General Anesthesia Not Linked to Raised Risk for Dementia

WEDNESDAY, May 1 (HealthDay News) -- Despite previous concerns, older people who receive general anesthesia are not at greater risk of developing long-term dementia or Alzheimer's disease, a new study says.

The study, by researchers from the Mayo Clinic in Rochester, Minn., involved 900 patients over the age of 45 who had dementia, a disease that affects brain functions such as memory, language, problem-solving and attention. All of the participants were residents of Olmsted County, Minn., from 1985 to 1994.

These patients were compared to other people of similar ages living in the area who did not develop dementia during that time frame.

About 70 percent of the study participants in both groups underwent surgery that required general anesthesia. Among patients who had already been diagnosed with dementia, there were no signs that their symptoms got worse due to receiving general anesthesia. Among those who did not have dementia, there was no evidence that they developed the disease after receiving general anesthesia, the investigators found.

The researchers concluded that general anesthesia does not increase elderly patients' long-term risk for dementia.

"It's reassuring we're adding to the body of knowledge that there is not an association of anesthesia and surgery with Alzheimer's," study senior author Dr. David Warner, a pediatric anesthesiologist at the Mayo Clinic, said in a Mayo news release. "There are a lot of things to worry about when an elderly person has surgery, but it seems that developing Alzheimer's isn't one of them."

The study was published in the May 1 online edition of the journal Mayo Clinic Proceedings.

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Mayo Clinic, news release, May 1, 2013

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Low Blood Sugar May Raise Dementia Risk in Diabetics: Study

Overly aggressive glucose control might backfire in older patients, findings suggest

By Steven Reinberg

HealthDay Reporter

MONDAY, June 10 (HealthDay News) -- Low blood sugar in older adults with type 2 diabetes may increase their risk of dementia, a new study suggests.

While it's important for diabetics to control blood sugar levels, that control "shouldn't be so aggressive that you get hypoglycemia," said study author Dr. Kristine Yaffe, a professor of psychiatry, neurology and epidemiology at the University of California, San Francisco.

The study of nearly 800 people, published online June 10 in JAMA Internal Medicine, found that people with episodes of significant hypoglycemia -- low blood sugar -- had twice the chance of developing dementia, Yaffe said. Conversely, "if you had dementia you were also at a greater risk of getting hypoglycemic, compared with people with diabetes who didn't have dementia," she said.

People with type 2 diabetes, by far the most common form of the disease, either don't make or don't properly use the hormone insulin. Without insulin, which the body needs to convert food into fuel, blood sugar rises to dangerously high levels. Over time, this leads to serious health problems, which is why diabetes treatment focuses on lowering blood sugar. But sometimes blood sugar drops to abnormally low levels, which is known as hypoglycemia.

Exactly why hypoglycemia may increase the risk for dementia isn't known, Yaffe said. Hypoglycemia may reduce the brain's supply of sugar to a point that causes some brain damage, Yaffe said. "That's the most likely explanation," she added.

Moreover, someone with diabetes who has thinking and memory problems is at particularly high risk of developing hypoglycemia, she said, possibly because they can't manage their medications well or perhaps because the brain isn't able to monitor sugar levels.

Whether preventing diabetes in the first place reduces the risk for dementia isn't clear, although it's a "very hot area" of research, Yaffe said.

But the findings do suggest that patients' mental status needs to be considered in the management of diabetes, Yaffe said.

Other experts agreed.

"This does raise concern about low blood sugar causing future problems with dementia and dementia causing problems with low blood sugar," said Dr. Stuart Weinerman, an endocrinologist at North Shore-LIJ in Great Neck, N.Y.

Weinerman isn't convinced that the association between hypoglycemia and dementia is cause-and-effect, however. "This is not a definitive study. It raises questions, but it doesn't answer them," he added.

But hypoglycemia is a serious problem for diabetics, Weinerman said. "Sooner or later, everyone is going to have some hypoglycemia," he said.

Episodes of hypoglycemia increase with age, perhaps because of changes in kidney function and drug metabolism, according to an accompanying journal commentary.

