Older adults' anemia linked to dementia risk

Wed Jul 31, 2013 4:30pm EDT

Kathryn Doyle

NEW YORK (Reuters Health) – Among people in their 70s, anemia may flag an increased risk of developing dementia later in life, according to a new study.

Researchers following more than 2,500 U.S. adults in their 70s for over a decade found that those who started out with anemia were 65 percent more likely to develop dementia by the end of the study period.

“Anemia is common in the elderly and occurs in up to 23 percent of adults ages 65 and older,” said senior author Dr. Kristina Yaffe of the University of California, San Francisco.

People with anemia lack enough healthy red blood cells to carry oxygen throughout the body.

Fewer healthy red blood cells could mean less oxygen travelling to the brain and may result in cognitive decline, she said.

Several conditions, including kidney disease and nutritional deficiencies, can cause anemia.

Previous studies have found an association between anemia and dementia, but they had not followed anemic adults over time to see if they developed cognitive problems, as the current study did, Yaffe told Reuters Health.

She and her coauthors used medical records to follow 2,552 people between the ages of 70 and 79 at the beginning of the study period. They were tested for anemia early in the study and given memory and thinking tests over a total of 11 years.

At the start of the study, 393 participants had anemia. And at the end of the study, 445, or about 18 percent of participants, had developed dementia, based on records of their hospital visits, prescribed dementia medication use or a significant downward change on the memory and thinking tests.

Of the roughly 400 men and women who were anemic at the start, 23 percent developed dementia, compared to 17 percent of the 2,000 others who were not anemic, according to the results published in the journal Neurology.

That six percent difference is a large change in risk on a population level, Yaffe said.

“I think doctors should be aware of this important connection especially as both anemia and dementia are common with aging,” she said.

The increased risk for dementia linked to anemia did not change based on race or gender.

Despite the association, the study does not prove that anemia causes dementia, cautioned Dr. Ruth Peters, who researches risk factors for dementia at Imperial College London and was not involved in the new study.

“There are many risk factors that are associated with dementia and these kinds of studies are very useful in identifying and clarifying these,” she told Reuters Health by email. “Each individual will have their own mosaic of risk factors.”

It is possible that a third influence, like chronic kidney disease, caused both anemia and dementia in the participants with both conditions, but the authors tried to rule that out, Yaffe said.

Low iron levels, which are one cause of anemia, can cause heart problems for older people, so doctors usually check iron and recommend getting more of it from foods like spinach or over the counter vitamins if levels are low, she said.

“However, a third of the time, doctors cannot find a common cause for the lower hemoglobin levels (anemia) in older adults,” said Dr. Raj Shah of Rush University Medical Center in Chicago.

Anemia can also result from poor nutrition, bleeding disorders or cancer, among other things, said Shah, who studies cognitive decline in older people but was not involved in the study.

“We still have to understand what is the mechanism by which low hemoglobin is associated with cognitive decline and risk of developing dementia in older persons,” Shah told Reuters Health.

Future research should investigate whether correcting anemia also improves cognitive health, Yaffe said.

SOURCE: bit.ly/a55XCO Neurology, online July 31, 2013.

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Older adults’ anemia linked to dementia risk

Wed Jul 31, 2013 4:30pm EDT

Kathryn Doyle

NEW YORK (Reuters Health) – Among people in their 70s, anemia may flag an increased risk of developing dementia later in life, according to a new study.

Researchers following more than 2,500 U.S. adults in their 70s for over a decade found that those who started out with anemia were 65 percent more likely to develop dementia by the end of the study period.

“Anemia is common in the elderly and occurs in up to 23 percent of adults ages 65 and older,” said senior author Dr. Kristina Yaffe of the University of California, San Francisco.

People with anemia lack enough healthy red blood cells to carry oxygen throughout the body.

Fewer healthy red blood cells could mean less oxygen travelling to the brain and may result in cognitive decline, she said.

Several conditions, including kidney disease and nutritional deficiencies, can cause anemia.

Previous studies have found an association between anemia and dementia, but they had not followed anemic adults over time to see if they developed cognitive problems, as the current study did, Yaffe told Reuters Health.

