Age-related Smelling Loss Significantly Worse in African-Americans: Study

The study, published early online in the Journal of Gerontology: Medical Sciences, found that as they aged, African-Americans and Hispanics had comparable deficits. For Hispanics, many of whom are recent immigrants, social and cultural factors, such as disparities in education and household assets and health-related cognitive problems, accounted for the sensory loss. For African-Americans, however, premature presbyosmia?age-related declines in the ability to smell?could not be explained by social, environmental or medical factors.

"We have long known that men begin to lose their sense of smell some years sooner than women, but this is the first study to point to racial or ethnic differences," said study author Jayant Pinto, MD, associate professor of surgery at the University of Chicago. "What surprised us was the magnitude of the difference. The racial disparity was almost twice as large as the well-documented difference between men and women."

Although many people live long lives with only minor age-related declines in the ability to smell, about 24 percent of Americans 55 years or older have a measurable problem with their sense of smell, according to data from the National Institute on Aging. That rises to about 30 percent for those ages 70 to 80, and to more than 60 percent for those over age 80.

This study was one component of the University of Chicago-based National Social Life, Health and Aging Project (NSHAP), the first in-home study of social relationships and health in a large, nationally representative sample of older adults, ages 57 to 85.

For this project, conducted from 2005 to 2006, survey teams from the National Opinion Research Center used a standard, well-validated test to assess the ability of 3,005 older participants to identify five common odors. The scents were presented one at a time. Subjects were asked to identify each smell from a set of four choices. The odors, in order of increasing difficulty, included peppermint, fish, orange, rose and leather.

Personal information about race and ethnicity was provided by the study subjects. The surveyors also assessed their physical and mental health, social and financial resources, education, and alcohol or substance abuse through questionnaires and careful observation.

The researchers found that: Only half (49 percent) of those tested correctly identified five out of five odors; 78 percent got four or more right, 92 percent got at least three and 97 percent got two or more correct. Performance declined steadily across the age groups; 64 percent of those age 57 identified all five, but that fell to 25 percent of those age 85. Non-white subjects had consistently poorer performance, scoring 47 percent lower, equivalent to a nine-year increase in age. The study confirmed previous reports that women perform better at this task, equivalent to being five years younger. This study extended that finding across the age range, 57-85.

Caucasian women typically begin to experience some loss of smelling acuity in their early 70s, Pinto said. Caucasian men start about five years earlier, in their late-60s. Black and Hispanic women start in their mid-60s. Non-white men start in their late-50s or early 60s. Because the changes occur gradually over several years, many older people do not notice the decline.

The cause of this disparity is not clear. Genetic variation may play a role, as could exposure to nerve-damaging substances in the environment, or both. "Race likely serves as a proxy for differential environmental exposures and life experiences, which may interact with biological differences," the authors note.

Certain medications, chronic or recurrent nasal disease or exposure to various volatile chemicals can harm olfactory function. "Sanitation workers, for example, are often affected," Pinto said. "They are routinely exposed to noxious odors that can trigger inflammation."

Presbyosmia can have a substantial impact on wellbeing, the researchers emphasize. Those who can't detect odors are unable to maintain their personal hygiene. Food smells have a huge impact on how foods taste, so many with smelling deficits lose the joy of eating.

"They make poor food choices, get less nutrition," Pinto said. "They can't tell when foods have spoiled or detect odors that signal danger, like a gas leak or smoke."

Follow-up interviews with the original study subjects five years later confirmed earlier findings that impaired olfaction also is a harbinger of mortality. Those with the poorest sense of smell in 2006 were three times more likely to have died by 2011 than those with normal smell function.

"Olfaction is the canary in the coal mine of human health," Pinto said.

Source-Eurekalert

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People With Treatment-Resistant Depression Benefit Significantly With Ketamine

by Kathy Jones on? May 19, 2013 at 3:38 PM General Health News The largest ketamine clinical trial to-date led by researchers from the Icahn School of Medicine at Mount Sinai has revealed that patients with treatment-resistant major depression saw dramatic improvement in their illness after treatment with ketamine.
The antidepressant benefits of ketamine were seen within 24 hours, whereas traditional antidepressants can take days or weeks to demonstrate a reduction in depression.

