My 2 Cents: Alzheimer's

Showing posts with label Alzheimer's. Show all posts

Showing posts with label Alzheimer's. Show all posts

Sunday, March 18, 2018

AAFP Geriatric Medicine July 18th-21st, 2018 in Charleston, SC

Featuring the latest evidence-based, in-depth information on family medicine topics, AAFP live courses make it convenient to learn and refresh your knowledge. Connect with your colleagues and experts, and improve patient care—all in just a few days.

Register for the AAFP’s Geriatric Medicine live course, July 18–21 in Charleston, SC.

More than 10,000 baby boomers turn 65 every day. As this generation ages,

the geriatric patient population will surge, and the need for care will continue

to rise. Gain clinical knowledge related to geriatric medicine you can directly apply to your practice.

At the end of this course, you will be able to:

· Improve adherence to evidence-based clinical guidelines in practice.

· Construct evidence-based strategies to diagnose, treat and manage common

·clinical conditions seen among the geriatric population.

· Demonstrate ability to communicate effectively with the patient to ensure

·that diagnosis and treatment recommendations are understood.

· Recognize when to refer to, or consult with, other specialists to provide

optimal patient care.

Earn up to 25.5 AAFP Prescribed credits—19.5 credits for attending the course and another 6 for participating in optional workshops (additional fees apply).

AAFP members: $895/Nonmembers: $1,195

Save $100 when you register by June 18. Register now or call (800) 274-2237.

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Monday, September 5, 2016

Alzheimer's Research & Me On TV!

You wouldn't know it by my lack of posting these last 6mo or so, but I do try to keep up-to-date w/medical literature. However, I've been using other means of getting my thoughts out for the masses, such as Facebook, LinkedIn & Twitter. In any case, some colleagues recently told me about a cure for Alzheimer's disease. Of course, I was intrigued b/c none of my usual sources had mentioned anything. It turns out they had, in turn, heard about it from their sources, Dementia Today, Telegraph & Time. So I went to the horse's mouth, Nature.

But is it the cure for which we've been searching, akin to the Holy Grail? In a word, no, I'm afraid. Yes, this drug does help support the beta amyloid theory as causing Alzheimer's disease but we're far from a cure as the monthly intravenous drug was studied in just 165 people w/mild cognitive impairment or mild dementia for just one year, so it's nowhere near ready for prime time, much less enough studies to determine appropriate dose & potential side effects.

So what's the big deal? Well, this research did get me an interview this Labor Day weekend w/Ms. Kyndell Nunley, a wonderful reporter w/KSNV 3 at Aegis of Las Vegas, where I serve as Medical Director. However, due to the usual issue of lots of worthy stories all vying for air time, much of my discussion was left on the cutting room floor. Let me know if you think I should insist on them shooting from my right side next time! And you'd think I'd be a bit smoother in my delivery after all these years of speaking from the podium, often w/cameras running to record for video CME, but it's not the same when the camera is right THERE in your face!

Bottom line, there's hope for the future but nothing new available right now. So continue to do what you can to protect your heart b/c that's the best way we know to protect your brain, too.

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Tuesday, April 7, 2015

Q&A Session at HealthTap.com

How can I find a great alzheimer's disease doctor?

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Q&A Session at HealthTap.com

Need expert help here. What are legitimate symptoms of alzheimers?

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Q&A Session at HealthTap.com

Which is most effective in slowing down Alzheimer's: aricept, exelon, or reminyl?

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Q&A Session at HealthTap.com

How does Alzheimer's disease start?

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Q&A Session at HealthTap.com

Can the Jamaica flower prevent Alzheimer's?

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Tuesday, March 31, 2015

Q&A Session at HealthTap.com

How does dementia affect someone's overall health?

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Q&A Session at HealthTap.com

How does dementia affect someone's physical health?

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Q&A Session at HealthTap.com

How does dementia affect someone's mental health?

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Q&A Session at HealthTap.com

What is the difference between Alzheimer's and dementia with Lewy bodies?

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Q&A Session at HealthTap.com

What are the differences in symptoms for Alzheimer's and dementia?

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Saturday, November 2, 2013

Q&A Session at HealthTap.com

Is it possible I have Alzheimer's? I'm about to turn 19, memory is fogged, feel pressure and sensations in head, no concept of time. No sleep,scared

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Monday, October 28, 2013

Fluke or Trend: Blood Pressure Lowering Medications vs Alzheimer's Disease

Just 3 days ago, I pointed out a study published in Neurology in which the authors concluded that beta blockers lowered one's risk for loss of cognitive function but that angiotensin converting enzyme (ACE) inhibitors, calcium channel blockers, diuretics & vasodilators did not. Ironically, in that very same issue, a secondary longitudinal data analysis of the Ginkgo Evaluation of Memory Study was published in which the authors concluded that ACE inhibitors, angiotensin II receptor blockers (ARBs) & diuretics reduced risk for Alzheimer's disease.