She and her coauthors used medical records to follow 2,552 people between the ages of 70 and 79 at the beginning of the study period. They were tested for anemia early in the study and given memory and thinking tests over a total of 11 years.

At the start of the study, 393 participants had anemia. And at the end of the study, 445, or about 18 percent of participants, had developed dementia, based on records of their hospital visits, prescribed dementia medication use or a significant downward change on the memory and thinking tests.

Of the roughly 400 men and women who were anemic at the start, 23 percent developed dementia, compared to 17 percent of the 2,000 others who were not anemic, according to the results published in the journal Neurology.

That six percent difference is a large change in risk on a population level, Yaffe said.

“I think doctors should be aware of this important connection especially as both anemia and dementia are common with aging,” she said.

The increased risk for dementia linked to anemia did not change based on race or gender.

Despite the association, the study does not prove that anemia causes dementia, cautioned Dr. Ruth Peters, who researches risk factors for dementia at Imperial College London and was not involved in the new study.

“There are many risk factors that are associated with dementia and these kinds of studies are very useful in identifying and clarifying these,” she told Reuters Health by email. “Each individual will have their own mosaic of risk factors.”

It is possible that a third influence, like chronic kidney disease, caused both anemia and dementia in the participants with both conditions, but the authors tried to rule that out, Yaffe said.

Low iron levels, which are one cause of anemia, can cause heart problems for older people, so doctors usually check iron and recommend getting more of it from foods like spinach or over the counter vitamins if levels are low, she said.

“However, a third of the time, doctors cannot find a common cause for the lower hemoglobin levels (anemia) in older adults,” said Dr. Raj Shah of Rush University Medical Center in Chicago.

Anemia can also result from poor nutrition, bleeding disorders or cancer, among other things, said Shah, who studies cognitive decline in older people but was not involved in the study.

“We still have to understand what is the mechanism by which low hemoglobin is associated with cognitive decline and risk of developing dementia in older persons,” Shah told Reuters Health.

Future research should investigate whether correcting anemia also improves cognitive health, Yaffe said.

SOURCE: bit.ly/a55XCO Neurology, online July 31, 2013.

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Stomach bug hits new Iowa patients in outbreak linked to salad mix

By Karen Brooks

Wed Jul 31, 2013 3:58pm EDT

(Reuters) – A severe stomach illness linked to prepackaged salad has struck two new patients in Iowa, state health officials said on Wednesday, as the bug spread through 16 states.

The salad mix has been blamed for most of the 145 total cases in Iowa and the 78 in Nebraska of the rare parasite cyclospora, which causes gastrointestinal illness. The two states account for nearly two-thirds of at least 378 cases in the United States since mid-June.

The cause of outbreaks in other states is still under investigation, but officials with the federal Centers for Disease Control and Prevention said they are working to determine whether the prepackaged salad mix, the brand name of which has not been released, is responsible for outbreaks in states from New York and New Jersey to Florida and Texas.

At least 21 people have been hospitalized in three states with the bug, CDC officials said.

Symptoms caused by the one-cell parasite include watery diarrhea, vomiting and body aches. The virus is commonly associated with contaminated fresh produce and can be difficult to wash off.

Officials in Iowa and Nebraska said the salad mix was distributed nationally and there is no indication that local produce was involved in the outbreak.

The mix, sold as prewashed and ready to eat, was described by health officials as a combination of iceberg lettuce, carrots and red cabbage.

The product has been pulled from the shelves in Iowa and appears to have been consumed by the stricken residents in mid-June, health officials said. It was unclear whether the product had been removed from distribution in Nebraska.

Nebraska health officials said earlier this week that the same salad mix appeared to be responsible for the outbreak there as well.

New cases are being reported in Nebraska daily, officials there said, but it is unlikely that the same batch is still on shelves or in refrigerators, as the product’s shelf life is short.

Cyclosporiasis symptoms usually manifest within several days of eating the contaminated food, and include diarrhea, cramps, nausea and fatigue. If not treated, the illness may last from a few days to a month or longer and patients have been known to relapse, the CDC said.

The first cases were reported in Iowa in late June, with the majority of the illnesses logged in early July. The CDC has not released the age range of those infected, but said it was working closely with the U.S. Food and Drug Administration and state officials to gather more information.

