Sleeping Pills Linked to Higher Risk for Dementia

Alan Mozes wrote . . . . . . . . .

Seniors who frequently take sleeping medications may be raising their risk for developing Alzheimer’s disease, a new study warns.

Sleep medications are one of the most commonly used medications in older adults, the authors say, but their frequent use may not be without harm.

Researchers found that older white adults who said they “often” or “almost always” took sleep aids had a 79% higher chance of developing dementia compared to those who “never” or “rarely” used them.

The connection was only seen among white adults, not Black participants.

In addition, “further studies are needed to confirm whether sleep medications themselves are harmful for cognition in older adults or [if] frequent use of sleep medications is an indicator of something else that links to an increased dementia risk,” said study lead author Yue Leng.

In other words, the investigation “cannot prove causation,” stressed Leng, an assistant professor in the Department of Psychiatry and Behavioral Sciences at the University of California, San Francisco.

Percy Griffin, director of scientific engagement with the Alzheimer’s Association, seconded the thought.

“We do want to be careful,” said Griffin, who wasn’t part of the study. He noted that observational studies of this kind can only identify an association between a “modifiable risk factor” — like medication habits — and dementia risk. “They don’t prove cause and effect,” he said.

For the study, Leng and her team enlisted roughly 3,000 seniors to share their sleep medication routines starting in 1997.

Participants were between 70 and 79 years old, and none had dementia. All lived in Memphis or Pittsburgh. Nearly 6 in 10 were white and 4 in 10 were Black.

Three times over five years all were asked how often they took sleeping aids: never, rarely (once a month or less), sometimes (2 to 4 times a month), often (5 to 15 times a month), or almost always (16 to 30 times a month).

Participants also discussed the quality of their sleep, indicating how frequently they struggled with falling asleep and/or getting up too early in the morning. Routine sleep duration was also noted.

Sleep aids encompassed both over-the-counter and prescription medications. Common over-the-counter options included antihistamines, melatonin and valerian. Prescription meds included antidepressants, antipsychotics, benzodiazepines and so-called Z-drugs such as Ambien (zolpidem).

Overall, 7.7% of the white participants said they took some type of sleep medication often or almost always.

Yet 2.7% of Black participants reported a similar level of routine usage.

Among white and Black participants, frequent usage was highest among women, those struggling with depression and the more highly educated.

The team noted that benzodiazepine use for chronic insomnia — including Halcion (triazolam), Dalmane (flurazepam) and Restoril (temazepam) — was twice as high among white seniors compared with Black seniors. White participants were also seven times more likely to take a Z-drug like Ambien, and 10 times as likely to take the antidepressant trazodone (Desyrel and Oleptro).

After tracking participants for up to 15 years, the researchers found about one-fifth developed dementia.

While white seniors who used sleeping pills frequently faced a 79% higher risk for dementia, that was not the case among Black seniors — and not just because far fewer Black adults took sleeping aids frequently. Those who did use them often appeared to face no higher risk for developing dementia than those who rarely or never took a sleeping med.

Leng said the racial gap her team identified was “surprising to us,” particularly since prior research suggests that Black people generally face a higher risk for developing Alzheimer’s than their white peers.

“One possible explanation could be that Black adults who have access to sleep meds are a selected group of people with high socio-economic status,” which might afford them a mental health leg up that’s protective against dementia, Leng said.

Yet even among white seniors, Leng “wouldn’t say sleep meds ‘boost’ Alzheimer’s disease risk” based on the findings. And her team stressed that “it remains controversial whether sleep medications are good or bad for cognition in the long run.”

It could turn out that certain meds might contribute to dementia risk, while others don’t. Or that having sleep problems — the reason for using sleep meds — is a symptom of dementia onset, Leng suggested.

Both she and Griffin agreed additional research is needed.

“More work needs to be done,” said Griffin. “And we shouldn’t be sounding the alarm bells just quite yet.”

Meanwhile, he offered some cautionary advice: “In general, before anyone takes any sleep medication, or any medication for that matter, they should have a conversation with their doctor to see how it might interact with any other medication they might already be taking.” Their medical history and life story in general should also be considered, he added.

The study results appear online in the Journal of Alzheimer’s Disease.

Source: HealthDay






How Many Daily Steps Do You Need to Lose Weight?

Cara Murez wrote . . . . . . . . .

