The New Old Age Blog: Study Links Cognitive Deficits, Hearing Loss

There’s another reason to be concerned about hearing loss — one of the most common health conditions in older adults and one of the most widely undertreated. A new study by researchers at Johns Hopkins Medicine suggests that elderly people with compromised hearing are at risk of developing cognitive deficits — problems with memory and thinking — sooner than those whose hearing is intact.

The study in JAMA Internal Medicine was led by Dr. Frank Lin, a hearing specialist and epidemiologist who over the past several years has documented the extent of hearing problems in older people and their association with falls and the onset of dementia.

The physician’s work is bringing fresh, and some would say much-needed, attention to the link between hearing difficulties and seniors’ health.

In his new report, Dr. Lin looked at 1,984 older adults who participated over many years in the Health ABC Study, a long-term study of older adults conducted in Pittsburgh and Memphis. Participants’ mean age was 77; none had evidence of cognitive impairment when the period covered by this research began. In 2001 and 2002, they received hearing tests and cognitive tests; cognitive tests alone were repeated three, five and six years later.

The tests included the Modified Mini-Mental State exam, which is administered through an interview and yields an overall picture of cognitive status, and the Digit Symbol Substitution Test, a paper-only exercise that asks people to match symbols and numbers, which can reveal deficits in someone’s working memory and executive functioning.

Dr. Lin found that annual rates of cognitive decline were 41 percent greater in older adults with hearing problems than in those without, based on results from the Modified Mini-Mental State Exam. A five-point decline on that test is considered a “clinically significant” indicator of a change in cognition.

Using this information, Dr. Lin found that elderly people with hearing problems experienced a five-point decline on the exam in 7.7 years, compared with 10.9 years for those with normal hearing.

Results from the Digit Symbol Substitution Test showed the same downward trend, though not quite as steep: older people with hearing loss recorded a yearly rate of cognitive decline 32 percent greater on it than those with intact hearing. In both cases, the results showed an association only, with no proof of causality.

Still, given the fact that nearly two-thirds of adults age 70 and older have hearing problems, it is an important finding.

For caregivers and older adults, the bottom line is “pay attention to hearing loss,” said Kathleen Pichora-Fuller, a professor of psychology at the University of Toronto who was not involved in the study.

Most people seek medical attention for hearing difficulties 10 to 20 years after they first notice a problem, she said, because “there’s a stigma about hearing loss and people really don’t want to wear a hearing aid.” That means years of struggling with the consequences of impairment, without interventions that can make a difference.

One consequence that may help explain Dr. Lin’s findings is social isolation. When people have a hard time distinguishing what someone is saying to them, as is common in older age, they often stop accepting invitations to dinners or parties, attending concerts or classes, or going to family events. Over time, this social withdrawal can become a self-fulfilling prophecy, leading to the loss of meaningful relationships and activities that keep older people feeling engaged with others.

A substantial body of research by cognitive scientists has established that seniors’ cognitive health depends on exercising both body and brain and remaining socially engaged, and “now we have this intersection of hearing research and cognitive research lining up and showing us that hearing health is part of cognitive health,” said Dr. Pichora-Fuller, who originally trained as an audiologist.

Family physicians and internists, too, often dismiss older patients’ complaints about hearing, and should pay close attention to Dr. Lin’s research, she said.

“I hope this study will be a wake-up call to clinicians that auditory tests need to be part of the battery of tests they employ to look at an older person’s health,” agreed Patricia Tun, an adjunct associate professor of psychology at Brandeis University.

Although the tests are effective and cause no known harm, a panel of experts recently failed to recommend them for older adults because of a lack of supporting evidence, as I wrote last August.

Another potential explanation for Dr. Lin’s new finding lies in a concept known as “cognitive load” that Dr. Tun has explored through her research. Basically, this assumes that “we only have a certain amount of cognitive resources, and if we spend a lot of those resources of processing sensory input coming in — in this case, sound — it’s going to be processed more slowly and understand and remembered less well,” she explained.

In other words, when your brain has to work hard to hear and identify meaningful speech from a jumble of sounds, “you’ll have less mental energy for higher cognitive processing,” Dr. Tun said.

Even seniors who hear sounds relatively well often report that words sound garbled or mumbled, she noted, indicating a deterioration in hearing mechanisms that process complex speech.

Also, as yet unidentified biological or neurological pathways may affect both speech and cognition. Or hearing loss may exacerbate frailty and other medical conditions that older people oftentimes have in ways that are as yet poorly understood, Dr. Lin’s paper notes.

A limitation to his study is its reliance, in part, on the Modified Mini-Mental State exam, which asks older adults to respond to questions posed by an interviewer, according to Barbara Weinstein, a professor and head of the audiology program at CUNY’s Graduate Center.

