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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Choline Supplements During Pregnancy May Prevent Schizophrenia

Research shows that the use of choline supplements during pregnancy may prevent schizophrenia.  Specifically, lower rates of physiological schizophrenic risk factors in infants 33 days old has been noted when the dietary supplement is given during the second and third trimesters of pregnancy and early infancy.

Robert Freedman, MD, professor and chairman of the Department of Psychiatry, University of Colorado School of Medicine and one of the study's authors states: "Basic research indicates that choline supplementation during pregnancy facilitates cognitive functioning in offspring. Our finding that it ameliorates some of the pathophysiology associated with risk for schizophrenia now requires longer-term follow-up to assess whether it decreases risk for the later development of illness as well."

Choline is a water-soluble essential nutrient, typically grouped within the B-complex vitamins. It can be found naturally in foods such as liver, muscle meats, fish, nuts and eggs.  According to the American Institute of Medicine, pregnant women require between 450 and 3500 milligrams of choline each day and 550 to 3500 milligrams while lactating.  Infants aged 0-6 months need a minimum daily dose of 125 milligrams of choline and 150 milligrams from 7-12 months of age.

“Choline is also being studied for potential benefits in liver disease, including chronic hepatitis and cirrhosis, depression, memory loss, Alzheimer's disease and dementia, and certain types of seizures.”

To test their theory, researchers observed infant responses to a clicking sound.  Typically, the brain responds fully to an initial click, however the response to a second click immediately following the first is inhibited.  This trait is often absent among schizophrenia patients and relates to poor sensory filtering and familial transmission of schizophrenia risk.  Researchers observed this effect among infants to represent the illness as schizophrenia does not normally appear until adolescence.

“Half the healthy pregnant women in this study took 3,600 milligrams of phosphatidylcholine each morning and 2,700 milligrams each evening; the other half took placebo. After delivery, their infants received 100 milligrams of phosphatidylcholine per day or placebo. Eighty-six percent of infants exposed to pre- and postnatal choline supplementation, compared to 43% of unexposed infants, inhibited the response to repeated sounds, as measured with EEG sensors placed on the baby's head during sleep.”

These results could not only assist in early detection of schizophrenia, but may even help in preventing the illness or developing more effective treatments.

Some examples of choline found in different food sources:

Type of Food	mg of choline
5 ounces (142 g) raw beef liver	473
Large hardboiled egg	113
Half a pound (227 g) cod fish	190
Half a pound of chicken	150
Quart of milk, 1% fat	173
A gram soy lecithin	30
100 grams of Soybeans dry	116
A pound (454 grams) of cauliflower	177
A pound of spinach	113
A cup of wheat germ	202
Two cups (0.47 liters) firm tofu	142
Two cups of cooked kidney beans	108
A cup of uncooked quinoa	119
A cup of uncooked amaranth	135
A grapefruit	19
Three cups (710 cc) cooked brown rice	54
A cup (146 g) of peanuts	77
A cup (143 g) of almonds	74

Choline Supplementation DuringPregnancy Presents a New Approach to Schizophrenia Prevention
Choline

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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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Early Emotional Neglect May Predict Strokes

New research conducted by the Rush Alzheimer's Disease Center at Rush University Medical Center suggests that emotionally neglected children are at risk of stroke as adults. 

"Studies have shown that children who were neglected emotionally in childhood are at an increased risk of a slew of psychiatric disorders. However, our study is one of few that looked at an association between emotional neglect and stroke," said study author Robert S. Wilson, PhD, a neuropsychologist at Rush.

Researchers’ selected 1,040 participants aged 55+ without dementia from the Memory and Aging Project were surveyed on physical and emotional abuse before the age of 18. Participants were questioned on such areas as how much love they felt from their parents or caregivers as children, whether they felt afraid or intimidated by their caregivers, the method of physical punishment suffered and other questions relating to divorce and family finances.

The participants were followed over a period of 3.5 years. In that time, 257 participants had died. Of the deceased participants, only 192 had brain autopsies, which revealed that 89 of them had experienced strokes. Furthermore, forty of the participants were said to have had strokes based on medical history or an examination.

Furthermore, participants that expressed moderately high levels of emotional neglect in childhood were nearly 3 times more likely to experience a stroke than those reporting moderately low levels of emotional childhood neglect, even when other factors such as diabetes, physical activity, smoking, anxiety and heart problems were controlled.

"The results add to a growing body of evidence suggesting that early life factors such as traumatic childhood experiences influence the development of physical illness and common chronic conditions of old age" says Dr. David A. Bennett, director of the Rush Alzheimer's Disease Center and co-author of the study

Of course results may not be completely reliable since this study relies on a self-report of recalled events many years later, which may be even further clouded given the nature of the potentially traumatic memories.

Emotional Neglect in Children Linked to Increased Stroke Risk Later in Life

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