Some blood pressure drugs may cut risk of dementia

Medicines commonly used to treat high blood pressure and heart disease may cut the risk of developing Alzheimer's disease and dementia, U.S. scientists said on Wednesday.

Researchers from Boston found that older people taking a certain type of blood pressure medication known as angiotensin receptor blockers (ARBs) were significantly less likely to develop the brain-wasting illnesses.

Dementia affects some 35 million people around the world and the number of cases -- and their impact on health policy and the economic and social costs of healthcare -- is set to grow dramatically as populations age.

Despite decades of research, doctors still have few effective weapons against dementia and experts commenting on the latest study said it could have major implications.

READ MORE @ REUTERS

Impact of FDA Safety Warnings Examined

A study published today in the Archives of Internal Medicine examines the impact of a safety warning issued by the Food and Drug Administration for commonly prescribed antipsychotic medications. The results show the warnings resulted in a decline in usage among the elderly with dementia, yet raise the question as to whether the FDA's system of communicating these warnings is sufficiently targeted and effective.

A study published today in the Archives of Internal Medicine examines the impact of a safety warning issued by the Food and Drug Administration for commonly prescribed antipsychotic medications. The results show the warnings resulted in a decline in usage among the elderly with dementia, yet raise the question as to whether the FDA’s system of communicating these warnings is sufficiently targeted and effective.

“Because this medication class has limited evidence of benefit among the elderly with dementia and significantly increases their risk of death, the ‘right’ magnitude of decline in usage is not clear,” said University of Rochester Medical Center neurologist Ray Dorsey, M.D., the study’s lead author. “More generally, the study raises larger issues about appropriate prescribing, particularly among the elderly, and the need to improve risk communication to patients and providers.”


Safety issues frequently emerge after a drug has been introduced to the market. These concerns arise either through ongoing clinical research or adverse events reported by post-market surveillance of the drug. The FDA can act upon this information in a number of ways. It can choose to remove the drug from the market or it can issue an advisory to physicians, the strongest of which is a “black box” warning which appears on the drug label.

The authors examined the impact of these warnings on a class of drugs called atypical antipsychotics. In April 2005, the FDA issued an advisory warning that elderly patients with dementia treated with these drugs were at increased risk of death.

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UK study warns against anti-psychotics for dementia

* Most dementia patients given anti-psychotics needlessly

* Report could inform clinical practice around the world

* Global dementia cases seen doubling to 66 mln by 2030

More than 140,000 dementia patients in Britain are given anti-psychotic drugs needlessly and overprescribing of the medicines is linked to an extra 1,800 deaths in elderly people each year, a report said on Thursday.

The government-backed review showed that only around 36,000 of around 180,000 dementia patients prescribed anti-psychotics got any benefit from them -- findings it said could affect clinical practice in dementia across the world.

"Anti-psychotics are used too often in dementia," Sube Banerjee, the report's author and a professor of mental health and ageing at the Institute of Psychiatry at King's College London, said in a statement.

He said use of anti-psychotics drugs for dementia should be cut to a third of current levels in Britain and said his study would "provide international leadership in this complex clinical area."

Alzheimer's Disease International predicted in September that more than 35 million people around the world will suffer from dementia in 2010. That number is expected to almost double every 20 years, to 66 million in 2030 and more than 115 million in 2050. [ID:nN20262573]

READ MORE @ REUTERS

Surgery, Illness Not Linked to Mental Decline in Seniors New findings contradict previous reports of increased risks of dementia

Illness and surgery don't contribute to long-term cognitive decline in seniors and don't accelerate progression of dementia, researchers say.

The findings of a new study, published in the November issue of Anesthesiology, challenge the widely held belief that elderly patients suffer major deterioration in mental function after surgery.

"The concerns surrounding postoperative cognitive decline (POCD) following surgery certainly will not evaporate following publication of this study," researcher Michael S. Avidan, of the Washington University School of Medicine, said in a news release from the American Society of Anesthesiologists. "The important message to take from these findings is that persistent cognitive deterioration following surgery might not be a major public health problem. The decision to proceed with surgery should presently be made based on a person's general health and the specific risks and benefits of the procedure."

For the study, Avidan and colleagues looked at 575 patients tested annually at Washington University's Alzheimer Disease Research Center. At the start of the study, 361 patients had very mild or mild dementia and 214 were dementia-free. The patients were divided into three groups -- those who'd undergone non-cardiac surgery, those with illness, and those with neither.

READ MORE @ U.S. NEWS & WORLD REPORT

Breakthrough in Alzheimer's research

A combination of proteins in the cerebrospinal fluid can reliably identify which patients with early symptoms of dementia will subsequently develop full-blown Alzheimer's disease, a research team at the University of Gothenburg, Sweden, has found in a major international study. The results were published in this week's edition of the Journal of the American Medical Association (JAMA).