The research will be discussed at the American Psychiatric Association meeting on Monday, May 20, 2013 at 12:30 pm in the Press Briefing Room at the Moscone Center in San Franscico.

Led by Dan Iosifescu, MD, Associate Professor of Psychiatry at Mount Sinai; Sanjay Mathew, MD, Associate Professor of Psychiatry at Baylor College of Medicine; and James Murrough, MD Assistant Professor of Psychiatry at Mount Sinai, the research team evaluated 72 people with treatment-resistant depression-meaning their depression has failed to respond to two or more medications-who were administered a single intravenous infusion of ketamine for 40 minutes or an active placebo of midazolam, another type of anesthetic without antidepressant properties. Patients were interviewed after 24 hours and again after seven days. After 24 hours, the response rate was 63.8 percent in the ketamine group compared to 28 percent in the placebo group. The response to ketamine was durable after seven days, with a 45.7 percent response in the ketamine group versus 18.2 percent in the placebo group. Both drugs were well tolerated.

"Using midazolam as an active placebo allowed us to independently assess the antidepressant benefit of ketamine, excluding any anesthetic effects," said Dr. Murrough, who is first author on the new report. "Ketamine continues to show significant promise as a new treatment option for patients with severe and refractory forms of depression."

Major depression is caused by a breakdown in communication between nerve cells in the brain, a process that is controlled by chemicals called neurotransmitters. Traditional antidepressants such as selective serotonin reuptake inhibitors (SSRIs) influence the activity of the neurotransmitters serotonin and noreprenephrine to reduce depression. In these medicines, response is often significantly delayed and up to 60 percent of people do not respond to treatment, according to the U.S Department of Health and Human Services. Ketamine works differently than traditional antidepressants in that it influences the activity of the glutamine neurotransmitter to help restore the dysfunctional communication between nerve cells in the depressed brain, and much more quickly than traditional antidepressants.

Future studies are needed to investigate the longer term safety and efficacy of a course of ketamine in refractory depression. Dr. Murrough recently published a preliminary report in the journal Biological Psychiatry on the safety and efficacy of ketamine given three times weekly for two weeks in patients with treatment-resistant depression.

"We found that ketamine was safe and well tolerated and that patients who demonstrated a rapid antidepressant effect after starting ketamine were able to maintain the response throughout the course of the study," Dr. Murrough said. "Larger placebo-controlled studies will be required to more fully determine the safety and efficacy profile of ketamine in depression."

The potential of ketamine was discovered by Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai, and Executive Vice President for Academic Affairs of The Mount Sinai Medical Center, in collaboration with John H. Krystal, MD, Chair of the Department of Psychiatry at Yale University.

"Major depression is one of the most prevalent and costly illnesses in the world, and yet currently available treatments fall far short of alleviating this burden," said Dr. Charney. "There is an urgent need for new, fast-acting therapies, and ketamine shows important potential in filling that void."

Dr. Murrough will present his research on Sunday, May 19, 2013 from 1:00 pm to 3:00 pm in the Moscone exhibit hall at the APA meeting.

About The Mount Sinai Medical Center
The Mount Sinai Medical Center encompasses both The Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai. Established in 1968, the Icahn School of Medicine at Mount Sinai is one of the leading medical schools in the United States. The Icahn School of Medicine is noted for innovation in education, biomedical research, clinical care delivery, and local and global community service. It has more than 3,400 faculty members in 32 departments and 14 research institutes, and ranks among the top 20 medical schools both in National Institutes of Health (NIH) funding and by U.S. News & World Report.

The Mount Sinai Hospital, founded in 1852, is a 1,171-bed tertiary- and quaternary-care teaching facility and one of the nation''s oldest, largest and most-respected voluntary hospitals. In 2012, U.S. News & World Report ranked The Mount Sinai Hospital 14th on its elite Honor Roll of the nation''s top hospitals based on reputation, safety, and other patient-care factors. Mount Sinai is one of just 12 integrated academic medical centers whose medical school ranks among the top 20 in NIH funding and by U.S. News & World Report and whose hospital is on the U.S. News & World Report Honor Roll. Nearly 60,000 people were treated at Mount Sinai as inpatients last year, and approximately 560,000 outpatient visits took place.

Source-Newswise

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