To arrive at their conclusion, the authors reviewed over 6 years worth of data for 1,928 adults w/normal cognitive function, who were older than 75yo at study entry. Some benefit was noted w/calcium channel blockers and even beta blockers, too, but w/o statistical significance. Ironic, isn't it then, that last week's study suggested benefit from beta blockers but not ACE inhibitors.

So what are we to make of this quandary & contradictory evidence. First, let's recall that science is never that clear cut & transparent. Second, in the big scheme of things, 5-6 year studies of 800-1900 participants is neither long nor large enough. Third, observational studies such as these are useful for developing hypotheses but not for proving cause & effect. But with all that said, I can't think of a single reason (aside from anaphylactic allergy) not to lower one's blood pressure and pray for secondary benefit, even as we wait for more definitive proof.

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Friday, October 25, 2013

Fluke or Trend: Beta Blockers vs Alzheimer's Disease

Back in August, I wrote about the possible link between centrally acting angiotensin-converting enzyme (ACE) inhibitors and risk for dementia. Which of course raises the question about the existence of a link between non-centrally acting ACE inhibitors and dementia risk. Then you could expand to ask whether the cousin class, angiotensin II receptor blockers (ARBs), show any benefit, after which you could apply the same query to other medications. Judging by the title to this post, I would like to direct your attention to a prospective, community-based cohort study published last month in Neurology in which the authors linked beta blocker use to a lower risk of developing cognitive impairment.

To arrive at their conclusion, the authors followed for close to 6 years 854 men average 77yo at study entry to the Honolulu-Asia Aging Study. All participants had hypertension but were without dementia or any cognitive impairment at baseline. Those who were taking beta blockers had a 31% lower risk of developing cognitive impairment compared to those who didn't take any blood pressure medication. So perhaps the benefit was due to lowering of hypertensive blood pressure? However, in contradiction to previous studies, use of ACE inhibitors alone was not linked to benefit, nor were diuretics, calcium channel blockers, or vasodilators.

Two steps forward, one step back, right? Was this study a fluke or a trend? You decide after reviewing the earlier studies. But more importantly, does this study apply to you? Perhaps if you're an elder male of Japanese heritage as were these participants. On the other hand, you might take a look at the bigger picture, which is that blood pressure lowering in general appears to be a good thing.

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Thursday, August 1, 2013

Fluke or Trend: ACE Inhibitors vs Alzheimer's Disease

ACE inhibitors & ARBs are two major classes of blood pressure lowering medications, related to each other like cousins. The former runs a slight risk of causing a dry ticklish cough. Otherwise, one or the other are often used to protect one's kidneys & heart, in addition to lowering blood pressure. Just under a year ago, another study was published linking the use of ARBs to lower rates of brain pathology consistent with that most common cause of dementia. But as I noted in my post, there have been several studies suggesting that ARBs are beneficial when it comes to dementia.

Interestingly enough, a longitudinal prospective population-based study was published 4 years ago in JAMA Internal Medicine looking at the effect of ACE inhibitors with regards to Alzheimer's disease. Taken as a whole, there was no link. But if you looked at just the centrally acting ACE inhibitors, their use was linked to a lower rate of cognitive decline, more so than when compared to noncentrally acting ACE inhibitors. Which brings me to an observational case-control study published last week/month in BMJ Open in which centrally acting ACE inhibitors were linked to improvement in cognition & reduction in cognitive decline. The authors made their conclusion after following for six months 361 patients w/Alzheimer's disease, of whom 85 received a centrally acting ACE inhibitor while 276 did not.

So if you need to take blood pressure medication(s), one of which is an ACE inhibitor, I'm sure you're curious which ones cross the blood-brain barrier: captopril, fosinopril, lisinopril, perindopril, ramipril & trandolapril. On the other hand, benazepril, enalapril, moexipril & quinapril do not. The good news for you & me is that captopril & lisinopril are available for $4/mo at WalMart and its competitors.

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Tuesday, June 11, 2013

Spaghetti on the Wall: Alzheimer's Disease, Heart Attacks & Death

Throw spaghetti on the wall and see if it sticks. The idea is to try some (random) ideas and see which one works. In one sense, you can look at observational studies as just that, throwing spaghetti on the wall, especially when a trial is published with a new association, heretofore unknown. Of course, you follow up that first strand of spaghetti with another, and perhaps even a few more for good measure, just to make sure you're looking at a trend and not a fluke. But when it comes to research, we need randomized controlled trials to offer proof of cause & effect, no matter how many observational studies are published.

