Hope Plays Role in Stroke Risk

By Todd Neale, Staff Writer, MedPage Today
Published: August 31, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

A feeling of hopelessness about the future appears to be associated with subclinical carotid atherosclerosis in apparently healthy, middle-age women, a cross-sectional study showed.

Those with greater degrees of hopelessness had higher mean (P=0.0139) and maximum (P=0.0297) carotid intimal-medial thickening compared with women who were more optimistic about their prospects in life, according to Susan Everson-Rose, PhD, MPH, of the University of Minnesota in Minneapolis, and colleagues.

This thickening is an early marker of atherosclerosis and stroke risk, they wrote online in Stroke: Journal of the American Heart Association.

Previous studies have linked depression and depressive symptoms -- including hopelessness -- to cardiovascular disease morbidity and mortality in men, but none has made the connection in women, the researchers said.

"This is the first study to suggest that hopelessness may be related to subclinical cardiovascular disease in women without clinical symptoms of heart disease and who are generally healthy," Everson-Rose said.

Her team looked at data from the Chicago and Pittsburgh sites of the Study of Women's Health Across the Nation (SWAN) Heart Study.

All 559 women included in the study were free from clinical cardiovascular disease.

Hopelessness was measured using a two-item questionnaire assessing expectations about the future and the ability to reach one's personal goals.

Intimal-medial thickening was measured using ultrasound.

Each 1-point increase in the hopelessness score was associated with a 0.0061-mm greater mean (P=0.0217) and 0.0074-mm greater maximum (P=0.0409) intimal-medial thickness.

The association remained significant after adjusting for demographic variables, depression, and cardiovascular risk factors.

Women who felt the most hopeless had an average intimal-medial thickness that was 0.066 mm greater than the rest (P=0.0008), which could be clinically significant, the researchers said.

"Such small incremental differences in intimal-medial thickness are associated with increased cardiovascular risk as well as incident cardiovascular disease and stroke," they said.

Although the mechanism underlying the association remains unclear, animal studies have shown that hopelessness -- demonstrated by exposure to learned helplessness and uncontrollable stressors -- causes autonomic, inflammatory, and neuroendocrine changes that can result in atherogenesis.

However, they said, the mechanism likely operates along multiple pathways, which need to be explored in future studies.

The authors acknowledged that the study was limited by its cross-sectional nature and said it is unclear whether hopelessness is associated with the progression of atherosclerosis.

In addition, they said, it is unknown whether the findings would apply to women who had poorer cardiovascular profiles or who were more socioeconomically disadvantaged.

Primary source: Stroke: Journal of the American Heart Association
Source reference:

The Elderly: Finding a Good Geriatric Care Manager

Such professionals can be a tremendous help if you're trying to take care of ailing parents but live far away

By Lauren Young

On a Tuesday night in late July, Jon Meyers, 42, got the call every child with an elderly parent dreads. His 84-year-old mother, Ruth, who suffers from dementia, had fallen in her kitchen and was heading to a New Jersey hospital by ambulance. But instead of agonizing over not being able to get there quickly—it's four hours from his home in Washington, D.C., to Point Pleasant, N.J.—Meyers took comfort in the fact that Stephen Mielach, a geriatric care manager, was following the ambulance, ready to take control.

Before 2007, Meyers had never heard of geriatric care managers (also called geriatric case managers). But then his mother developed problems that required hospitalization, and Meyers couldn't keep taking days off from his job as an art director at the Cato Institute, a Washington think tank. On the recommendation of his mother's physician, Meyers, an only child, hired Mielach. He accompanies Meyer's mother on doctor visits, looks after her dog on occasion, and even helped with the paperwork for a reverse mortgage so that she could stay in her home.

The role of a geriatric care manager goes well beyond that of a home health aide. The primary job of home health aides is to administer medication and provide companionship. By contrast, care managers oversee many things busy or far-flung family members might not be able to stay on top of: vetting nursing homes and assisted living facilities, overseeing home health aides, providing guidance about applying for federal, state, and other benefits. They may also tend to more day-to-day tasks, like making sure that rugs in a parent's home don't slip and that refrigerators are stocked.

