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Early Imaging, Diagnosis of Alzheimer’s Leads to Better Outcomes for Patients in Early Stages of the Disease

By MedImaging International staff writers
Posted on 02 Oct 2013

Patients has present with early symptoms of Alzheimer’s disease (AD) who were diagnosed sooner using a brain imaging modality received Alzheimer-specific drugs earlier than those who did not have the brain imaging findings available. These patients also had substantially better clinical outcomes during the following years they were clinically tracked.

The study, called Metabolic Cerebral Imaging in Incipient Dementia, is an ongoing US national clinical trial sponsored by the US Centers for Medicare and Medicaid Services (CMS; Washington DC, USA). These interim data revealed that patients whose physicians gathered data from a brain positron emission tomography (PET) imaging scan performed with the tracer fluorodeoxyglucose (FDG) did better over two years than those whose doctors were randomized to not have access to the scan information.

Study lead investigator Dr. Daniel Silverman, a University of California, Los Angeles (UCLA; USA) professor of molecular and medical pharmacology, said, “During the subsequent two years after their PET scans, these patients had superior executive function, better memory abilities and greater preservation of overall cognitive function, providing the first direct evidence that patients whose early Alzheimer’s disease is revealed by FDG-PET will do better than patients with the same condition, but with their brain metabolism pattern remaining unknown to their doctors and themselves.”

The findings from the study were presented September 26, 2013, at the Medical Biotech Forum, held in Shenzhen (China). US Medicare currently does not reimburse for PET scans for patients showing signs of persistent cognitive decline, but who do not yet have dementia, according to Dr. Silverman. By the time Medicare covers an FDG-PET scan, for which they reimburse roughly USD 1,200 per patient, a lot of impairment, some of it irreversible, has already been done to the brain tissue.

Medicare currently is reexamining reimbursement policies for PET scans obtained in dementia cases, specifically with respect to amyloid imaging. A US healthcare coverage decision is expected October 1, 2013, according to Dr. Silverman. Prior to the findings of the study being presented, there was no thoroughly controlled scientific data available that evaluated the long-term clinical advantages associated with obtaining a PET scan, or any other kind of neuroimaging, in the assessment of cognitively declining patients.

According to the investigators, this multicenter, prospective, randomized and blinded study demonstrates significant clinical benefit, which may also cost less healthcare dollars. “Patients who don’t have Alzheimer’s disease may be prescribed drugs that won’t help them, or even make them worse,” Dr. Silverman said.

An undiagnosed AD patient, furthermore, will not get drugs that the study is showing will help them maintain their cognitive abilities when administered earlier. This may lead to the need for nursing home care six to nine months earlier than for those with the same AD brain pattern, but who are diagnosed and treated sooner as a result of the early availability of the PET scan data. “With nursing home care costing an average of about USD 7,000 a month, there is the potential for CMS and American taxpayers to save several billion dollars per year,” Dr. Silverman said.

These interim findings included 63 patients who underwent FDG-PET and neuropsychologic testing at baseline. The doctors in the arm of the study who were able to view the PET scan immediately treated their patients differently than the physicians in the other arm, who did not get scan results until the end of the two-year study. Approximately 40% of the patients whose clinicians were informed of the presence of the AD brain metabolism pattern were given drugs specifically indicated for dementia within the first six months of the study.

Of the patients whose brain PET scans showed the Alzheimer metabolism patterns randomized to a two-year delay of release of their scan results, none were prescribed Alzheimer drugs in the first six months, and only 12% were prescribed those medications by the end of the first year, according to Dr. Silverman. “[…] This study provides the first direct evidence for improved cognitive outcomes attributable to a neuroimaging test of any kind.”

Related Links:
US Centers for Medicare and Medicaid Services
University of California, Los Angeles

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60 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

61 (141.14379882812): 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

62 (663.99574279785): SELECT fid FROM jos_deeppockets WHERE id=294748489 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294748489 AND published='1' LIMIT 1

63 (63.896179199219): 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=213 ORDER BY `ordering`

64 (61.03515625): select jos_twitters.link from jos_twitters where cat=10

65 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

66 (40.054321289062): select jos_google_plus.link from jos_google_plus where cat=10

67 (37.908554077148): select jos_linkedin.link from jos_linkedin where cat=10

68 (73.909759521484): SELECT fid FROM jos_deeppockets WHERE id=294748489 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294748489 AND published='1' LIMIT 1

69 (51.975250244141): 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=213 ORDER BY `ordering`

70 (638.96179199219): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (305.17578125): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (71.048736572266): 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`

73 (86.069107055664): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (44.822692871094): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (66.995620727539): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (31.948089599609): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (36.001205444336): 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`

90 (87.02278137207): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (44.822692871094): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (117.06352233887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

105 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

106 (96.797943115234): 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=294748489 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (69.856643676758): 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=294748489 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (124.21607971191): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

109 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

110 (70.095062255859): 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=294748489 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (824.92828369141): 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=294748489 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (751.01852416992): 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

113 (807.04689025879): 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

114 (564.0983581543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

115 (178.09867858887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

116 (120.87821960449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

117 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

118 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

119 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

120 (!!!!! 3165.0066375732): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

121 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

122 (359.05838012695): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 53694.9634552): 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

124 (569.10514831543): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748489 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748489 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 28642.177581787): ( 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

126 (79.870223999023): ( 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

127 (78.916549682617): 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

128 (50.067901611328): 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

129 (122.0703125): 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

130 (64.13459777832): 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

131 (454.90264892578): 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

132 (46.014785766602): 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

133 (74.863433837891): 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

134 (53.167343139648): 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

135 (!!!!! 2192.0204162598): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (558.13789367676): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (82.969665527344): SELECT name FROM jos_deeppockets WHERE id=213

138 (46.014785766602): SELECT name FROM jos_deeppockets WHERE id=213

139 (789.16549682617): 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 '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (648.02169799805): 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 '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 2331.9721221924): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

142 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

143 (!!!!! 14357.089996338): TRUNCATE TABLE jos_trademed_module

144 (215.05355834961): 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=294748489 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (823.02093505859): 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=294748489 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 4311.0847473145): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (152.8263092041): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (108.95729064941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

149 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

150 (!!!!! 1807.9280853271): 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

151 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

152 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

153 (50.067901611328): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294748489 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294748489 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (41.961669921875): 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=213 or channel_id is null)

155 (38.862228393555): 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=213 or channel_id is null)

156 (66.995620727539): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 1054.048538208): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

158 (158.07151794434): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294748489 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294748489 AND published='1' LIMIT 1

159 (82.969665527344): select jos_twitters.link from jos_twitters where cat=10

160 (!!!!! 5659.1033935547): select jos_facebook.link from jos_facebook where cat=10

161 (154.97207641602): select jos_google_plus.link from jos_google_plus where cat=10

162 (58.174133300781): select jos_linkedin.link from jos_linkedin where cat=10

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