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17 January 2006 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians. These highlights are not intended to substitute for articles as sources of information. For an embargoed copy of an article, call 1-800-523-1546, ext. 2656, or 215-351-2656.

Exercise Reduces Risk for Dementia by 30% to 40%, New Study Finds

A large prospective study -- the most definitive yet of the relationship between exercise and dementia -- found that older adults who exercised at least three times per week were less likely to develop dementia than those who were less active (Article, p. 73). The study participants were 65 or older with normal mental function and were followed for six years. Of the 1,740 subjects, 158 developed dementia, and, of these, 107 were diagnosed with Alzheimer's disease. Statistically, the rate of dementia was 13.0 per 1,000 person-years for people who exercised three or more times per week, compared with 19.7 per 1,000 person-years for those who exercised fewer than three times per week. An editorial writer says that this study is the "first to report an interaction between the level of physical function and physical activity and dementia risk" (Editorial, p. 135). Future research should try to determine whether this association is causal or whether physical activity is a proxy for "life engagement," or other lifestyle or sociodemographic characteristics. Also needed is research to determine the "type, frequency, intensity or duration of physical activity that is most beneficial in preventing cognitive deterioration."

Notes to Editors: The entire article is available to the public on Jan. 17, 2006. The editorial is also available. The article is the subject of a video news release. Call for coordinates. A study participant may be available for interview.

Help 'Problem Doctors' by National Effort to Improve Hospital Systems

"At least one third of all physicians will experience a condition that impairs their ability to practice medicine safely," say authors of an article in the "Improving Patient Care" series in Annals of Internal Medicine (Improving Patient Care, p. 107). Hospitals, where a credentialing process is already in place, are the place to implement a nationwide system to monitor physician performance based on validated clinical and behavioral measures. The authors outline such a national system, but say that hospitals must be supported by "those that already bear a fiduciary responsibility for ensuring safe, competent care": the state medical boards, medical specialty boards, and the Joint Commission on Accreditation of Healthcare Organizations.

Wealth Disparities Not the Cause of Disparate Death Rates from MI

Although some studies have found that wealthier patients have lower death rates after myocardial infarctions than poorer patients, a new study finds that income status was not a determining factor for the death rates after heart attacks when data were adjusted for factors such as age, sex, ethnicity, social support, cardiovascular history and risk, and other health conditions (Article, p. 82). The most important risk factors for heart attacks were age and heath status before the heart attack. This study looked at 3,407 patients hospitalized for acute myocardial infarction between 1999 and 2003 in a universal health system in which medical services were available regardless of income. (Also, Editorial, p. 137.)

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