Commonly Used Medications Linked to Dementia

A new study reveals that higher doses or prolonged use of medications with anticholinergic effects significantly increases the risk for developing dementia.  Although, this is not the first study to discover such a link, it is the first to suggest that the risk of dementia as a result of taking such medications may not be reversible.

“An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. Anticholinergics inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells. The nerve fibers of the parasympathetic system are responsible for the involuntary movement of smooth muscles present in the gastrointestinal tract, urinary tract, lungs, etc.”

Anticholinergic agents are used to treat a variety of conditions such as gastrointestinal disorders, respiratory disorders, insomnia, dizziness etc.  Some of these commonly used medications include Diphenhydramine (Benadryl, Advil PM etc.), Bupropion (Zyban, Wellbutrin), Dextromethorphan (cough suppressant) and the list goes on.  In addition, some of these medications can be acquired without a prescription and can have very strong anticholinergic effects.

Moreover, many older patients, already at higher risk of developing dementia, are frequently using these types of medications.  Doctors should be taking a proactive approach and monitoring the use of these drugs, including non-prescription use.

“For instance, the most commonly used medications in the study were tricyclic antidepressants like doxepin (Sinequan), first-generation antihistamines like chlorpheniramine (Chlor-Trimeton), and antimuscarinics for bladder control like oxybutynin (Ditropan). The study estimated that people taking at least 10 mg/day of doxepin, 4 mg/day of chlorpheniramine, or 5 mg/day of oxybutynin for more than three years would be at greater risk for developing dementia.”

Consequently, the study suggests that medical professionals should seek substitutes such as citalopram (Celexa) or fluoxitene (Prozac) for depression or loratadine (Claritin) for allergies or behavioral changes for urinary incontinence.  However, if substitutes are not available, the suggestion is to prescribe the lowest dose possible, monitor its effectiveness closely and cease use if there is no real benefit to the patient.

This study differs from other research as it used more rigorous methods, longer follow-up periods and better assessment of medication use by using pharmacy records of both prescription and non-prescription use.  It is also the first of its kind to link anticholinergic medication dosages to dementia risk.  Results were obtained by tracking nearly 3,500 Group Health seniors participating in the long-running Adult Changes in Thought study (a longitudinal population-based prospective cohort study of brain aging and incident dementia in the Seattle metropolitan area), some of which have also agreed to have their brains autopsied after they die.  Stay tuned.

Quick Facts:

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life.

Alzheimer's is the most common type of dementia.

While symptoms of dementia can vary greatly, at least two of the following core mental functions must be significantly impaired to be considered dementia:

• Memory
• Communication and language
• Ability to focus and pay attention
• Reasoning and judgment
• Visual perception

Many dementias are progressive, meaning symptoms start out slowly and gradually get worse.
Dementia is caused by damage to brain cells, which interferes with the ability of brain cells to communicate with each other.

There is no one test to determine if someone has dementia. Doctors diagnose Alzheimer's and other types of dementia based on a careful medical history, a physical examination, laboratory tests, and the characteristic changes in thinking, day-to-day function and behavior associated with each type.

Some risk factors for dementia, such as age and genetics, cannot be changed, however some of the most active areas of research in risk reduction and prevention include cardiovascular factors, physical fitness, and diet.

The total number of new cases of dementia each year worldwide is nearly 7.7 million, implying one new case every four seconds. The number of people with dementia is expected to nearly double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050.

The costs are estimated at US$ 604 billion per year at present and are set to increase even more quickly than the prevalence.

Caring for dementia patients is overwhelming for caregivers. The stresses include physical, emotional and economic pressures. Care givers require support from the health, social, financial and legal systems.

People with dementia are frequently denied the basic rights and freedoms available to others. For example, physical and chemical restraints are used extensively in aged-care facilities and acute-care settings.

Improving the awareness and understanding of dementia across all levels of society is needed to decrease discrimination and to improve the quality of life for people with dementia and their caregivers.

More research is needed to develop new and more effective treatments and to better understand the causes of dementia. Research that identifies the modifiable risk factors of dementia is still scarce.