Anyone taking drugs that lower blood sugar should be aware of the signs of hypoglycemia, and be prepared to deal with it, Weinerman said. Symptoms can include confusion, jitteriness, fainting, heart palpitations and blurred vision.

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U.S. Spends More on Dementia Care Than Heart Disease or Cancer: Study

Annual bill now tops $200 billion, largely for long-term care, researchers say

By Amy Norton

HealthDay Reporter

WEDNESDAY, April 3 (HealthDay News) -- The cost of caring for Americans with Alzheimer's and other forms of dementia may now be as high as $215 billion a year -- more than the cost of caring for heart disease or cancer, a new study finds.

And that number is expected to escalate as the elderly population grows.

In 2010, the United States spent somewhere between $157 billion and $215 billion on dementia care, researchers reported in the April 4 issue of the New England Journal of Medicine. That includes direct medical expenses and the costs of caring for people with dementia -- both professional care and the "informal" care that families provide.

Dementia is a progressive deterioration in memory, thinking ability, judgment and other vital brain functions.

Alzheimer's disease is the most common form of dementia, and a recent study estimated that with the aging baby boom generation, the number of Americans with Alzheimer's could triple by 2050, to nearly 14 million.

The new study tried to take a "comprehensive look" at the financial impact -- including the costs to family caregivers, said lead researcher Michael Hurd, a senior principal researcher at the nonprofit research institute RAND.

"It's not a happy situation," Hurd said. "A lot of the costs fall on families, and right now, there's no solution in sight."

The researchers based their estimates on a government study of older Americans, plus Medicare records and other data sources. Of the billions spent on dementia in 2010, only a small portion went to medical treatments, the study found.

Instead, long-term care -- either nursing homes, or home care provided by professionals or family members -- was the big expense, accounting for up to 84 percent of the total.

Per person, the costs ranged from about $41,700 to $56,300, depending on how the researchers calculated the cost of family caregiving. In the first case, they considered only family members' lost wages; in the second, they gave family members' time the same value as formal paid care.

As for who paid, Medicare foot the bill for $11 billion out of the up to $215 billion in total expenses, Hurd's team said.

It's a small share because Medicare does not usually cover nursing home or other long-term care. Medicaid, the government health insurance program for the poor, will cover it -- but only after certain patient assets have been spent down.

"A large part of the burden is borne by families," said Dr. Richard Hodes, director of the U.S. National Institute on Aging, which funded the study.

Hodes noted that things could get tougher in the years to come. The younger baby boomers had fewer children compared with past generations -- so along with the rise in the number of elderly adults with dementia, there will be fewer family members to care for them.

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Early Thinking Problems May Signal Future Dementia in Parkinson's Patients

Title: Early Thinking Problems May Signal Future Dementia in Parkinson's Patients
Category: Health News
Created: 3/25/2013 4:36:00 PM
Last Editorial Review: 3/26/2013 12:00:00 AM

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A Third of U.S. Seniors Die With Dementia, Study Finds

Title: A Third of U.S. Seniors Die With Dementia, Study Finds
Category: Health News
Created: 3/19/2013 10:35:00 AM
Last Editorial Review: 3/19/2013 12:00:00 AM

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A Third of U.S. Seniors Die With Dementia, Study Finds

Report tallies enormous medical, financial and caregiver toll of conditions like Alzheimer's

By Serena Gordon

HealthDay Reporter

TUESDAY, March 19 (HealthDay News) -- There's more troubling news for America's aging population: A new report finds that one in every three seniors now dies while suffering from Alzheimer's or another form of dementia.

In many cases, dementia is the cause of death or contributes to it, the Alzheimer's Association study finds.

The rate of deaths related to Alzheimer's disease rose 68 percent from 2000 to 2010, according to the report. At the same time, deaths from other major diseases, such as heart disease and HIV/AIDS, have declined.

"Alzheimer's disease is a public health crisis that is here," said Beth Kallmyer, vice president of constituent services for the Alzheimer's Association. "One in three seniors is dying with Alzheimer's or another dementia. For other major diseases, the death rate is going down because the federal government funds and invests in research. We have not seen that same commitment for Alzheimer's disease."