Alzheimer's is one of the most common dementia disorders. Around 160,000 people in Sweden currently suffer from dementia, and an estimated 60 per cent of them have Alzheimer's.

"There is currently no medication that can alter the course of the disease, but the medicines currently under development will probably have the greatest effect if they are used from an early stage, so methods are needed for early diagnosis of the disease," says Dr Niklas Mattsson, a member of Kaj Blennow's group at the Institute of Neuroscience and Physiology at the University of Gothenburg's Sahlgrenska Academy.

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Elderly patients boost sales of dangerous antipsychotics

Bill Wiggins believes a powerful antipsychotic medication helped save his wife, Kathye.

Helen Shields believes one of these drugs helped kill her mother, Helen Marciniszyn.

Two families, two drugs, two stories that capture the extremes of a debate about using these medicines to treat the diseases of aging when there are no other effective alternatives.

Kathye Wiggins took Johnson & Johnson's Risperdal. Marciniszyn took AstraZeneca's Seroquel. Both drugs are atypical antipsychotics, a category of psychotropic drugs that also includes Zyprexa from Eli Lilly & Co., Abilify by Bristol-Myers Squibb Co., and Pfizer Inc.'s Geodon.

The federal government approved atypicals in the 1990s to treat schizophrenia and bipolar disorder. Since then, they have become popular for treating disorders including autism and Alzheimer's, despite mixed evidence that they help and ample evidence that they hurt.

Doctors prescribe atypicals for these illnesses because they may calm people and help them sleep. Also, patients with Alzheimer's and dementia can lose touch with reality, as schizophrenics do, so, in theory, atypicals could help.

Sales of atypicals rose to $14.36 billion in 2008 from $8.4 billion in 2003, according to data provider IMS Health.

Elderly patients have been a major source of that growth. Studies suggest that 20 percent to 30 percent of nursing-home residents take an atypical, despite not having a psychosis diagnosis.

READ MORE @ PHILADELPHIA INQUIRER

Dementia care 'human rights' call

Urgent action should be taken to protect the human rights of people with dementia in care homes, a charity says.

The call from Alzheimer Scotland came as two watchdogs published a report after visiting 30 care homes and interviewing 1,335 residents.

It said drugs had been hidden in food to make patients more manageable and about half never went outside.

The Scottish Government is to launch a national dementia strategy later on Thursday.

About 65,000 people in Scotland have dementia and about 40% are in care homes or hospitals.

The Care Commission and Mental Welfare Commission visited a sample of homes between August and March and detailed their findings in a report, Remember I'm Still Me.

It said before the patients were admitted most had already had a good medical assessment, with input from GPs and dieticians.

But after admission, the report said very few had annual GP health checks and there was little evidence that medication was regularly reviewed.

READ MORE @ BBC NEWS

Comorbidity: Psychiatric Comorbidity in Persons With Dementia

The assessment and treatment of psychiatric symptoms in persons with cognitive dysfunction are becoming increasingly important. Prevalence estimates of dementia in the United States range from 5% in those aged 71 to 79 years to 25% to 50% in those 90 or older. Up to 90% of patients with dementia have psychiatric comorbidities.1,2

Physicians who treat patients with dementia must remember that dementia is not merely a problem with memory. The presence of one or more additional cognitive disturbances, including aphasia, apraxia, or agnosia, is required to make the diagnosis according to DSM-IV-TR criteria. Furthermore, some patients may present with changes in personality or deficits in executive function rather than memory impairment, which complicates the initial diagnosis.3 Additional mental and behavioral disturbances often affect patients and caregivers as much as memory deficits and may influence quality of life, the need for institutionalization, mortality, and caregiver burden.2,4,5

This article emphasizes neuropsychiatric disturbances with the greatest prevalence and morbidity in persons with dementia. It also addresses comorbid depressive and anxiety disorders, as well as psychological and behavioral disturbances associated with dementia—psychosis and agitation/aggression.3,6

READ MORE @ PSYCHIATRIC TIMES

Women-only gene link to dementia

Scientists have found a genetic risk factor for late onset Alzheimer's disease which is only carried by women.

The discovery is the first evidence to suggest that genetics may partly explain why more women than men tend to develop the disease.

The key variant was found in a gene on the X chromosome, of which females have two copies, but males only one.

The study, by the Mayo Clinic College of Medicine, features in the journal Nature Genetics.

The Mayo team carried out a detailed genetic analysis of patients with Alzheimer's diease.

They identified a particular variant of a gene called PCDH11X which appeared to be closely linked to a higher risk of the disease.

However, further analysis showed that the association was almost entirely restricted to women.

READ MORE @ BBC

Antipsychotic drug 'stroke risk'

More people than previously thought could be at higher risk of having a stroke caused by their antipsychotic drugs, say UK scientists.