Higher dementia risk linked to more use of common drugs
Anticholinergic
alz.org
World Health Organization

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Diabetic Medication Helps Improve Memory

Researchers at the University of Texas Medical Branch at Galveston revealed that an FDA-approved medication called rosiglitazone that is used to treat insulin resistance in diabetics also enhances learning and memory. This discovery could improve cognitive performance for those with Alzheimer’s disease.

By studying genetically engineered mice designed to serve as models for Alzheimer's, “the scientists believe that the drug produced the response by reducing the negative influence of Alzheimer's on the behavior of a key brain-signaling molecule.”

The molecule in question is called extracellular signal-regulated kinase (ERK). In the brains of Alzheimer's patients as well as the mice in the study, this molecule becomes hyperactive, which leads to improper synaptic transmission between neurons thereby interfering with learning and memory.

“Rosiglitazone brings ERK back into line by activating what's known as the peroxisome proliferator-activated receptor gamma (PPARγ) pathway, which interacts with genes that respond to both PPARγ and ERK.”

Basically, the medication helps to restore signals between neurons so that cognitive functions become more normal. This research opens a gateway allowing researchers to test more FDA-approved drugs to try and normalize insulin resistance in Alzheimer's patients while potentially improving their memory at the same time. It could also lead to a greater understanding of the biology behind the cognitive issues in Alzheimer's disease.

Alzheimer's disease (AD) is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death.

Symptoms:

• Memory loss that disrupts daily life.
• Challenges in planning or solving problems.
• Difficulty completing familiar tasks at home, at work or at leisure.
• Confusion with time or place.
• Trouble understanding visual images and spatial relationships.
• New problems with words in speaking or writing.
• Misplacing things and losing the ability to retrace steps.
• Decreased or poor judgment.
• Withdrawal from work or social activities.
• Changes in mood and personality.

Prevalence:

• An estimated 5.4 million Americans of all ages have Alzheimer’s disease in 2012. This figure includes 5.2 million people age 65 and older and 200,000 individuals under age 65 who have younger-onset Alzheimer’s.
• One in eight people age 65 and older (13 percent) has Alzheimer’s disease.
• Nearly half of people age 85 and older (45 percent) have Alzheimer’s disease.
• Of those with Alzheimer’s disease…
• an estimated 4 percent are under age 65
• 6 percent are 65 to 74
• 44 percent are 75 to 84
• 46 percent are 85 or older
• Every 68 seconds, someone in America develops Alzheimer’s.
• By mid-century, someone in America will develop the disease every 33 seconds.

Diabetes Drug Improves Memory, Study Suggests
Alzheimer's disease
Facts and Figures facts and figures

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Loss of Chewing Ability May Be Linked to Dementia

Researchers from the Department of Dental Medicine and the Aging Research Center (ARC) at Karolinska Institutet and from Karlstad University in Sweden suggest that the loss of chewing ability may be linked to cognitive decline and a higher risk of dementia.

Dementia is a serious loss of global cognitive ability in a previously unimpaired person, beyond what might be expected from normal aging. It is not considered a single disease, but rather a set of signs and symptoms, in which affected areas of cognition may be memory, attention, language, and problem solving.

The study randomly selected a nationwide sample of 577 participants aged 77 or older to investigate tooth loss, chewing ability and cognitive function. Results showed that individuals that experienced more difficulty chewing hard foods were more at risk of developing cognitive impairments, even when controlling other variables such as sex, age, education and mental health. In addition, chewing with dentures or real teeth had no impact on their results.

It could be that “few or no teeth makes chewing difficult, which leads to a reduction in the blood flow to the brain. However, to date there has been no direct investigation into the significance of chewing ability in a national representative sample of elderly people.”

Unfortunately, this study does not specify whether all participants consumed similarly nutritious meals. Those with a reduced ability to chew certain foods may have been malnourished, which could have played a major role in their cognitive decline.

Nevertheless, the preliminary results of such research certainly provide further support for the fact that oral health impacts overall health. Good oral health brings significant benefits to self-esteem, dignity, social integration and general nutrition.

According the World Health Organization, the proportion of people aged 60 years and older is growing faster than any other age group, as a result of both longer life expectancy and declining fertility rates. Therefore, as our society ages, this type of research becomes more and more relevant…

• As of 2010, more than 35.6 million people worldwide are living with dementia, or more than the total population of Canada.


