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.

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

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.

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Q&A Session at HealthTap.com

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

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Q&A Session at HealthTap.com

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

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Q&A Session at HealthTap.com

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

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Q&A Session at HealthTap.com

How does Alzheimer's disease start?

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Q&A Session at HealthTap.com

Can the Jamaica flower prevent Alzheimer's?

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Q&A Session at HealthTap.com

How does dementia affect someone's overall health?

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Q&A Session at HealthTap.com

How does dementia affect someone's physical health?

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Q&A Session at HealthTap.com

How does dementia affect someone's mental health?

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Q&A Session at HealthTap.com

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

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Q&A Session at HealthTap.com

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

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

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

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Glucose Control vs Memory: When Good Enough Isn't

Don't ask me why or how but I must've stumbled upon a treasure trove dementia related studies recently, not unlike the blind squirrel finding the occasional nut.  In any case, I want to offer you an analogy to explain my philosophy towards health care.  When I was in grade school, then high school, and then college, the typical grading system went something like this: F = failure, D = low pass, C = average, B = high pass & A = honors.  Or something like that.  In other words, if all you wanted to do was pass, you could get by with a D grade.  After all, that D grade was good enough to move you on to the next grade or even towards graduation.  But for some of us, good enough just wasn't good enough.  If we wanted to become a doctor, we needed to get straight A's in college which meant straight A's in high school, etc.  Even a B grade wasn't good enough.

So think about Hemoglobin A1c, the running 3 month measure of sugar control.  I liken it to your average trip speed on a long drive whereby you speed up & slow down & speed up again, perhaps coming to a complete stop due to traffic, stop lights or stop signs.  Glucose, whether random or fasting, is represented in this scenario by your speedometer which tells you how fast you're going at that precise moment in time that you glance at it.  However, that very same speedometer tells you nothing about how fast you were going a minute ago, 5 minutes ago, 30 minutes ago, an hour ago, etc.  

Well, back in the day, "normal" A1c was any value less than 6.  Well controlled for a diabetic was 6-7 while poorly controlled diabetics had values greater than 7.  A few years ago, we tightened our perspective and declared normal as less than 5.6.  At risk for diabetes (also known as pre-diabetes) is now 5.7 to 6.4.  And greater than 6.4 is now considered consistent w/diabetes.  Notice the semantics as well as the reference ranges (which will vary slightly depending upon your lab).

With all this in mind, a cross-sectional study was published early online last week prior to print next month in Neurology in which the authors concluded that lower A1c within the normal reference range was associated w/better memory & larger hippocampal volume, a structure linked to Alzheimer's disease risk.  Now, before you go out and ask your doctor for insulin to lower your sugars, notice that this conclusion is based upon 141 participants, half of whom were women, average age 63yo.  This study says nothing about what happens if you lower your blood sugar.  It's not a double-blind, placebo-controlled, randomized trial.  Instead, the authors compared various domains of memory & cognition to A1c, blood glucose, insulin and magnetic resonance imaging scans.  Even in those without diabetes or impaired glucose tolerance, lower A1c was linked to better delayed recall, learning ability & memory performance.  Think about that before you take that next bite of food.

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

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.

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

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.

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Q&A Session at HealthTap.com

Can diabetic medicines cause memory lose?

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Mirror, Mirror, On the Wall . . . Part 3

Knowledge without action is futile.  Abu Bakr

Do you really want to know your future?  But if you now acted upon that knowledge in a manner in which you would not have, had you not known your future, haven't you just altered your future?  It's a bit of a philosophical conundrum played over & over again in different movies under the guise of time travel.  In it's most common form, the protagonist is warned not to change anything in the past during time travel lest s/he alter the present/future.

But with that said, what if you made use of the information for the better.  Case in point is a study published this week in Lancet Diabetes & Endocrinology in which the authors report having developed & validated a 10 year risk calculator that predicts dementia risk in those with type 2 diabetes.  Using a model derived from microvascular disease, diabetic foot, cerebrovascular disease, cardiovascular disease, acute metabolic events, depression, age & education, the authors were able to predict dementia risk with reasonable accuracy.  Those with the lowest score had only 5.3% risk of developing dementia compared to those with the highest score who had a 73.3% risk.  

My question is this: why go through the trouble of estimating/predicting your risk for developing dementia if you're not going to do anything to lower your risk?  The calculator & prediction model is not immutable.  You're not destined to repeat your errors if you learn from them.  Improve your nutrition.  Get physically active on a regular basis.  Optimize your risk factors as noted above.  Take control of your future.

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Glucose & Slippery Slope Towards Dementia

With many tests, the results aren't always clear cut, black & white. There's often quite a bit of gray in between.  For instance, normal fasting glucose is less than 100mg/dL while diabetes is greater than 125mg/dL on two different occasions.  But what about numbers from 100mg/dL up to 124mg/dL?  They lay in that slippery slope that we now call impaired fasting glucose.  So what.  Why bother to care?

Turns out that in a longitudinal study published last week in the New England Journal of Medicine, the authors concluded that higher average glucose levels were linked to an increase risk of dementia, something that we've known about diabetes for quite some time.  In this particular study, the authors followed for almost 7yrs 2,067 participants who were cognitively intact at baseline.  In those w/diabetes, higher A1c values were linked to as much as 40% greater risk of developing dementia.  In those w/o diabetes, even an average glucose of 115mg/dL was linked to 18% greater risk compared to average glucose of just 100mg/dL.  

Now you have to understand that this study only proves a link.  It doesn't demonstrate cause & effect.  And it definitely doesn't say anything about what might happen if you actively lowered your glucose.  That bit of information will hopefully come out of current/future studies.  In the meantime, I think it's still reasonable to be as aggressive as possible and aim for fasting glucose less than 100mg/dL via healthy nutrition & regular physical activity.  No harm in a healthy lifestyle, right?

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

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.

Follow @alvinblin
Tweet
This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites: