Antipsychotics and older people - new evidence on health risks

There has been much criticism in the past about the overuse of newer, atypical antipsychotic drugs to manage problem behaviour in elderly people with dementia. However, a new study by researchers from Brigham and Women's Hospital in Boston has suggested that alternative drugs may be just as dangerous. The researchers studied 10,900 people who were admitted to nursing homes in British Columbia between 1996 and 2006 and who received a psychotropic drug within 90 days of admission. The study found that people taking conventional antipsychotics, antidepressants and benzodiazepines were at higher risk of death and fractures of the femur. Levels of pneumonia and heart failure did not differ between those taking atypical antipsychotics and those taking other drugs.

NICE issues new Alzheimer's guidelines

The U.K.'s National Institute for Health and Clinical Excellence (NICE) has changed its policy on the Alzheimer's drugs Aricept, Exelon and Reminyl. Previously the drugs could only be prescribed to people with moderate to severe symptoms but they can now be prescribed to people with milder symptoms as well. The drugs cost around £2.80 per day and slow down the progress of the disease helping people put their affairs in order and stay independent for longer. A fourth drug, Ebixa, which was previously only given late in the progression of the disease can also now be prescribed earlier.

You can find out more about this story here.

Atrial fibrillation and dementia risk

Atrial fibrillation is a disturbance in people's heartbeat. It is harmless in itself but can increase the risk of stroke. A new study, by researchers at the University of East Anglia, suggests that those people who have atrial fibrillation after a stroke are at an increased risk of developing dementia. The researchers analysed 15 studies and found that stroke survivors with atrial fibrillation were 2.4 times as likely to develop dementia. Blood-thinning drugs and medication to slow people's irregular heartbeats are often prescribed to reduce the risk of further strokes and this study shows that they could reduce the incidence of dementia as well.

Alzheimer's decline could start much earlier

People with Alzheimer's disease could start going downhill years before they develop the condition. Researchers from the Rush Alzheimer's Disease Center in Chicago studied 2,071 older adults who were all free of dementia at the beginning of the study. Over the course of the study the participants were tested on working memory, perceptual speed and visuo-spatial ability. Over 16 years 462 people developed Alzheimer's disease. The researchers found that Alzheimer's disease was preceded by an average of five to six years of cognitive decline during which the rate of cognitive decline accelerated more than 15-fold. Mild cognitive impairment - the precursor to Alzheimer's disease - was also preceded by about six years of cognitive decline.

U.S. report reveals huge Alzheimer's burden

The 2011 annual report of the U.S. Alzheimer's Association has revealed the huge burden of the condition. It is estimated that 5.4 million people in the U.S. suffer from Alzheimer's - about one in eight senior citizens. Nearly 15 million people in the U.S. look after someone with Alzheimer's disease amounting to 17 billion hours of unpaid care worth more than $202bn. More than 60% of caregivers said they were stressed and more than a third said they were depressed. The $202bn in unpaid care comes on top of around $183bn of formal care from healthcare workers, hospitals and nursing homes, up $11bn on a year ago.

You can find out more about this story here.

A tiny tipple could stave off dementia

Moderate drinking - a glass of wine, or a pint of beer a day - could cut dementia risk by almost a third. Researchers from the Central Institute of Mental Health in Mannheim in Germany studied 3,200 people over three years. The participants were all over 75 at the start of the study and none of them had symptoms of dementia, although 217 developed the condition as the study went on. Those participants who drank between two or three units of alchohol a day were 29% less likely to develop dementia than those who were teetotal. However, drinking only protected against Alzheimer's disease not vascular dementia or cognitive decline and prolonged heavy drinking is associated with about one in 10 cases of dementia.

Alzheimer's. More risk on the mother's side?

Alzheimer's disease is known to have a hereditary element and people with first-degree relatives with the condition are four to 10 times more likely to develop the disease themselves compared to people with no family history of it. Researchers from the University of Kansas School of Medicine studied 53 people aged 60 and over who were followed for two years. 11 had a mother with Alzheimer's disease, 10 had a father with Alzheimer's and 32 had no family history of the condition. The groups took cognitive tests and had brain scans throughout the study. The researchers found that those participants who had a mother with Alzheimer's disease had twice as much grey-matter shrinkage and one-and-a-half times as much whole-brain shrinkage as people whose fathers had had the disease or who had no family history of it.

