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

Canada Grocer Testing In-Store Robotic Micro-fulfillment

Chris Albrecht wrote . . . . . . . . .

Loblaws, Canada’s largest grocery chain, announced this week that it was piloting Takeoff Technologies‘ robot-powered micro-fulfillment center in one of its stores. Supermarket News reports that the two companies have already started building out the center in Toronto and will fulfill orders for Lawlaws’ PC Express pickup service next year.

Typically built into the back of a retailer, Takeoff’s automated fulfillment centers use a series of totes, rails and conveyors to shuttle food items around. Once an online grocery order comes in, totes automatically bring the items to a human who assembles them into bags that go out to the car. According to Supermarket News, Takeoff’s system can gather grocery orders of 60 items in less than five minutes.

Ideally, micro-fulfillment technology like Takeoff’s allows retailers to convert un- or little-used space into more productive and revenue-generating areas for a store while creating a faster, more convenient online grocery shopping experience for customers. Online grocery shopping is still a small percentage of overall grocery spending, but it’s growing, and automated fulfillment (and the holidays!) could help spur more food shopping from home.

This new partnership expands Takeoff’s reach across North America and into Canada and adds another high profile partner for the startup. Here in the U.S., Takeoff already has a number of pilots going on with Sedano’s, Albertsons, Ahold Delhaize and Wakefern.

While Takeoff has a few partnerships it can point to, there are plenty of automated fulfillment players getting into the game or trying out different approaches to fulfillment. Alert Innovation also builds in-store fulfillment and has partnered with Walmart on a pilot location. Fabric just raised $110 million and moved its headquarters to the U.S. to expand its robotic fulfillment presence here. And instead of inside its stores, Kroger is building 20 standalone robot-powered smart warehouses domestically.

Despite all this, automated fulfillment is still in the early days of testing, and it remains to be seen if and how it will impact a retailer’s bottom line. As more of these systems come online in 2020, we’ll definitely see if they fulfill their robotic promise.

Source: The Spoon

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

At Museums Around the World, a Focus on Food

Vivian Song wrote . . . . . . . . .

The city of Lyon, France, is hoping to cement its reputation as the cradle of French gastronomy with the opening of a new cultural gastronomy center that is being described as the first of its kind in France, and the largest of its kind in the world.

Six years in the making, the Cité Internationale de la Gastronomie de Lyon (International City of Gastronomy) opened its doors last month inside the Grand Hôtel-Dieu, a former hospital that dates back to the 12th century.

Spanning four floors and 43,055 square feet, the center, which cost €20 million (around $22 million), is designed to be an interactive and sensorial experience for visitors: The smell of chicken bubbling away in a casserole pot wafts through the space dedicated to traditional Lyonnaise cuisine, while a virtual exhibit recreates the sights and sounds of an open-air farmer’s market.

The center’s opening adds to an already rich gastronomic landscape in Lyon: The city is home to Bocuse d’Or, the real-life “Iron Chef” international cooking competition; bouchons, traditional Lyonnaise restaurants; and the celebrated chef Paul Bocuse, who died last year.

Florent Bonnetain, project director and general manager, said that the culinary center aims to draw on the building’s heritage as a former hospital by exploring the connections between food and nutrition, along with sustainability, economics and international food culture.

“We’re looking at the subject of gastronomy as a whole,” Mr. Bonnetain said. “There are thematic food museums around the world, but here we wanted to take gastronomy and approach it from a cultural and educational point of view.”

Indeed, thematic museums centered around a single food item have been around for decades, be it chocolate, ice cream, French fries or ramen. Then there are the branded food museums from SPAM, Guinness, Coca-Cola or Jell-O. They can tend to be cartoonish or self-promotional, and verge on kitsch.

But in recent years, conversations around food security, climate change and public health have led to more ambitious and thoughtfully curated exhibitions around the world.

After first launching as a mobile exhibition in 2013, the Museum of Food and Drink found a permanent space in a 5,000-square-foot studio in New York City in 2015. It has explored natural and artificial flavors in the food industry, the evolution of Chinese-American restaurants and, next February, will open an exhibition on the contributions of African-American chefs, farmers and producers to food culture.

The executive director, Peter Kim, began pitching the idea in 2012, and said he was met primarily with skepticism and “bewilderment.” But since then, he’s noticed a sea change in the museum’s reception, and the way people think about food, thanks to a confluence of factors: food-related public policies, immigration, media attention, climate change and growing interest inside academia.

“All these things feed into each other and reinforce an understanding of food as being much more than just gustatory experience. Instead, there’s an understanding that when you take a bite of something, you plug into the world every time,” he said.

International media interest also helped the Disgusting Food Museum — which opened last fall as a temporary exhibition in Malmӧ, Sweden — become permanent this January and organize pop-up versions globally. Despite its name, the exhibition is meant less to provoke revulsion, but to challenge people’s notions of what’s edible and what’s not, as one person’s trash, be it maggot-infested cheese or bull testicles, could be another person’s delicacy. Moreover, curators point out that changing our ideas of disgust could help us embrace more environmentally sustainable foods — notably bugs and insects — in the future.

In Europe in recent months, the Museum of Mankind in Paris opened the exhibition “I Eat, Therefore I Am,” exploring the evolutionary, ecological and cultural role of food in civilization, and the Victoria and Albert Museum in London just wrapped up “Food: Bigger than the Plate,” which looked at urban farming, gastronomy, politics and sustainability.

At the Cité, working kitchens, experimental laboratories and spaces for conferences and debates are designed to enrich the visitor experience. The overall concept mirrors Bordeaux’s Cité du Vin, a wine museum which opened in 2016 and explores winemaking throughout civilization and also hosts industry conferences.

“We know that gastronomy is a big tourist attraction for Lyon,” Mr. Bonnetain said. “With the museum, our hope is that visitors will be able to experience gastronomy differently here. We want to be a complementary experience to restaurants in Lyon.”

Source: The New York Times