Medicine & Health

With the graying of America, millions of people across the nation are facing the same tough question: when do older people become unsafe drivers? In one of the first studies to track driving performance in older adults, researchers at Washington University in St. Louis found that over time, driving abilities predictably worsen in individuals with early Alzheimer’s disease and, to a lesser extent, in older adults without dementia. People with mild dementia had the fastest rate of decline, but there also were declines in nondemented study participants. The researchers also found that increased age alone appeared to be a risk factor in driving performance. Because Alzheimer’s disease is progressive and driving performance inevitably does worsen, the challenge is to figure out how to predict and evaluate dangerous declines in driving performance. The researchers suggest that testing individuals with mild dementia every six months might be a useful way to keep unsafe drivers off the roads.

In some people smoking rewires the brain, producing a powerful addiction that may never be entirely cured, experts say. An estimated 35 million smokers try to kick the habit each year, but only about 7 percent succeed in remaining smoke-free for more than a year. Most relapse within a few days of quitting and require multiple attempts before they can give up cigarettes. “The people who could quit, quit. Now we’re left with a group of really committed smokers,” explains WUSTL geneticist Laura Bierut in a recent St. Louis Post-Dispatch news article.

Little is understood about how depression makes people feel sad, but neuroscientists do know that the brain chemical serotonin is involved. School of Medicine researchers studied 46 people with active depression and compared positron emission tomography (PET) scans of their brains to scans from 29 people who were not depressed. The team was measuring levels of a particular type of serotonin receptor called the 5-HT2A receptor.

Human nuclear cataract (as seen through a slit lamp)Ophthalmology researchers at Washington University School of Medicine in St. Louis have identified a key risk factor for the development of cataracts. For the first time, they have demonstrated an association between loss of gel in the eye’s vitreous body — the gel that lies between the back of the lens and the retina — and the formation of nuclear cataracts, the most common type of age-related cataracts.

WUSTL professors David N. Harris and John C. Morris were among experts commenting in a recent St. Louis Post-Dispatch story on public health implications of the discovery of mad cow disease at a Washington state dairy farm. Harris, who conducts research on prion brain proteins associated with the disease, said that no one yet knows what the protein’s regular function is. Morris, a neurology specialist, said that Great Britain’s experience with the disease suggests that most people who were exposed to tainted meat did not get sick. “It’s undeniable that there is this link (with BSE), and it’s such a scary illness that it overshadows the fact that the individual risk is quite small,” Morris said.

Photo courtesy of National Eye Institute, National Institutes of HealthVisual perception changes as eyes age.Graphic design can be a matter of life and death. Literally. According to the Journal of the American Medical Association, more than 40 percent of Americans aged 65 and over use five or more different medications each week, making unintended drug interactions a major contributor to an estimated annual 180,000 fatal or life-threatening adverse drug reactions. Yet drug labeling is a kind of typographical Wild West, says Ken Botnick, professor of visual communications in the School of Art at Washington University in St. Louis. “Drug companies are required to divulge certain types of information but there are no requirements in terms of how accessible that information is made,” Botnick explains. “Typically, decisions about the way information is organized — the hierarchy of presentation, the size and clarity of type — are simply afterthoughts.” Medical information design is just one of the issues to be explored as part of “Visual Design for an Aging Population,” a national symposium Botnick is organizing in March 2004.

Photo by David Kilper/WUSTL PhotoWendy F. Auslander, Ph.D. (left), works with St. Louis-area peer counselors in the “Eat Well, Live Well” program she pioneered with colleagues at the School of Medicine.As the cases of type 2 diabetes in African-American women increase at an epidemic rate, researchers are examining risk factors involved with this disease in order to create programs that will hopefully slow this growing problem. According to a recent study at the George Warren Brown (GWB) School of Social Work at Washington University in St. Louis, African-American women at risk for type 2 diabetes experience long periods of depression due, in part, to a lack of economic and social resources. “At the beginning of our study, 40 percent of our sample of African-American women at risk for type 2 diabetes reported clinically significant depression,” says Wendy Auslander, Ph.D., professor at GWB and co-author of the study. “Unlike their nondepressed peers, these women reported fewer economic assets and greater economic distress. Issues such as unemployment, low self-esteem and a low appraisal of their economic situation contributed to their depression.”

Chest x-ray of a lung affected by pneumoniaMany medical advances involve complicated new technologies or procedures. But Linda Mundy, M.D., associate professor of medicine and an infectious diseases specialist at Washington University School of Medicine in St. Louis, recently reported good results with a new pneumonia treatment that can be summed up in a single sentence: Get patients up out of bed earlier and more often, and they check out of the hospital an average of one day sooner. Mundy says the high volume of U.S. pneumonia hospitalizations could make the new treatment a potent cost-saver, but added that a second study of the approach, known as early mobilization, is needed to confirm the beneficial effects.

Image courtesy of William C. Chapman, M.D.William Chapman monitors his surgical instrument’s position on corresponding CT scans during liver surgery.Despite being the largest vital organ in the body, the liver has very few identifiable landmarks to help guide a cancer surgeon around its surface. Two-dimensional ultrasound images currently are the standard navigational tool, making it difficult to discern depth and location in the liver during surgery to remove tumors. That’s why a research team led by William C. Chapman, M.D., professor of surgery and chief of the Abdominal Transplantation Section at Washington University School of Medicine in St. Louis plans to launch trials examining the use of three-dimensional imaging techniques to complement ultrasound during liver surgery. The research team will investigate standard three-dimensional imaging techniques like MRI, CT scanning and PET for guiding surgeons during tumor removal surgery.

The mind and the body are intimately linked, but although more and more research is demonstrating that the mind plays a role in sickness and in health, little is understood about how a person’s mental health affects physical health. A Washington University team of investigators led by Ray E. Clouse, M.D, professor of medicine and psychiatry, and Patrick J. Lustman, Ph.D., professor of psychiatry, hopes to change that by launching a new Center for Mind/Body Research that will focus specifically on ways that mental health affects heart disease, diabetes, cancer and other illnesses. New research has shown, for example, that although women are at a lower risk for heart attacks than men, the risk for women with diabetes and depression is virtually identical to what’s seen in men. The investigators believe that depression is the main cause of that increased risk, but they hope that by focusing more closely on mind/body interactions they will be able to understand more about the relationship between mental health and physical well being.