An estimated 7 million people care for adult relatives from a distance, according to the National Alliance for Caregiving. On top of the logistical benefits of hiring a care manager, preliminary research indicates that elderly patients who have a geriatric care manager get more thorough care than patients who do not. Evercare by UnitedHealthcare (UNH), which hooks up patients with care managers, conducted the research in conjunction with Santa Monica (Calif.) think tank Rand Corp.

GOOD CHEMISTRY

What kind of expertise do geriatric case managers bring to the table? They often have some background in nursing or social work. Linda Fodrini-Johnson, president-elect of the National Association of Professional Geriatric Care Managers, estimates that 35% of the group's 2,000 members have nursing degrees and 50% have social work or counseling backgrounds. The other 15% have experience in fields such as physical therapy or occupational therapy, or have advanced degrees in gerontology and related fields.

When choosing a care manager, find one with experience dealing with issues similar to those of your relative. If a parent has a complicated medical history, consider hiring someone with a nursing background to coordinate care among doctors, who often don't talk with each other, says Julie Davis, managing editor of Parentgiving.com, a caregiving Web site. And make sure there is good chemistry with your family.

The network of caregivers in most communities is fairly small, and many people say the best referrals come from their parent's doctor, local hospital, or nursing home. Jan Rosenbaum, 53, a molecular pharmacologist working in the life sciences group at CincyTech in Cincinnati, which invests in technology startups, got a recommendation from a psychologist working at her dad's independent living facility in Orange County, Calif. "We were concerned—and rightly so—that the facility would not be paying careful attention to the details of his case and that as his memory worsened, he might not be properly understanding or communicating everything the doctors were saying," she says.

Rosenbaum's advice is to include the elderly parent in the selection process—after all, he or she is the one who will have the most direct contact with the professional caregiver. " The relationship will only work once a high level of trust is established between the two of them," says Rosenbaum.

It's also a good idea to ask potential care managers if they receive financial incentives from nursing homes or other providers for directing clients there. "Make sure you are dealing with a care manager who is most concerned with recommending the appropriate care for your parent vs. someone who might have a special financial relationship with a facility," says Paul Hogan, co-author of Stages of Senior Care (McGraw-Hill), to be published this November.

Caregivers kick off the process with an assessment. This includes a review of the medical history, and, if your parent is living at home, an evaluation of the setup, looking at stairs, lighting, and other issues. Care managers may even take a peek at the checkbook to find out if bills are being paid on time (some people give care managers power of attorney and the right to make medical decisions, but that's unusual).

Hiring one of these professionals isn't cheap. Initial assessments, which last a few hours, range from $200 to $850, depending where you live. Hourly rates can range from $80 to $200. While most payments are out-of-pocket, check your parent's long-term care insurance policy to see if it covers the expense, and check your employer's elder-care benefits.

In the end, finding someone to help you take care of an elderly relative can benefit your health as well as theirs. Suzanne and Peter Cooper of Upper Saddle River, N.J., are raising their five-year-old son while living with her 84-year-old mother, Irma, who has Alzheimer's disease. Suzanne, 49, says her own mental and physical state has improved dramatically since she hired Nancy Bortinger, the director of geriatric services at Vantage Health System in Dumont, N.J.

Bortinger plowed through a list of 20 local day-care facilities to get Suzanne's mother out of the house for stimulation and socialization. Now Bortinger is helping Suzanne place Irma in a respite care center for a week while the family takes a much needed vacation. Suzanne equates the role of a geriatric care manager with a global positioning system for your car. "Even if you have maps in the glove compartment, the GPS gets you right to the place you need to get to," she says.

To see a geriatric care manager discuss her role in assisting families with caregiving, go to www.businessweek.com/go/09/care

The ‘quicker and sicker’ exit strategy

By Deborah G. Schuss July 30, 2009

WHEN MY cellphone rang, I expected the emergency-room doctor with an update on my father’s condition. Diagnosed with pneumonia and an apparent infection, my dad was in a holding area while waiting for a hospital bed to clear.

