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Wednesday, October 11, 2017

Is high blood sugar a dementia risk

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Group Health Research Institute.

17 out of 17 levels of people's sugar showed a direct connection between sugar & dementia. See the results and read researcher's conclusions.

A joint Group Health-University of Washington (UW) study in the New England Journal of Medicine has found that higher blood sugar levels are associated with higher dementia risk, even among people who do not have diabetes. (Continued below video.)

Continued below video...

Blood sugar levels averaged over a five-year period were associated with rising risks for developing dementia, in this report about more than 2,000 Group Health patients age 65 and older in the Adult Changes in Thought (ACT) study.

For example, in people without diabetes, risk for dementia was 18 percent higher for people with an average glucose level of 115 milligrams per deciliter compared to those with an average glucose level of 100 mg/dl. And in people with diabetes, whose blood sugar levels are generally higher, dementia risk was 40 percent higher for people with an average glucose level of 190 mg/dl compared to those with an average glucose level of 160 mg/dl.

"The most interesting finding was that every incrementally higher glucose level was associated with a higher risk of dementia in people who did not have diabetes," said first author Paul K. Crane, MD, MPH, an associate professor of medicine at the UW School of Medicine, adjunct associate professor of health services at the UW School of Public Health, and affiliate investigator at Group Health Research Institute. "There was no threshold value for lower glucose values where risk leveled off."

"One major strength of this research is that it is based on the ACT study, a longitudinal cohort study, where we follow people for many years as they lead their lives," said senior author Eric B. Larson, MD, MPH, a senior investigator at Group Health Research Institute who also has appointments at the UW Schools of Medicine and Public Health. "We combine information from people's research visits every other year with data from their visits to Group Health providers whenever they receive care. And this gave us an average of 17 blood sugar measurements per person: very rich data."

These measurements included blood glucose (some fasting, some not) and glycated hemoglobin (also known as HbA1c). Blood sugar levels rise and fall in peaks and valleys throughout each day, but glycated hemoglobin doesn't vary as much over short intervals.

Combining glucose and glycated hemoglobin measures into a composite measure required special statistical techniques, which Drs. Crane and Larson's co-authors Rod Walker, MS, a biostatistician, and Rebecca Hubbard, PhD, an associate investigator, both from Group Health Research Institute, had developed. (Dr. Hubbard is also an affiliate assistant professor of biostatistics at the UW School of Public Health.) These sophisticated statistical models required specialized data on the relationships between glycated hemoglobin and glucose levels, and they used data generated by co-author David M. Nathan, MD, a professor of medicine at Harvard Medical School and director of the Diabetes Center at Massachusetts General Hospital.

Journal Reference:So should people try to eat less sugar -- or foods with a lower "glycemic index"? Not necessarily, Dr. Crane said: "Your body turns your food into glucose, so your blood sugar levels depend not only on what you eat but also on your individual metabolism: how your body handles your food." But he does suggest that taking walks couldn't hurt: The ACT study has previously linked physical activity to later onset and reduced risk of dementia, including Alzheimer's disease.

Furthermore, Dr. Crane emphasized that these results come from an observational study: "What we found was that people with higher levels of glucose had a higher risk of dementia, on average, than did people with lower levels of glucose," he said. "While that is interesting and important, we have no data to suggest that people who make changes to lower their glucose improve their dementia risk. Those data would have to come from future studies with different study designs."

Paul K. Crane, Rod Walker, Rebecca A. Hubbard, Ge Li, David M. Nathan, Hui Zheng, Sebastien Haneuse, Suzanne Craft, Thomas J. Montine, Steven E. Kahn, Wayne McCormick, Susan M. McCurry, James D. Bowen, Eric B. Larson. Glucose Levels and Risk of Dementia. New England Journal of Medicine, 2013; 369 (6): 540 DOI: 10.1056/NEJMoa1215740

Monday, October 9, 2017

Can you tell if your memory is failing

Erin Abner, an assistant professor at University of Kentucky Sanders- Brown Center on Aging, asked 3,701 men aged 60 and higher a simple question: "Have you noticed any change in your memory since you last came in?"

