabetes between 1999 and 2001 showed that 5 years after starting therapy, patients who started on metformin had a 23% lower 5-year risk for dementia compared with patients who started on a thiazolidinedione (TZD) such as rosiglitazone (Avandia), reported Rachel Whitmer, Ph.D., an investigator in the research division of Kaiser Permanente Northern California, Oakland.

Metformin users also had a 20% lower risk for any dementia compared with those on a sulfonylurea such as glyburide. Among patients with a diabetes duration of less than 5 years, metformin users had a 40% lower dementia risk than did sulfonylurea users, and among those with a diabetes duration of at least 10 years, the risk for metformin users was 19% lower.

It is estimated that 12%-25% of people over age 65 have type 2 diabetes, putting them at about a 50% increase in risk for dementia, compared with nondiabetic people of the same age.  - Dr. Rachel Whitmer

The differences between the drug types held up after adjustment for race, sex, education, and hemoglobin A_1c (HbA_1c) levels, Dr. Whitmer said.

It is estimated that 12%-25% of people over age 65 have type 2 diabetes, putting them at about a 50% increase in risk for dementia, compared with nondiabetic people of the same age. Nearly all elderly patients with type 2 diabetes will be started on some antidiabetic agent at some point, she noted.

"A lot of work out there [indicates] that insulin, and specifically insulin resistance, may play a role in Alzheimer’s disease, and there has been some nice work from animal models and cell-culture studies looking at metformin specifically," Dr. Whitmer said.

Metformin appears to lessen neuronal insulin resistance and is associated with neurogenesis. In addition, because it is associated with reduced risk of myocardial infarction and stroke, metformin may protect against vascular dementias, she added.

Dr. Whitmer and her colleagues delved into the Kaiser Permanente database to identify 14,891 patients aged 55 years and up with no history of dementia who were started on new diabetes pharmacotherapy between October 1999 and November 2001.

In all, 9.9% of patients in the sample were diagnosed with dementia during 5 years of follow-up, including 9.5% of 8,528 patients on metformin, 19.9% of 3,383 patients on a sulfonylurea, 9.8% of 2,095 patients on a TZD, and 11.1% of 905 patients on insulin.

In multivariate models adjusting for age, race, education, and diabetes duration, metformin was associated with a hazard ratio (HR) for any dementia of 0.77, compared with a TZD. Neither sulfonylureas nor insulin was associated with a significant reduction in risk. When glycemic control (HbA_1c) was added to the model, metformin remained significantly better (HR, 0.84) at protecting against dementia, whereas the other agents were not significantly better than a TZD.

Similarly, in a model with sulfonylureas as the referent, metformin was significantly better, with adjusted HRs of 0.79 and 0.80 in models without and with HbA_1c, respectively.

An analysis of effect by dementia subtype also showed significant benefit for metformin vs. sulfonylurea for protection against Alzheimer’s disease (HR, 0.70) and vascular dementia (HR, 0.75).

The investigators plan to examine relationships between dose and dementia, and to look at the effects of combination therapies.

The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, and by Kaiser Permanente. Dr. Whitmer is employed by Kaiser Permanente Northern California.

BOSTON – Older adults with type 2 diabetes who were taking metformin had a significantly lower 5-year risk for dementia than did peers who were taking other oral antidiabetic agents, investigators reported at the Alzheimer’s Association International Conference 2013.

A retrospective study of nearly 15,000 adults aged 55 years and older who started on single-agent drug therapy for type 2 diabetes between 1999 and 2001 showed that 5 years after starting therapy, patients who started on metformin had a 23% lower 5-year risk for dementia compared with patients who started on a thiazolidinedione (TZD) such as rosiglitazone (Avandia), reported Rachel Whitmer, Ph.D., an investigator in the research division of Kaiser Permanente Northern California, Oakland.

Metformin users also had a 20% lower risk for any dementia compared with those on a sulfonylurea such as glyburide. Among patients with a diabetes duration of less than 5 years, metformin users had a 40% lower dementia risk than did sulfonylurea users, and among those with a diabetes duration of at least 10 years, the risk for metformin users was 19% lower.