(Reporting by Karen Brooks in Austin, Texas; Editing by Greg McCune and Richard Chang)

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Stafford trust ‘should be dissolved’

31 July 2013 Last updated at 00:06 ET

Stafford Hospital in February 2013A public inquiry was triggered at Stafford Hospital after a higher than expected number of deaths at the trust

Continue reading the main story

  • No more covering up errors, NHS told
  • NHS cover-ups ‘should be a crime’
  • Stafford Hospital: Does NHS boss have case to answer?
  • Stafford Hospital Q&A

A report by administrators running the scandal-hit Stafford Hospital into the future of services there will be published later.

The Mid Staffordshire NHS Trust went into administration on 16 April after a report concluded it was not “clinically or financially sustainable”.

A public inquiry, led by Robert Francis QC, was triggered by a higher than expected number of deaths at the trust.

The Trust Special Administrators’ (TSA) report will be published at 14:00 BST.

The administrators were initially given 45 days to design new patient services, but health regulator Monitor granted them an extra 30 days.

The consultation on the draft report will start on 6 August and end on 1 October.

‘Fragile offering’

Conservative-controlled Staffordshire County Council, which took on the public health remit in April, said a single trust should be created to provide health and social care for Staffordshire.

Campaigners demonstrating in Stafford in April to keep major health services at the hospitalCampaigners demonstrated in April to keep major health services at the hospital

Council leader Philip Atkins said: “Instead of looking to break up an already fragile offering we need to look at creating a stronger, single Staffordshire NHS Trust offering integrated health and social care as a basis for a sustainable NHS.”

The Mid Staffordshire trust, which also runs Cannock Chase Hospital, was the first NHS foundation trust to be put into administration.

Mr Francis’s inquiry, into one of the biggest scandals in the history of the NHS, looked at why the problems at Stafford Hospital, where hundreds of needless deaths were caused by abuse and neglect in 2005-08, was not picked up earlier.

The report concluded patients had been “betrayed” because the NHS put corporate self-interest ahead of patients.

It argued for “fundamental change” in the culture of the NHS to make sure patients were put first.

Continue reading the main story

“Practically ignored by nurses”

Find out more about the victims of the Stafford Hospital scandal

  • The victims of “appalling care”

The inquiry ran for a year between 2010 and 2011, and took evidence from more than 160 witnesses over 139 days, at a cost of £13m.

The findings of the Francis Report prompted a separate review of 14 NHS hospitals in England with high mortality rates.

As a result of that review, 11 of the hospitals were placed in “special measures” for “fundamental breaches of care”.

On Thursday 25 July, two Stafford Hospital nurses who falsified A&E discharge times were struck off the nursing register.

The Nursing and Midwifery Council panel found that Tracey-Ann White and Sharon Turner had brought their profession into serious disrepute.

On Tuesday 23 July, it was announced the director of nursing at the hospital, Colin Ovington, was to leave and become the new chief nurse of Sandwell and West Birmingham Hospitals NHS Trust.

He was recruited in 2010 to help improve the quality of care at the Mid Staffordshire trust.

Sandwell and West Birmingham Hospitals NHS Trust, which runs Sandwell Hospital and City Hospital in Birmingham, has said Mr Ovington was expecting to take up his new post later this year.


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Right-to-die campaigners lose battle

30 July 2013 Last updated at 19:59 ET

Paul LambPaul Lamb was severely injured in a car accident in 1990

The Court of Appeal is to rule on Wednesday on the case of a paralysed man who wants to be helped to die.

Paul Lamb wants the law changed so he can kill himself with a doctor’s help.

Mr Lamb, from Leeds, has been almost completely paralysed from the neck down since a car accident 23 years ago and says he is in constant pain.

Unable to end his own life, he wants a court ruling that any doctor who helped him die would have a defence against the charge of murder.

The defence – known as “necessity” – would be that it had been necessary for the doctor to act to stop intolerable suffering.

This is the same argument put forward by another paralysed man, Tony Nicklinson, who died shortly after his case was rejected by the High Court last year.

Mr Nicklinson’s widow is challenging that ruling, which stated that it was for Parliament, not judges to decide whether the law on assisted dying should change.