Previous research suggested only some types of the drug increased the risk, particularly for people with dementia.

However a study published in the British Medical Journal says all forms of antipsychotics boost the risk, in all patients.

A mental health charity said patients on the drugs must be closely monitored.

Antipsychotic drugs are generally used to control psychotic symptoms in patients with disorders such as schizophrenia, and some severe forms of depression.

They are also thought to be widely used to control symptoms of dementia such as aggression, leading to accusations they were being used unnecessarily as a "chemical cosh" in some circumstances.

READ MORE @ BBC

Anti-psychotic drug use in the elderly increases despite drug safety warnings

Three regulatory warnings of serious adverse events slowed the growth of use of atypical antipsychotic drugs among elderly patients with dementia, but they did not reduce the overall prescription rate of these drugs, found a research analysis of prescription drug claims data in Ontario http://www.cmaj.ca/press/pg438.pdf. The rate of use of these drugs actually increased 20% from the month prior to the first warning in September 2002 to the end of the study period in February 2007.

About 70% of people receiving antipsychotic drugs lived in nursing homes, and approximately 40% were aged 85 or older.

READ MORE @ EUREKALERT

FDA Orders Warning Label on Older Antipsychotics

The U.S. Food and Drug Administration is cautioning physicians that certain types of antipsychotic drugs can boost the death risk of seniors with dementia.

Doctors sometimes use antipsychotics to help treat behavioral problems in demented patients.

But from now on these older, so-called "conventional" antipsychotics -- which include drugs such as thorazine and prolixin -- will carry a new black box warning alerting physicians of the danger, FDA officials announced Monday.

"We issued letters to all the manufacturers of antipsychotic drugs, both conventional and atypical, requiring them to update their labeling with new language for a box warning about an increased risk of death in elderly patients with dementia," Dr. Thomas Laughren, director of the FDA's Division of Psychiatry Products at the Center for Drug Evaluation and Research, said during an afternoon teleconference.

This is a new warning for conventional antipsychotics, but it is not new for another class of the medications, called atypical antipsychotics. Back in 2005, the FDA ordered warning labeling for those medications, which include newer drugs such as Zyprexa and Risperdal. That labeling warned of a higher risk for heart attack and pneumonia for elderly patients with dementia who received atypical antipsychotics.

READ MORE @ WASHINGTON POST

Short-term use of antipsychotics in older adults with dementia linked to serious adverse events

Older adults with dementia who receive short-term courses of antipsychotic medications are more likely to be hospitalized or die than those who do not take the drugs, according to a report in the May 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

“Newer antipsychotic drugs (olanzapine, quetiapine fumarate and risperidone) have been on the market for more than a decade and are commonly used to treat the behavioral and psychological symptoms of dementia,” the authors write as background information in the article. “Antipsychotic drugs are often used for short periods to treat agitation in clinical practice. They are frequently prescribed around the time of nursing home admission.” About 17 percent of individuals admitted to nursing homes are starting on antipsychotic medication within 100 days, and 10 percent receive only a single prescription. Given the widespread use of short-term prescriptions, it is important to evaluate their safety, the authors note.

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Nursing homes undertreat dementia patients' pain

Nursing home residents with dementia appear to be less likely to receive pain medication than other residents, even though they have just as many painful health conditions, a new study suggests.

Researchers at the University of North Carolina Chapel Hill evaluated data for 551 residents of six nursing homes across the state and found that residents who were cognitively impaired were less likely to receive regular doses of pain medication or to receive pain drugs at all.

This was despite the fact that dementia patients and cognitively healthy patients had similar rates of often-painful conditions like cancer, osteoarthritis and degeneration in the spinal disks.

Pain medications are often prescribed to be taken "as needed," the researchers note. The findings suggest that more nursing home residents with dementia should be on regularly scheduled doses of pain medication, they report in the Journal of Pain and Symptom Management.

READ MORE @ REUTERS

Stop drugging dementia patients, urges report

Ministers should step in to stop inappropriate prescriptions of powerful antipsychotic drugs for Alzheimer's patients, an influential group of MPs has said.

Up to 105,000 people with dementia in Britain are wrongly being treated with the drugs, which are used to control behavioural symptoms such as aggression, they claim. Research has shown that the medications have side effects that can accelerate mental decline, triple the risk of stroke, and double the chances of premature death.

They are intended for psychotic patients suffering from delusions, paranoia and hallucinations. Yet the drugs continue to be used as a first resort to address the challenging behaviour of people suffering from Alzheimer's disease and other types of dementia, according to the MPs.

A report from the all-party parliamentary group on dementia demanded Government action on the problem and urged the National Institute for Health and Clinical Excellence, the health watchdog, to carry out a review.

