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What Did I Need at the Grocery Store?

Can't recall what items were on your grocery list? Forget who cuts your grass every Saturday? The ability to store new memories and retrieve old ones declines with age, even in the absence of brain-altering conditions like stroke and Alzheimer's disease. And while researchers are spending millions to understand diseases that rob elderly people of memory and cognition, they are just beginning to understand the natural decline of brain function with age.

The answers are more than just academic, said David Madden, professor of medical psychology in the department of psychiatry.

"Learning how the healthy, aging brain functions can help us distinguish between normal memory decline versus abnormal brain events, like stroke, depression or disease-related dementia," Madden said. "Without a baseline to compare it against, how can we know by looking at a brain scan that something abnormal has occurred?"

In a series of imaging studies aimed at defining what is "normal" in the aging brain, Madden found that older adults store and retrieve information at a slower rate than young adults. In addition, older adults require more "brain power" than younger folks, meaning that they engage more brain regions to accomplish the same level of memory and recall as a younger person.

While young adults used their right prefrontal cortex to memorize a list of words and then distinguish these words from a group of newly presented ones, older adults used prefrontal regions in both hemispheres. Madden measured these effects using positron emission topography, a brain imaging technique that illuminates regions of increased blood flow in the brain and hence tells researchers what regions are being used during particular brain tasks.

"Essentially, what we have shown is a form of functional compensation, in which age-related increases in some brain regions compensate for the decreases occurring in other regions," said Madden.

While the speed and accuracy of memory processes had slowed in older adults, the fact that older adults can recruit other brain regions to assist them in memory suggests that the brain is still adaptive late in life, Madden said.

Madden can be reached at (919) 660-7537.

Best Medicine For Families Doesn't Come from the Doctor

"I swore with every fiber of my being that I would never put my husband in a nursing home. I had made him give me the same promise. I took care of him at home for 12 years. My doctor finally said to me, 'You must put Jack in a nursing home or you'll die, and then we'll put him in a nursing home.'

"In my heart of hearts, I knew he was right. But now I have so many concerns about the care he's getting. There are nights I can't sleep. I feel I have abandoned him, though I visit him almost every day. I am not sure this is a better answer."

For this distraught spouse of a man with Alzheimer's disease, the best medicine she can give and receive comes in the form of love, support and understanding. Without a cure, a remedy or even a certain diagnosis, Alzheimer's support programs fill in the gap where medicine has yet to provide relief.

Lisa Gwyther knows this all too well. As director of the Duke Family Support Program, Gwyther has ministered to hundreds of spouses, children, sisters and brothers of patients with this devastating illness. While medicine has fallen short of offering the remedies that stave off the memory and behavioral decline so typical of this disease, support programs can teach families how to cope with the loss of their loved one's former abilities.

With a staff of two, Gwyther serves families members throughout the state of North Carolina, but with far more than the usual counseling and support. Gwyther has written manuals that cover everything from financial considerations to cutting-edge research and has developed specialized education and training programs for families and health care professionals alike.

Her extensive outreach efforts have earned her program the 1999 Agency of the Year award from the North Carolina chapter of the National Association of Social Workers, (NASW) and her only social worker was named social worker of the year by the NASW and social worker of the year by Duke in 1995.

"We've developed a national reputation for excellence as a technical assistance and training center, and we've done that with no increase in state funding in 15 years," Gwyther said. "We provide support for family members, but we do much more - we train health professionals, we organize a regional Alzheimer's conference for families and health care professionals, and we staff a hotline."

From tips on dealing with behavior changes to translating the research findings discovered by scientists in the Joseph and Kathleen Bryan Alzheimer's Disease Research Center of Duke, Gwyther and colleagues Edna Ballard and Claire McDonnell have built a model program used as a template by their colleagues around the nation, said Kathy Boyd, executive director of North Carolina chapter of the National Association of Social Workers.

Gwyther can be reached at (919) 660-7510.

New Treatments for Alzheimer's

Can a herb or a drug that reduces inflammation help stave off Alzheimer's disease -- or even prevent it? Researchers at Duke don't know, but they think it's worth testing.

Alzheimer's disease is still a devastating, mysterious malady, but it seems to have turned a bit of a corner, according to Dr. Murali Doraiswamy, director of clinical trials in Duke's psychiatry department.

Clinicians have been heartened that symptoms of the disorder have become more treatable due to the two-year-old drug Aricept, which aids memory, thinking and general functioning in some AD patients. The disorder affects the ability of brain cells to pass signals, and Aricept helps boost that signal transmission. Now Doraiswamy and other researchers at Duke are looking at ways of giving Aricept a one-two punch by combining it with other medications. One ongoing clinical trial pairs Aricept with the common anti-oxidant vitamin E; another links it with a powerful new type of anti-inflammatory drug called a cox-2 inhibitor.

Based on a line of research that suggests brain inflammation is central to the Alzheimer's disease process, Duke researchers are also studying the ability of a cox-2 inhibitor to help prevent, or at least slow, the onset of the disease. They are also looking at the effects of gingko biloba, a herb said to enhance memory function, in preventing forgetfulness in patients who have a family history of Alzheimer's disease.

Doraiswamy can be reached at (919) 684-5933.

Move Over Viagra; Some Men Need More than a Pill

Viagra is touted as the wonder drug for aging men who've lost their sexual prowess. But a much more insidious condition may be at work in men who have the symptoms of low sex drive or inability to perform. The dreaded disorder is hypogonadism or testosterone deficiency, and it affects up to half a million men in the United States alone. Although men over 60 are at greater risk, it can affect men of all ages, causing a multitude of social and physical concerns.

Men who have it frequently experience unexplained fatigue, loss of sexual interest or function, sparse facial hair, osteoporosis or spinal fractures, and increased body fat. And while good treatments do exist, they have traditionally been cumbersome or carry a number of unpleasant side effects.

Now, doctors at Duke are testing a testosterone derivative in gel form that may hold the same benefits of traditional testosterone replacement therapy but without the side effects. Because the gel contains a derivative of testosterone, called dihydrotestosterone, it doesn't pose the same risks to the prostate as could a recently approved testosterone gel, used for younger men with the same condition.

If the new gel proves more successful in clinical trials at Duke and elsewhere, it could replace existing therapies, which Duke doctors say are impractical: intra-muscular injections, skin patches and pills. Injections require biweekly visits to the doctor and cause serious fluctuations in hormone levels; skin patches can cause allergic reactions to the skin and often don't adhere well due to perspiration; and pills must be taken three times daily and held under the tongue until they dissolve to prevent liver toxicity. The new gel need only be applied once a day to the forearm or chest. Its alcohol base allows the gel to evaporate quickly, leaving the testosterone derivative to be absorbed throughout the day. Dr. Thomas Weber of Duke said the clinical trial should confirm its safety and effectiveness in older men.