Common Muscle Relaxant Could Pose Mental Dangers for Seniors

Dennis Thompson wrote . . . . . . . . .

A commonly prescribed muscle relaxant known as baclofen can leave older kidney patients so disoriented that they land in the hospital, a new study warns.

“It can present with acute stroke-like symptoms, even though it’s not a stroke,” said senior researcher Dr. Amit Garg, a professor of nephrology at Western University in Ontario, Canada. “It can present with dementia-like symptoms.”

About 1 in 25 people with low kidney function prescribed high doses of baclofen wound up being admitted to a hospital for severe confusion, according to a study of nearly 16,000 older Canadians with chronic kidney disease.

By comparison, only one in 500 kidney patients not prescribed baclofen wound up hospitalized for confusion.

“There was a pretty marked difference in risk,” Garg said, noting that these findings “highlight a potential risk associated with these drugs that hasn’t been fully appreciated.”

Other seniors might also face this risk, since kidney function often declines as people grow older, he added.

Baclofen is typically prescribed to people suffering muscle spasms, Garg said. Doctors hand out more than 8 million prescriptions of baclofen every year. It’s sold under a number of different brand names, including Lioresal, Gablofen and Kemstro.

The drug leaves the body when the kidneys filter it out of a person’s blood, Garg explained.

“If someone’s kidney function isn’t working very well, that means the drug is accumulating in the system,” he said.

Garg and other doctors had started noticing that kidney patients on baclofen sometimes became disoriented and dazed.

For example, nephrologist Dr. Holly Koncicki remembers some dialysis patients showing up with noticeably clouded mental capacity.

“Of those I can remember, they often presented with confusion or being very sleepy and lethargic,” said Koncicki, of the Icahn School of Medicine at Mount Sinai, in New York City.

In the Canadian study, Garg and his colleagues combed the medical literature and found 30 prior case reports linking baclofen to hitches in brain function, so they decided to more closely study this potential problem.

The researchers pulled health data on nearly 16,000 older Ontario residents with chronic kidney disease who had been prescribed baclofen between 2007 and 2018.

The investigators compared those patients’ hospitalizations for mental conditions against those from a group of almost 300,000 kidney patients who’d not been prescribed the drug.

Patients were at greatest risk of hospitalization for confusion if their kidney function was very impaired — 30% or less — and they had been prescribed a high dose of baclofen, more than 20 milligrams (mg) per day.

But even patients with kidney function as high as 60% had an increased risk of confusion when prescribed high doses of baclofen, the findings showed. About 1 in 5 older adults live with kidney function of less than 60%.

Kidney patients prescribed baclofen at 20 mg/day or higher had nearly 20 times the relative risk of being hospitalized for an altered mental state, compared with patients not taking the drug, the researchers found.

Doses lower than 20 mg/day were associated with a nearly sixfold increase in kidney patients’ risk of hospitalization.

The results were published online in the Journal of the American Medical Association, to coincide with a planned presentation at the American Society of Nephrology annual meeting, in Washington, D.C.

Koncicki, who was not involved with the study, said, “In our older patients with impaired kidney function, there should be cautious use of this medication.”

Garg added that the effect might be even more widespread than what was found in the study, which only considered people so severely affected that they landed in the hospital.

He said he’s concerned that many more people “might have more subtle changes in their thinking who we aren’t even picking up in this study.”

People already taking baclofen should keep taking the drug but ask their doctor about these possible mental side effects, Koncicki and Garg said.

Patients “should feel empowered to ask questions about the risks and benefits of medications,” Koncicki said, “and side effects to watch out for so they can make an informed decision about whether a medication is right for them.”

Dr. Teresa Murray Amato, director of geriatric emergency medicine at Northwell Health in New Hyde Park, N.Y., agreed.

“All patients should speak to their doctors regarding side effects of all medications,” Murray Amato said. “For patients over 65, make sure you understand your kidney function and ask about potential renal dosing on all medications. If you are on baclofen now, make sure you contact your health care provider so that you can have an expedited conversation.”

“Please seek emergency care if you or your family member is showing any signs of altered [mental activity] and you suspect medications may be involved,” Murray Amato said.

Regulatory agencies also might consider strengthening the drug warning for baclofen to include this potential effect, Garg said.

Source: HealthDay

Increased Exercise Over the Age of 60 Reduces Risk of Heart Disease and Stroke

People over the age of 60 should do more exercise not less in order to prevent heart disease and stroke, according to findings from a study of over 1.1 million elderly people published in the European Heart Journal [1] today (Friday).

The researchers in South Korea found that people who did less moderate or vigorous physical activity as they got older had as much as a 27% increased risk of heart and blood vessel problems, while those who increased their levels of activity had a reduced risk of cardiovascular disease of up to 11%.