That question led to some interesting results. "It seems that subjective memory complaint can be predictive of clinical memory impairment," Abner said. "Other epidemiologists have seen similar results, which is encouraging, since it means we might really be on to something."

The results are meaningful because it might help identify people who are at risk of developing Alzheimer's Disease sooner. "If the memory and thinking lapses people notice themselves could be early markers of risk for Alzheimer's disease, we might eventually be able to intervene earlier in the aging process to postpone and/or reduce the effects of cognitive memory impairment."

Abner, who is also a member of the faculty in the UK Department of Epidemiology, took pains to emphasize that her work shouldn't necessarily worry everyone who's ever forgotten where they left their keys.

"I don't want to alarm people," she said. "It's important to distinguish between normal memory lapses and significant memory problems, which usually change over time and affect multiple aspects of daily life."

Saturday, October 7, 2017

B vitamins help the brain stay fit

The American Academy of Neurology, an association of more than 22,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as epilepsy, dystonia, migraine, Huntington’s disease, and dementia. For more information about the American Academy of Neurology, visit http://www.aan.com.

B vitamins protect the brain and lower Alzheimer's risk. How do they work? See which ones are best for various diets.

ST. PAUL, Minn. – A key study shows that vitamin B12 may protect against Alzheimer’s, adding more evidence to the scientific debate about whether the vitamin is effective in reducing risk of memory loss. The research is published in Neurology®, the medical journal of the American Academy of Neurology.

Article continued below...

“Our findings show the need for further research on the role of vitamin B12 as a marker for identifying people who are at increased risk of Alzheimer’s disease,” said study author Babak Hooshmand, MD, MSc, with Karolinska Institutet in Stockholm, Sweden. “Low levels of vitamin B12 are surprisingly common in the elderly. However, the few studies that have investigated the usefulness of vitamin B12 supplements to reduce the risk of memory loss have had mixed results.”

For the seven-year study, researchers took blood samples from 271 Finnish people age 65 to 79 who did not have dementia at the start of the study. During that time, 17 people developed Alzheimer’s disease. Blood samples were tested for levels for homocysteine, an amino acid associated with vitamin B12, and for levels of the active portion of the vitamin, called holotranscobalamin. Too much homocysteine in the blood has been linked to negative effects on the brain, such as stroke. However, higher levels of vitamin B12 can lower homocysteine.

The study found that for each micromolar increase in the concentration of homocysteine, the risk of Alzheimer’s disease increased by 16 percent, whereas each picomolar increase in concentration of the active form of vitamin B12 reduced risk by two percent. The results stayed the same after taking into account other factors, such as age, gender, education, smoking status, blood pressure and body mass index. The addition of folate did not appear to raise or lower the risk of Alzheimer’s disease.

“More research is needed to confirm these findings before vitamin B12 should be used solely as a supplement to help protect memory,” said Hooshmand.

Vitamin B12 can be found in fish, poultry and other meat products.

MORE INFORMATION:

The study was supported by the Karolinska Institutet, the Swedish Research Council for Medical Research, the European Commission Seventh Framework Programme, the Academy of Finland, the Ragnhild and Einar Lundströms Minne Lindhés Foundation, the Stohnes Foundation, the Gamla Tjanarinnor Foundation and the Dementia Foundation of Sweden.

Thursday, October 5, 2017

Reduce Alzheimer's Agitation with Dextromethorphan-Quinidine Pill

In a preliminary 10-week randomized trial, patients with probable Alzheimer disease who received the combination medication dextromethorphan-quinidine demonstrated less occurrences and severity of agitation, compared to patients who received placebo, according to a study in JAMA (The Journal of the American Medical Association)¹.

