Researchers at New York Presbyterian Hospital have defined two distinct patterns of memory loss in the elderly that could help lead to a new test for Alzheimer's disease.

Reporting earlier this month at the annual meeting of the American Academy of Neurology, the scientific team reported that a noninvasive modification of magnetic resonance imaging can be used to analyze changes in the hippocampus of the brain during memory tests.

"The hippocampus is the first brain structure to be targeted by Alzheimer's disease," said Scott A. Small, clinical assistant neurologist at New York Presbyterian Hospital and author of the study. Detection of changes in this area of the brain could provide early diagnosis of Alzheimer's disease.

The test is called functional MRI (fMRI). Other tests, such as positron emission tomography (PET) scans can also snap functional images of the brain, but none have been able to selectively assess specific regions of the hippocampus.

By using fMRI on 21 people over 65 years of age, Small and his colleagues have identified two distinct patterns of age-related memory decline in otherwise healthy seniors without any signs of dementia.

People who showed changes in an area of the hippocampus called the entorhinal region are believed to exhibit early signs of Alzheimer's disease, Small said, while those with dysfunction in other parts of the hippocampus are thought to be free of Alzheimer's.

Results of the study suggest that fMRI could play a role one day as a screening tool for Alzheimer's disease, which would lead to earlier intervention. It could also provide "reassurance for patients with non-Alzheimer's disease-related pattern that their memory decline is not associated with that disease," Small said.

--Sally Squires



Despite the country's aging population, the proportion of elderly Americans living in nursing homes has declined over the past decade, according to a report based on national health surveys.

While a falling prevalence of disability is one possible factor, the report said, the shift to home-delivered care and assisted living "were likely more important in filling the gap left by declining nursing home use." Assisted living offers independent housing for older people, with access to care for disabilities.

The latest statistics reflect "a change in the role of the nursing home," the report concluded. Nursing homes increasingly focus on patients with severe disabilities and on "a group of patients barely in evidence" in 1985: people receiving temporary, Medicare-covered care following surgery or illness.

The study, reported in the current edition of Health Affairs, is based on the National Nursing Home Survey conducted periodically by the National Center for Health Statistics. The latest data, from 1995, are compared against data from 10 years earlier.

The comparison shows "some unexpected shifts in the way elders are using the nursing home," Brandeis University researcher Christine E. Bishop reported.

The proportion of Americans 65 and older who were staying in a nursing home on a given day fell from 4.6 percent in 1985 to 4.2 percent a decade later, with the decline most striking in the so-called "oldest old," those over 85. If the 1985 rate for those over 65 had held up for the next decade, about a quarter-million more elderly people would have been in nursing homes in 1995 than the 1.4 million who actually were in these facilities, Bishop estimated.

Those data also show that elderly African Americans have a higher rate of nursing home use than white Americans, reversing past disparities.

Medicare home health use "grew phenomenally" after the eligibility criteria were broadened in 1989, Bishop noted. By 1995, about 10 percent of all Medicare beneficiaries used home health care--double the rate a decade earlier.

And families pitched in. "It is important," Bishop noted, "to remember the crisis that has not happened: Despite unfavorable demographic trends, informal, unpaid support continues to sustain care for older persons living at home."

--Don Colburn



Have the salad, but hold the sprouts.

The Food and Drug Administration issued a new warning earlier this month advising the elderly, children and those with weakened immune systems to avoid eating raw sprouts because of the risk of food-borne illness.

Since 1995, raw sprouts have been linked to salmonella and E. coli 0157 outbreaks, according to the FDA. Alfalfa and clover sprouts have been most commonly associated with outbreaks of food-borne illnesses, but all raw sprouts pose a risk, according to the agency.

Although these food-borne infections can cause serious illness, most healthy adults eventually recover. But the diseases take an especially hard toll on the elderly, children and those with compromised immune systems, such as people undergoing cancer treatment, organ transplant recipients or others with serious chronic illnesses.

Efforts by the sprout industry to improve seed treatment strategies, manufacturing processes and sanitation have not stopped the outbreaks, the FDA reported. In two outbreaks this year, a total of 100 people in California and Colorado became ill with salmonella after eating clover sprouts, according to the FDA. A third outbreak sickened 85 people in Oregon, Washington and California who ate alfalfa sprouts.

"Despite all these efforts to make raw sprouts safer, we continue to receive reports of illnesses associated with raw sprouts," said FDA Commissioner Jane E. Henney. "Consumers need to understand that, at this time, the best way to control this risk is not to eat raw sprouts."

Even home-grown sprouts can present a risk, according to the FDA, which advised that if bacteria are present in or on the seed, they can grow to high levels during sprouting even under clean conditions.

The FDA last issued a health advisory warning about consumption of raw sprouts on August 31, 1998.

--Sally Squires