Forgot where you put your car keys? Having trouble recalling your colleague's name? If so, this may be a symptom of subjective cognitive impairment (SCI), the earliest sign of cognitive decline marked by situations such as when a person recognizes they can't remember a name like they used to or where they recently placed important objects the way they used to. Studies have shown that SCI is experienced by between one-quarter and one-half of the population over the age of 65. A new study, published in the January 11, 2010, issue of the journal Alzheimer's & Dementia, finds that healthy older adults reporting SCI are 4.5 times more likely to progress to the more advanced memory-loss stages of mild cognitive impairment (MCI) or dementia than those free of SCI.
The long-term study completed by researchers at NYU Langone Medical Center tracked 213 adults with and without SCI over an average of seven years, with data collection taking nearly two decades. Further cognitive decline to MCI or dementia was observed in 54 percent of SCI persons, while only in 15 percent of persons free of SCI.
"This is the first study to use mild cognitive impairment as well as dementia as an outcome criterion to demonstrate the outcome of SCI as a possible forerunner of eventual Alzheimer's disease," said Barry Reisberg, MD, professor of psychiatry, director of the Fisher Alzheimer's Disease Program and director, Clinical Core, NYU Alzheimer's Disease Center at NYU Langone Medical Center. "The findings indicate that a significant percentage of people with early subjective symptoms may experience further cognitive decline, whereas few persons without these symptoms decline. If decline does occur in those without SCI symptoms, it takes considerably longer than for those with subjective cognitive symptoms."
According to the authors, scientists and physicians can now target the prevention of eventual Alzheimer's disease in the SCI stage, beginning more than 20 years before dementia becomes evident
"These intriguing results more fully describe the possible relationship between early signs of memory loss and development of more serious impairment. This is critical to know, as we look for ways to define who is at risk and for whom the earliest interventions might be successful," said Neil Buckholtz, PhD, National Institute on Aging (NIA) which supported the research. "These findings also underscore the importance of clinicians' asking about, and listening to, concerns regarding changes in cognition and memory among their aging patients."
Co-authors of Dr. Reisberg at the NYU Alzheimer's Disease Center include Melanie B. Shulman, MD, Carol Torossian, PsyD, and Wei Zhu, PhD.
Primary funding for this study was provided by the NIA, which is part of the National Institutes of Health. Additional funding was provided by Mr. Leonard Litwin and the Fisher Alzheimer's Research Foundation.
Article Date: 08 Jan 2010 Source: NYU Langone Medical Center
Monday, January 11, 2010
Friday, January 8, 2010
Why Older Americans Will Have to Wait for Swine-Flu Shots by Betsy McKay
On a visit to his doctor last week for a blood-pressure check, Neil Johnson, a former mortgage lender, dutifully got his annual flu shot. Having suffered from flu in the past—"you ache, you cough...you have fever all over"—he wanted to make sure to get his shot early.
But Mr. Johnson, an 81-year-old resident of an assisted-living facility in Sandy Springs, Ga., will have to wait quite a while before he can roll up his sleeve for a vaccine against this season's best-known virus: the H1N1 swine flu. People age 65 and older are nearly last in line for that shot.
Older Americans are normally at the front of the queue for shots against the seasonal flu viruses that circulate every fall and winter, and public-health officials and doctors strongly urge them to get one each year. There's little wonder why: An estimated 36,000 people die in the U.S. every year from the seasonal flu, and 90% of them are 65 or older.
Perk of Age
But so far the new H1N1 flu is largely sparing the 60-plus demographic, instead hitting children and young adults the hardest. While it has spread like wildfire through secondary schools and colleges, and claimed more than 2,800 lives world-wide, few older people have even gotten sick.
That's because many people 60 and older were exposed to H1N1 viruses that circulated between 1918 and 1957. Those earlier viruses were similar to the new H1N1 virus, so the immunity that some people built up then is helping them now.
A study by scientists at the Centers for Disease Control and Prevention found that about one-third of adults age 60 and older had antibodies that protected them against the new H1N1 virus. By contrast, children had none.
The pattern is similar to one seen in the deadly 1918 pandemic, in which death rates were highest among young adults, according to infectious-disease experts. One possible reason is that older adults had been exposed to similar flu viruses in the 1800s.
Be Patient
With the risk of infection lower for older adults, federal health officials are allotting the swine-flue vaccine first to pregnant women, children and young adults, and anyone under 65 with asthma, diabetes or another medical condition that can increase their risk of complications from the flu. The CDC says older adults should be offered the vaccine only when there's enough medicine for all the other priority groups.
That's likely to take a few months. The federal government expects to receive and distribute 195 million doses of swine-flu vaccine by year-end. Officials estimate that 159 million people make up the top-priority groups—not including older adults—though not everyone in those groups is likely to opt for a shot. The new vaccine is free, and many insurance companies have said they will cover administration fees for the shot.