Dr. Jeffrey Cummings, director of the Cleveland Clinic Lou Ruvo Center for Brain Health, said, "Agitation in Alzheimer's disease is one of the most disabling aspects of the disease. It interferes with the patient's life. It interferes with the ability of the caregiver to take care of the patient. It degrades the quality of life of both the patient and the caregiver."

Agitation & Aggression

Agitation and aggression are highly prevalent in patients with dementia and are associated with distress for patients and caregivers, greater risk of institutionalization, and accelerated progression to severe dementia and death. Nonpharmacological interventions are recommended as first-line therapy, but many patients fail to respond. Although many classes of psychotropic drugs are prescribed for agitation, safety concerns and modest or unproven efficacy limit their use, according to background information in the article.

Drug Combo

Dextromethorphan is commonly used in cough medicine. Quinidine is normally used to regulate an abnormal heart beat. Cummings said the combination pill had a substantial effect, greatly reducing agitation compared to the patients who got the placebo. Furthermore, he said, the caregivers also benefited. "There was a reduction in the stress experienced for caregivers of the patients who were treated with the dextromethorphan-quinidine combination.

The combination of the drugs is also approved for the treatment of pseudobulbar affect (a neurologic disorder characterized by episodes of emotional displays such as crying), and there is evidence suggesting the potential benefit of these drugs for agitation. The researchers randomly assigned 220 patients to receive dextromethorphan-quinidine or placebo in stage 1. In stage 2, patients receiving dextromethorphan-quinidine continued; those receiving placebo were stratified by response and re-randomized to dextromethorphan-quinidine or placebo. The 10 week trial was conducted at 42 study sites.

Trial Results

A total of 194 patients (88 percent) completed the study. Analysis combining stages 1 (all patients) and 2 (re-randomized placebo nonresponders) showed significantly reduced measures of agitation (occurrence and severity of symptoms). Patients treated with only dextromethorphan-quinidine had an average 51 percent reduction in the measure of agitation from baseline to week 10, compared with 26 percent for those treated with only placebo.

Adverse events included falls (8.6 percent for dextromethorphan-quinidine vs 3.9 percent for placebo), diarrhea (5.9 percent vs 3.1 percent, respectively), and urinary tract infection (5.3 percent vs 3.9 percent, respectively). Serious adverse events occurred in 7.9 percent with dextromethorphan-quinidine vs 4.7 percent with placebo. Dextromethorphan-quinidine was not associated with cognitive impairment or sedation.

Conclusions

"These preliminary findings require confirmation in additional clinical trials with longer treatment duration," the authors write.

Pending further evidence, there is a reasonably strong case to prioritize dextromethorphan-quinidine as an off-label treatment for agitation, possibly as a safer alternative to atypical antipsychotics, writes Anne Corbett, Ph.D., of King's College London, and colleagues in an accompanying editorial.

"However, while further studies are conducted to verify the efficacy and safety of this approach, it will be important to achieve a robust international expert consensus regarding the prioritization of potential treatments for agitation in patients with dementia to improve the consistency of clinical practice. This approach also must understand and incorporate patient and caregiver views regarding the evaluation of risk and benefits in relation to these treatments."

References:

Clive Ballard, Samantha Sharp, Anne Corbett. Dextromethorphan and Quinidine for Treating Agitation in Patients With Alzheimer Disease Dementia. JAMA, 2015; 314 (12): 1233 DOI: 10.1001/jama.2015.10215
Jeffrey L. Cummings, Constantine G. Lyketsos, Elaine R. Peskind, Anton P. Porsteinsson, Jacobo E. Mintzer, Douglas W. Scharre, Jose E. De La Gandara, Marc Agronin, Charles S. Davis, Uyen Nguyen, Paul Shin, Pierre N. Tariot, João Siffert. Effect of Dextromethorphan-Quinidine on Agitation in Patients With Alzheimer Disease Dementia. JAMA, 2015; 314 (12): 1242 DOI: 10.1001/jama.2015.10214

Tuesday, October 3, 2017

Pharmacists can help with dementia

Study reveals patients often struggle to manage their drug regime
Community pharmacists could be used more to support patients and carers
Some carers find the responsibility of their role stressful

New research funded by Pharmacy Research UK, reveals people with dementia may struggle with managing their medication – exposing them to side-effects, medication errors and an increased risk of non-adherence to drug treatment.