“I need your plan for discharge,’’ announced a hospital official whose name I had to extract.

So went my introduction to the case manager, a hospital fixture and healthcare’s equivalent of the meter maid. Pat’s no-nonsense demeanor as she proceeded with her revenue-focused mission of orchestrating my father’s departure even before his formal admission is emblematic of what’s often missing these days for patients’ families: a genuine sense of caring to accompany the care.

It wasn’t so long ago that a hospital social worker would meet with family caregivers a day or two before our loved one was discharged; patient advocacy was the dominant theme, as this person sorted out post-hospital challenges and weaved a plan to cushion patients while propping up their caregivers.

Now, hospitalizations beyond a day or two are rare, and there is an army of Pats lined up at the command post to bounce patients from their hospital beds quicker and sicker: One day they are on oxygen and IV drips, the next day the ambulance driver is depositing them at their doorstep. The lucky ones have relatives or friends to step in as caregivers and tend to their health needs.

In a recent study, the New York-based Commonwealth Fund reported that about one-third of US patients hospitalized with heart failure in 2006 didn’t even receive written discharge instructions. And that is only one component of discharge planning.

Dena Salzberg, a Massachusetts patient advocate and care coordinator, has “gone head to head’’ with hospital case managers after receiving frantic calls from families who hire her to intervene. “They’re saying, ‘I’m so scared. They’re kicking my mother out of the hospital,’ ’’ says Salzberg, a nurse who runs Care Management Consultants. “People are leaving hospitals with a lot more complex needs.’’

So who are these uber-efficient hospital case managers? They are nurses, social workers, or even an embedded care manager of your insurance company, all operating against a backdrop of managed-care and Medicare mandates on length of stay. Their goal is simple: swift exit.

The results? Sometimes the discharge plan is unworkable. The case manager assigned to my father the day he was expected to go home apparently never bothered to find out he was incapable of walking up the steps to his house.

Other times, families or their hired guns - like patient-advocate Salzberg - are doing battle with case managers over post-hospital placement driven by moving patients out rather than forward.

And still other times, a patient is boomeranged back to the same hospital within days of an express-lane discharge. Eighteen percent of chronically ill people hospitalized in the United States were readmitted or went to an emergency room as a result of complications after a discharge, according to the Commonwealth Fund.

And as families race to their bedsides, or work the office phones to craft a care plan, the ripple effects are felt elsewhere in the economy: American businesses lose up to $33.6 billion a year because of employees’ caregiving responsibilities for someone age 18 or older, according to a 2006 study conducted by the MetLife Mature Market Institute and the National Alliance for Caregiving.

Of course, there are some outstanding, compassionate case managers. Let’s make sure they are not part of a dying breed. As the ailing US healthcare system once again lies on the national examination table, some elixirs go back to basics: more resources directed toward exceptionally coordinated continuity of care - as much a patient lifeline as the heart surgery she received in the operating room.

A high-quality and efficient care-delivery system also recognizes the public value of family caregivers in this process. With insurance cutbacks that narrowed reimbursable services, we are required to dispense post-hospital medical care previously unthinkable for anyone except a healthcare professional; by flushing feeding tubes and dressing amputees’ wounds, we help our loved ones remain at home and away from more costly alternatives. It’s all the more reason for gold-standard care coordination.

Discharge planning should not require paying an advocate to wage war, further dividing the rich from the poor in healthcare. And families should be part of a collaborative effort, not treated as though we are double-parked in a tow zone.

The Coffee Brew-haha Most studies find drinking coffee brings health benefits, but old myths persist

By: Sid Kirchheimer | Source: AARP Bulletin Today | May 22, 2009

So far this year, the findings are enough to perk up coffee drinkers beyond what they get with their morning jolt.

In just the last five months, studies have found that coffee may protect against dementia, stroke and skin cancer.