It’s clear that staying active is key to being healthy, and fitness trackers and smartwatches have become popular tools for tracking activity.

But just how many steps does someone need to take to lose weight?

That’s not such a simple a question.

While evidence is limited on exactly how many steps a day it takes to lose weight, experts say to get about 150 to 300 minutes of moderate- to vigorous-intensity exercise weekly, said Amanda Paluch, an assistant professor in the department of kinesiology and Institute for Applied Life Sciences at the University of Massachusetts, Amherst.

That’s about an average of 22 minutes per day on the low end and 45 minutes on the high end, Paluch said.

“And we do know that for weight loss and weight maintenance, you really need to get to that higher end,” Paluch said.

“We do need to exercise more often at this moderate to vigorous intensity to really see weight loss,” Paluch added, but “we really haven’t figured out how much that equates to in terms of steps per day.”

Tracking steps

That doesn’t mean a person shouldn’t track their steps.

“These types of devices can really help us with tracking and goal-setting,” Paluch said.

Harvard Health cited a review of recent studies that found people who were overweight or obese and who had chronic health conditions were helped in losing weight by wearing fitness trackers.

In the reviewed studies, participants had weekly goals for steps or minutes walked and were most successful when those programs lasted at least 12 weeks.

Those 10,000 steps

The idea of getting 10,000 steps is not new, but proving that number works is more challenging.

Yet, a study published in the journal Obesity found that getting 10,000 steps per day, with about 3,500 of those as moderate to vigorous physical activity for at least 10 minutes at a time, was found to be associated with enhanced weight loss in a behavioral intervention that included a calorie-restricted diet.

Another study, published recently in the journal JAMA Internal Medicine, found that for every 2,000 steps a study participant logged, their risk of early death dropped by between 8% and 11%, up to 10,000 steps. Researchers also found that 9,800 steps per day showed the greatest benefit.

And a recent study published in the journal Nature Medicine, found walking 10,000 steps a day reduced the risk for dementia, heart disease and cancer.

More walking or running equals more calories burned, Dr. Chip Lavie, medical director of cardiac rehabilitation and prevention at John Ochsner Heart and Vascular Institute in New Orleans said about the study when it was published.

“Generally, we say 100 calories are burned per mile walked or run,” Lavie noted.

Getting started on walking to lose weight

Don’t get discouraged if you get only modest weight loss. Even that can have big benefits. Losing just 5% to 10% of total weight can improve blood pressure, blood sugar and blood cholesterol, according to the U.S. Centers for Disease Control and Prevention.

Walking can also reduce the risk of obesity, heart disease, diabetes, high blood pressure and depression, according to the Mayo Clinic, which says most Americans walk about 3,000 to 4,000 steps per day.

Figure out how much you walk, then add 1,000 extra steps every two weeks, the Mayo Clinic suggests, by walking the dog, hiking together as a family or parking farther away from your destination.

Setting the pace

Pacing can also make a difference.

“We do know that intensity does tend to matter for weight loss. So, getting in more brisk walking, that’s really where we feel confident that if you do enough of it that could support weight loss,” Paluch said.

This could be done in short intermittent bouts or in longer organized workouts.

It may be that for a particular person the goal isn’t the steps but the minutes of physical activity. Or it could be counting the miles per day and being aware of how many they achieve at a brisk pace.

Even with robust exercise, in most cases, diet is crucial for weight loss, Paluch noted.

“Physical activity can provide lots of additional improvements in other health factors, but without any nutritional program, it’s very difficult to lose weight,” Paluch said. “They really go hand in hand when we think about weight loss. It is the combination of being active and following a structured diet.”

Source: HealthDay





Initial Symptoms Could Predict How Fast Alzheimer’s Progresses

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

Memory loss is the most common symptom associated with Alzheimer’s disease — the terrifying prospect of slowly forgetting yourself and everything around you.

But people who exhibit memory loss early on in their dementia actually have a slower rate of decline than those who develop other symptoms earlier, a new study reports.

Difficulty forming sentences, making plans, solving problems or judging space and distance — these symptoms all herald a steeper and faster decline for Alzheimer’s and dementia patients than do early memory problems, researchers found.

“People with memory changes in fact have a slightly slower rate of disease progression than people who have other symptoms, like language or judgment issues, in terms of their ability to function independently and take care of themselves,” said lead researcher Dr. Jagan Pillai, a neurologist with the Cleveland Clinic Center for Brain Health, in Ohio.

