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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Mental Illness Can Have More Impact on Life Expectancy Than Smoking

According to researchers at Oxford University, mental illness has an effect on life expectancy that is equivalent or greater than smoking. A great deal of effort and spending has been invested into smoking cessation programs and smoking awareness campaigns. This new research should prompt the government, health care and social services to shift their focus in an effort to increase life expectancy for those living with mental illness.

Researchers reviewed 20 review papers from clinical studies that reported mortality risk among mental health problems, substance and alcohol abuse, dementia, autistic spectrum disorders, learning disability and childhood behavioral disorders. These studies included over 1.7 million individuals and over 250,000 deaths. They also used studies and reviews that reported life expectancy and risk of dying by suicide. All results were compared to data for heavy smoking.

According to their findings, “one in four people in the UK will experience some kind of mental health problem in the course of a year” while smokers consist of roughly 21% of British men and 19% of women. 

They discovered that all diagnoses studied had an increased mortality risk similar or greater than heavy smoking. Some of the estimated reductions in life expectancy were found to be as follows:

• Bipolar Disorder: 9 - 20 years
  
• Schizophrenia: 10 – 20 years
  
• Drug and Alcohol Abuse: 9 - 24 years
  
• Recurrent Depression: 7 - 11 years
  
• Heavy smoking: 8 - 10 years

Dr. Seena Fazel of the Department of Psychiatry at Oxford University said: "We found that many mental health diagnoses are associated with a drop in life expectancy as great as that associated with smoking 20 or more cigarettes a day."
Despite the fact that this study did not mention the prevalence of smoking among persons with mental illness, the results are still devastating.

There may be many reasons for this phenomenon. For example:

• Psychiatric patients and those with drug and/or alcohol dependence can be more likely to engage in high-risk behaviours.
  
• Physical health problems may not be taken seriously and treated properly due to the stigma attached to their mental illness.
  
• Many mental illnesses can create physical health problems and/or worsen pre-existing ones.
  
• People with serious mental illness may not access healthcare effectively.
  
• The de-medicalization of mental illness may increase the likelihood that physical health problems go untreated or neglected.
  

Life expectancy may increase if only we could make mental health a priority as we have with smoking. In addition to funding and advancing research on mental illness, we should improve health and social services to ensure that persons with mental illness have better access to health care, suitable employment and supports in their community.

Many mental illnesses reduce life expectancy more than heavy smoking

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Late Night Smartphone Use Affects Productivity

Research suggests that you should put away your smartphone at the end of the work day in order to be more productive the following day.

Michigan State University business scholar, Russell Johnson and colleagues discovered that workers that tried to continue working on their smartphone past 9:00 p.m. were more worn out and less engaged during the following work day.

"Smartphones are almost perfectly designed to disrupt sleep," said Johnson, MSU assistant professor of management who acknowledges keeping his smartphone at his bedside at night. "Because they keep us mentally engaged late into the evening, they make it hard to detach from work so we can relax and fall asleep."

According to research, at least 50% of U.S. adults own a smartphone.  Many of them consider their phones to be critical workforce productivity tools; however the National Sleep Foundation indicates that only 40% of Americans get enough sleep on most nights.  Likewise, much of the self-reported data suggests that the lack of sleep can be attributed to smartphone usage for work. 

To study this phenomenon, researchers asked 82 upper-level managers to complete multiple surveys daily for two weeks.  They also surveyed 161 employees daily in a variety of occupations, such as nursing, manufacturing and dentistry etc.

All workers from all occupations indicated in their surveys that smartphone use for business purposes affected their sleep and drained their energy the following work day. The study also noted that smartphones more negatively impacted workers than watching television or using laptops and tablet computers.

“In addition to keeping people mentally engaged at night, smartphones emit "blue light" that seems to be the most disruptive of all colors of light. Blue light is known to hinder melatonin, a chemical in the body that promotes sleep.”

It seems that smartphone use late at night impacts the amount and quality of sleep we get, which affects our attention and abilities the following day.  That being said, this small study may be reason enough to turn that phone off after 9:00 p.m. to see how it might benefit us physiologically and psychologically.

Nighttime Smartphone Use Zaps Workers' Energy

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Dad's Absence Affects Neurobiology of Offspring

Scientists at the Research Institute of the McGill University Health Centre (RI-MUHC) have discovered that an absent father during critical growth periods can lead to social and behavioral impairments in adults. This is the first study of its kind to correlate paternal deprivation and social attributes with physical changes in the brain.

"Although we used mice, the findings are extremely relevant to humans," says senior author Dr. Gabriella Gobbi, a researcher of the Mental Illness and Addiction Axis at the RI-MUHC and an associate professor at the Faculty of Medicine at McGill University. "We used California mice which, like in some human populations, are monogamous and raise their offspring together."