The link between levels of physical activity and risk of cardiovascular disease in older people held true even for those with disabilities and chronic conditions such as high blood pressure, high cholesterol levels and type 2 diabetes.

Researchers, led by Mr Kyuwoong Kim, a PhD student at Seoul National University Graduate School Department of Biomedical Sciences in Seoul, under the supervision of Professor Sang Min Park, carried out the study in 1,119,925 men and women aged 60 years or older and who underwent two consecutive health checks provided by the Korean National Health Insurance Service (NIHS) from 2009 to 2010 and 2011 to 2012. The NIHS provides healthcare services for approximately 97% of the Korean population. The participants were followed up until December 2016.

At each health check the participants answered questions about their physical activity and lifestyle. The researchers calculated the amount of moderate exercise (e.g. 30 minutes or more a day of brisk walking, dancing, gardening) and vigorous exercise (e.g. 20 minutes or more a day of running, fast cycling, aerobic exercise) per week at each screening, and how it had changed during the two years between the screenings.

The researchers collected data on heart disease and stroke from January 2013 to December 2016. They adjusted their analyses to take account of socioeconomic factors, such as age and sex, other medical conditions and medication taken, and lifestyle behaviours, such as smoking and alcohol consumption.

The average age of the participants was 67 years and 47% were men. About two-thirds said they were physically inactive at both the first and second screening period. A higher proportion of women were physically inactive (78% and 77%) compared to men (67% and 66%) in both screening periods. Only 22% of inactive people increased their physical activity by the time of the second health check, and 54% of people who had been exercising five or more times a week at the time of the first screening had become inactive by the time of the second. During the follow-up period a total of 114,856 cases of heart disease or stroke occurred.

The researchers found that people who moved from being continuously inactive at the 2009-2010 health check to being moderately or vigorously active three to four times a week at the 2011-2012 health check had an 11% reduced risk of cardiovascular problems. Those who were moderately or vigorously active one or two times a week at the first check had a 10% reduced risk if they increased their activity to five or more times a week.

In contrast, those who were moderately or vigorously active more than five times a week at the first check and then became continuously inactive at the second check had a 27% increased risk of cardiovascular problems.

When the researchers looked specifically at people with disabilities and chronic conditions, they found that those who changed from being inactive to being moderately or vigorously active three to four times a week also reduced their risk of cardiovascular problems. People with a disability had a reduced risk of 16%, and those with diabetes, raised blood pressure or cholesterol levels had a reduced risk of between 4-7%.

Mr Kim said: “The most important message from this research is that older adults should increase or maintain their exercise frequency to prevent cardiovascular disease. Globally, this finding is of public health importance because the world’s population aged 60 years and older is expected to total two billion by 2050, which is an increase from 900 million in 2015 according to the World Health Organization. While older adults find it difficult to engage in regular physical activity as they age, our research suggests that it is necessary to be more physically active for cardiovascular health, and this is also true for people with disabilities and chronic health conditions.

“We believe that community-based programmes to encourage physical activity among older adults should be promoted by governments. Also, from a clinical perspective, physicians should ‘prescribe’ physical activity along with other recommended medical treatments for people with a high risk of cardiovascular disease.”

Although the size of the study is a strength, a limitation is that it was carried out in the Korean population and so the researchers cannot be certain their findings will apply to other populations due to differences in ethnicity and lifestyle. Other limitations include: physical activity was assessed by a self-reported survey, which is subject to bias; information was lacking on other types of physical activity, such as housework, and also muscle-strengthening activities; and the researchers were unable to assess the reasons why people changed their levels of physical activity because this was a study based on ‘real world’ data rather than data from an intervention study.

Source: European Society of Cardiology


Today’s Comic

Improved Fitness Can Mean Living Longer without Dementia

Anders Revdal wrote . . . . . . . . .

“It is important to say that it is never too late to begin exercising. The average participant in our study was around 60 years old at baseline, and improvement in cardiorespiratory fitness was strongly linked to lower dementia risk. Those who had poor fitness in the 1980s but improved it within the next decade could expect to live two years longer without dementia,” says Atefe Tari of the Cardiac Exercise Research Group (CERG) at the Norwegian University of Science and Technology (NTNU).

Tari is lead author of a new study that was recently published in Lancet Public Health, a highly ranked journal in the prestigious Lancet family.

“Persistently low fitness is an independent risk factor for dementia and death due to dementia,” the authors concluded.

The higher, the better

Dementia involves a progressive decline in cognitive functions, severe enough to interfere with the ability to function independently. Alzheimer’s disease is the most common form of dementia.

By 2050, it is estimated that 150 million people in the world will have dementia – a tripling of the incidence of the disease today. There is no cure. Men live on average five years after being diagnosed with dementia, while women live for seven years on average after the diagnosis.