• The global prevalence of dementia stands to double every 20 years, to 65.7 million in 2030, and 115.4 million in 2050.


• Total health-care costs for people with dementia amount to more than 1 per cent of the global gross domestic product (GDP), or US$604 billion in 2010.

Chewing Ability Linked to Reduced Dementia Risk
Dementia
Ageing
Facts about dementia

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A Simple Blood Test for Alzheimer's Disease on the Horizon

William Hu, MD, PhD, assistant professor of neurology at Emory University School of Medicine and collaborators at the University of Pennsylvania and Washington University, St. Louis are getting closer to uncovering an in inexpensive and very convenient test for Alzheimer's disease. 

This type of test has been studied for several years; however reliability of results and an inability to replicate the same results have prevented such a test from being discovered.  Now, scientists have finally found a group of markers that hold up in statistical analyses in three independent groups of patients.

Basically, they measured the levels of 190 proteins in the blood of 600 participants. The subjects studied included healthy volunteers and individuals that had been diagnosed with Alzheimer's disease or mild cognitive impairment (MCI).

“A subset of the 190 protein levels (17) were significantly different in people with MCI or Alzheimer's. When those markers were checked against data from 566 people participating in the multicenter Alzheimer's Disease Neuroimaging Initiative, only four markers remained: apolipoprotein E, B-type natriuretic peptide, C-reactive protein and pancreatic polypeptide.”

Coincidentally, they discovered a correlation among patients that showed changes in their levels of these four proteins and their measurements of proteins [beta-amyloid] levels in their cerebrospinal fluid, a protein previously connected with Alzheimer's disease.  These correlations allowed researchers to group together people with MCI that may be at high risk of developing Alzheimer's.

 "We were looking for a sensitive signal," says Hu. "MCI has been hypothesized to be an early phase of AD, and sensitive markers that capture the physiological changes in both MCI and AD would be most helpful clinically." 

"The specificity of this panel still needs to be determined, since only a small number of patients with non-AD dementias were included," Hu says. "In addition, the differing proportions of patients with MCI in each group make it more difficult to identify MCI- or AD-specific changes."

Unfortunately, researchers have not yet been able to uncover a simple blood test to detect Alzheimer’s disease; however they have discovered ways to ensure that any future tests will be reliable. 

Therefore, neurologists will have to continue to diagnose Alzheimer's disease based mainly from an analysis of clinical symptoms or at times expensive PET brain imaging or painful spinal tap.

Blood Test for Alzheimer's Gaining Ground

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Concussions Are Quite Common In Canadian Junior Hockey

The November 2010 issue of Neurosurgical Focus illustrates concern for young players in Canadian junior ice hockey as researchers have uncovered alarming data and trends regarding head injuries and concussions.

"The aftermath of a concussion can impact memory, judgment, social conduct, reflexes, speech, balance and coordination. Epidemiological studies have suggested an association between sport concussions and both immediate and later-life cognitive impairment. As such, this is a public health issue that needs to be taken more seriously by players, parents, coaches, and medical professionals," said Dr. Echlin.

Although, the issue of sports-related head injuries has been a growing concern for some time, this new study is the first to document the significance of this concern among junior hockey players.

Specifically, the Hockey Concussion Education Project (HCEP), a cohort study conducted between 2009 and 2010, researched 67 male ice-hockey players between the ages of 16 and 21 among two fourth-tier teams.

Before the hockey season began, the players were assessed with the Sideline Concussion Assessment Test (SCAT2) and the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT). Following these tests, players were monitored by one independent physician and one to three independent, non-physician observers, at each regular season game.

The disturbing results…

• 17 players experienced a total of 21 concussions in only 52 games.
  
  
• 5 of those 17 players suffered a second or recurrent concussion during the hockey season.
  
  
• 15 of the same 17 players admitted to having at least one concussion in the past, while 2 admitted to hiding the fact to continue playing.
  
  
• The positions most affected by concussion are: forward position (71%) and defense (29%).
  
  
• No concussions were incurred by goalies.
  
