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Three-Test Combo Helps Predict Risk of Alzheimer’s Disease

By MedImaging International staff writers
Posted on 09 Nov 2011

With age, forgetfulness and other signs of memory loss sometimes appear, motivating older individuals to seek a medical evaluation amid worries that they may be experiencing early symptoms of Alzheimer’s disease (AD), the most common type of dementia among individuals in the United States aged 65 and older.

However, even when early memory problems suggest the potential for impending AD, the actual risk is variable. More...

Some patients are at high risk while others are not. The challenge for doctors has long been to differentiate that risk so they can determine the appropriate course of management.

In an article to be published in the October 25, 2011, issue of the journal Neurology, a team of physicians and scientists from the University of California (UC), San Diego School of Medicine (USA) and other institutions worldwide described using a combination of widely available medical tests to generate a much improved predictive picture of the likelihood of impending AD in patients with mild cognitive impairment (MCI) an intermediate stage between the expected cognitive decline of normal aging and the more marked decline of dementia.

“I’m extremely excited about these results,” said neurologist James Brewer, MD, PhD, an associate professor of radiology and neurosciences and part of the Alzheimer’s Disease Neuroimaging Initiative research team at UC San Diego. “The good news is that we can partially reassure those folks who are negative on these tests, at least regarding their next three years. We have never been able to do that before. These individuals, despite having a real memory problem, have no greater risk of near-term dementia than a similarly aged healthy person without a memory complaint.”

To determine the probability of developing AD, the UC San Diego researchers compared risk factors based on magnetic resonance imaging (MRI), cerebrospinal fluid (CSF), and neuropsychologic testing. Unlike other efforts that have evaluated the predictive capabilities of research-based biomarkers, MRI, CSF and neuropsychologic tests are all technologies widely available to clinicians.

The researchers discovered that these available biomarkers considerably improved accuracy in predicting near-term conversion to dementia. In combination, their prediction rate was almost perfect: None of the individuals who tested negative on all three measures went on to develop AD in the three-year follow-up. By comparison, almost 90% of individuals who tested positive on all three measures were demented at the end of three years.

The presence of medial temporal atrophy, determined by automated analysis of MRI using a US Food and Drug Administration (FDA)-approved software package, was associated with the likeliest chance of near-term dementia, with a median dementia-free survival time of only 15 months.

Dr. Brewer reported that the findings forecast a paradigm shift in the diagnosis of AD. “Instead of saying, ‘Let’s wait a year and see if this gets worse,’ our neurologists can say, ‘Let’s get a volumetric MRI and check back in a month to see if your complaint is due to neurodegeneration.’ That ability makes a huge difference in how we proceed. Maybe the memory complaint isn’t due to neurodegeneration, but rather it’s a side effect of a medication, a sign of depression or someone is simply anxious and worried. Being able to reassure at least some patients that they are not at significant near-term risk of AD is something we never could do in the past, given the high prevalence of the disease.”

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University of California, San Diego School of Medicine

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58 (459.90943908691): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294737958 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

59 (!!!!! 1425.9815216064): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

60 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

61 (112.05673217773): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

62 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

63 (119.20928955078): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

64 (604.86793518066): SELECT fid FROM jos_deeppockets WHERE id=294737958 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294737958 AND published='1' LIMIT 1

65 (440.12069702148): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=216 ORDER BY `ordering`

66 (69.856643676758): select jos_twitters.link from jos_twitters where cat=10

67 (50.067901611328): select jos_facebook.link from jos_facebook where cat=10

68 (41.961669921875): select jos_google_plus.link from jos_google_plus where cat=10

69 (38.862228393555): select jos_linkedin.link from jos_linkedin where cat=10

70 (58.174133300781): SELECT fid FROM jos_deeppockets WHERE id=294737958 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294737958 AND published='1' LIMIT 1

71 (37.908554077148): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=216 ORDER BY `ordering`

72 (283.00285339355): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737958 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (233.88862609863): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737958 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (38.14697265625): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

75 (74.863433837891): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (58.174133300781): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (57.93571472168): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737958 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (30.994415283203): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737958 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (33.855438232422): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

92 (54.836273193359): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (57.93571472168): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (78.201293945312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

107 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

108 (52.928924560547): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294737958 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (46.968460083008): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294737958 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (80.82389831543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

111 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

112 (52.928924560547): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294737958 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (700.95062255859): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294737958 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (!!!!! 1247.1675872803): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

115 (458.0020904541): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

116 (129.93812561035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

117 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

118 (199.0795135498): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

119 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

120 (207.90100097656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

121 (118.01719665527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

122 (180.00602722168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

123 (539.06440734863): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

124 (298.02322387695): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 67866.086959839): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

126 (756.97898864746): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737958 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737958 AND type='deeppockets_item' AND published='1' LIMIT 1

127 (!!!!! 17235.040664673): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

128 (113.01040649414): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

129 (89.168548583984): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

130 (45.061111450195): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

131 (83.92333984375): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

132 (46.014785766602): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

133 (558.13789367676): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

134 (64.13459777832): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

135 (39.100646972656): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

136 (41.007995605469): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

137 (442.9817199707): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (404.11949157715): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (199.0795135498): SELECT name FROM jos_deeppockets WHERE id=216

140 (51.021575927734): SELECT name FROM jos_deeppockets WHERE id=216

141 (754.83322143555): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))216((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (730.99136352539): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))216((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

144 (49.829483032227): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

145 (!!!!! 7444.1432952881): TRUNCATE TABLE jos_trademed_module

146 (!!!!! 2916.0976409912): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294737958 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (134.94491577148): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294737958 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (404.83474731445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (182.15179443359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

151 (48.87580871582): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

152 (!!!!! 1581.9072723389): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

153 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

154 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

155 (41.961669921875): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294737958 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294737958 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (32.901763916016): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=216 or channel_id is null)

157 (36.001205444336): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=216 or channel_id is null)

158 (31.948089599609): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (139.95170593262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

160 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294737958 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294737958 AND published='1' LIMIT 1

161 (!!!!! 3870.0103759766): select jos_twitters.link from jos_twitters where cat=10

162 (103.95050048828): select jos_facebook.link from jos_facebook where cat=10

163 (54.836273193359): select jos_google_plus.link from jos_google_plus where cat=10

164 (44.107437133789): select jos_linkedin.link from jos_linkedin where cat=10

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