Commonly prescribed medications could almost double dementia risk

Researchersrecently conduced a study to explore the link between a certain class of drugs and the memory loss condition. 

To do so, they used QResearch, a large database of anonymized health records, to examine nearly 285,000 adults in the U.K., aged 55 and older, between 2004 and 2016. 

The team then reviewed each subject's prescription records to determine their exposure to anticholinergics, which can include antidepressants, bladder antimuscarinics, antipsychotics and antiepileptic drugs.

After analyzing the results, they found those on anticholinergic medications had almost a 50% increased chance of developing dementia, compared to those who didn’t have prescriptions for anticholinergic drugs. The risk was only associated with 1,095 daily doses within a 10-year period, which is equivalent to an older adult taking a strong anticholinergic medication daily for at least three years.

“The study is important because it strengthens a growing body of evidence showing that strong anticholinergic drugs have long term associations with dementia risk,” coauthor said. “It also highlights which types of anticholinergic drugs have the strongest associations. This is important information for physicians to know when considering whether to prescribe these drugs.”

Although the authors said “no firm conclusions can be drawn about whether these anticholinergic drugs cause dementia,” they hope their findings can help professionals better understand the disease. They also advised patients to not stop taking their medications until consulting with their doctor.

As for antihistamines, skeletal muscle relaxants, gastrointestinal antispasmodics, anti-arrhythmics, or antimuscarinic bronchodilators, the scientists noted there were no significant dementia risks associated with them.

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Is it major depression or bipolar disorder?

People suffering from bipolar disorder swing between emotional highs (manic episodes) and severe depression. Perhaps not surprisingly, they're often mistakenly diagnosed as simply having major depression, which actually requires a different treatment. According to a new study, however, the two conditions can be told apart by monitoring the patient's heartbeat.

When treating a bipolar patient's depression, an antidepressant is typically prescribed along with a mood stabilizer or anti-psychotic drug, the latter keeping the antidepressant from triggering a manic episode. This is why it's important to be able to differentiate between bipolar disorder and major depression.

To that end, the team studied 64 adult test subjects with major depression, and 37 with bipolar disorder. All 101 of them initially underwent 15-minute-long electrocardiograms, which were subsequently analyzed using special software.

It was discovered that the subjects with major depression all had a higher respiratory sinus arrhythmia – which is a type of heart rate variability – than those with bipolar disorder. That said, further research is required in order to confirm the findings.

"Having a noninvasive, easy-to-use and affordable test to differentiate between major depression and bipolar disorder would be a major breakthrough in both psychiatric and primary care practices," says the Dr. who led the study.

THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.   

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Kids With ADHD, Aggression May Benefit From 2nd Med

Children with attention-deficit/hyperactivity disorder (ADHD) who also are extremely aggressive might benefit from taking an antipsychotic drug along with their stimulant medication, a new study suggests.

Prescribing powerful antipsychotic medications to children with behavioral problems is controversial. Little is known about the long-term safety of these medications, which are approved by the U.S. Food and Drug Administration to treat severe mental illnesses such as schizophrenia and bipolar disorder. And previous studies have provided little evidence to support the idea that they help quell youngsters' violent outbursts.

But the new study, which was published online in the January issue of the Journal of the American Academy of Child and Adolescent Psychiatry, suggests there might be some merit to the idea, at least for severely troubled kids.

The study looked at a subset of children with ADHD who also are physically violent, meaning they're either destructive or aggressive toward themselves or others, the researchers said.

"The children who participated in this trial had far more significant behavioral issues than the typical child with ADHD alone," said study author Michael Aman, director of clinical trials at Ohio State University's Nisonger Center.

"These are children who are really in conflict with their communities and their families," Aman said. "They seem to be in a spiral they can't get out of."

The 168 children in the study were between 6 and 12 years old with a diagnosis of ADHD and oppositional-defiant disorder or conduct disorder. All had displayed recent episodes of serious physical aggression in which they destroyed property or, at a minimum, left bruises on themselves or others.

All were started on a stimulant medication -- typically long-acting methylphenidate (sold under the brand name Concerta), which is a common treatment for ADHD. Their parents got special training in how to manage impulsive behaviors.

After three weeks, those who had not been helped enough by the basic measures were allowed to start a second medication, which was assigned at the start of the study. Sixty-one kids who started the second medication took the antipsychotic risperidone (Risperdal) for six more weeks, while 69 children continued basic treatment and got an added placebo pill.