It is estimated that 12%-25% of people over age 65 have type 2 diabetes, putting them at about a 50% increase in risk for dementia, compared with nondiabetic people of the same age.  - Dr. Rachel Whitmer

The differences between the drug types held up after adjustment for race, sex, education, and hemoglobin A_1c (HbA_1c) levels, Dr. Whitmer said.

It is estimated that 12%-25% of people over age 65 have type 2 diabetes, putting them at about a 50% increase in risk for dementia, compared with nondiabetic people of the same age. Nearly all elderly patients with type 2 diabetes will be started on some antidiabetic agent at some point, she noted.

"A lot of work out there [indicates] that insulin, and specifically insulin resistance, may play a role in Alzheimer’s disease, and there has been some nice work from animal models and cell-culture studies looking at metformin specifically," Dr. Whitmer said.

Metformin appears to lessen neuronal insulin resistance and is associated with neurogenesis. In addition, because it is associated with reduced risk of myocardial infarction and stroke, metformin may protect against vascular dementias, she added.

Dr. Whitmer and her colleagues delved into the Kaiser Permanente database to identify 14,891 patients aged 55 years and up with no history of dementia who were started on new diabetes pharmacotherapy between October 1999 and November 2001.

In all, 9.9% of patients in the sample were diagnosed with dementia during 5 years of follow-up, including 9.5% of 8,528 patients on metformin, 19.9% of 3,383 patients on a sulfonylurea, 9.8% of 2,095 patients on a TZD, and 11.1% of 905 patients on insulin.

In multivariate models adjusting for age, race, education, and diabetes duration, metformin was associated with a hazard ratio (HR) for any dementia of 0.77, compared with a TZD. Neither sulfonylureas nor insulin was associated with a significant reduction in risk. When glycemic control (HbA_1c) was added to the model, metformin remained significantly better (HR, 0.84) at protecting against dementia, whereas the other agents were not significantly better than a TZD.

Similarly, in a model with sulfonylureas as the referent, metformin was significantly better, with adjusted HRs of 0.79 and 0.80 in models without and with HbA_1c, respectively.

An analysis of effect by dementia subtype also showed significant benefit for metformin vs. sulfonylurea for protection against Alzheimer’s disease (HR, 0.70) and vascular dementia (HR, 0.75).

The investigators plan to examine relationships between dose and dementia, and to look at the effects of combination therapies.

The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, and by Kaiser Permanente. Dr. Whitmer is employed by Kaiser Permanente Northern California.

BOSTON – Eating well may be the best revenge against cognitive decline, a study has shown.

Among 818 dementia-free participants in a longitudinal study of memory and aging, those who adhered to the basic components of the DASH (Dietary Approaches to Stop Hypertension) diet had a slower rate of cognitive decline than others who followed more typical American diets, reported Martha Clare Morris, Sc.D., professor and director of the section of nutrition and nutritional epidemiology at Rush University Medical Center in Chicago.

The relationship between diet and cognition was linear, with people who most closely followed the DASH dietary pattern having the slowest rates of decline, Dr. Morris said at the Alzheimer’s Association International Conference 2013.

©Ron Chapple Studios/thinkstockphotos.com

"The individual dietary components that were contributing to this slower decline were higher servings of vegetables, nuts, seeds, and legumes, and lower intake of total and saturated fats," she said.

The investigators chose to look at dietary patterns because they provide an index of overall dietary quality and incorporate the interactions or synergies that may occur among food groups that constitute a specific pattern.

The DASH diet has been shown to lower blood pressure, increase insulin sensitivity, and reduce weight, serum cholesterol level, inflammation, and oxidative stress.

The diet is similar to a Mediterranean-style eating pattern: heavy on fruits and vegetables, nuts, seeds, legumes, lean meats, fish, poultry, and low- or nonfat dairy, and light on sugar and salt.

To see whether a DASH diet pattern could have similarly beneficial effects on cognition and memory, the authors studied 818 adults who participated in the Rush Memory and Aging Project (MAP) and who agreed to fill out a 139-item food frequency questionnaire.

MAP enrolled residents from 40 retirement communities who were dementia free at enrollment and who agreed to have annual cognitive and motor tests and blood draws. Participants also agreed to donate their brains, spinal cords, muscles, and nerve tissue at death.