Released Tuesday, the report also focuses on the toll that Alzheimer's takes on families, particularly those caregiving from a distance. In 2012, more than 15 million people were Alzheimer's caregivers. They provided more than 17 billion hours of unpaid care that the Alzheimer's group estimated was valued at $216 billion.

Direct out-of-pocket costs for families of people with Alzheimer's are $34 billion, according to Kallmyer. "The cost of care is a challenge, and not everyone has access to the services they need," she said.

About 15 percent of Alzheimer's caregivers live more than an hour away from their loved ones. Out-of-pocket costs for these long-distance caregivers are nearly twice as high as those who live close by. Each year, a long-distance caregiver has nearly $10,000 in expenses compared with about $5,000 for a local caregiver, according to the report.

"Long-distance caregiving can be financially, emotionally and physically more draining. Managing the day-to-day care can certainly be a challenge, but long-distance caregivers can feel guilt, and they may feel resentment from other family members. And, they may have to manage the daily care from a long distance," Kallmyer said.

Overall, the cost of caring for the 5 million people with Alzheimer's disease is about $203 billion, according to the report. That figure includes Medicare, Medicaid, family costs and private insurance costs. The lion's share of the cost -- about $142 billion -- is paid by Medicare and Medicaid.

Even more concerning is that the Alzheimer's Association estimates that by 2050, nearly 14 million people will have Alzheimer's disease. That could drive costs for Alzheimer's care as high as $1.2 trillion in 2050.

The U.S. government currently funds about $500 million in Alzheimer's research, according to Kallmyer. In comparison, heart disease receives about $4 billion in research funding and cancer gets about $6 billion, she said.

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High-Antioxidant Diet May Not Prevent Stroke, Dementia, Study Finds

By Carina Storrs

HealthDay Reporter

WEDNESDAY, Feb. 20 (HealthDay News) -- Antioxidants are celebrated as "brain foods" and "super foods," but a new study suggests that not all diets high in antioxidants reduce the risk of dementia and stroke.

The study involved more than 5,000 people in the Netherlands who were 55 years and older. Researchers determined each participant's antioxidant score, based on questionnaires about the foods they typically ate, and kept track of whether they developed dementia or had a stroke over the next 14 years.

"We asked, 'Is the [measure] of total antioxidant levels the important predictor for dementia and stroke, irrespective of what foods are contributing?'" said Elizabeth Devore, an instructor in medicine at Harvard Medical School in Boston and lead author of the study.

Although the study did not find lower rates of dementia and stroke among people with antioxidant-rich diets, similar research in other populations has come to different conclusions. For example, a study of older Italian adults found that higher antioxidant levels were linked to lower stroke risk.

The difference between the Dutch and Italian groups could lie in the types of antioxidants they eat, Devore said.

Almost 90 percent of the variability in antioxidant levels among the Dutch participants was due to coffee and tea consumption, whereas the antioxidants in the Italian cohort came largely from eating fruits and vegetables.

"There's a lot of [studies] to suggest that higher fruit and vegetable intake is associated with lower risk of stroke," Devore said. "It is possible that, though the Italian study did report diet antioxidant score, that is really being driven by those specific foods."

"It is not about total antioxidant level, it is about specific antioxidant-rich foods," Devore added.

The research in the Dutch population was published Feb. 20 in the online issue of the journal Neurology.

"It's a little bit hard to interpret the finding that total antioxidant capacity of the diet does not have a role, because of the abundance of evidence showing that oxidative stress [on cells] has a role in these diseases," said Gene Bowman, a nutritional epidemiologist at Oregon Health and Science University, in Portland.

However, "it may be that the antioxidants that they're capturing aren't the ones that are the big players," Bowman said.

Still, the idea of looking at total antioxidant capacity instead of individual antioxidant-rich foods is a new and important approach, he said.

"We've already had large observational studies showing us that certain antioxidants are linked to less stroke and dementia risk, but when giving these antioxidants in clinical trials to reduce risk for less stroke and dementia, the results have been disappointing," Bowman said.

The current study included almost 5,400 people who did not show signs of dementia and almost 5,300 people who had never had a stroke.