After nine weeks, children who took Risperdal in addition to their stimulant medication saw modest but significant improvements in behavior compared to those who continued on the stimulant by itself.

"I don't think it's a grand slam, but I do think it indicates that there is some justification for what doctors have begun to do, which is to combine treatment," Aman said.

Aman said the average improvement on Risperdal was moderate. "Buried in that moderate are kids who did much better, kids who did somewhat better and some kids who didn't do better at all," he said.

Aman said scientists really need to look more closely to understand why some children had big improvements with the addition of Risperdal while others got no further help.

In some cases, Risperdal seemed to cancel some of the most bothersome side effects of the stimulants, including loss of appetite and trouble falling asleep.

But Aman cautioned that antipsychotics must always be prescribed with great care since they cause weight gain and increase the risk for type 2 diabetes.

The study was sponsored by a grant from the U.S. National Institute of Mental Health.

About half of children with ADHD who are referred for psychiatric help have behavioral disorders as well as ADHD, according to the U.S. Centers for Disease Control and Prevention.

An expert who was not involved in the research praised the study and said it would help doctors sort out what is often a tricky treatment decision.

In kids with ADHD and aggressive behaviour, "recent guidelines say you should try to treat the ADHD first," said Joseph Blader, an associate professor at the University of Texas Health Science Center at San Antonio. "Then the issue is, how long do you spend doing that if the child is having these explosions, these meltdowns, potentially hurting people, on the threshold of getting kicked out of school? Two weeks? Three weeks?"

Blader said that, because so many of the kids in the study's placebo group continued to improve on the stimulant medication alone, doctors might be justified in waiting a few more weeks to see if the aggression improves along with the ADHD.

"I think this study shows that you get a lot of bang for your buck with stimulants and parent training," he said. "Unless it's a very extreme situation, it's optimal to let those play out [before trying a second medication]."

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SURPRISING REASONS FOR WEIGHT GAIN

What's With the Weight Gain?
If you started taking in more calories than usual or cutting back on exercise, you wouldn't be surprised if the numbers on the scale crept higher. But what if you're doing everything the same as you always do and your weight still goes up? It's time to delve a little deeper into what else might be going on.

Lack of Sleep
There are two issues at work with sleep and weight gain. The first is intuitive: If you're up late, the odds are greater that you're doing some late-night snacking, which will increase your calorie intake. The other reason involves what's going on biochemically when you're sleep deprived. Changes in hormone levels increase hunger and appetite and also make you feel not as full after eating.

Stress
When life's demands get too intense, our bodies go into survival mode: Cortisol, the "stress hormone," is secreted, which causes an increase in appetite. And then of course, we may reach for high-calorie comfort foods in times of stress as well. This combination is a perfect breeding ground for weight gain.

Antidepressants
An unfortunate side effect from some antidepressants is weight gain. Talk to your doctor about making changes to your treatment plan if you think your antidepressant is causing weight gain. But never stop or change your medication on your own. Realize that some people experience weight gain after beginning drug treatment simply because they're feeling better, which leads to a better appetite. Also, depression itself can cause changes in weight.

Steroids
Anti-inflammatory steroid medications like prednisone are notorious for causing weight gain. Fluid retention and increased appetite are the main reasons. Although weight gain is common, the severity of this side effect depends on the strength of the dose and length of time on the drug. Some people may also see a temporary redistribution of fat while taking the drug -- to places like the face, back of the neck, or the abdomen.

Drugs That May Cause Weight Gain
Several other prescription drugs have been associated with weight gain. The list includes antipsychotic drugs (used to treat mood disorders like schizophrenia and bipolar disorders), along with medications to treat migraines, seizures, high blood pressure, and diabetes. Work with your doctor to find a medication that treats your symptoms without disrupting side effects.

Don't Jump to Blame the Pill
Contrary to popular belief, there is lack of evidence that combination birth control pills (estrogen and progestin) cause lasting weight gain. It is thought that some women taking the combination pill may experience some weight gain related to fluid retention, but this is usually short-term. If you're still concerned about possible weight gain, talk to your healthcare provider.

Hypothyroidism
If your thyroid (the butterfly-shaped gland in the front of your neck) is not making enough thyroid hormone, you're probably feeling tired, weak, cold, and gaining weight. Without enough thyroid hormone, the metabolism slows, making weight gain more likely. Even a thyroid functioning at the lower end of the normal range might cause weight gain. Treating hypothyroidism with medication may reverse some of the weight gain.