Her research has shown that hearing-compromised seniors may not understand questions and answer incorrectly, confounding results. Another limitation arises from the failure to test participants’ hearing over time, as happened with cognitive tests, making associations more difficult to tease out.

Dr. Lin hopes to address this through another research project that would follow older adults over time and test whether interventions such as hearing aides help prevent the onset or slow the progression of cognitive decline. In the meantime, older people and caregivers should arrange for hearing tests if they have concerns, and consider getting a hearing aid if problems are confirmed.

Getting sound to the brain is the “first and most important step” in preventing sensory deprivation that can contribute to cognitive dysfunction, said Kelly Tremblay, a professor of speech and hearing science at the University of Washington.

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The New Old Age Blog: Study Links Cognitive Deficits, Hearing Loss

There’s another reason to be concerned about hearing loss — one of the most common health conditions in older adults and one of the most widely undertreated. A new study by researchers at Johns Hopkins Medicine suggests that elderly people with compromised hearing are at risk of developing cognitive deficits — problems with memory and thinking — sooner than those whose hearing is intact.

The study in JAMA Internal Medicine was led by Dr. Frank Lin, a hearing specialist and epidemiologist who over the past several years has documented the extent of hearing problems in older people and their association with falls and the onset of dementia.

The physician’s work is bringing fresh, and some would say much-needed, attention to the link between hearing difficulties and seniors’ health.

In his new report, Dr. Lin looked at 1,984 older adults who participated over many years in the Health ABC Study, a long-term study of older adults conducted in Pittsburgh and Memphis. Participants’ mean age was 77; none had evidence of cognitive impairment when the period covered by this research began. In 2001 and 2002, they received hearing tests and cognitive tests; cognitive tests alone were repeated three, five and six years later.

The tests included the Modified Mini-Mental State exam, which is administered through an interview and yields an overall picture of cognitive status, and the Digit Symbol Substitution Test, a paper-only exercise that asks people to match symbols and numbers, which can reveal deficits in someone’s working memory and executive functioning.

Dr. Lin found that annual rates of cognitive decline were 41 percent greater in older adults with hearing problems than in those without, based on results from the Modified Mini-Mental State Exam. A five-point decline on that test is considered a “clinically significant” indicator of a change in cognition.

Using this information, Dr. Lin found that elderly people with hearing problems experienced a five-point decline on the exam in 7.7 years, compared with 10.9 years for those with normal hearing.

Results from the Digit Symbol Substitution Test showed the same downward trend, though not quite as steep: older people with hearing loss recorded a yearly rate of cognitive decline 32 percent greater on it than those with intact hearing. In both cases, the results showed an association only, with no proof of causality.

Still, given the fact that nearly two-thirds of adults age 70 and older have hearing problems, it is an important finding.

For caregivers and older adults, the bottom line is “pay attention to hearing loss,” said Kathleen Pichora-Fuller, a professor of psychology at the University of Toronto who was not involved in the study.

Most people seek medical attention for hearing difficulties 10 to 20 years after they first notice a problem, she said, because “there’s a stigma about hearing loss and people really don’t want to wear a hearing aid.” That means years of struggling with the consequences of impairment, without interventions that can make a difference.

One consequence that may help explain Dr. Lin’s findings is social isolation. When people have a hard time distinguishing what someone is saying to them, as is common in older age, they often stop accepting invitations to dinners or parties, attending concerts or classes, or going to family events. Over time, this social withdrawal can become a self-fulfilling prophecy, leading to the loss of meaningful relationships and activities that keep older people feeling engaged with others.

A substantial body of research by cognitive scientists has established that seniors’ cognitive health depends on exercising both body and brain and remaining socially engaged, and “now we have this intersection of hearing research and cognitive research lining up and showing us that hearing health is part of cognitive health,” said Dr. Pichora-Fuller, who originally trained as an audiologist.

Family physicians and internists, too, often dismiss older patients’ complaints about hearing, and should pay close attention to Dr. Lin’s research, she said.

“I hope this study will be a wake-up call to clinicians that auditory tests need to be part of the battery of tests they employ to look at an older person’s health,” agreed Patricia Tun, an adjunct associate professor of psychology at Brandeis University.

Although the tests are effective and cause no known harm, a panel of experts recently failed to recommend them for older adults because of a lack of supporting evidence, as I wrote last August.

Another potential explanation for Dr. Lin’s new finding lies in a concept known as “cognitive load” that Dr. Tun has explored through her research. Basically, this assumes that “we only have a certain amount of cognitive resources, and if we spend a lot of those resources of processing sensory input coming in — in this case, sound — it’s going to be processed more slowly and understand and remembered less well,” she explained.

In other words, when your brain has to work hard to hear and identify meaningful speech from a jumble of sounds, “you’ll have less mental energy for higher cognitive processing,” Dr. Tun said.