But with all that in mind, I must admit that my curiosity was piqued when I stumbled upon a study published early online last week in the European Heart Journal in which the authors concluded that use of cholinesterase inhibitors (ChEI) in those with Alzheimer's disease (AD) was associated w/lower risk of heart attack & death. I don't know about you, but for me, that came out of left field. The authors followed 7,073 Swedes (avg 79yo) w/AD for an average of 503 days (just over a year & 4mo for those of you who think like I do in those terms).

After taking into account the usual suspects (confounders), the authors noted that those participants w/AD who took a ChEI had a one-third lower risk for heart attack or death compared to those who did not take a ChEI. Similar statistics were noted when ChEI use was compared to heart attacks & deaths in isolation in non-users. More importantly, use of the highest ChEI doses was associated w/lowest risk of heart attack (65% lower) and death (46% lower), again compared to non-users.

So what's this mean for you & me? I dunno! But it's certainly intriguing! And I'm definitely looking forward to that next strand of spaghetti being flung against the wall . . .

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Thursday, May 9, 2013

A Blood Vessel Is A Blood Vessel Is A Blood Vessel Is A Blood Vessel Part 2

Just 2 months ago, I commented on a study linking heart disease to stroke risk. Well, in a cross-sectional study published early online last week prior to print next month in Stroke, the authors concluded that cardiovascular risk was linked to worse cognitive function. What's surprising in this analysis of data from 3,778 participants 35-82yo w/avg 54yo w/o baseline heart disease or stroke that this association was found as early or young as in the 35-44yo class.

While we normally think of dementia as a disease of the elderly, it would appear that our heart health is related to our brain health. When you think about this, it makes sense because both the heart and the brain require adequate blood flow, which can be affected by age, gender, diabetes, tobacco use, blood pressure (and use of BP lowering medications), and total & HDL cholesterol. Of these factors, age, diabetes, smoking & HDL cholesterol had the strongest link to cognitive function.

So don't wait for the inevitable. Take charge of your life now. Choose to eat right & get active. Stop smoking. And optimize your sugar, blood pressure & cholesterol. Investing in your health now will pay major dividends later on.

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Thursday, May 2, 2013

Mediterranean Diet vs (Loss of) Memory

It never ceases to amaze me but I keep getting asked which is the best diet. Both patients & physicians want a definitive answer, even those who attended the recent American Academy of Family Physicians' Geriatric Medicine conference held in Santa Ana Pueblo, NM last week. Whether for fat loss, muscle gain, heart disease, diabetes, etc, we're all searching for that elusive best diet. Perhaps it's even scarier that so many different authors have stepped in to fill this void as we're inundated each day with the diet du jour. that claims to be the newest, greatest way to lose fat, gain muscle, prevent heart disease & treat diabetes. And of course, each of the authors claims to have discovered the key to unlocking the secrets of our poor health.

But if you think about it, typically when there are many clamoring for the attention of the same demographic, there usually isn't one best. Take cars, medications, music & movies, for example. Sure, we attempt to name a Car of the Year, and offer both a Grammy award & Oscar, but when it comes to medications, the best one is the one you can afford that will do what you want when administered in a manner & frequency which you can accept with tolerable side effects. Not so easy, right?

Likewise, when it comes to eating habits, we need to take into account cultural, ethnic & religious factors. But what separates diet & medications from cars, music & movies is the evidence available to support one's claim to best. And when it comes to diets, only the Mediterranean diet has continuous, consistent & compelling evidence to support its adoption. Most recently, a randomized controlled trial of the Mediterranean diet was shown to be better than placebo at preventing an initial cardiac event. Of course, we've always had plenty of observational data suggesting benefit from eating in a manner similar to the Mediterranean diet.

The best news is that earlier this week, a prospective, population-based, cohort study was published in Neurology in which the authors concluded that greater adherence to the Mediterranean diet was linked to lower risk of cognitive impairment. They followed 17,478 participants for an avg of 4yrs during which time cognitive status was assessed annually while food frequency was just assessed once at study onset.

And what of those other diets? While they can make any number of miraculous claims, none have peer-reviewed published outcome data to support their capitalistic attempts. So check out the Mediterranean diet and adopt your variation on a theme. No one stands to receive any (financial) gain, just you.

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Saturday, April 20, 2013

Q&A Session at HealthTap.com

All my life been disoriented in buildings, even familiar ones. Problems retracing steps from bathroom or finding exit, etc. Husband notices. Help?

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