This follows previous research—among some 20,000 studies to date exploring the health impact of America’s most popular beverage—that suggests regular coffee consumption may reduce the risk of Parkinson’s, type 2 diabetes, several types of cancer, suicide and some mood disorders, gallstones, liver cirrhosis and even cavities.

Coffee has long been known as an effective emergency treatment for an asthma attack and a go-to headache remedy, and, more recently, as an aid to help alcoholics quit drinking. It may even extend a person’s lifespan, researchers say. It’s the second most studied substance after cigarettes, and the studies keep percolating along.

In January, Finnish researchers reported in the Journal of Alzheimer’s Disease that after tracking 1,400 adults for 20 years and controlling for their other lifestyle and dietary habits, those drinking three to five cups per day were two-thirds less likely to develop dementia than non-imbibers.

In February came two studies—one by Harvard University School of Public Health and Spanish researchers tracking 83,000 middle-aged women since 1980, and the other by University of California, Los Angeles and University of Southern California scientists analyzing data on 9,400 adults older than 40—that showed a lower risk of stroke among coffee drinkers, with rates decreasing with the more cups consumed each day. Then there was also research in the Journal of Investigative Dermatology suggesting that consuming caffeine may protect against skin cancer by disrupting a protein that causes sun-damaged skin cells to self-destruct.

March was quiet on the java front, but with April came two more findings: Researchers at Roswell Park Cancer Institute in Buffalo, N.Y., reported that among 1,100 women studied for 16 years, those who regularly drank coffee or tea had a lower risk of endometrial cancer compared with nondrinkers. The more coffee the women consumed, the lower the disease rates. And in the International Journal of Sport Nutrition and Exercise Metabolism, scientists from the University of Iceland and the University of Illinois-Urbana found that drinking coffee seems to help relieve the pain of exercise.

Coffee shakes bad reputation

There seems to be a new coffee study published in medical journals every few weeks, for several reasons. It’s readily available, inexpensive and popular. Some 400 billion cups are consumed every year worldwide. It’s not fattening, with zero calories when served black or with artificial sweeteners. And, researchers say, it may just be one of the healthiest substances you can get.

But it wasn’t always regarded that way. Even today, some folks (typically, those not doing the research) still avoid this virtuous vice—believing coffee causes ailments ranging from bone loss and heart problems to stomach and pancreatic cancer and “the shakes.”

“When I was in medical school, we were taught that coffee was bad,” says Peter R. Martin, M.D., director of Vanderbilt University’s Institute for Coffee Studies. “But that was because early studies in the 1960s and 1970s were not well done, not taking into effect other lifestyle factors, such as that people who drank coffee also tended to smoke. And they developed health problems.” (Researchers have now realized that in those early studies, coffee-drinking smokers tended to under-report how much they smoked.)

Today, however, epidemiological studies are done more carefully, tracking various factors affecting health and illness in large groups for many years or decades. Most, say leading researchers, reach the same conclusion: For those not prone to its effect on sleep problems (decaf solves that) or indigestion, and not worried that it can slightly raise “bad” cholesterol, coffee is healthy and may even help prevent many age-related conditions.

“Coffee is most famous for being the best source of caffeine—there’s three times as much in a cup of coffee compared to an equal amount of cola—and despite its bad reputation, caffeine has some health benefits. But coffee is a very complex substance with as many as 2,000 different chemical components, including many powerful antioxidants and phytochemicals,” notes James Coughlin, a food and chemical toxicologist who has studied coffee’s health effects for more than three decades and has personally conducted or analyzed data from some 10,000 studies.

What’s more, roasting coffee beans causes a chemical reaction that makes some of these disease-fighting antioxidants even more powerful, adds Coughlin, past president of the Association for Science and Information on Coffee, a Paris-based organization of scientists who conduct coffee-related research and are funded in part by the coffee industry. This may explain why, measure for measure, coffee has been documented as the richest source of antioxidants in the American diet.