Budgie Amparo, senior vice president of quality and risk management for Emeritus Corp., which operates senior-living facilities, including the facility where Mr. Johnson lives, says it's working on getting swine-flu vaccine for its residents as quickly as it can through its regular supplier of seasonal-flu shots. "We've taken some proactive steps," Mr. Amparo says. "We were reassured that once it's available, we're going to get it."
Extra Precautions
In the meantime, nurses at Emeritus properties plan to spend more time educating residents about ways to protect themselves from the flu, such as washing their hands, Mr. Amparo says. They will also more actively monitor residents' health, to reduce their chances of complications should they get the flu. "We want to make sure we're managing their overall medical condition," helping residents get medications in a timely fashion, or helping those with respiratory conditions such as asthma see doctors quickly, he says.
One reason for the extra precautions: While older adults account for the fewest U.S. cases of swine flu, the proportion of those who have died is higher than for other age groups, according to CDC data. "Once you do get infected, your risk is higher," says Charlotte Yeh, chief medical officer for AARP Services Inc., part of the Washington-based advocacy group. Many older Americans have chronic conditions that affect their immune status, making it harder to fight off any flu, she says.
Moreover, the seasonal-flu vaccine may not offer full protection this year against a long-circulating virus that traditionally is linked with more hospitalizations and deaths among older adults than other strains. A new variant of the H3N2 seasonal flu virus has been identified on several continents that differs from the H3N2 strain covered by this year's vaccine. So far it's in the minority of H3N2 circulating viruses, and it's unclear how widely it will circulate in the U.S. this flu season, particularly given the current dominance of the swine-flu virus. But officials at the CDC and the World Health Organization say they're keeping a close eye on it.
Doctors can't quickly determine what strain of flu a patient has. "If you come in with all the signs of flu, we can't tell you which flu you have," Dr. Yeh says. "The critical thing is that if you have fever, aches, congestion, cough, dizziness, that is something you should talk with your doctor about." A doctor may prescribe an antiviral such as Tamiflu, which can't cure the flu but can shorten its duration and severity if started early.
Read Why Older Americans Will Have to Wait for Swine-Flu Shots for more information.
By Betsy McKay is deputy chief of The Wall Street Journal's Atlanta bureau.
But Mr. Johnson, an 81-year-old resident of an assisted-living facility in Sandy Springs, Ga., will have to wait quite a while before he can roll up his sleeve for a vaccine against this season's best-known virus: the H1N1 swine flu. People age 65 and older are nearly last in line for that shot.
Older Americans are normally at the front of the queue for shots against the seasonal flu viruses that circulate every fall and winter, and public-health officials and doctors strongly urge them to get one each year. There's little wonder why: An estimated 36,000 people die in the U.S. every year from the seasonal flu, and 90% of them are 65 or older.
Perk of Age
But so far the new H1N1 flu is largely sparing the 60-plus demographic, instead hitting children and young adults the hardest. While it has spread like wildfire through secondary schools and colleges, and claimed more than 2,800 lives world-wide, few older people have even gotten sick.
That's because many people 60 and older were exposed to H1N1 viruses that circulated between 1918 and 1957. Those earlier viruses were similar to the new H1N1 virus, so the immunity that some people built up then is helping them now.
A study by scientists at the Centers for Disease Control and Prevention found that about one-third of adults age 60 and older had antibodies that protected them against the new H1N1 virus. By contrast, children had none.
The pattern is similar to one seen in the deadly 1918 pandemic, in which death rates were highest among young adults, according to infectious-disease experts. One possible reason is that older adults had been exposed to similar flu viruses in the 1800s.
Be Patient
With the risk of infection lower for older adults, federal health officials are allotting the swine-flue vaccine first to pregnant women, children and young adults, and anyone under 65 with asthma, diabetes or another medical condition that can increase their risk of complications from the flu. The CDC says older adults should be offered the vaccine only when there's enough medicine for all the other priority groups.
That's likely to take a few months. The federal government expects to receive and distribute 195 million doses of swine-flu vaccine by year-end. Officials estimate that 159 million people make up the top-priority groups—not including older adults—though not everyone in those groups is likely to opt for a shot. The new vaccine is free, and many insurance companies have said they will cover administration fees for the shot.
Budgie Amparo, senior vice president of quality and risk management for Emeritus Corp., which operates senior-living facilities, including the facility where Mr. Johnson lives, says it's working on getting swine-flu vaccine for its residents as quickly as it can through its regular supplier of seasonal-flu shots. "We've taken some proactive steps," Mr. Amparo says. "We were reassured that once it's available, we're going to get it."