READ MORE @ DAILY TELEGRAPH

‘Lethal’ drugs given for dementia

WHEN David Ramsay, a former senior consultant at Guy’s hospital in London, was diagnosed with dementia in 1998, his wife fought for three years to have him taken into full-time care.

But just months after winning her battle, David’s neck twisted by 90 degrees, leaving his chin permanently fixed to his chest and forcing him to spend the rest of his life staring at the ground.

His condition, a rare neurological disorder, was a side-effect of a powerful antipsychotic drug prescribed to control the symptoms of Alzheimer’s. According to a parliamentary report, to be published later this month, his case is far from isolated.

The report, by the all party parliamentary group on dementia, has found that elderly people are routinely being prescribed antipsychotic drugs to make the lives of carers easier, despite evidence that they are of little benefit to the patient and have potentially lethal side effects.

Jeremy Wright MP, the Conservative chairman of the group, said: “It is clear that there are many occasions when these drugs are being used as a method of chemical restraint. This is undoubtedly systematic abuse.”

READ MORE @ TIMESONLINE

Dementia Drugs a Danger to Seniors - Warnings lost in reams of drug company literature

A group of drugs that can have serious adverse effects when used by the elderly continues to be widely prescribed in Canada and the United States, despite concerns about their safety.

The drugs, called atypical antipsychotics, are used to manage the behavior of seniors who have dementia, but many experts consider them to be dangerous and possibly ineffective in elderly patients.

In 2005, both Health Canada and the Food and Drug Administration (FDA) in the United States warned that atypical antipsychotic medications increased the risk of death among elderly patients with dementia.

The Health Canada warning stated that in 13 scientific studies, elderly patients with dementia who were prescribed atypical antipsychotics had a 60 percent higher death rate on average than similar patients taking placebos.

READ MORE @ EPOCH TIMES

Dangerous drugs continue to be prescribed to seniors: CBC report

Doctors are continuing to prescribe drugs dangerous to seniors in spite of government warnings, a CBC News investigation reveals.

More than two years ago, CBC News first reported that more than a million seniors were prescribed atypical antipsychotics. Atypical antipsychotics are specific kinds of antipsychotic drugs. They are considered by many experts to be ineffective or even dangerous for elderly patients.

Health Canada followed up with warnings pointing to the drugs' side effects — including a 60 per cent greater risk of death in seniors who were taking the drugs than in patients taking placebos — gleaned from 13 scientific studies. It also warned that elderly patients taking atypical antipsychotics were almost twice as likely to die from side effects such as heart failure.

In its advisory, Health Canada requested that the drugs' manufacturers include a warning describing the risk in the safety information sheet provided along with the drugs, and that health care providers refrain from relying too much on the drugs to treat dementia.

READ MORE @ CBC

Antipsychotics, Nursing Homes And Abuse

Keeping them quiet down on the farm. That’s the tone of one story after another these days about how nursing homes increasingly give antipsychotics to patients, whether they need them or not. And of course, the tab is often picked up, unnecessarily by Medicaid, for instance. A couple of weeks ago, The St. Petersburg Times ran such a piece in which Barbara Hengstebeck, executive director of the Coalition to Protect America’s Elders in Tallahassee, Fla., offered an explanation: “A lot of people feel like the elderly in nursing homes are expendable.”

The latest spend-a-gram comes from The Wall Street Journal, which notes that the Centers for Medicare & Medicaid Services says nearly 21 percent of nursing-home patients who don’t have a psychosis diagnosis are on antipsychotic drugs. The use comes amid a wider debate about how to care for the rising numbers of seniors, many of whom have behavior problems stemming from dementia. And a big question, the paper writes, is whether to use a medical model - administering these meds as the way to alleviate distressing symptoms or trying to find other ways to help these patients.

READ MORE @ PHARMALOT

Dementia relief, with a huge side effect

The off-label use of some drugs is helping elderly patients, but may be killing thousands.

Two years ago, federal regulators sounded a dire warning: Elderly people with dementia who take drugs like Seroquel, Risperdal and Zyprexa could suffer the ultimate side effect.

They could die.

Yet today, about one in four nursing home residents still take these antipsychotic drugs. Sales to the elderly continue to rise, generating a total of $13-billion in revenues for their manufacturers this year.

The disconnect between government warnings about the increased risk of death and physician prescribing practices led a prominent Food and Drug Administration safety expert to make a stunning estimate.

Dr. David Graham, who had blown the whistle on the dangers of Vioxx, was back before a congressional panel in February. He testified that Zyprexa and other antipsychotics kill about 15,000 nursing home residents each year.

His pronouncement did not spark any followup investigations; it did not prompt government-sponsored research for safer alternatives. Instead, there was resounding silence.

READ MORE @ ST. PETERSBURG TIMES