The Appeal Court will also rule on the case of another paralysed man, known only as Martin, who wants the Director of Public Prosecutions to change his policy on suicide. Martin wants it to be lawful for a doctor or nurse to help him travel abroad to die with the help of a suicide organisation in Switzerland.

At the beginning of the appeal, the lord chief justice said that despite the desperate situation of those involved, the case had to be decided on the basis of principles of law rather than as a matter of sympathy.

Mr Lamb has no function in any of his limbs apart from a little movement in his right hand. He says he has been in pain for 23 years, needs 24-hour care and his life consists of “being fed and watered”.

In a statement to the courts, he said: “I am in pain every single hour of every single day. I have lived with these conditions for a lot of years and have given it my best shot.

“Now I feel worn out and I am genuinely fed up with my life. I feel I cannot and do not want to keep living. I feel trapped by the situation and have no way out.

“I am fed up of going through the motions of life rather than living it. I feel enough is enough.”

Mr Lamb, a divorced father of two, said he was not depressed and just wanted to end his life in a dignified way, with his loved ones around him.


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House Republicans leery of 'Obamacare' defunding idea

A Tea Party member reaches for a pamphlet titled ''The Impact of Obamacare'', at a ''Food for Free Minds Tea Party Rally'' in Littleton, New Hampshire in this October 27, 2012 file photo. REUTERS/Jessica Rinaldi//Files

A Tea Party member reaches for a pamphlet titled ”The Impact of Obamacare”, at a ”Food for Free Minds Tea Party Rally” in Littleton, New Hampshire in this October 27, 2012 file photo.

Credit: Reuters/Jessica Rinaldi//Files

By Richard Cowan and Caren Bohan

WASHINGTON | Wed Jul 31, 2013 3:32pm EDT

WASHINGTON (Reuters) – A Tea Party-inspired plan to kill President Barack Obama’s healthcare law by forcing a government shutdown unless funds to implement the law are denied has not gained traction among senior Republicans in the U.S. House of Representatives, lawmakers said on Wednesday.

“I think leadership is giving other options that they think are more effective,” said Republican Representative Pat Tiberi, a close ally of House Speaker John Boehner.

Tiberi, speaking to Reuters following a closed-door meeting of House Republicans, said that while a final decision probably had not been made, his colleagues are more likely to continue pushing for Congress to repeal individual provisions of “Obamacare.”

Republicans have been on a continuous campaign to kill Obama’s landmark healthcare law, which aims to help provide medical insurance for millions of people who cannot afford it on their own. They argue that the law, which is taking effect in stages, will discourage job creation and saddle businesses with higher costs.

Tea Party-backed conservatives in the Senate, including Senators Marco Rubio, Ted Cruz and Mike Lee, have been trying to persuade enough of their fellow Republicans to join them in a high-stakes gamble that would threaten a government shutdown on the start of the new fiscal year, October 1, unless legislation to keep Washington operating specifically defunds Obamacare.

More senior Senate Republicans have savaged the idea, with some calling it “dumb,” “silly,” “feckless” and “dishonest.”

On September 30, federal funding expires for hundreds of federal programs, ranging from military activities and NASA space exploration to federal parks, education and job training.

A dozen funding bills for the fiscal year starting on October 1 are pending in Congress but are unlikely to be completed by that deadline.

The result is that Congress will either have to pass a temporary funding bill, called a continuing resolution or CR, or risk government closings. Tea Party-backed senators who want to attach the Obamacare provision have complicated already difficult negotiations over government spending levels.

House Appropriations Committee Chairman Harold Rogers, asked about chances of his chamber going along with demands of Tea Party-backed senators on the funding bill, told reporters: “This is just something the White House will not accept and we’ve got to have a CR.”

Representative Tom Cole, another longtime House Republican, told reporters that he had seen “an awful lot of push-back” on the idea, adding, “I don’t sense that there’s nearly enough unanimity in either the Senate or the House Republican conferences to push an approach like that.”

With Congress about to start a month-long break, Boehner said he will keep mulling ways to tackle end-of-fiscal-year funding problems.

“I’m confident that when we get into the fall, it may be a messy process, but I suspect we’ll find a way to deal with it,” Boehner told reporters.