Don't Blame Menopause
Most women do gain some weight around the time of menopause, but hormones probably aren't the only cause. Aging slows the metabolism, so you burn fewer calories, and changes in lifestyle (such as exercising less) play a role. But where you gain weight also may be related to menopause, with fat accumulating around your waist, not your hips and thighs.

Cushing's Syndrome
Weight gain is a common symptom of Cushing's syndrome, a condition in which you are exposed to too much of the hormone cortisol, which in turn causes weight gain and other abnormalities. Cushing's syndrome can occur if you take steroids for asthma, arthritis, or lupus. It can also occur when your adrenal glands produce too much of the hormone, or be related to a tumor. The weight gain may be most prominent around the face, neck or upper back, or waist.

Polycystic Ovary Syndrome (PCOS)
PCOS is a common hormonal problem in women of childbearing age. Most women with PCOS grow many small cysts on their ovaries. The condition leads to hormone imbalances that affect a woman's menstrual cycle and can lead to excessive body hair and acne. Women with this condition are resistant to insulin, which may cause weight gain. The weight tends to collect around the abdomen, putting these women at greater risk for heart disease.

Quitting Smoking
On average, people who stop smoking gain less than 10 pounds. Why? Because without nicotine you may:
Feel hungrier and eat more (this feeling should go away after several weeks)
Experience a decrease in your metabolism, without reducing your calorie intake
Find food tastes better, which may lead to overeating
Eat more high-fat, high-sugar snacks and drink more alcohol

Rule 1: If You Do Gain Weight ...
Don't stop taking any medications without first consulting your doctor. Recognize the importance of the drug you're taking. It may be critical to your health.

Rule 2: If You Do Gain Weight ...
Don't compare yourself to other people taking the same drug. Not all people experience the same side effects on the same drug. Even if one drug caused someone else to lose weight, the same might not be true for you. Consult your doctor.

Rule 3: If You Do Gain Weight ...
Don't freak out if the weight gain is just from water retention, which is not permanent weight or fat. Once you've finished taking the drug or gotten the medical condition under control, the puffiness from fluid retention may subside. Stick to a lower-sodium diet in the meantime.

Rule 4: If You Do Gain Weight ...
Check with your doctor about another drug you can take. In many cases, your doctor can switch you to another medication that might not have the same side effects.

Rule 5: If You Do Gain Weight ...
Learn if the weight gain is from a decrease in metabolism -- from either a medical condition or medication. And if so, take the time to participate in metabolism-raising activities. Get moving!

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Many Risk Factors for Early Dementia Can Show Up in Teens

 The researchers have identified nine risk factors -- many occurring during a person's teens -- that are tied to early onset dementia.

The good news is that several of these symptoms and behaviours can be prevented or treated, experts noted.

Early onset (or young-onset) dementia occurs before the age of 65. Alcohol abuse was the most important risk factor found in the study, said lead researcher. "In contrast, the influence of hereditary factors, that is dementia in the parents, was very small."

For the study, the group collected data on men drafted into the military from mid-1969 through 1979. They were about 18 years old when they were drafted.

During the follow-up period of roughly 37 years, 487 men developed young-onset dementia at an average age of 54, the researchers found.

The risk factors identified "were multiplicative, most were potentially modifiable and could be traced to adolescence, suggesting excellent opportunities for early prevention," said the Dr.

Alcohol intoxication, stroke, use of antipsychotic drugs, depression, drug abuse, a father with dementia, poor mental function as a teen, being short and having high blood pressure were the risk factors they found.

Taken together, these accounted for 68 percent of the cases of young-onset dementia, the researchers said. Men with at least two risk factors and in the lowest third of overall mental ability had a 20-fold increased risk.

"Young-onset dementia, before age 65, is a devastating condition for patients and their families," said the Dr. 

One priority for young-onset dementia is research that identifies ways to prevent it, she said. Another is to improve care and access to long-term services for adults who are diagnosed with dementia before 65.

"This is urgent because adults with young-onset dementia and their families really need our help," she said. "More Americans may develop young-onset dementia because of increases in traumatic brain injury among young veterans and stroke among young African-Americans and middle-aged adults."

Dr.  for Cognitive Health , said the new study is "extraordinary and deserves attention by others studying adolescent populations to see whether this experience can be confirmed elsewhere and independently.

"I always prefer to see replication of data -- especially 'game-changing' data like these -- before I sound any alarm, but given the treatability of these risks, I would say that these observations should prompt aggressive attention by physicians with access to adolescents," he said.

Dementia affects an estimated 35 million people worldwide and is expected to rise sharply by 2050, according to study background information.

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