Researchers at Aston University, Hull University and the UEA interviewed family carers, people with dementia, nurses, GPs and community pharmacists for the project.

Their year-long research found that as dementia develops the person struggles to manage their own medication and increasingly relies on support from family carers. This is often their partner, who may also be taking many medicines and finding the carer role stressful, thus increasing the risk of medication error.

The study showed that for some carers this was a real burden of responsibility and that they hid their anxieties.

Lead researcher Dr. Ian Maidment, Senior Lecturer in Clinical Pharmacy at Aston said: “Our study found incorrect dosing, forgetting to give the medication and taking medicines which should have been stopped.”
Professor Chris Fox, Consultant Old Age Psychiatrist from UEA’s Norwich Medical School said: “There can be severe health impact for both the patient and carer - too often in my clinical practice I come across patients and families overburdened and unclear about their medication regimes. This can result in more visits to their GP and hospital and is a cause of avoidable NHS admissions.”

Dr. Andrea Hilton from Hull University added: “There is a substantial role for community pharmacists and their teams to assist carers; many pharmacists have day-to-day contact both with carers and people with dementia. Community pharmacy is in a unique position to support and embrace patient-centred care and this is currently under-utilised. This research highlights that community pharmacists should be working more with GP practices and have full access to patients’ medical records. Furthermore, home visits should be conducted for medication reviews.” Barbara Woodward-Carlton a former carer and a member of the Alzheimer’s Society Research Network highlighted: “During the years I looked after my mother who had Alzheimer's disease I wish I had known what help I could have had from community pharmacists.

“My mother was an extremely pleasant person who always wanted to co-operate but found it incomprehensible that she should be taking any medication at all. At one point when she was very ill, I continued the medication she had been given including 'water tablets' without realising that she was dehydrated..."

"I live with the shame of not knowing that as she was barely drinking and eating I should have stopped that medication. I welcome that community pharmacists are increasingly seen as those who can advise, educate and help those of us who care for others."

Dr. Clare Walton, Research Manager at Alzheimer’s Society said: “Seven in 10 people with dementia are also living with other health conditions and managing multiple medications which can be a tremendous challenge. Finding new and innovative ways to support people with dementia and their carers to safely and correctly age their medication is a focus for future research.”

Dr. Maidment added: “People with dementia are amongst the most vulnerable members of society and need more support with medication management. We need to develop new ways of supporting people with dementia manage their management and then test how well these new ways work.”

Reference Article: A qualitative study exploring medication management in people with dementia living in the community and the potential role of the community pharmacist, Ian D. Maidment PhD, Lydia Aston MA, Tiago Moutela MA, Chris G. Fox MBBS Bsc Mmmedsci MRCPsych MD, Andrea Hilton PhD, Health Expectations>, doi: 10.1111/hex.12534, published 19 January 2017.

About the study

A qualitative study exploring medication management in people with dementia living in the community and the potential role of the community pharmacist is published in the journal Health Expectations.
The research was funded by Pharmacy Research UK (PRUK), the principal funder of pharmacy research in the UK. Founded as a result of a merger in 2012 of two previous research funding charities, PRUK has a broad programme of research in place. PRUK funds both research projects and individual bursaries to improve skills across the pharmacy sector. More information is on their website www.pharmacyresearchuk.org
The National Institute for Health Research (NIHR) Dementias Writing Group support was critical to develop this research. The NIHR Dementias Writing Groups are a central component of the framework for co-ordinating and supporting dementia research in the UK. The groups provide a route through which new ideas for clinical studies are developed.
Anyone interested in registering their interest in participating in other dementia research studies can sign up to Join Dementia Research online at www.joindementiaresearch.nihr.ac.uk