Even seniors who hear sounds relatively well often report that words sound garbled or mumbled, she noted, indicating a deterioration in hearing mechanisms that process complex speech.

Also, as yet unidentified biological or neurological pathways may affect both speech and cognition. Or hearing loss may exacerbate frailty and other medical conditions that older people oftentimes have in ways that are as yet poorly understood, Dr. Lin’s paper notes.

A limitation to his study is its reliance, in part, on the Modified Mini-Mental State exam, which asks older adults to respond to questions posed by an interviewer, according to Barbara Weinstein, a professor and head of the audiology program at CUNY’s Graduate Center.

Her research has shown that hearing-compromised seniors may not understand questions and answer incorrectly, confounding results. Another limitation arises from the failure to test participants’ hearing over time, as happened with cognitive tests, making associations more difficult to tease out.

Dr. Lin hopes to address this through another research project that would follow older adults over time and test whether interventions such as hearing aides help prevent the onset or slow the progression of cognitive decline. In the meantime, older people and caregivers should arrange for hearing tests if they have concerns, and consider getting a hearing aid if problems are confirmed.

Getting sound to the brain is the “first and most important step” in preventing sensory deprivation that can contribute to cognitive dysfunction, said Kelly Tremblay, a professor of speech and hearing science at the University of Washington.

Read More..

DealBook: Microsoft May Back Dell Buyout

The effort to take Dell private has gained a prominent, if unusual, backer: Microsoft.

The software giant is in talks to help finance a takeover bid for Dell that would exceed $20 billion, a person briefed on the matter said on Tuesday. Microsoft is expected to contribute up to several billion dollars.

An investment by Microsoft — if it comes to pass — could be enough to push a leveraged buyout of the struggling computer maker over the goal line. Silver Lake, the private equity firm spearheading the takeover talks, has been seeking a deep-pocketed investor to join the effort. And Microsoft, which has not yet made a commitment, has more than $66 billion in cash on hand.

Microsoft and Silver Lake, a prominent investor in technology companies, are no strangers. The private equity firm was part of a consortium that sold Skype, the online video-chatting pioneer, to Microsoft for $8.5 billion nearly two years ago. And the two companies had discussed teaming up to make an investment in Yahoo in late 2011, before Yahoo decided against selling a minority stake in itself.

A vibrant Dell is an important part of Microsoft’s plans to make Windows more relevant for the tablet era, when more and more devices come with touch screens. Dell has been one of the most visible supporters of Windows 8 in its products.

That has been crucial at a time when Microsoft’s relationships with many PC makers have grown strained because of the company’s move into making computer hardware with its Surface family of tablets.

Frank Shaw, a spokesman for Microsoft, declined to comment.

If completed, a buyout of Dell would be the largest leveraged buyout since the financial crisis, reaching levels unseen since the takeovers of Hilton Hotels and the Texas energy giant TXU. Such a deal is taking advantage of Dell’s still-low stock price and the abundance of investors willing to buy up the debt issued as part of a transaction to take the company private. And Silver Lake has been working with Dell’s founder, Michael S. Dell, who is expected to contribute his nearly 16 percent stake in the company to a takeover bid.

Yet while many aspects of the potential deal have fallen into place, including a potential price of up to around $14 a share, talks between Dell and its potential buyers may still fall apart.

Shares of Dell closed up 2.2 percent on Tuesday, at $13.12. They began rising after CNBC reported Microsoft’s potential involvement in a leveraged buyout. Microsoft shares slipped 0.4 percent, to $27.15.

Microsoft’s lending a hand to Dell could make sense at a time when the PC industry is facing some of the biggest challenges in its history. Dell is one of Microsoft’s most significant, longest-lasting partners in the PC business and among the most committed to creating machines that run Windows, the operating system that is the foundation of much of Microsoft’s profits.

But PC sales were in a slump for most of last year, as consumers diverted their spending to other types of devices like tablets and smartphones. Dell, the third-biggest maker of PCs in the world, recorded a 21 percent decline in shipments of PCs during the fourth quarter of last year from the same period in 2011, according to IDC.

In a joint interview in November, Mr. Dell and Steven A. Ballmer, Microsoft’s chief executive, exchanged friendly banter, as one would expect of two men who have been in business together for decades.

Mr. Dell said Mr. Ballmer had gone out of his way to reassure him that Microsoft’s Surface computers would not hurt Dell sales.

“We’ve never sold all the PCs in the world,” said Mr. Dell, sitting in a New York hotel room brimming with new Windows 8 computers made by his company. “As I’ve understood Steve’s plans here, if Surface helps Windows 8 succeed, that’s going to be good for Windows, good for Dell and good for our customers. We’re just fine with all that.”