Researchers were able to control the environment in which the mice were raised, including the factors among the different groups.  As a result, mice studies may be clearer than human studies claims Francis Bambico, a former student of Dr. Gobbi at McGill and now a post-doc at the Centre for Addiction and Mental Health (CAMH) in Toronto.

Researchers compared the social behaviour and brain structure of mice in different groups; those raised with both parents and those raised by their mothers. Findings show that mice raised by single mothers experienced abnormal social interactions and were more aggressive than those raised with both parents present. In addition, these findings were more prevalent among female mice.  Furthermore, females also experienced an increased sensitivity to amphetamine.

"The behavioral deficits we observed are consistent with human studies of children raised without a father," says Dr. Gobbi, who is also a psychiatrist at the MUHC. "These children have been shown to have an increased risk for deviant behavior and in particular, girls have been shown to be at risk for substance abuse. This suggests that these mice are a good model for understanding how these effects arise in humans."

Further studies may uncover a clearer reasoning for such findings.  Is it merely the presence of a male role model?  Could it be that two parents, regardless of gender, have more influence than one?  Could male mice be more sensitive to amphetamine if raised by fathers alone?  Many questions remain for future studies to uncover, however this research demonstrates that the role of the father and/or the presence of both parents during critical stages of growth appear to be relatively important in children's mental health development. 

Dads: How Important Are They? New Research Highlights Value of Fathers in Both Neurobiology and Behavior of Offspring

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Sleep Quality Linked to Alzheimer's Disease

According to a new study published by Johns Hopkins Bloomberg School of Public Health, sleep quality may influence the onset and progression of Alzheimer's disease. Lead author, Adam Spira, PhD, and his team of researchers discovered a link between shorter and/or poor sleep quality and higher levels of Amyloid beta build-up in the brain.

“Amyloid beta is a peptide of 36–43 amino acids that is processed from the amyloid precursor protein (APP). While best known as a component of amyloid plaques in association with Alzheimer's disease, as Aβ is the main component of certain deposits found in the brains of patients with Alzheimer's disease, evidence has been found that Aβ is a highly multifunctional peptide with significant non-pathological activity.” 

Researchers observed self-reported sleep habits and β-Amyloid deposits of adults from the neuro-imaging sub-study of the Baltimore Longitudinal Study of Aging where the average participant age was 76 years. Subjects reported sleep that ranged from more than 7 hours to no more than 5 hours. Using the Pittsburgh compound B tracer and PET scans of the brain to determine the amount of β-Amyloid in the brain, researchers noted that shorter sleep duration and lower sleep quality were both associated with greater amounts of β-Amyloid deposits.

Even though no causal link has been established, if sleep habits do in fact have such an impact, researchers suggest that these findings could potentially slow the progression of Alzheimer’s simply by promoting and maintaining healthy sleep patterns. Furthermore, as this is not the first study to link sleep and Alzheimer’s disease, more research with objective sleep measures could determine whether poor sleep actually contributes to or accelerates Alzheimer's disease.

“Results could have significant public health implications as Alzheimer's disease is the most common cause of dementia, and approximately half of older adults have insomnia symptoms."

Alzheimer's disease is a type of dementia that causes problems with memory, thinking and behaviour. It is most common in people over 65 years of age; however up to 5% of people develop early-onset in their 40s or 50s. The most common early symptom of Alzheimer's is difficulty remembering newly learned information as changes in the part of the brain associated with learning is often the first to be affected. Eventually these individuals will experience symptoms, including disorientation, mood and behaviour changes; more serious confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more severe memory loss and behaviour changes; followed by difficulty speaking, swallowing and walking.

Shorter Sleep Duration, Poorer Sleep Quality Linked to Alzheimer ’s Disease
Beta amyloid
Alz.org

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Childhood Disability Rates Rising For The Past 10 Years

A recent study shows a rise among children with disabilities over the past 10 years. The same study also revealed that disabilities relating to physical health conditions have decreased, while disabilities relating to neurodevelopment and mental health have increased dramatically. In addition, the most significant increase has occurred among children from higher-income families.

Lead author Amy J. Houtrow, MD, PhD, MPH, chief, Division of Pediatric Rehabilitation Medicine at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center and associate professor of physical medicine and rehabilitation and pediatrics at University of Pittsburgh School of Medicine admits that previous studies have already demonstrated that the prevalence of childhood disability is on the rise. "Nearly 6 million kids had a disability in 2009-2010 -- almost 1 million more than in 2001-2002" says Houtrow.