Participants were tested at baseline and annually with a summary measure of 19 tests assessing global cognitive function in domains of episodic, semantic, and working memory; visuospatial ability; and perceptual speed. Tests scores were standardized and averaged to come up with the composite measure.

Adherence to the DASH diet was scored on a scale ranging from 0 to 10, with 10 being a perfect score. The study participants had a mean DASH score of 4.1 (range, 1.5-8.5).

The investigators created linear mixed models incorporating global cognition, individual cognitive domains, DASH total scores, and scores for 10 dietary components. They also created a basic model adjusted for age, sex, education, and total caloric intake, with further adjustment for apolipoprotein E (apo E) status and depression.

Median DASH scores ranged from 2.5 in the lowest tertile to 4.0 in the middle to 5.5 in the highest tertile. At baseline, the mean global cognitive score was 0.14 (range, –3.24 to 1.61).

Over an average of 4.7 years of follow-up, DASH scores were significantly associated in a linear fashion (the higher the score, the slower the rate of decline) in the basic model alone and after adjustment for apo E status (P = .005) and after adjustment for both apo E and depression (P = .006).

The association was significant for all cognitive domains except visuospatial abilities, which trended toward significance but did not reach it (P = .06).

Dietary components significantly associated with slower decline include vegetables (P = .02); nuts, seeds, and legumes (P = .01); total fat (P = .05); and saturated fat (P = .01).

The Rush MAP is supported by grants from the National Institute on Aging, the Illinois Department of Public Health, the Elsie Heller Brain Bank Endowment Fund, and a Rush University endowment. Dr. Morris reported having no relevant financial disclosures.

BOSTON – Eating well may be the best revenge against cognitive decline, a study has shown.

Among 818 dementia-free participants in a longitudinal study of memory and aging, those who adhered to the basic components of the DASH (Dietary Approaches to Stop Hypertension) diet had a slower rate of cognitive decline than others who followed more typical American diets, reported Martha Clare Morris, Sc.D., professor and director of the section of nutrition and nutritional epidemiology at Rush University Medical Center in Chicago.

The relationship between diet and cognition was linear, with people who most closely followed the DASH dietary pattern having the slowest rates of decline, Dr. Morris said at the Alzheimer’s Association International Conference 2013.

©Ron Chapple Studios/thinkstockphotos.com

"The individual dietary components that were contributing to this slower decline were higher servings of vegetables, nuts, seeds, and legumes, and lower intake of total and saturated fats," she said.

The investigators chose to look at dietary patterns because they provide an index of overall dietary quality and incorporate the interactions or synergies that may occur among food groups that constitute a specific pattern.

The DASH diet has been shown to lower blood pressure, increase insulin sensitivity, and reduce weight, serum cholesterol level, inflammation, and oxidative stress.

The diet is similar to a Mediterranean-style eating pattern: heavy on fruits and vegetables, nuts, seeds, legumes, lean meats, fish, poultry, and low- or nonfat dairy, and light on sugar and salt.

To see whether a DASH diet pattern could have similarly beneficial effects on cognition and memory, the authors studied 818 adults who participated in the Rush Memory and Aging Project (MAP) and who agreed to fill out a 139-item food frequency questionnaire.

MAP enrolled residents from 40 retirement communities who were dementia free at enrollment and who agreed to have annual cognitive and motor tests and blood draws. Participants also agreed to donate their brains, spinal cords, muscles, and nerve tissue at death.

Participants were tested at baseline and annually with a summary measure of 19 tests assessing global cognitive function in domains of episodic, semantic, and working memory; visuospatial ability; and perceptual speed. Tests scores were standardized and averaged to come up with the composite measure.

Adherence to the DASH diet was scored on a scale ranging from 0 to 10, with 10 being a perfect score. The study participants had a mean DASH score of 4.1 (range, 1.5-8.5).

The investigators created linear mixed models incorporating global cognition, individual cognitive domains, DASH total scores, and scores for 10 dietary components. They also created a basic model adjusted for age, sex, education, and total caloric intake, with further adjustment for apolipoprotein E (apo E) status and depression.

Median DASH scores ranged from 2.5 in the lowest tertile to 4.0 in the middle to 5.5 in the highest tertile. At baseline, the mean global cognitive score was 0.14 (range, –3.24 to 1.61).