Microsoft has been willing to open its purse strings in the past to help close partners. Last April, Microsoft committed to invest more than $600 million in Barnes & Noble’s electronic books subsidiary, in a deal that ensures a source of electronic books for Windows devices. Microsoft also agreed in 2011 to provide the Finnish cellphone maker Nokia billions of dollars’ worth of various forms of support, including marketing and research and development assistance, in exchange for Nokia’s adopting Microsoft’s Windows Phone operating system.

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IHT Rendezvous: A Crystal Award for Charlize Theron

DAVOS, Switzerland — The actress Charlize Theron and two documentary filmmakers received awards for their humanitarian work as the World Economic Forum opened in Davos Tuesday.

Ms. Theron, who won the best actress Oscar in 2004 for the film “Monster,” was honored Tuesday for her work fighting H.I.V. among impoverished young people in South Africa, where she was born.

Ms. Theron’s appearance was a bit of a departure for the World Economic Forum, which had dialed back the celebrity glamour after the appearance in 2006 by Brad Pitt and Angelina Jolie threatened to overshadow the rest of the annual meeting.

Ms. Theron was decidedly lowkey and humble as she accepted the Forum’s Crystal award from a stage in the Davos Congress Center.

“There is an incredible brain trust in this room,” she said, referring to the Davos participants. “I feel like I’m getting smarter just by osmosis.”

Wearing a simple blue dress and heels, Ms. Theron noted, with some understatement, that she was often in the spotlight. “I decided the best thing you can do with that spotlight is to stand in the shadow of something and shed some light,” she said.

The Charlize Theron Africa Outreach Project finances programs designed to prevent the spread of H.I.V. among young Africans, particularly in South Africa, which has 5.9 million infected people, Ms. Theron said. According to the organization’s Web site, charlizeafricaoutreach.org, the programs include mobile health services in an exceptionally impoverished region of South Africa.

The World Economic Forum also honored two other artists: Sharmeen Obaid-Chinoy, a Pakistani filmmaker; and Vik Muniz, a Brazilian artist.

Ms. Obaid-Chinoy’s film “Saving Face” chronicles the efforts of a plastic surgeon to help women disfigured by acid thrown by abusive husbands or other family members. In her acceptance remarks, Ms. Obaid-Chinoy said the film, which won an Oscar in 2012 for best short documentary, had prompted Pakistan to increase criminal penalties for such acts.

Mr. Muniz and his work was featured in “Waste Land,” a documentary about the lives of scavengers at the world’s largest garbage dump, outside Rio de Janeiro. In 2011 the film was nominated for an Academy Award.

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DealBook: Atari's U.S. Division Files for Bankruptcy, Hoping for a Sale

Nearly three decades after Atari closed the doors on its first iteration, the video game pioneer is trying another reinvention. It just had to file for bankruptcy first.

The company’s United States subsidiary, Atari Interactive, filed for Chapter 11 protection on Monday as part of an effort to cleave itself from its French parent, Atari S.A.

The move, made in the Bankruptcy Court for the Southern District of New York, is meant to pave the way for a sale of the division, including its distinctive logo and rights to the staples from the childhoods of many members of Generation X: Pong, Asteroids and Centipede, among other games. The company will continue to operate normally during the bankruptcy case.

If successful, the move will be the latest chapter for a company that introduced video games to millions by letting them thwack a crude virtual ball back and forth across a television screen.

Atari first faltered during the bursting of the video game bubble in 1983 and has made periodic efforts to remake itself since. Its latest phase is more in keeping with the times: the company now focuses on producing mobile and online games, including remakes of its top titles for iOS and Android devices.

Beginning in 2000, the company began its absorption into Infogrames, a French video game producer that in 2008 adopted the name of its prominent subsidiary. But Atari S.A., as the newly rechristened company is now known, has struggled financially. Several weeks ago, the company lost access to new money from its primary lender, BlueBay Asset Management.

Atari S.A.’s shares have tumbled nearly 49 percent over the last 12 months, closing on Monday at just 86 euro cents.

Now, Atari is seeking to sell its American operations through what is known as a 363 sale, allowing a buyer to gain control of the company’s core assets free of any liabilities.

“In light of the current situation with BlueBay, we have decided to take what we think is the best decision to protect the company and its shareholders,” Jim Wilson, Atari S.A.’s chief executive, said in a statement. “Through these ongoing procedures, and especially the auction process in the U.S., we will seek to maximize the proceeds in the best interest of the company and all of its shareholders.”

In a court filing, Atari listed having less than $50 million in assets and less than $500,000 in liabilities. It has obtained about $5.25 million in bankruptcy financing from Tenor Capital Management.

Atari Interactive's bankruptcy filing by

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The New Old Age Blog: The Brutal Truth of 'Amour'

It has been a few days since I left the movie theater in a bit of a daze, and I’m still thinking about “Amour.”