If these early symptoms prove to be a reliable clue, they could help patients and their families better prepare for what’s ahead, he said.

Future Alzheimer’s drug trials could also avoid potential bias by making note of people’s early symptoms and sorting out those expected to have a more rapid decline, Pillai added.

“In clinical trials, everyone with Alzheimer’s disease is lumped together,” Pillai said. “You can imagine bias occurring if the medication arm of the trial has more people with non-memory problems than the placebo arm. That could bias the results.”

For the study, his team analyzed data on more than 2,400 people with dementia, drawn from a database maintained by the National Alzheimer’s Coordinating Center.

Many Alzheimer’s treatment centers in the United States regularly feed information into the federal database, which since its start in 1984 has grown into a large repository of patient data for research.

Memory problems are the most common early symptom of Alzheimer’s and dementia. Nearly 80% of the time, memory loss serves as the first sign that something is wrong, results show.

“When anyone thinks about Alzheimer’s disease, they think about someone having memory loss and how it progressed over time to affect other areas of their function or their thinking,” Pillai said. “It’s less well-known to the general public that Alzheimer’s can present with other symptoms initially.”

But nearly 10% of dementia patients initially have symptoms related to their executive function, the researchers found.

“They might have problems making judgments,” Pillai said. “They cannot plan their day or perform a task like signing on to a computer.”

Another 10% first present with symptoms related to language.

“They’re just not able to speak in full sentences, and struggle with expressing themselves,” Pillai said.

People with those rarer early symptoms had a faster rate of decline in their brain function and their ability to maintain their quality of life, study results showed.

“That really means that a good clinician actually has a lot of opportunity to have insight into what’s going to happen to a patient over time,” said Mary Sano, director of the Alzheimer’s Disease Research Center at Mount Sinai, in New York City.

“I think that’s really important because there’s always some hesitancy about whether or not to diagnose Alzheimer’s disease,” Sano said. “And what you can see is that it is important to get the evaluation. It will tell you a little bit about your prognosis and what you might expect over time.”

There’s no way to know why these differences in decline exist, but it could be based on how Alzheimer’s or dementia affects specific regions of the brain, Pillai said.

A brain region affected by dementia might produce specific early symptoms, and that region might also be prone to rapid decline.

Another potential explanation might involve how these early symptoms affect a person’s everyday life, Pillai said.

“Let’s say someone has a memory problem, but they can still function independently in their daily routine, because their routine has been pretty consistent over a period of time for them, so they’re able to function within that specific limitation,” he said.

“Whereas if you have changes like language problems, that limits your ability to go out and make things happen in society. Your social life changes pretty significantly. Or if you have a spatial problem, it’s difficult to navigate outside of home, outside of your comfort zone. If you have judgment issues, you cannot take on any new projects pretty early,” Pillai continued.

So those things start affecting daily functioning much earlier than memory issues, which people can likely compensate for longer, he suggested.

Claire Sexton, the Alzheimer’s Association senior director of scientific programs and outreach, agreed with Pillai.

“If language abilities and executive functioning are somewhat preserved, this may limit the rate of decline in overall cognition and functioning,” she said.

Researchers said the difference in the speed of decline is enough that it could have biased the clinical trials that led to the approval of the Alzheimer’s drugs Aduhelm (aducanumab) and Leqembi (lecanemab).

“Future clinical trials might have to be more careful in making sure that people with memory or non-memory problems are equally balanced in both the drug and the placebo arms, so there’s no bias in terms of measuring effectiveness,” Pillai said.

He doubts that these symptoms could be used to determine who might benefit from the new Alzheimer’s drugs.

“If future studies show that the disease itself is very different for memory problems versus other non-memory changes, then it might have future implications for therapies,” Pillai said. “But we’re not there yet.

But Sano said the symptoms might give doctors an idea of what to expect from the drug in specific patients.

“If you knew that a person’s first symptom was one of these other ones and you might expect that they were going to deteriorate more rapidly, then your expectation of the treatment might be that it could still have an effect but it might not be as effective as it is if someone didn’t have those additional symptoms,” Sano said.

The findings were recently published online in the journal Alzheimer’s & Dementia.

Source: HealthDay





‘Spare Tire’ in Middle Age Could Mean a Frail Old Age

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

Any ‘middle-age spread’ of excess weight around your tummy could raise your risk of becoming frail decades later, a new study suggests.