“As there is currently no effective drug for dementia, it is important to focus on prevention. Exercise that improves fitness appears to be one of the best medicines to prevent dementia,” says Tari.

Tari’s study is far from the first to show a link between good fitness and lower risk of getting dementia. What is unique, however, is that Tari and her research colleagues have measured the fitness level of participants twice ten years apart.

Thus, they have been able to evaluate how changes in fitness over time are related to dementia risk. And the results were clear.

Exercise that improves fitness appears to be one of the best medicines to prevent dementia.

“If you increase your cardiorespiratory fitness from poor to good you almost halve the risk of getting dementia. You also reduce the risk of dying from or with dementia. In our study, each increase of 1MET was associated with a 16% lower risk of getting dementia and a 10% lower risk of dementia-related death. This is an improvement that is very achievable for most people”, says Tari.

A MET is a measurement unit used by researchers to quantify the rate at which a person expends energy relative to their body weight.

Followed for 30 years

Between 1984 and 1986, almost 75,000 Norwegians participated in the first wave of the HUNT Survey (HUNT1). Eleven years later, HUNT2 was organized, and 33,000 of the same people participated. More than 30,000 of them answered enough questions to be included in Tari’s analyses.

The researchers calculated cardiorespiratory fitness with a formula previously developed and validated by the Cardiac Exercise Research Group, called the Fitness Calculator.

Previous studies have shown that those who score poorly on this calculator have an increased risk of heart attack, atrial fibrillation, depression and non-alcoholic fatty liver disease, and also that they generally die younger than people who achieve a higher fitness level.

The new study links results from the Fitness Calculator to the risk of dementia and dementia-related deaths up to 30 years later. To investigate these associations, Tari has used data from two different databases, the Health and Memory Study in Nord-Trøndelag and the Norwegian Cause of Death Registry.

Almost half the risk

Between 1995 and 2011, 920 people with dementia were included in the Health and Memory Study in Nord-Trøndelag. A total of 320 of them had also participated in both HUNT1 and HUNT2 and provided enough information about their own health to be included in the analyses.

It turned out that poor cardiorespiratory fitness in both the 1980s and 1990s was significantly more common in this group than among otherwise comparable HUNT participants who had not been diagnosed with dementia.

In fact, the risk of developing dementia was 40% lower for those who were among the 80% with the best fitness in both the 1980s and 1990s. Furthermore, it was 48% lower if one had changed from poor to higher fitness levels between the two surveys.

All participants were followed until death or end of follow-up in the summer of 2016. Via the Norwegian Cause of Death Registry, the NTNU researchers found 814 women and men who had died from or with dementia during the period. This means that dementia was stated as the underlying, immediate or additional cause of death.

The risk was lowest for those who had good fitness at both HUNT surveys. However, also those who had changed from poor to better fitness over the years had a 28% reduced risk.

Cause or coincidence?

In observational studies, there will always be questions about cause-effect relationships. For example, one might ask what causes what: Is it bad fitness that weakens the brain, or do people with cognitive impairment find it more difficult to be physically active and increase their fitness?

“Our study made it easy to see which came first. We estimated the fitness of the participants for the first time in the 1980s, and looked for dementia cases and deaths from 1995 onwards. We have also done separate analyses where we excluded those who got dementia or died during the first few years of the follow-up period, and the results were the same,” says Tari.

It’s also reasonable to ask if the association is random; it might not be the poor fitness that increases the risk of dementia, but people with poor fitness might also have several of the more well-known risk factors for dementia – such as high blood pressure, low level of education and a family history of brain diseases. That is an unlikely explanation, says Tari.

“The HUNT studies give us very broad information about the health of the participants, including body composition, smoking habits, educational level, blood pressure, diabetes, cholesterol levels and family history of stroke. By adjusting the analyses for these factors, we have ruled out that they fully explain the relationship between fitness and dementia risk in our study,” she says.

Physical activity vs. fitness

In other words, the study provides very good evidence that maintaining good fitness is also good for the brain. However, Tari points out that this does not necessarily mean that everyone who is physically active on a regular basis is guaranteed that a good effect on brain health.

“High-intensity exercise improves fitness faster than moderate exercise, and we recommend that everyone exercise with a high heart rate at least two days each week. Regular exercise that makes you sweaty and out of breath will ensure your fitness will be good for your age. Our study suggests that good fitness for your age can delay dementia by two years and that you can also live two to three years longer after being diagnosed with dementia,” she said.

Source: Norwegian SciTech News

Link Between Hearing and Cognition Begins Earlier Than Once Thought

Research has shown that adults with age-related hearing loss have higher rates of cognitive decline.

Now, a study from researchers at Columbia University Vagelos College of Physicians and Surgeons has found that even the earliest stage of hearing loss—when hearing is still considered normal—is linked to cognitive decline.