So much of this already much-honored film rings utterly true: the way a long-married Parisian couple’s daily routines, their elegant life of books and music and art, can be upended in a moment. The tender care that Georges (Jean-Louis Trintignant) provides for Anne (Emmanuelle Riva) as multiple strokes claim her body and her mind, and the inexorable way that care wears them both down. Their withdrawal into a proud dyad that seeks and accepts little help from outsiders, even family. “We’ve always coped, your mother and I,” Georges tells their daughter.

The writer and director Michael Haneke’s previous movies, which I haven’t seen, tend to be described as shocking, violent, even punitive. “Amour,” which Times critic Manohla Dargis called a masterpiece, includes one brief spasm of violence, but the movie remains restrained, not graphic. It’s brutal only because life, and death, can be brutal.

Is popular culture paying more attention to aging and caregiving? In the last couple of years, I have written about these subjects surfacing in a YouTube series (“Ruth & Erica”), in movies like “The Iron Lady,” in novels like Walter Mosley’s “The Last Days of Ptolemy Grey.”

A couple of weeks back, watching a play called “The Other Place,” starring the remarkable Laurie Metcalfe, I suddenly realized that the dynamic physician and businesswoman onstage had some sort of early-onset dementia. Dementia seems a particularly popular subject, in fact. Intrinsically dramatic, it suffuses the Mosley novel and Alice LaPlante’s “Turn of Mind,” and some of my favorite movies about aging, “Away From Her,” “Iris” and “The Savages.”

“Kings Point,” Sari Gilman’s compelling documentary about a retirement community in Florida where nobody seemed to expect to grow old, just won an Oscar nomination for best short-subject documentary and will be shown on HBO in March. And “Amour,” which won the Palme d’Or at Cannes, is up for five Academy Awards, including best picture, best director and a best actress nomination for the 85-year-old Ms. Riva. (Academy voters: Just give it to her.)

A number of these artists, Mr. Haneke included, have spoken about their own experiences with aged relatives. Perhaps, as the population ages and more people confront the consequences, the stories our culture tells itself have evolved to include more old people, more caregivers. Or maybe I just want that to be true.

“Do not go see this,” my movie-going buddy had been warned, probably because her mother has dementia and friends who had seen the film wanted to spare her. I know some people found “Amour” too slow-paced or claustrophobic — like many elderly couples’ lives, it basically takes place in four rooms — or too grim. (If you’ve seen it, tell us what you thought.)

If you’re a full-time caregiver or you’re coping with a relative with dementia, perhaps you would prefer to spend your 2 hours 7 minutes of precious time off watching something funny. Escapism has its virtues.

But I found “Amour” unflinching and provocative and beautiful.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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The New Old Age Blog: The Brutal Truth of 'Amour'

It has been a few days since I left the movie theater in a bit of a daze, and I’m still thinking about “Amour.”

So much of this already much-honored film rings utterly true: the way a long-married Parisian couple’s daily routines, their elegant life of books and music and art, can be upended in a moment. The tender care that Georges (Jean-Louis Trintignant) provides for Anne (Emmanuelle Riva) as multiple strokes claim her body and her mind, and the inexorable way that care wears them both down. Their withdrawal into a proud dyad that seeks and accepts little help from outsiders, even family. “We’ve always coped, your mother and I,” Georges tells their daughter.

The writer and director Michael Haneke’s previous movies, which I haven’t seen, tend to be described as shocking, violent, even punitive. “Amour,” which Times critic Manohla Dargis called a masterpiece, includes one brief spasm of violence, but the movie remains restrained, not graphic. It’s brutal only because life, and death, can be brutal.

Is popular culture paying more attention to aging and caregiving? In the last couple of years, I have written about these subjects surfacing in a YouTube series (“Ruth & Erica”), in movies like “The Iron Lady,” in novels like Walter Mosley’s “The Last Days of Ptolemy Grey.”

A couple of weeks back, watching a play called “The Other Place,” starring the remarkable Laurie Metcalfe, I suddenly realized that the dynamic physician and businesswoman onstage had some sort of early-onset dementia. Dementia seems a particularly popular subject, in fact. Intrinsically dramatic, it suffuses the Mosley novel and Alice LaPlante’s “Turn of Mind,” and some of my favorite movies about aging, “Away From Her,” “Iris” and “The Savages.”

“Kings Point,” Sari Gilman’s compelling documentary about a retirement community in Florida where nobody seemed to expect to grow old, just won an Oscar nomination for best short-subject documentary and will be shown on HBO in March. And “Amour,” which won the Palme d’Or at Cannes, is up for five Academy Awards, including best picture, best director and a best actress nomination for the 85-year-old Ms. Riva. (Academy voters: Just give it to her.)