Over an average of 4.7 years of follow-up, DASH scores were significantly associated in a linear fashion (the higher the score, the slower the rate of decline) in the basic model alone and after adjustment for apo E status (P = .005) and after adjustment for both apo E and depression (P = .006).

The association was significant for all cognitive domains except visuospatial abilities, which trended toward significance but did not reach it (P = .06).

Dietary components significantly associated with slower decline include vegetables (P = .02); nuts, seeds, and legumes (P = .01); total fat (P = .05); and saturated fat (P = .01).

The Rush MAP is supported by grants from the National Institute on Aging, the Illinois Department of Public Health, the Elsie Heller Brain Bank Endowment Fund, and a Rush University endowment. Dr. Morris reported having no relevant financial disclosures.

BOSTON – Eating well may be the best revenge against cognitive decline, a study has shown.

Among 818 dementia-free participants in a longitudinal study of memory and aging, those who adhered to the basic components of the DASH (Dietary Approaches to Stop Hypertension) diet had a slower rate of cognitive decline than others who followed more typical American diets, reported Martha Clare Morris, Sc.D., professor and director of the section of nutrition and nutritional epidemiology at Rush University Medical Center in Chicago.

The relationship between diet and cognition was linear, with people who most closely followed the DASH dietary pattern having the slowest rates of decline, Dr. Morris said at the Alzheimer’s Association International Conference 2013.

©Ron Chapple Studios/thinkstockphotos.com

"The individual dietary components that were contributing to this slower decline were higher servings of vegetables, nuts, seeds, and legumes, and lower intake of total and saturated fats," she said.

The investigators chose to look at dietary patterns because they provide an index of overall dietary quality and incorporate the interactions or synergies that may occur among food groups that constitute a specific pattern.

The DASH diet has been shown to lower blood pressure, increase insulin sensitivity, and reduce weight, serum cholesterol level, inflammation, and oxidative stress.

The diet is similar to a Mediterranean-style eating pattern: heavy on fruits and vegetables, nuts, seeds, legumes, lean meats, fish, poultry, and low- or nonfat dairy, and light on sugar and salt.

To see whether a DASH diet pattern could have similarly beneficial effects on cognition and memory, the authors studied 818 adults who participated in the Rush Memory and Aging Project (MAP) and who agreed to fill out a 139-item food frequency questionnaire.

MAP enrolled residents from 40 retirement communities who were dementia free at enrollment and who agreed to have annual cognitive and motor tests and blood draws. Participants also agreed to donate their brains, spinal cords, muscles, and nerve tissue at death.

Participants were tested at baseline and annually with a summary measure of 19 tests assessing global cognitive function in domains of episodic, semantic, and working memory; visuospatial ability; and perceptual speed. Tests scores were standardized and averaged to come up with the composite measure.

Adherence to the DASH diet was scored on a scale ranging from 0 to 10, with 10 being a perfect score. The study participants had a mean DASH score of 4.1 (range, 1.5-8.5).

The investigators created linear mixed models incorporating global cognition, individual cognitive domains, DASH total scores, and scores for 10 dietary components. They also created a basic model adjusted for age, sex, education, and total caloric intake, with further adjustment for apolipoprotein E (apo E) status and depression.

Median DASH scores ranged from 2.5 in the lowest tertile to 4.0 in the middle to 5.5 in the highest tertile. At baseline, the mean global cognitive score was 0.14 (range, –3.24 to 1.61).

Over an average of 4.7 years of follow-up, DASH scores were significantly associated in a linear fashion (the higher the score, the slower the rate of decline) in the basic model alone and after adjustment for apo E status (P = .005) and after adjustment for both apo E and depression (P = .006).

The association was significant for all cognitive domains except visuospatial abilities, which trended toward significance but did not reach it (P = .06).

Dietary components significantly associated with slower decline include vegetables (P = .02); nuts, seeds, and legumes (P = .01); total fat (P = .05); and saturated fat (P = .01).

The Rush MAP is supported by grants from the National Institute on Aging, the Illinois Department of Public Health, the Elsie Heller Brain Bank Endowment Fund, and a Rush University endowment. Dr. Morris reported having no relevant financial disclosures.