  
• The rate of concussion increases as the game progresses: first period (14%); second period (29%); and third period (57%).
  
  
• 24% of the concussions occurred in players directly involved in a fight.
  
  
• The mean clinical return-to-play duration in 15 players was 12.8 days.

These statistics suggest that more education is needed to convince players, coaches and parents alike that concussion really is a serious problem that should not be ignored. Testing and monitoring after a concussion occurs is extremely important, however more often than not, the extra attention required is more of a burden to most.

In addition, educating players on the dangers should reduce the number of unreported cases and the concealment of concussions to avoid sitting on the bench. Players need to be aware that concussions are quite common in sport and the tough guy act could have devastating results to both physical and mental abilities that could last decades.

Junior Ice Hockey Study Uncovers Alarming Concussion Rates

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No Evidence That Ginkgo Biloba Benefits Cognition

A recent study, Ginkgo Evaluation of Memory (GEM), by Beth E. Snitz, Ph.D., of the University of Pittsburgh, demonstrates that the use of the herbal supplement Ginkgo biloba does not slow the rate of cognitive decline among older adults as construed.

“The randomized, double-blind, placebo-controlled clinical trial included 3,069 community-dwelling participants, ages 72 to 96 years, who received a twice-daily dose of 120-mg extract of G biloba (n = 1,545) or identical-appearing placebo (n = 1,524). The study was conducted at six academic medical centers in the United States between 2000 and 2008, with a median (midpoint) follow-up of 6.1 years. Change in cognition was assessed by various tests and measures.”

In 2000, older adults that had normal to mild cognitive impairment were chosen and observed. The researchers placed the subjects into 3 distinct groups. Some were given a placebo over the 8 year period. Others were given either Ginkgo biloba or the placebo, where their group identity was not disclosed to the participant or the experimenter. The third group was randomly assigned to either of the groups. Double-blind studies are said to achieve greater scientific rigor than other types of research. The conclusion of this double-blind study is that Ginkgo biloba is not effective in reducing the incidence of Alzheimer dementia or dementia in general. In addition, no evidence was found to support any effects on memory, language, attention, visuospatial abilities and executive functions. Furthermore, no differences were detected through age, sex, race, education or baseline cognitive status.

Basically, no evidence was found to support the widely marketed fact that Ginkgo biloba slows the rate of cognitive decline.

What is Ginkgo Biloba?

Ginkgos are very large trees, normally reaching a height of 66–115 feet, with some specimens in China being over 50 m. The tree has an angular crown and long, somewhat erratic branches, and is usually deep rooted and resistant to wind and snow damage. A combination of resistance to disease, insect-resistant wood and the ability to form aerial roots and sprouts makes ginkgos long-lived, with some specimens claimed to be more than 2,500 years old. Extreme examples of the Ginkgo's tenacity may be seen in Hiroshima, Japan, where six trees growing between 1–2 km from the 1945 atom bomb explosion were among the few living things in the area to survive the blast. While almost all other plants and animals in the area were destroyed, the ginkgos, though charred, survived and were soon healthy again. The trees are alive to this day.

Extracts of Ginkgo leaves contain flavonoid glycosides and terpenoids and have been used pharmaceutically. Ginkgo supplements are usually taken in the range of 40–200 mg per day. Ginkgo has many alleged nootropic properties, and is mainly used as a memory and concentration enhancer, and an anti-vertigo agent. According to some studies, in a few cases, Ginkgo can significantly improve attention in healthy individuals. Allegedly, the effect is almost immediate and reaches its peak in 2.5 hours after intake.

Ginkgo has been used for…

• Alzheimer's disease
  
• Improving blood flow
  
• Protecting against oxidative cell damage
  
• Blocking the effects of platelet-activating factor (platelet aggregation, blood clotting)
  
• Intermittent claudication
  
• Easing the symptoms of tinnitus
  
• Improving cognition and fatigue in those with multiple sclerosis
  
• Arresting the development of vitiligo

Ginkgo may have undesirable effects, especially for individuals with blood circulation disorders and those taking anticoagulants such as ibuprofen, aspirin, or warfarin. Ginkgo should also not be used by people who are taking certain types of antidepressants (monoamine oxidase inhibitors and selective serotonin reuptake inhibitors) or by pregnant women, without first consulting a doctor.