A number of these artists, Mr. Haneke included, have spoken about their own experiences with aged relatives. Perhaps, as the population ages and more people confront the consequences, the stories our culture tells itself have evolved to include more old people, more caregivers. Or maybe I just want that to be true.

“Do not go see this,” my movie-going buddy had been warned, probably because her mother has dementia and friends who had seen the film wanted to spare her. I know some people found “Amour” too slow-paced or claustrophobic — like many elderly couples’ lives, it basically takes place in four rooms — or too grim. (If you’ve seen it, tell us what you thought.)

If you’re a full-time caregiver or you’re coping with a relative with dementia, perhaps you would prefer to spend your 2 hours 7 minutes of precious time off watching something funny. Escapism has its virtues.

But I found “Amour” unflinching and provocative and beautiful.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..

Media Decoder: Pew Survey Finds Reliance on Libraries for Computers and Internet

Free access to computers and the Internet is now nearly as important to library patrons as borrowing books, according to a new survey.

The survey, released Tuesday by the Pew Research Center’s Internet & American Life Project, found that 80 percent of Americans said book borrowing was a “very important” library service, but 77 percent said the same thing about computers and the Internet.

The study also found that library patrons were open to having even more technological options.

“In the past generation, public libraries have reinvented themselves to become technology hubs in order to help their communities access information in all its new forms,” Kathryn Zickuhr, a research analyst with Pew and a co-author of a report on the survey’s findings, said in a written statement.

Pew questioned 2,252 Americans ages 16 and older via cellphones and landlines from Oct. 15 to Nov. 10 last year, in both English and Spanish. More than half of those surveyed said that they wanted more e-book selections in their public libraries, and would be likely to check out e-readers already loaded with books — a significant increase from a survey a year ago.

Roughly 69 percent said they would like to be able to try new technology devices through libraries, and 63 percent said they would like to receive customized book and music recommendations from their libraries as they do from online retailers like Amazon.com.

Some library users seemed willing to support even more changes. When asked whether libraries “should move some printed books and stacks out of public locations to free up space for tech centers, reading rooms, meeting rooms, and cultural events,” 20 percent of respondents said yes and 39 percent said maybe.

Still, of the 53 percent of respondents who had actually visited a library or mobile book location in the last year, 73 percent said they went in order to borrow print books, and only 49 percent said they visit libraries “to sit, read, and study, or watch or listen to media.”

As a result of these conflicting messages, Ms. Zickuhr said, “Many libraries are torn between expanding their digital offerings on the latest platforms and still providing quality resources for patrons who may lack experience with technology or the means to own the latest devices.”

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France’s National Library Hopes to Buy Sade’s ‘120 Days’

PARIS — “The 120 Days of Sodom,” by the Marquis de Sade, is one of the most perverse works of 18th-century literature.

It tells the story of four rich “libertines” who lock themselves in a remote medieval castle with 46 victims (including eight boys and eight girls, ages 12 to 15). The men are assisted by four female brothel keepers who arouse their hosts by recounting their outlandish (and embellished) experiences.

The work describes orgies and acts of abuse — sexual and otherwise — including pedophilia, necrophilia, incest, torture, rape, murder, infanticide, bestiality, violent anal and oral sex acts and the use of urination and defecation to humiliate and punish.

Sade called it “the most impure tale that has ever been told since our world began.”

There is nothing erotic about it.

Even Bruno Racine, director of the Bibliothèque Nationale de France, the National Library, calls it “depraved.”

But that hasn’t stopped him from negotiating long and hard to buy Sade’s manuscript. He has convinced the Foreign and Culture Ministries of its importance. He has argued in front of the Commission of National Treasures to declare it provisionally a “national treasure” that needs to be preserved in the library. And he is ready to pay more than $5 million to get it.

“The document is Sade’s most atrocious, extreme, radical work,” Mr. Racine said. “But we make no moral judgment about it.” A rambling, unfinished draft, “120 Days” has been praised and vilified. Simone de Beauvoir defended it as an important contribution to the dark side of humanity in her essay “Must We Burn Sade?”

The American feminist writer Andrea Dworkin branded it a “vile” story written by a woman-hating pornographer. In a 1975 film Pier Paolo Pasolini set the story in an imaginary Italian republic as a condemnation of Mussolini’s Fascist regime.

Sade wrote the draft in 37 days in 1785 in the Bastille, where he had been imprisoned under a royal order initiated against him by his mother-in-law. He wrote in tiny script on both sides of a sheaf of narrow paper, whose sheets he attached into a single 39-foot-long roll. Fearing that his work would be confiscated, he hid the roll in a crevice in a stone wall of his cell.