(Editing by Vicki Allen)

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House Republicans leery of ‘Obamacare’ defunding idea

A Tea Party member reaches for a pamphlet titled ''The Impact of Obamacare'', at a ''Food for Free Minds Tea Party Rally'' in Littleton, New Hampshire in this October 27, 2012 file photo. REUTERS/Jessica Rinaldi//Files

A Tea Party member reaches for a pamphlet titled ”The Impact of Obamacare”, at a ”Food for Free Minds Tea Party Rally” in Littleton, New Hampshire in this October 27, 2012 file photo.

Credit: Reuters/Jessica Rinaldi//Files

By Richard Cowan and Caren Bohan

WASHINGTON | Wed Jul 31, 2013 3:32pm EDT

WASHINGTON (Reuters) – A Tea Party-inspired plan to kill President Barack Obama’s healthcare law by forcing a government shutdown unless funds to implement the law are denied has not gained traction among senior Republicans in the U.S. House of Representatives, lawmakers said on Wednesday.

“I think leadership is giving other options that they think are more effective,” said Republican Representative Pat Tiberi, a close ally of House Speaker John Boehner.

Tiberi, speaking to Reuters following a closed-door meeting of House Republicans, said that while a final decision probably had not been made, his colleagues are more likely to continue pushing for Congress to repeal individual provisions of “Obamacare.”

Republicans have been on a continuous campaign to kill Obama’s landmark healthcare law, which aims to help provide medical insurance for millions of people who cannot afford it on their own. They argue that the law, which is taking effect in stages, will discourage job creation and saddle businesses with higher costs.

Tea Party-backed conservatives in the Senate, including Senators Marco Rubio, Ted Cruz and Mike Lee, have been trying to persuade enough of their fellow Republicans to join them in a high-stakes gamble that would threaten a government shutdown on the start of the new fiscal year, October 1, unless legislation to keep Washington operating specifically defunds Obamacare.

More senior Senate Republicans have savaged the idea, with some calling it “dumb,” “silly,” “feckless” and “dishonest.”

On September 30, federal funding expires for hundreds of federal programs, ranging from military activities and NASA space exploration to federal parks, education and job training.

A dozen funding bills for the fiscal year starting on October 1 are pending in Congress but are unlikely to be completed by that deadline.

The result is that Congress will either have to pass a temporary funding bill, called a continuing resolution or CR, or risk government closings. Tea Party-backed senators who want to attach the Obamacare provision have complicated already difficult negotiations over government spending levels.

House Appropriations Committee Chairman Harold Rogers, asked about chances of his chamber going along with demands of Tea Party-backed senators on the funding bill, told reporters: “This is just something the White House will not accept and we’ve got to have a CR.”

Representative Tom Cole, another longtime House Republican, told reporters that he had seen “an awful lot of push-back” on the idea, adding, “I don’t sense that there’s nearly enough unanimity in either the Senate or the House Republican conferences to push an approach like that.”

With Congress about to start a month-long break, Boehner said he will keep mulling ways to tackle end-of-fiscal-year funding problems.

“I’m confident that when we get into the fall, it may be a messy process, but I suspect we’ll find a way to deal with it,” Boehner told reporters.

(Editing by Vicki Allen)

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Stroke Centers Don’t Drive Up Costs

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Cardiovascular

Published: Jul 31, 2013

By Todd Neale, Senior Staff Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

Action Points

  • Establishing a coordinated stroke center at a tertiary care community hospital did not increase the total direct and indirect costs of treating patients at one institution.
  • Note that among patients with acute ischemic stroke, multivariate analysis revealed that total costs were significantly lower for patients 65 and older compared with younger patients.

Establishing a coordinated stroke center at a tertiary care community hospital did not increase the total direct and indirect costs of treating patients at one institution, researchers found.

The median total hospital cost was $12,812, and that did not significantly increase as the stroke program was enhanced over time, according to Marilyn Rymer, MD, of Saint Luke’s Neuroscience Institute in Kansas City, Mo., and colleagues.

“The implication is that the increase in costs for personnel and technology was offset by improved efficiencies in process, although this analysis did not allow identification of the cost savings attributable to a specific change in process,” they wrote in the August issue of Stroke: Journal of the American Heart Association.