Deafness and dementia

Losing your hearing could increase your risk of developing dementia. Researchers from Johns Hopkins University in Baltimore studied more than 600 men and women over an average of 12 years and all the participants had a hearing test done at the start of the study. Overall 9% of the participants developed dementia over the course of the study. Those with mild hearing loss had twice the risk of developing dementia, while those with moderate hearing loss had three times the risk. People with severe hearing loss had five times the risk of developing dementia.

Less use of 'chemical cosh' for dementia patients

Elderly people in the U.S. are being prescribed fewer antipsychotics - which can have side effects including an increased risk of stroke, weight gain and diabetes - to manage their behaviour. The change comes after the Food and Drug Administration issued a 'black-box warning' about using the drugs in this way. Researchers from the University of Michigan in Ann Arbor analyzed data on more than 250,000 veterans from the national Veterans Affairs registers. They found that the overall use of antipsychotics in elderly dementia patients fell from nearly 18% in 1999 to 12% in 2007.

Researchers find protein linking Down's syndrome with Alzheimer's

People with Down's syndrome develop Alzheimer's disease much earlier than other people - often in their 30s. Researchers from the University of British Columbia in Canada have been investigating the link between Down's syndrome and Alzheimer's and have found that people with Down's syndrome produce too much of a protein called RCAN1 which sets off a chain reaction which kills neurons in the hippocampus and cortex. People with Down's syndrome have an extra copy of the gene which produces RCAN1 but the researchers also found raised levels of the protein in people with Alzheimer's who did not have Down's syndrome. The researchers thought the raised level of protein in this group could be due to strokes or high blood pressure.

New blood test for Alzheimer's could be new breakthrough

Researchers from the Florida campus of the Scripps Research Institute have developed a new blood test for Alzheimer's disease which could detect the condition much earlier than current methods. The test is based on the body's immune system which produces antibodies in response to proteins on viruses and bacteria and those produced in Alzheimer's disease. The team used 15,000 synthetic proteins as 'bait' to 'fish' for antibodies in blood samples taken from six patients with Alzheimer's disease, six with Parkinson's and six healthy individuals. The test proved successful in this small sample but lots more research is needed before it can be fully established.

Alzheimer's decay could start earlier than thought

Alzheimer's disease is thought to be caused by the build up of tangles, or plaques, of a protein called beta amyloid in the brain. However, researchers from Washington University School of Medicine in St Louis have found that in people who have a genetic variation linked to an increased risk of Alzheimer's disease the brain can start going downill even in the absence of amyloid plaques. The researchers studied 100 people with an average age of 62. None of them had amyloid plaques or any sign of the protein in their spinal fluid but half of them had a variation in the gene APOE4 which is linked to an increased risk of Alzheimer's. The participants with the genetic variation showed different functioning in a region of the brain - centred on a structure called the precuneus - called the default mode network. This region is thought to be connected to what the brain does when it is not thinking about anything in particular - wool-gathering or day-dreaming - but is also connected to lots of other regions so a deterioration here could have widespread effects on other thought processes.

Uncovering the roots of unconscious memory

In In Search of Lost Time Proust describes a whole host of memories suddenly brought back to him when he dips a madeliene biscuit into a cup of lime tea. Psychologists call this process unconscious memory and researchers from the University of California Davis believe that they have found the region of the brain responsible for it. The researchers compared people with amnesia who had damage to an area of the brain called the perirhinal cortex to a group of healthy people. They gave the subjects a long list of words and asked them to think of any pleasant associations they brought to mind; later they were asked to think up words in different categories such as 'furniture.' The participants had MRI scans as they took the tests and in the healthy participants, who performed better in the tests, the perirhinal cortex showed increased activity. The study ties in with other research which shows that Alzheimer's disease often attacks the perirhinal cortex before other brain areas.