About Aston University

Founded in 1895 and a University since 1966, Aston University has been always been a force for change. For 50 years the University has been transforming lives through pioneering research, innovative teaching and graduate employability success. Aston is renowned for its opportunity enabler through broad access and inspiring academics, providing education that is applied and has real impact on all areas of society, business and industry. True to Aston’s Coat of Arms which bears the word ‘Forward’, in 2016 Aston held a year-long anniversary celebration to recognise its heritage and achievements, but with a focus to drive forward the next stage in the University’s exciting journey. www.aston.ac.uk/50
Aston's Vice Chancellor and Chief Executive, Professor Alec Cameron, is the principal academic and executive officer of the University. Alec has overall responsibility for Aston's executive management and day-to-day direction.

Sunday, October 1, 2017

Anticholinergic drugs NOT for those with dementia

University of East Anglia

Memory and thinking work by activating brain cells with acetyl-choline. Alzheimer's drugs boost acetyl-choline. Medicines for other conditions are often anti-cholinergic drugs, which lower acetyl-choline. From allergies to insomnia, these can spell big trouble for people with dementia. Learn which drugs to avoid and what to look out for.

Drugs widely prescribed to the elderly could be responsible for a decline in cognitive and physical function according to research from the University of East Anglia and the Regenstrief Institute.

A key report reveals that anti-cholinergic drugs -- which are used to treat conditions including asthma, high blood pressure, insomnia, dizziness and diarrhea -- could impact physical functions in elderly patients such as eating and getting dressed.

Up to half the UK's elderly population are prescribed at least one medication with anti-cholinergic properties. Other anti-cholinergic drugs are also sold over the counter without the need for a prescription.

These medications affect the brain by blocking a key neurotransmitter called acetylcholine. But they have been associated with side effects including dizziness, sedation, confusion, delirium, constipation and blurred vision.

Previous studies have shown a link between these drugs and cognitive impairment, but this study is the first to summarise evidence of a physical decline among the elderly.

The research team looked at 46 studies from around the world that included 60,944 patients who had taken anti-cholinergic medications for up to 10 years.

Lead researcher Dr. Chris Fox, from UEA's Norwich Medical School, said. "We examined the effect of anti-cholinergic medication on physical function over a large time frame spanning decades of research.

"This is the first research to show a significant decline in physical, as well as cognitive, function. This means patients could become less and less able to carry out everyday activities like walking around, feeding themselves, washing and getting dressed.

"This is likely due to the direct effect on cholinergic neurons compounded by an increase in the blood-brain permeability.

"We have also seen that the type of anti-cholinergic drug may be important, and more research needs to be done to ascertain which types are more dangerous than others.

"Further studies are also needed to establish whether the cognitive decline is definitely induced by these medications -- or the whether the diseases for which they are prescribed are a factor too.

"In the meantime, the prescription of these medications for people with dementia should be cautiously assessed, monitored and attempts made to reduce the burden whenever feasible. Clinicians should conduct regular reviews of the medication taken by their older patients, both prescribed and over the counter, and wherever possible avoid prescribing multiple drugs with anti-cholinergic effects."

The international research team included experts from the Regenstrief Institute and the Indiana University Center for Aging Research in the US, Aston University, the University of Aberdeen and the Norfolk and Norwich University Hospital in the UK.

Co-author Dr Noll Campbell, from the Regenstrief Institute, IU Center for Aging Research and Purdue University College of Pharmacy, said: "Anticholinergics, both over-the-counter and prescription medications, impact the lives of older adults in ways doctors, patients and their families may not realize.

"I don't see use of these medications declining. Doctors and patients are familiar with these drugs and unfortunately are far less familiar with equally effective alternatives."

Dr Campbell advises that rather than taking sleeping pills with anti-cholinergic properties, one could refrain from napping, limit evening exercise and remove distractions from the bedroom. Meanwhile hospitals and nursing homes could work to keep older adults awake and stimulated during the day, naturally encouraging night-time slumber.