Results were derived from the analysis of data gathered from 102,468 parents of children ages 0-17 years of age that participated in the National Health Interview Survey conducted by the Centers for Disease Control and Prevention in 2001-2002 and survey data from 2009-2010.

The surveys questioned parents on whether their child…

• had any limitations in play or activity
• received special education services
• needed help with personal care
• had difficulty walking without equipment
• had difficulty with memory
• had any other limitation

If parents responded yes to any of the preceding questions, the surveys questioned whether their child's limitations were due to…

• a vision or hearing problem
• an asthma or breathing problem
• a joint, bone or muscle problem
• an intellectual deficit or mental retardation
• an emotional or behavioral problem
• epilepsy
• a learning disability
• a speech problem
• attention-deficit/hyperactivity disorder
• a birth defect
• an injury
• some other developmental problem

Meanwhile, researchers classified conditions into three groups:

1. Physical
2. neurodevelopmental/mental health
3. other

Their research uncovered that “the prevalence of disability increased by 16.3% from 2001-2002 to 2009-2010”. In particular, the neurodevelopmental and mental health-related disabilities increased while those disabilities resulting from physical conditions had decreased over the decade. Remarkably, the increase was most significant among children less than 6 years of age, as their rate of neurodevelopmental disabilities nearly doubled over the decade.

Furthermore, results demonstrated higher rates of disabilities among children living in poverty over the entire period of study without any real increase; however the highest rate of growth was identified among children living in higher income households (i.e. household incomes at or above 300% of the federal poverty level or $66,000 a year for a family of four).

Unfortunately, Dr. Houtrow states: "the survey did not break out autism, but we suspect that some of the increase in neurodevelopmental disabilities is due to the rising incidence or recognition of autism spectrum disorders".

Evidently this study has put a broader perspective on an area in desperate need of research. The study leaves the several unanswered questions. Why are rates of disabilities rising among children? What could these demographics really mean? Could it be that children living in poverty are simply being undiagnosed? Could it be that affluent families are more persistent in obtaining a diagnosis? Could there be other reasons or factors yet to be revealed?

Childhood Disability Rate Jumps 16 Percent Over Past Decade

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Cyberbullying Continues To Rise

Research shows that about 5 out of every 30 high school students report being victims of cyberbullying within the past year. In addition, roughly 10 of those 30 students spend about three or more hours per day playing video games or using a computer for other purposes than school work.

These numbers arise from the analysis of data gathered from the 2011 Youth Risk Behavior Survey, conducted by the Centers for Disease Control and Prevention, where 81% of schools and 87% of students from the 15,425 public and private high schools responded. The survey represents a national sample of high school students and takes place every two years “to monitor six types of health-risk behaviors that contribute to the leading causes of death, disability and social problems among U.S. youths”.

"Electronic bullying of high school students threatens the self-esteem, emotional well-being and social standing of youth at a very vulnerable stage of their development," said study author Andrew Adesman, MD, FAAP, chief of Developmental and Behavioral Pediatrics at Cohen Children's Medical Center of New York. "Although teenagers generally embrace being connected to the Web and each other 24/7, we must recognize that these new technologies carry with them the potential to traumatize youth in new and different ways."

In 2011, the Centers for Disease Control and Prevention surveyed students about whether they had been bullied in the past 12 months either through email, chat rooms, instant messaging, websites and/or texting. In addition, students were questioned on the number of hours they spent playing video games or using a computer for any other purpose than school work.

Results showed that 1 in 6 high school students or 16.2% reported being a victim of electronic bullying within the past 12 months. More specifically, results revealed that 22.1% of girls reported being bullied electronically while only 10.8% of boys reported being victims of electronic bullying, making girls more than twice as likely to report being victims of cyberbullying. In addition, “whites reported being the victim of cyberbullying more than twice as frequently as blacks”.

Furthermore, thirty-one percent of high school students reported playing video games or using a computer for something other than school work for 3 or more hours each day. Interestingly, boys (35.3%) were more likely than girls (26.6%) to report playing video games for more than three hours per day.

"Electronic bullying is a very real yet silent danger that may be traumatizing children and teens without parental knowledge and has the potential to lead to devastating consequences," said principal investigator Karen Ginsburg, also at Cohen Children's Medical Center of New York. "By identifying groups at higher risk for electronic bullying, it is hoped that targeted awareness and prevention strategies can be put in place."

Unfortunately, cyberbullying will only become more and more common in society, especially teens, as technology continues to advance. More research should help to spread awareness and develop legislation that may succeed in decreasing the number of victims of cyberbullying, thereby reducing the rising number of extreme cases that often result in fatalities.

Cyberbullying Rampant Among High School Students: Nearly One-Third of Youths Also Report Playing Video/Computer Games for More Than 3 Hours a Day

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