Side effects can include…

• possible increased risk of bleeding
  
• gastrointestinal discomfort
  
• nausea
  
• vomiting
  
• diarrhea
  
• headaches
  
• dizziness
  
• heart palpitations
  
• restlessness

Other precautions…

Ginkgo biloba leaves contain long-chain alkylphenols together with the extremely potent allergens, the urushiols (similar to poison ivy). Individuals with a history of strong allergic reactions to poison ivy, mangoes, and other urushiol-producing plants are more likely to experience an adverse reaction when consuming Ginkgo-containing pills, combinations, or extracts.

The nut-like gametophytes inside the seeds are particularly esteemed in Asia, and are a traditional Chinese food. When eaten by children, in large quantities (over 5 seeds a day), or over a long period, the raw gametophyte (meat) of the seed can cause poisoning by MPN (4-methoxypyridoxine).

Bottom line...

It is very important to remember that herbal supplements are not regulated by the FDA in the US and Canada’s regulation of such health products is quite often confusing and inconsistent. Therefore, personal responsibility is essential when relying on this type of treatment.

Ginkgo Biloba Does Not Appear to Slow Rate of Cognitive Decline

Wikipedia

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Walnuts Improve Age-Related Motor and Cognitive Shortfalls

Walnuts are said to be rich in fiber, vitamin B, magnesium, and antioxidants such as Vitamin E. They are also loaded with more omega 3 fatty acids than any other types of nuts. Omega 3 fatty acid has been shown to lower cholesterol. In addition, walnuts assist in reducing the risk of heart disease by improving elasticity of blood vessels and reducing plaque accumulation.

Furthermore, the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University in Boston, Massachusetts has conducted a study observing
the effects of walnut consumption on behavioural and motor skills.

Our brain ages with us and as such, changes occur that alter or impair neurons in our brain. The synaptic connections in the brain can become weak or change entirely altering the functions of relative connections. Increased oxidative damage to neural tissue also alters the way in which our brain functions. In the study, aged rodents displayed these types of changes behaviorally through impairments in performance on age-related tasks such as balance, coordination, and spatial working memory.

The study consisted of 4 distinct groups of aged rats of similar weight. The diet of the first group of rats consisted of a chow mix containing 2% walnuts, the second 6%, third 9% and fourth 0%. The rats were then subjected to a battery of memory and motor tests. In comparison, the group that ingested 6% walnut in their chow mix would be equivalent to a human eating 1 ounce or 7 to 9 walnuts per day.

“The study found that in aged rats, the diets containing 2 percent or 6 percent walnuts were able to improve age-related motor and cognitive shortfalls, while the 9 percent walnut diet impaired reference memory.”

It seems that a healthy diet and 7 to 9 walnuts per day could be beneficial in reducing the effects of aging on motor and behaviour skills.

Health Benefits of Walnuts
Adding Walnuts To Good Diet May Help Older People Improve Motor And Behavioral Skills

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Could Excessive Cell Phone Use Lead to Cognitive Impairment Among Youth?

Dr. Gaby Badre, of Sahlgren’s Academy in Gothenberg, Sweden presented to the Associated Professional Sleep Societies (APSS) that there is a relationship between excessive cell phone use and sleeping problems, such as disrupted sleep, restlessness, stress and fatigue, among youth 14 to 20 years of age.

The study consisted of two groups; those who made less than 5 calls and/or text messages per day (control group) and those who made more than 15 calls and/or text messages per day (experimental group).

The results showed that youth in the experimental group had "increased restlessness with more careless lifestyles, more consumption of stimulating beverages, difficulty in falling asleep and disrupted sleep, more susceptibility to stress and fatigue". Furthermore, there seems to be a connection between excessive cell phone use and a tendency toward unhealthy habits such as smoking and drinking among youth.

The study suggests that youth are delaying their biological clocks in order to remain in constant connection with the world. The impact on mental health and cognition could be detrimental if youth continue to disrupt their sleep patterns at a period in life where sleep is so critical. It makes me wonder if this trend will hinder the potential of today's youth.

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