“These results suggest that a comprehensive stroke care program with improved access, stroke care, and outcomes may be financially feasible for hospitals to implement,” they added.

The impetus behind the establishment of a stroke program at Saint Luke’s Hospital was the low usage of intravenous tissue plasminogen activator (tPA), which has been shown to improve outcomes when administered shortly after onset of an ischemic stroke.

In a previous study, Rymer and her colleagues found that the use of guidelines-based stroke care and patient outcomes significantly improved after formation of the program and an accompanying regional stroke network.

To evaluate the financial aspect of setting up the system, the researchers retrospectively evaluated total hospital costs and payments from all payers for treating patients with ischemic stroke. The analysis included 1,570 patients treated from 2005 to 2010.

Overall, total hospital costs were lower in the current study compared with other published estimates. Costs varied in certain patient subgroups.

Among patients with acute ischemic stroke, for example, multivariate analysis revealed that total costs were significantly lower for:

  • Patients 65 and older versus younger patients (by $1,883)
  • Those with lower NIH Stroke Scale scores at baseline (by $103 per 1-unit decrease)
  • Those with shorter hospital stays (by $1,705 per day)
  • Those who did not receive intra-arterial tPA or embolectomy (by $9,727)
  • Those who did not have reperfusion attempted (by $4,578)

In general, the stroke center lost money on a per-patient basis. Payments from all payers came in below the total hospital costs for all patients (by a median of $2,324), patients who received IV or intra-arterial tPA or embolectomy (by $3,220), and those in whom reperfusion was not attempted (by $2,186).

“Because tPA has been associated with improved clinical outcomes, it may be appropriate for Medicare and private insurers to assess the overall cost savings associated with better outcomes resulting from acute stroke therapy and modify reimbursements to incentivize treatment,” Rymer and colleagues wrote.

“If evidence is established that intra-arterial tPA or embolectomy yields better outcomes in patients with large vessel occlusions, payment coverage should be even higher than intravenous tPA because this analysis noted that the financial losses were greater when intra-arterial tPA or embolectomy was used,” they wrote.

They noted that after adjustment for inflation, payments to the hospital increased over time; the hospital received $8,918 more per patient in 2010 than in 2005.

Limitations of the analysis included the uncertain generalizability of the findings to other centers, the lack of randomized assignment to treatment or no reperfusion, the retrospective design, and the use of imputed values for indirect overhead costs.

Partial funding was obtained from GE Healthcare.

Rymer is on the speakers’ bureau for Covidien Medical and consults for Medtronic. Her co-authors reported relationships with GE Healthcare and Strategic Therapeutics. One of the study authors is employed by GE Healthcare.


Primary source: Stroke: Journal of the American Heart Association
Source reference: Rymer M, et al “Analysis of the costs and payments of a coordinated stroke center and regional stroke network” Stroke 2013; 44: 2254-2259.

Todd Neale, MedPage Today Staff Writer, got his start in journalism at Audubon Magazine and made a stop in directory publishing before landing at MedPage Today. He received a B.S. in biology from the University of Massachusetts Amherst and an M.A. in journalism from the Science, Health, and Environmental Reporting program at New York University.

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Diabetes Doesn’t Seem to Affect Alzheimer’s Disease Progression

News Picture: Diabetes Doesn't Seem to Affect Alzheimer's Disease ProgressionBy Serena Gordon
HealthDay Reporter

Latest Alzheimers News

  • Diabetes Doesn’t Affect Alzheimer’s Disease
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MONDAY, July 29 (HealthDay News) — Conditions that cause problems maintaining normal blood sugar levels — such as glucose intolerance, insulin resistance and type 2 diabetes — don’t appear to be linked to specific signs of Alzheimer’s disease, new research indicates.

“When older folks develop dementia, it’s usually from a host of factors [including Alzheimer’s disease and hardening of the arteries]. Our study has shown that when older people with diabetes have dementia, it’s not through Alzheimer’s disease pathology,” said senior study author Dr. Richard O’Brien.

However, O’Brien was quick to note that these findings don’t mean that people with diabetes don’t need to be concerned about their blood sugar levels. They do. “People with diabetes need to be good about blood sugar control,” he said. “Atherosclerosis is a very important contributor to dementia in the elderly, and diabetes increases the risk of atherosclerosis.”