Days before the storming of the Bastille on July 14, 1789, Sade was transferred at night to a prison for the insane. He wrote that he “wept tears of blood” over the manuscript’s loss, and he went to his grave in 1814 without knowing its fate.

But it was recovered, sold, resold and then published for the first time by a German doctor in an error-filled version in 1904.

In 1929 Viscount Charles de Noailles, whose wife, Marie-Laure, was a direct descendant of Sade’s, bought the manuscript. The couple, wealthy and passionate patrons of the arts, handed it down to their daughter, Natalie, who kept it in a drawer at the family’s estate in Fontainebleau. She would sometimes unroll it and show it to guests; the Italian writer Italo Calvino was one of them.

“My mother showed me the manuscript when I was a boy,” Carlo Perrone, an Italian newspaper publisher who is Natalie de Noailles’s son, said in a telephone interview from Rome. “I remember the handwriting was so small, and that there were no corrections. It gave you the impression that paper was very scarce and precious for him, and that he had to fill up every space.”

Ms. de Noailles eventually entrusted both that manuscript and the manuscript of Stravinsky’s ballet “Les Noces” to a friend, the publisher Jean Grouet.

Mr. Grouet turned out to be a swindler. In 1982 he smuggled the Sade manuscript into Switzerland and sold it to Gérard Nordmann, a Swiss collector of erotica, for about $60,000.

Ms. de Noailles sued. After a long legal case, France’s highest court ruled in 1990 that the work had been stolen and must be returned. (The family was able to retrieve the Stravinsky manuscript, which had remained in France.)

Since Switzerland had not yet signed the Unesco convention requiring the restitution of stolen cultural objects, Ms. de Noailles was forced to sue again in that country. In 1998 the Swiss federal court ruled in Mr. Nordmann’s favor, saying that he had bought the manuscript in good faith.

Afterward, the manuscript was kept at a cultural foundation in Switzerland.

Then, last January, Mr. Nordmann’s heirs offered to sell the manuscript to a French collector. Mr. Perrone intervened.

“Anyone who wants to buy the manuscript in France needs my consent,” he said in the interview. “My mother had a very strong wish that one day the manuscript would be given to the Bibliothèque Nationale, which is my wish as well. It’s an important historical document, a piece of French history.”

Enter Mr. Racine. Since taking over as director of the Bibliothèque Nationale in 2007, he has sought to have important manuscripts classified as “national treasures” in order to acquire them for the library.

Among other purchases, he has bought Casanova’s memoirs with $9.6 million from an anonymous donor; the archives of the French philosopher Michel Foucault; and the archives of the French Marxist theorist, writer and filmmaker Guy Debord (preventing them from leaving the country and going to Yale).

“I don’t know of any director of a world-class library today who is making the kind of brilliant strategic acquisitions that Bruno Racine is making at the Bibliothèque Nationale,” said Paul Le Clerc, the former head of the New York Public Library and the director of Columbia University’s programs in Europe.

Now Mr. Racine is negotiating with Mr. Perrone and the heirs of Mr. Nordmann to buy the Sade manuscript and give each party a cut. The estimated sale price — more than $5 million — would be raised from private donors.

Mr. Racine’s goal is to put the manuscript on display, along with other Sade works in the library’s collection, for the 200th anniversary of Sade’s death next year.

“It is a unique, exceptional work, and a miracle that it survived,” he said. “It is part of our cultural heritage. Whether we like it or not, it belongs in the Bibliothèque Nationale.”

Emerik Derian contributed reporting.

This article has been revised to reflect the following correction:

Correction: January 22, 2013

An earlier version of this story misstated the offenses for which Marquis de Sade was imprisoned in 1785. He had been imprisoned under a royal order initiated against him by his mother-in-law, not for assaulting women and girls.

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DealBook: In Davos, Atmosphere for Bankers Improves

Two years ago, Jamie Dimon, chief executive of JPMorgan Chase, told an audience in Davos, Switzerland, that people should stop picking on bankers. Mr. Dimon is still waiting for his wish to come true.

Bankers, always a big presence at the World Economic Forum in Davos, will arrive this year under less regulatory pressure and with better profits than in past years. But they are still on the defensive.

Mr. Dimon, scheduled to appear on one of the first panels when the Davos forum opens on Wednesday, is again embroiled in controversy. Last week, JPMorgan’s board cut his pay for 2012 in half, to $11.5 million, holding him accountable for a multibillion-dollar loss on derivatives trading.

International bankers are under pressure from the law enforcement authorities as well, and examples can be found near Davos.

UBS, based in Zurich, agreed to pay a $1.5 billion fine to the global authorities after admitting this month that it had helped manipulate a benchmark rate used to set mortgage and other interest rates.

And Wegelin & Company, a private bank based in St. Gallen, Switzerland, shut down this month after admitting it had helped wealthy Americans evade taxes. The bank, founded in 1741, was the oldest in Switzerland.