Beyond caffeine, benefits of the bean

On its own, caffeine reacts with certain brain receptors—one explanation why studies have shown it protects against Alzheimer’s and Parkinson’s, boosts mood and lowers suicide risk, and reduces pain. But an additional brain-boosting benefit comes from coffee’s abundance of chlorogenic acids, a family of antioxidants that also protect the brain and other body systems, adds Martin. “Chlorogenic acids improve the capacity of the body to metabolize sugar and glucose, which is perhaps the reason why it may be protective against type 2 diabetes and liver disease.”

In one notable study that analyzed data on 126,000 people over a period of 18 years, Harvard researchers found that, all else being equal, those drinking one to three cups of caffeinated coffee each day were slightly less likely than nondrinkers to develop type 2 diabetes. But among those drinking six or more cups daily, men’s risk was slashed by 54 percent and women’s by 30 percent compared with nondrinkers. Since then, other studies have found that regularly drinking decaf also lowers the risk of diabetes.

“Whether you drink regular or decaf coffee, you’re getting chlorogenic acids,” notes Frank Hu, M.D., professor of nutrition and epidemiology at Harvard’s School of Public Health, who led that January 2004 diabetes study published in Annals of Internal Medicine and participated in the recent February report indicating a lower risk of stroke among coffee drinkers. “These substances have a powerful, positive effect on cardiovascular health and in preventing gallstones, which, similarly to diabetes, is related to insulin resistance.”

Antioxidants in coffee may also play a role in reducing the risk of certain cancers. “There really seems to be a strong, consistent protective effect against liver and endometrial cancer, with the benefit coming with at least two cups per day,” says Lenore Arab, a researcher at UCLA’s David Geffen School of Medicine who analyzed more than 500 previous coffee studies for a study soon to be published in Nutrition & Cancer. “There is increasing evidence that coffee is protective against colorectal cancer.” Her research indicates that coffee has little impact—positive or negative—on cancers of the breast, pancreas, kidney, ovaries, prostate or stomach. And in one of the first studies of its kind, a recent study from Japan finds lower rates of oral cancers among coffee drinkers.

However, more than six cups a day is linked with a higher risk of bladder cancer in men, but not women, adds Arab. And higher rates of leukemia occur in people whose mothers drank more than two cups a day during pregnancy.

What about bone loss leading to osteoporosis, a common concern from drinking coffee? “There is very little risk in drinking up to four cups per day,” Coughlin says.

Even many patients with heart arrhythmias—long told to avoid coffee—can drink it with their doctor’s approval. In fact, mounting evidence suggests that coffee may be heart-healthy. A study last year that tracked nearly 128,000 adults for 18 year or longer indicated that, all else considered, coffee drinkers have a longer lifespan than nondrinkers. Why might that java habit help people live longer? Coffee is rich in magnesium—important for heart health—and its bounty of antioxidants helps reduce inflammation and protect the inner lining of blood vessels, says lead researcher Esther Lopez-Garcia of the Universidad Autónoma de Madrid in Spain.

The bottom line: “For most people in their 50s, 60s or older,” says Harvard’s Hu, “there is no reason to worry about coffee. Just don’t add too much sugar or cream.”

Stillwater Senior Center presents 'Baubles, Bangles & Bobbers'

The Stillwater Senior Center will host its sixth annual fundraiser, Baubles, Bangles & Bobbers, from 9 a.m. to 4 p.m. Thursday, Aug. 20.

People will have the chance to rummage through and purchase jewelry and homemade desserts from the bake sale at 2300 W. Orleans St. in Stillwater.

"It's the best sale of the year for just about everyone, but it's particularly suited to the accessories-challenged and frugal," event organizers said in a release. "Baubles, Bangles & Bobbers features funky used jewelry and purses in almost endless variety, plus a bake sale to tempt the wise shopper who knows it's almost impossible to 'outgrow' a classy pair of earrings."

Also, new this year is a "men's room" offering fishing gear and memorabilia for men, who will finally have a feature of their own at this event.