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Heart Problems Tied to Early Signs of Dementia

Jan. 29, 2013 -- Older women with heart problems may be at greater risk for mental changes that are thought to signal the beginnings of a type of dementia, a new study shows.

Called vascular dementia, it is a type of mental decline that’s thought to be caused by problems in blood flow to the brain. It is believed to be different from the loss of memory and function that happens in Alzheimer’s disease, which is linked to the buildup of proteins in the brain.

The study, which is published in the journal JAMA Neurology, followed 1,450 men and women in the Rochester, Minn., area. At the start of the study, all participants, who were in their 70s and 80s, were free of memory loss or thinking difficulties. Researchers gave them tests to measure brain function every 15 months.

After about four years, 348 people in the study had developed some form of mild cognitive impairment (MCI). This can include problems such as memory loss, having trouble making decisions, coming up with the right words, or navigating a familiar neighborhood.

Of those people, 94 had developed the type of mild cognitive impairment linked to vascular dementia. This type does not include memory loss, but does include the other problems such as with decision making, reasoning, and visual-spatial relations.

Heart health did seem to influence the risk of developing these types of mental changes. Even after researchers took into account other factors known to raise the risk of dementia (like family history, stroke, high blood pressure, diabetes, depression, and exercise) having heart problems -- including atrial fibrillation, coronary artery disease, and heart failure -- nearly doubled a person’s risk for developing mild cognitive impairment without memory loss.

The link was particularly strong in women. Women with heart problems were about three times more likely to develop it than women without heart concerns. The link was not significant in men.

Researchers say preventing heart disease, through regular exercise and a healthy diet, is the first step. For people who’ve already been diagnosed with heart disease, regular checkups to make sure diabetes, blood pressure, and cholesterol are under control may be important for brain and heart health.

“If we reduce the risk of the conditions that lead to cardiac disease, hopefully we can reduce the risk of developing MCI, and thereby reduce the risk of developing dementia,” says researcher Rosebud Roberts, MD, professor of epidemiology at the Mayo Clinic in Rochester, Minn.

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Depression in Elderly May Predict Dementia

Dec. 31, 2012 -- Depression is common among older people who go on to develop Alzheimer’s disease, leading to widespread speculation that it may be one possible cause for age-related dementias.

Now, a new study suggests that rather than being a cause of memory decline, depression in older people may be an early symptom of dementia.

When researchers evaluated 2,000 elderly New Yorkers for depression and then followed them, they found that depression accompanied memory declines but did not necessarily come first.

Having memory problems that are not severe enough to be diagnosed as dementia, but that are more pronounced than the changes associated with normal aging, is known as mild cognitive impairment. Many people with MCI develop dementia, but some do not.

The new research shows that having mild cognitive impairment along with depression doubled the risk of developing full-blown dementia.

But researcher Jose A. Luchsinger, MD, MPH, of Columbia University Medical Center, says depression appears to be a symptom that accompanies age-related memory loss, such as mild cognitive impairment, rather than a separate risk factor for it.

It also means that depression among the elderly should be recognized as a possible early warning sign of age-related memory decline.

The study was published online today in the journal Archives of Neurology.

“When depression and memory complaints occur together in the elderly it is often assumed that the memory problems are caused by the depression,” Luchsinger says. “The thinking is often that by treating the depression the memory problems will go away, but this may not be the case.”

He says older people who are depressed and have memory complaints should be evaluated for mild cognitive impairment or other early signs of dementia.

Neurologist Gayatri Devi, MD, of New York City’s Lenox Hill Hospital, says it makes sense that older people with early memory loss would be more vulnerable to depression.

“Especially in the early stages when people realize that something is not quite right but they don’t really understand what is happening, it is natural to become depressed,” she says.

Devi agrees that depression and memory loss in older patients are too often lumped together instead of being evaluated separately.

“Depression may be related to (memory) decline or it may be totally unrelated,” she says. “From a clinical perspective it is important to understand this. If a patient comes to me in her 70s or 80s with no history of depression and no clear reason for depression, such as the loss of a spouse or a child, I will certainly consider cognitive loss as a possible reason and do the appropriate tests.”

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