At a news conference last week in Washington, the managing director of the International Monetary Fund, Christine Lagarde, lamented a “waning commitment” to tougher financial regulation and called upon the banking authorities to finish the job of fixing the world’s banks.

For all that, though, bankers may find the atmosphere in Davos a bit more congenial than in some recent years. Among the government overseers who will also be in attendance, there appears to be a growing sentiment that the banks have taken enough abuse.

This month in Basel, Switzerland, for instance, an international gathering of central bankers and bank supervisors relaxed new rules that were intended to ensure that banks would be able to survive an event like the collapse of Lehman Brothers in 2008.

The rules, which are not binding but serve as a benchmark for national regulators, would require banks to maintain a 30-day supply of cash or liquid assets that are easy to convert into cash. But after the decision in Basel this month, banks would have until 2019 to accumulate the additional cash and assets, instead of 2015.

The regulators also broadened the types of assets that could be used to include even some mortgage-backed securities — the same general class of security that was at the heart of the crisis.

Many analysts see the decision as a gift to the banking industry, which had insisted that planned new regulations would lead banks to curtail lending. Bank stocks in Europe rose after the decision.

“Most bankers I talked to breathed a huge sigh of relief,” said Cornelius K. Hurley, a professor at the Boston University School of Law and former assistant general counsel to the board of governors of the Federal Reserve.

Gavan Nolan, a credit analyst at Markit, a data provider in London, agreed that changes in the rules “went further than many had presumed, and in a direction that seems to favor the banks.” Still, he wrote in a note to clients, “the effects shouldn’t be overstated,” adding that the rules “will still make it more difficult to make money, in comparison to the previous era.”

The discussions at Davos may offer clues about whether the Basel decisions foreshadow other concessions.

There is a risk that efforts to rein in financial risk could lose momentum as the trauma of Lehman’s collapse fades, Mr. Hurley said.

“We said to ourselves back in 2008, a crisis is a terrible thing to waste,” he said. “It seems the farther away we get, the evidence is that we are wasting it.”

The World Economic Forum tends to be a place for talk rather than action, but it is one of the few events that reliably brings central bankers, regulators, economists, legislators and bankers under one snow-laden roof.

The discussions have sometimes been contentious, as in 2010 when American policy makers like Representative Barney Frank met behind closed doors with top bankers including Brian T. Moynihan, then the chief executive of Bank of America.

Mr. Frank left the meeting fuming about bankers’ unwillingness to accept more safeguards and vowed to impose them anyway. Six months later, Congress passed the sweeping financial regulation bill known as Dodd-Frank.

But Mr. Frank has retired, and there are signs that the officials who set the tone for global regulation of banks have become more worried about a credit squeeze in Europe than about the risk of another banking crisis.

Some of the most influential people in the regulation debate are sounding more conciliatory.

“We welcome these rules, we think they are important,” Mario Draghi, president of the European Central Bank and a member of the group that met in Basel, said this month. “We also welcome their gradual phasing in.”

At least some banks have had a profit rebound recently, including JPMorgan, Morgan Stanley and Goldman Sachs, whose chief executive, Lloyd C. Blankfein, is scheduled to take part in a panel on competitiveness at Davos on Friday.

European banks are still ailing, though, which threatens the fragile calm that has prevailed in financial markets. Whereas the euro zone debt crisis has fallen most heavily on southern European countries like Spain, weakness in the banking system is a problem even in healthier countries like Germany.

Deutsche Bank, the largest lender in Germany, is profitable but faces official investigations in Germany and the United States, mostly related to its activities before the financial crisis.

In December, police officers surrounded the bank’s headquarters in Frankfurt and seized documents as part of a tax-evasion inquiry that involves one of the bank’s co-chief executives, Jürgen Fitschen.

Other large German banks like Commerzbank and several of the state-owned landesbanks are still hobbled by bad investments they made before Lehman collapsed.

Belgium, France and Austria also have troubled banks, even though they are not considered to be countries in crisis.

“The bottom line is that I don’t think the banking system is in good condition, and I don’t expect it to come back to good condition soon,” said Nicolas Véron, a senior fellow at Bruegel, a research institute in Brussels.

Mr. Véron said he did not have reservations about the decision in Basel to ease new regulations on liquid assets, noting that previously there were no rules at all on liquidity.

“I think the big headline remains that liquidity regulations have been introduced,” he said. “When you look at what has happened in the crisis, that is a good thing.”

But he sounded less optimistic that policy makers meeting in Davos or elsewhere were making progress on other important banking issues, like how to close down terminally ill banks at no cost to taxpayers.

“We have not had the systemwide restructuring process I believe is necessary to get back to sound conditions,” he said.

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