As the Senior Center's biggest annual fundraiser, this sale raised $5,000 last year to support various programs, activities and speakers for area senior citizens, according to Senior Program Director Karla Bataglia. She added that a successful sale is more important than ever this year when donations to non-profits are down due to the poor economy.

Approximately 75 volunteers have been involved in preparations for the sale, and many will be on hand to assist shoppers as clerks and cashiers at the event.

Donated jewelry is sorted, evaluated and priced by volunteers, who include former local jeweler Jeff Sherburne and antiques dealer Sandra Bjorndahl. Local jewelry maker Lonnie Lovness donates the use of small, yellow boxes for shoppers.

Shoppers will find bracelets, necklaces, chains, earrings (screw, clip-on and pierced), pins, matching sets, rings, watches, children's, holiday, religious and vintage jewelry, all at bargain basement prices. Tables are replenished throughout the day of the sale "so shoppers can come anytime and be assured of finding a great buy," organizers said.

Community Thread (formerly Community Volunteer Service and Senior Centers) is a nonprofit human service agency that has been in existence since 1967.

A Way Found to Judge Driving Safety of Alzheimer's Patients

By Kristina Fiore, Staff Writer, MedPage Today
Published: February 11, 2009
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.

IOWA CITY, Iowa, Feb. 11 -- The difficult judgment call on whether Alzheimer's patients are safe to drive can be helped by a battery of cognitive tests, researchers here said.
Action Points

* Explain to interested patients that tests of memory, visual, and motor abilities may predict which patients with Alzheimer's disease may make more safety errors while driving.

Patients who performed better on these tests made fewer errors during a supervised test drive, Jeffrey D. Dawson, M.D., of the University of Iowa, and colleagues reported in the Feb. 10 issue of Neurology.

"By measuring driver performance through off-road tests of memory, visual, and motor abilities, we may be able to develop a standardized assessment of a person's fitness to drive," Dr. Dawson said.

To determine whether performance on tests of cognition, visual perception, and motor function could predict the level of safety in licensed drivers with early Alzheimer's, the researchers conducted a controlled trial of 40 patients with mild disease and 115 patients without dementia.

All participants were tested on a battery of cognitive, visual, and motor tasks, from which the researchers calculated a composite measure of cognitive impairment (COGSTAT).

An experimental drive was conducted aboard ARGOS (Automobile for Research in Ergonomics and Safety), which has hidden instrumentation and sensors. Participants drove a supervised 35-mile test drive on roads within and surrounding Iowa City.

A certified safe driving instructor reviewed video tapes of each drive to assess the number and type of safety errors made by the drivers.

The researchers found that drivers with Alzheimer's disease committed an average of 42 safety errors per drive, compared with an average of 33.2 for controls.

Lane observance errors were significantly more common in the Alzheimer's group, but no other general category of errors was significantly more common in Alzheimer's patients.

"This suggests that patients with mild Alzheimer's have the ability to handle certain aspects of driving," the researchers said.

Some of the more serious errors in this class included straddling the center line and failing to proceed through the intersection even though the light had turned green.

Drivers with higher overall cognitive function as measured by COGSTAT tended to make fewer total safety errors, the researchers said.

Other tests that were significant predictors of safety errors among drivers with the disease included working memory, visual search and visual motor speed, visuo-constructional abilities, and motor function.

"Given that driving puts demands on diverse cognitive functions, it is unlikely that a test of any single cognitive ability will be an accurate predictor of driving safety," the researchers said.

The study may have been limited by a lack of investigation of other environmental factors, such as having family members in the vehicle and time of day, as well as a possible lack of generalizability because only seven of the 40 patients in the experimental group were women.

Still, the researchers concluded that for predicting safety errors within the Alzheimer's disease group, "off-road neuropsychological tests of cognition, vision, and motor abilities gave additional information above and beyond diagnosis alone. Hence, performance on these tests can be helpful when predicting whether a patient with Alzheimer's disease can safely drive a vehicle."