The study was published online today in JAMA Otolaryngology-Head and Neck Surgery.

Link Between Hearing Loss and Cognitive Impairment

Age-related hearing loss is one of the most common health disorders of aging, affecting two-thirds of those over age 70. However, few adults are tested for hearing loss, and even fewer are treated. Only 14% of adults with hearing loss in the United States wear hearing aids, the standard treatment.

Because studies show people with age-related hearing loss are more likely to have impaired cognition, it is thought that hearing loss may trigger cognitive decline. But these studies have only examined people diagnosed with hearing loss, which is defined as the inability to hear sounds under 25 decibels (dB).

“Physicians in this field have used 25 dB—about the loudness of a whisper—to define the border between normal hearing and mild hearing loss in adults, but this level is arbitrary,” says Justin S. Golub, MD, MS, assistant professor of otolaryngology-head & neck surgery at Columbia University Vagelos College of Physicians and Surgeons and a hearing specialist at Columbia University Irving Medical Center and NewYork-Presbyterian.

“It has been assumed that cognitive impairment wouldn’t begin until people passed this threshold. But no one actually looked at whether this was true.”

Any Hearing Loss May Be Cause for Concern

The researchers looked at data from 6,451 adults (average age 59) who were enrolled in two ethnically diverse epidemiologic studies. Participants underwent hearing and cognitive testing as part of the studies.

Golub and his colleagues found that for every 10 dB decrease in hearing, there was a significant decrease in cognitive ability, a pattern seen across the entire spectrum of hearing.

Surprisingly, the largest decrease in cognitive ability occurred in those whose hearing was just starting to become impaired, just 10 dB off the perfect mark.

“Most people with hearing loss believe they can go about their lives just fine without treatment, and maybe some can,” says Golub. “But hearing loss is not benign. It has been linked to social isolation, depression, cognitive decline, and dementia. Hearing loss should be treated. This study suggests the earlier, the better.”

Can Hearing Aids Prevent Cognitive Loss?

The current study did not address whether hearing loss causes cognitive impairment. It is possible that early declines in both hearing and cognitive performance are related to common aging-related processes, the researchers noted.

“But it’s also possible that people who don’t hear well tend to socialize less and, as a result, they have fewer stimulating conversations. Over many years, this could have a negative impact on cognition,” says Golub. “If that’s the case, preventing or treating hearing loss could reduce dementia incidence by more than 9%, according to a recent analysis published in The Lancet.”

A new study, funded by the National Institutes of Health, is now testing the possibility that hearing aids can slow cognitive decline in older people with age-related hearing loss.

More studies are needed before recommending changes in hearing loss categories. “One possibility is to formally introduce a new category, such as borderline hearing loss, ranging from 16 to 25 dB of hearing ability,” says Golub.

Source: Columbia University


Today’s Comic

New Research Reveals Protein Bars Not as Healthy as People Think

A new research report launched today by safefood has revealed that chocolate is the main ingredient in almost 40% of protein bars surveyed, with many also being high in saturated fat and containing added sugar and salt. The research also found that over 1 in 3 people (37%) surveyed think protein bars are “healthy”. When comparing current protein intakes among adults with what’s recommended, both men and women are already consuming more protein than they need from their diet.

The safefood research looked at the nutritional content of 83 high-protein snack foods and drinks available for sale in supermarkets on the island of Ireland. These foods included protein bars, yoghurts, yoghurt-style products and milk drinks. According to industry sources², there was a 498% increase in products launched between 2010 and 2016 with a high-protein claim.

Introducing the research, Dr Catherine Conlon, Director of Human Health & Nutrition, safefood said, “We’ve witnessed a significant and consistent upsurge in the number and variety of foods and drinks for sale which claim to be ‘high-protein’. From bars to milks and yoghurts, high-protein foods have now become mainstream in our supermarkets. When we asked people about protein bars, a third of them thought they were healthy. However, many of these bars are, in reality, highly processed foods with a calorie content similar to that of a bar of chocolate”.

“What’s also evident from dietary data is that men and women are already consuming more than enough protein in their diets and simply don’t need this extra, highly processed protein,” stated Dr Conlon.

Of the 39 protein bars surveyed, 38% listed chocolate as their main ingredient. 77% were high in saturated fat with 79% being a source of salt. The average bar size was 55g with an average price of €2.27 / 1.78 though some bars cost as much as €3.00 / £2.49 each.

“Processed snack foods high in protein need to be combined with fat, sugar or salt in order to make them tasty,” continued Dr Conlon. “People would be better sticking to natural sources of protein in their diet, which tend to be much healthier. And if you need a source of protein as a snack, alternatives like some nuts, a small glass of milk or a yoghurt is the way to go instead of these foods with added chocolate.”

Source: Safefood


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