Reference:

C. Fox, T. Smith, I. Maidment, W.-Y. Chan, N. Bua, P. K. Myint, M. Boustani, C. S. Kwok, M. Glover, I. Koopmans, N. Campbell. Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality: a systematic review. Age and Ageing, 2014; DOI:10.1093/ageing/afu096

Friday, September 29, 2017

Dementia and sense of smell

University of Pennsylvania-School of Medicine

PHILADELPHIA--Tests that measure the sense of smell may soon become common in neurologists' offices. Scientists have been finding increasing evidence that the sense of smell declines sharply in the early stages of Alzheimer's, and an innovative study from the Perelman School of Medicine at the University of Pennsylvania published in the Journal of Alzheimer's Disease confirms that administering a simple "sniff test" can enhance the accuracy of diagnosing this dreaded disease.

The sniff test also appears to be useful for diagnosing a pre-dementia condition called mild cognitive impairment (MCI), which often progresses to Alzheimer's dementia within a few years.

Neurologists have been eager to find new ways to identify people who are at high risk of Alzheimer's dementia but do not yet show any symptoms. There is a widespread consensus that Alzheimer's medications now under development may not work after dementia has set in.

"There's the exciting possibility here that a decline in the sense of smell can be used to identify people at risk years before they develop dementia," said principal investigator David R. Roalf, PhD, an assistant professor in the department of Psychiatry at Penn.

Roalf and his colleagues used a simple, commercially available test known as the Sniffin' Sticks Odor Identification Test, in which subjects must try to identify 16 different odors. They administered the sniff test, and a standard cognitive test (the Montreal Cognitive Assessment), to 728 elderly people.

The subjects had already been evaluated by doctors at Penn with an array of neurological methods, and according to expert consensus had been placed in one of three categories: "healthy older adult," "mild cognitive impairment," or "Alzheimer's dementia." Roalf and his team used the results from the cognitive test alone, or combined with the sniff test, to see how well they identified subjects in each category.

As researchers report, the sniff test added significantly to diagnostic accuracy when combined with the cognitive test.

For example, the cognitive test alone correctly classified only 75 percent of people with MCI, but that figure rose to 87 percent when the sniff test results were added. Combining the two tests also enabled more accurate identification of healthy older adults and those with Alzheimer's dementia. The combination even boosted accuracy in assigning people to milder or more advanced categories of MCI.

"These results suggest that a simple odor identification test can be a useful supplementary tool for clinically categorizing MCI and Alzheimer's, and even for identifying people who are at the highest risk of worsening," Roalf said.

Prompted by prior studies that have linked a weakening sense of smell to Alzheimer's, doctors in a few larger dementia clinics already have begun to use smell tests in their assessments of elderly patients. Part of the reason the practice has not yet become common is that the tests that seem most useful take too long to administer. Roalf and colleagues are now trying to develop a briefer test that works as well as the longer ones.

"We're hoping to shorten the Sniffin' Sticks test, which normally takes 5 to 8 minutes, down to 3 minutes or so, and validate that shorter test's usefulness in diagnosing MCI and dementia--we think that will encourage more neurology clinics to do this type of screening," Roalf said.

Roalf and his laboratory also plan to investigate whether protein markers of Alzheimer's, which are present in the olfactory region of the brain before dementia occurs, can be detected in nasal fluid to provide an even earlier warning of the disease process.

Studies suggest that a high proportion of older adults who have cognitive impairment are not identified as such, in part due to lack of adequate screening.

MORE INFORMATION:

The study's first author was Penn's Megan Quarmley; the other co-authors were Paul J. Moberg, Dawn Mechanic-Hamilton, Sushila Kabadi, and David A. Wolk, all of Penn, and Steven E. Arnold of Harvard University and Massachusetts General Hospital. Data for this study was collected through the Penn Memory Center.
Funding was provided by the National Institute of Mental Health (K01 497 MH102609), National Institute on Aging (P30 AG10124), and the Penn Center of Excellence for Research on Neurodegenerative Diseases.