Alzheimer's Linked to Cholesterol Level in Middle Age

By Crystal Phend, Senior Staff Writer, MedPage Today
Published: August 04, 2009

Action Points

* Explain to interested patients that cholesterol levels are an important marker of cardiovascular health and may likewise be linked to dementia risk.


* Note that the retrospective observational study suggested a temporal relationship but could not determine causality.

Even modestly elevated cholesterol in midlife portends greater Alzheimer's disease risk in old age, researchers found.

Above average cholesterol of 220 mg/dl or higher at age 40 to 45 raised the risk 31% to 58% for Alzheimer's diagnosis in the next three decades, compared with low cholesterol, Alina Solomon, MD, of the University of Kuopio, Finland, and colleagues reported in the August issue of Dementia & Geriatric Cognitive Disorders.

These results suggested a lower threshold for risk than some prior studies, the researchers noted.

Cholesterol over 250 mg/dl in middle age elevated Alzheimer's disease risk in the CAIDE study and Finnish cohort of the Seven Countries Study, although it has not been linked over a broader time course in other studies, including the Framingham study.

Rather than waiting to address dementia symptoms as they arise with age, the results support a shift toward earlier attention, the researchers wrote. That means "addressing risk factors as early as midlife, before the underlying disease(s) or the symptoms appear."

Effective management requires a cross-disciplinary approach to lifestyle changes, added co-author Rachel Whitmer, PhD, of Kaiser Permanente in Oakland, Calif.

The researchers analyzed the longitudinal electronic medical record databases of Kaiser Permanente of Northern California.

The cohort included members of the health maintenance organization who had completed detailed health evaluations as part of a "multiphasic" well-care initiative in the organization from 1964 through 1973, when they were ages 40 to 45.

Overall, 9,844 individuals remained members through at least 1994, after which dementia ascertainment started.

In the cohort, cholesterol levels of at least 240 mg/dl during their 40s -- considered high by Adult Treatment Panel (ATP) III guidelines -- were associated with 57% elevated Alzheimer's disease risk three decades later (HR 1.57, 95% CI 1.23 to 2.01).

Cholesterol levels considered borderline (200 to 239 mg/dl) showed a more modest trend for increased Alzheimer's risk compared with cholesterol under 200 mg/dl (HR 1.23, 95% CI 0.97 to 1.55).

Interestingly, the opposite was true for the second most common type of dementia.

Borderline-elevated cholesterol at age 40 to 45 significantly predicted elevated vascular dementia risk (HR 1.50, 95% CI 1.01 to 2.23), whereas frank hypercholesterolemia did not (HR 1.26, 95% CI 0.82 to 1.96).

Further refining the analysis by quartiles of cholesterol at midlife revealed a significant link for both above-average groups compared with the lowest quartile (cholesterol levels under 198 mg/dl).

Those in the top quartile (249-mg/dl-and-over) quartile were at 58% higher Alzheimer's risk (95% CI 1.22 to 2.06), while those in the quartile with 221-248 mg/dl cholesterol were at 31% elevated risk (95% CI 1.01 to 1.71).

The researchers noted that the vascular dementia findings were based on relatively few events and that the study did not include data on subtypes of cholesterol or use of lipid-lowering therapy.

However, because the initial cholesterol measurements were collected at a time in life when Alzheimer's disease and other forms of dementia would be unlikely, the results suggested a temporal association.

The mechanism for it may have been vascular since serum cholesterol is related to both cardiovascular and cerebrovascular conditions, which have been in turn been linked to Alzheimer's disease.

But the researchers noted that their findings were significant even after adjustment for major vascular factors and conditions.

Other possible pathways might be cholesterol turnover in the brain, which has been associated with neurodegenerative diseases, they said.

Cholesterol plays a key function in the brain and, while it does not cross the blood-brain barrier, stores of it in the serum and brain do interact.

The authors noted that "about 60 to 70% of the total serum cholesterol is typically represented by LDL cholesterol, the major atherogenic lipoprotein. However, the role of LDL as a risk factor for AD or VaD could not be investigated in this study because data on LDL levels in 1964 to 1973 was not available."