O’Brien is a professor of neurology at the Johns Hopkins University School of Medicine, and chair of neurology at the Johns Hopkins Bayview Medical Center, in Baltimore. Results of the study were published online July 29 in JAMA Neurology.

O’Brien and his colleagues initiated the study because other research has suggested that problems with maintaining blood sugar levels, such as glucose intolerance and diabetes, increase the risk of Alzheimer’s disease. O’Brien said some experts have even gone so far as to refer to Alzheimer’s disease as “type 3 diabetes.” (There’s no such condition.)

Alzheimer’s disease is the most common, but not the only, type of dementia. It occurs when deposits of amyloid beta (also known as plaques) build up in the brain along with twisted fibers of another protein (tangles), according to the Alzheimer’s Foundation. Many people develop some plaques and tangles with age, but those with Alzheimer’s disease have many more than the average person. Experts aren’t sure exactly how this build-up of plaques and tangles may cause the symptoms of Alzheimer’s disease.

There are several types of diabetes, but the most predominant is type 2 diabetes. Before developing type 2 diabetes, people generally show signs of insulin resistance and glucose intolerance. Insulin is a hormone that’s necessary for the body to metabolize the carbohydrates in food and use the sugar (glucose) from those carbohydrates as fuel for the cells in body and brain.

If someone has insulin resistance, his or her body isn’t using insulin efficiently, which allows glucose to build up in the blood. This is evident when someone does an oral glucose tolerance test. This test requires you to drink a sugar liquid, and then have your blood sugar levels tests at periodic intervals, such as at the start of the test, after an hour and then again after two hours. If you’re insulin-resistant, the results of your oral glucose tolerance test will show higher levels of glucose than expected.

Such a finding indicates a higher risk of type 2 diabetes, according to the American Diabetes Association. Or, if the results are high enough, that may even indicate existing type 2 diabetes.

In the current study, the researchers followed 197 people who’d had at least two oral glucose tolerance tests during their lifetime. Thirty of these people had diabetes and were taking medications to control their diabetes. When these study volunteers died, autopsies of their brains were done. The average age at autopsy was 88.

A smaller group, consisting of 53 people who’d had two or more oral glucose tolerance tests, was also involved in the study. This group underwent positron emission tomography (PET) scans of their brains while they were alive. The average age at which they underwent imaging was 79.

The researchers found no significant correlation between glucose intolerance, insulin resistance or diabetes and the amount of amyloid beta in the brain, according to the study. That means that blood glucose levels likely don’t contribute to the development of Alzheimer’s disease specifically. Though, as O’Brien pointed out, blood glucose levels may still play a role in other types of dementia.

One expert said that the study scope may not be wide enough to allow definitive conclusions.

“There has been a lot of debate about diabetes and dementia. Is there a cause-and-effect relationship, or is it just an association? This study suggests that Alzheimer’s isn’t really related to insulin resistance and impaired glucose tolerance, but the number of patients with true diabetes was very small,” said Dr. Joel Zonszein, director of the clinical diabetes center at Montefiore Medical Center, in New York City.

Zonszein said the study also doesn’t look at the length of time someone has had diabetes, and whether or not it’s well-controlled.

“We see a lot of people who have [small strokes] who have hypertension and type 2 diabetes,” he said, noting that this can cause a lot of the symptoms of dementia, such as loss of memory. “Clinically, it’s very difficult to tell the difference between dementia and Alzheimer’s disease. And, although it may not be true [for] Alzheimer’s disease, this won’t mean any difference in current clinical practice.”

“Early and aggressive treatment to control the blood sugar is the best treatment right now,” he added. “Hopefully, with more studies, we can find out what medications are better for people with diabetes to help prevent dementia.”

MedicalNews
Copyright © 2013 HealthDay. All rights reserved.

SOURCES: Richard O’Brien, M.D., Ph.D., professor, neurology, Johns Hopkins University School of Medicine, and chair, neurology, Johns Hopkins Bayview Medical Center, Baltimore; Joel Zonszein, M.D., director, clinical diabetes center, Montefiore Medical Center, and professor, clinical medicine, Albert Einstein College of Medicine, New York City; July 29, 2013, JAMA Neurology, online



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