Extra Precautions
In the meantime, nurses at Emeritus properties plan to spend more time educating residents about ways to protect themselves from the flu, such as washing their hands, Mr. Amparo says. They will also more actively monitor residents' health, to reduce their chances of complications should they get the flu. "We want to make sure we're managing their overall medical condition," helping residents get medications in a timely fashion, or helping those with respiratory conditions such as asthma see doctors quickly, he says.
One reason for the extra precautions: While older adults account for the fewest U.S. cases of swine flu, the proportion of those who have died is higher than for other age groups, according to CDC data. "Once you do get infected, your risk is higher," says Charlotte Yeh, chief medical officer for AARP Services Inc., part of the Washington-based advocacy group. Many older Americans have chronic conditions that affect their immune status, making it harder to fight off any flu, she says.
Moreover, the seasonal-flu vaccine may not offer full protection this year against a long-circulating virus that traditionally is linked with more hospitalizations and deaths among older adults than other strains. A new variant of the H3N2 seasonal flu virus has been identified on several continents that differs from the H3N2 strain covered by this year's vaccine. So far it's in the minority of H3N2 circulating viruses, and it's unclear how widely it will circulate in the U.S. this flu season, particularly given the current dominance of the swine-flu virus. But officials at the CDC and the World Health Organization say they're keeping a close eye on it.
Doctors can't quickly determine what strain of flu a patient has. "If you come in with all the signs of flu, we can't tell you which flu you have," Dr. Yeh says. "The critical thing is that if you have fever, aches, congestion, cough, dizziness, that is something you should talk with your doctor about." A doctor may prescribe an antiviral such as Tamiflu, which can't cure the flu but can shorten its duration and severity if started early.
Read Why Older Americans Will Have to Wait for Swine-Flu Shots for more information.
By Betsy McKay is deputy chief of The Wall Street Journal's Atlanta bureau.
Wednesday, January 6, 2010
Irrevocable Trusts and the Reverse Mortgage Opportunity
Irrevocable trusts can now be used for reverse mortgages, according to Paul N. Lovegrove Esq., President of Attorney Trust Review.
While traditionally reverse mortgages have not been permissible if the home is in an irrevocable trust, Lovegrove says there is no basis for the policy, adding that there is, “Nothing in the HECM guidelines that says you can’t use an irrevocable trust.”
Although lenders cant sell a reverse mortgage with an irrevocable trust to Fannie Mae, the recent growth of Ginnie Mae’s HMBS program has provided an opportunity for HECMs.
Lovegrove, an attorney who has been closing reverse loans for thirteen years and performs trust reviews for many lenders, including MetLife, proposes drawing up an agreement to the irrevocable trust that is agreed upon by all parties as a way to comply with the guideline.
An irrevocable trust may also not qualify for a reverse mortgage if one of the current beneficiaries does not meet HECM guidelines, amongst other things. All current beneficiaries of a trust must be HECM eligible for a HECM to be done on the home.
In addition, irrevocable trusts can pose a problem when the trust does not allow invasion of the principle by the settler. However, a lump sum distribution deposited into a bank account controlled by the estate can help solve this issue.
Lovegrove thinks that banks are not doing reverse mortgages on irrevocable trusts because they “never thought they could.” But Lovegrove adds, “By saying we can’t do it that’s closing out a lot of potential business that’s out there.”
By Reva Minkoff, Reverse Mortgage Daily, January 06, 2010
While traditionally reverse mortgages have not been permissible if the home is in an irrevocable trust, Lovegrove says there is no basis for the policy, adding that there is, “Nothing in the HECM guidelines that says you can’t use an irrevocable trust.”
Although lenders cant sell a reverse mortgage with an irrevocable trust to Fannie Mae, the recent growth of Ginnie Mae’s HMBS program has provided an opportunity for HECMs.
Lovegrove, an attorney who has been closing reverse loans for thirteen years and performs trust reviews for many lenders, including MetLife, proposes drawing up an agreement to the irrevocable trust that is agreed upon by all parties as a way to comply with the guideline.
An irrevocable trust may also not qualify for a reverse mortgage if one of the current beneficiaries does not meet HECM guidelines, amongst other things. All current beneficiaries of a trust must be HECM eligible for a HECM to be done on the home.
In addition, irrevocable trusts can pose a problem when the trust does not allow invasion of the principle by the settler. However, a lump sum distribution deposited into a bank account controlled by the estate can help solve this issue.
Lovegrove thinks that banks are not doing reverse mortgages on irrevocable trusts because they “never thought they could.” But Lovegrove adds, “By saying we can’t do it that’s closing out a lot of potential business that’s out there.”
By Reva Minkoff, Reverse Mortgage Daily, January 06, 2010
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