'Good' cholesterol and Alzheimer's disease

Researchers from Columbia University in New York have been looking into the links between 'good' cholesterol - high-density lipoprotein (HDL) - and Alzheimer's disease. They studied 1,130 adults in northern Manhattan none of whom had dementia or cognitive impairment at the start of the study. As the participants were followed over time there were 101 new cases of Alzheimer's disease. Having higher levels of HDL cholesterol was associated with a decreased risk of developing Alzheimer's even after adjusting for vascular (blood vessel) risk factors and cholesterol-lowering treatments. Being Hispanic and having diabetes at the start of the study both increased the risk of developing Alzheimer's.

Albumin and cognitive decline

Having a protein called albumin in one's urine can be a symptom of disease and new research suggests that it could also be linked to cognitive decline. Researchers from Brigham and Women's Hospital in Boston studied 1,200 women over 70 who were tested on their cognition and provided urine samples. The women were assessed every two years until they had been tested three times. The women who had albumin in their urine suffered cognitive decline at a rate between two and seven times quicker than would be expected during the normal ageing process. In another study researchers from Stanford University studied 19,399 people over 3.8 years, 1,184 of whom developed cognitive impairment. The people with albumin in their urine were 31-57% more likely to develop cognitive impairment.

HRT and dementia

Researchers from the Kaiser Permanente health organization in the U.S. have been looking into the effects of hormone therapy on women's risk of developing dementia. They took a large sample of women and asked them about their hormone use during middle age and old age; 1,524 of the women were diagnosed with dementia during the course of the study. The study found that women who took the hormones in both middle age and old age had a similar risk of dementia while women who took hormones only in old age had a 48% higher risk of developing it. Women who took hormones only in middle age had a 26% lower risk of developing dementia.

Getting to grips with the neuroscience of Alzheimer's

Researchers from Rush University Medical Center in Chicago have been using MRI scans to investigate what happens in people's brains when they develop Alzheimer's disease. They followed 52 people with mild cognitive impairment, often seen as a forerunner of dementia, over five to six years; 23 of them went on to develop full-blown Alzheimer's. The researchers concentrated on a region deep within the brain called the substantia innominata. They found that although this region was unaffected the parts of the cerebral cortex (which is responsible for reasoning and memory) that received signals from it were significantly thinner in those people who went on to develop Alzheimer's.

New study - Omega-3s no help with Alzheimer's

Omega-3 fish oils do not slow the cognitive decline of people with Alzheimer's disease. Researchers from Oregon Health and Science University studied 215 people with mild to moderate Alzheimer's disease. Over 18 months 171 of them took fish-oil tablets while the rest took a placebo. The researchers tested the participants' cognitive abilities and, in a smaller group of participants measured their brain volumes with an MRI scanner. The researchers found that taking the fish oil had no beneficial effects on the participants' cognition and no effect on total brain volume. The authors concluded that "in summary these results indicate that DHA (docosahexanoic acid, an Omega-3 found in fish oil) supplementation is not useful for the population of individuals with mild to moderate Alzheimer disease."

New evidence on smoking and dementia

A large U.S. study of over 21,000 people has added to the considerable pile of evidence linking smoking to dementia. The study - carried out by Dr Rachel Wittmer from the U.S. health organization Kaiser Permanente - found that smoking 40 or more cigarettes a day led to a 157% increase in the risk of Alzheimer's disease and a 172% increase in the risk of vascular dementia. However, there was no increase in risk in those smoking less than ten cigarettes a day and people who gave up smoking by middle age had the same level of risk as people who had never smoked.

Vitamin B12 and Alzheimer's disease

Researchers from the Karolinska Institute in Sweden have added further evidence to the theory that vitamin B12 could help to prevent Alzheimer's disease. The researchers followed 271 people, aged between 65 and 79 at the start of the study, for seven years. Those with high levels of vitamin B12 were at a lower risk of developing Alzheimer's over the course of the study. One of the ideas behind this theory is that vitamin B12 - which is found in meat, fish, eggs and milk - reduces the level of a harmful chemical called homocysteine which is known to raise the risks of both strokes and dementia and the study found that those with higher levels of homocysteine were at greater risk.