Obese folks who’ve packed on pounds around their waist are more likely to develop symptoms of frailty, including exhaustion, weak grip strength, slow walking speed and reduced physical activity levels, researchers say.

Those symptoms can make a person more likely to hurt themselves in a fall, suffer disability, require hospitalization, have a lower quality of life and die prematurely.

Frailty affects as many as 17% of older adults, according to the American Academy of Family Physicians.

The new study, published in BMJ Open, tracked more than 4,500 people in Norway for an average 21 years, starting at an average age of 51. Measurements of body mass index (an estimate of body fat based on height and weight) and waist circumference were taken at the start.

Waistlines were categorized as “normal” if they were 37 inches or less for men and 31 inches or less for women; “moderately high” as 37-40 inches for men and 32-35 inches for women, and “high” if above 40 inches for men and 35 inches for women.

People who were obese at the outset were nearly 2.5 times more likely to be frail or on the edge of frailty by the study’s end, said lead researcher Shreeshti Uchai, a research fellow in the Department of Nutrition at the University of Oslo.

Likewise, people with a large waist circumference were twice as likely to be pre-frail or frail compared to those with a normal waistline, while those with a moderately large waistline were 57% as likely.

However, the risk of frailty was not increased in people who either started off with a normal BMI but a moderately large waistline or those who were overweight but with a normal waistline.

Higher odds of frailty also were observed among folks who put on weight or grew a spare tire, compared with those who kept about the same weight and waistline throughout the study.

The findings add to mounting evidence that obesity aggravates age-related declines in muscle strength, aerobic capacity and physical function, researchers said.

They speculate that extra fat might spur increased inflammation in aging people, which is likely to boost natural age-related declines in muscle mass and strength. As people grow weaker, their risk of frailty increases.

Frailty often is looked at as someone wasting away, but this study shows that some aging adults can be seen as “fat and frail,” the researchers said in a journal news release.

The study “highlights the importance of routinely assessing and maintaining optimal BMI and [waist circumference] throughout adulthood to lower the risk of frailty in older age,” the researchers concluded.

Source: HealthDay





Intensive Blood Pressure Control May Lower Risk for Cognitive Problems in More People

Laura Williamson wrote . . . . . . . . .

Several years ago, researchers published in JAMA a promising discovery: intensively lowering blood pressure appeared to reduce the risk for cognitive decline in people 50 and older with high blood pressure. But questions remained about whether the strategy was safe or effective in people whose diastolic blood pressure – the bottom number in a blood pressure reading – was low. Some data suggested intensive control might raise the risk for dementia in this group.

A new study led by researchers in China suggests otherwise. The findings, published Monday in the American Heart Association journal Hypertension, show no evidence that intensive systolic (top number) blood pressure control is harmful to people whose diastolic blood pressure is low. Compared to people whose systolic blood pressure was lowered to standard levels, people who intensively reduced their systolic levels had a lower risk for probable dementia or mild cognitive impairment, regardless of whether their diastolic levels were high or low before treatment.

“I think this further supports the general notion that for most people, intensive blood pressure control is safe and has potential benefits,” said Dr. Rebecca Gottesman, chief of the stroke branch at the National Institute of Neurological Disorders and Stroke Intramural Research Program in Bethesda, Maryland.

Gottesman, who was not involved in the research, said the study addressed an important gap in the scientific literature about who could benefit from intensive blood pressure control. “It gives us at least some confidence that across diastolic blood pressure levels, it is similarly safe.”

A blood pressure reading has two numbers. The top number measures systolic pressure, the force against artery walls when the heart beats. The bottom number, diastolic pressure, measures the same force between beats.

Previous studies have established high systolic blood pressure, especially during midlife, as a risk factor for cognitive decline and dementia and have shown that lowering it reduces that risk.

Mild cognitive impairment, or MCI, is defined as having more difficulty thinking, remembering and reasoning than other people of the same age. Dementia creates more severe challenges which interfere with the ability to perform basic functions of daily life.

In the new analysis, researchers used data from the SPRINT MIND trial, short for Systolic Blood Pressure Intervention Trial – Memory and Cognition In Decreased Hypertension, which randomly assigned people 50 and older with high systolic blood pressure to an intensive blood pressure control target (less than 120 mmHg) or a standard one (less than 140 mmHg). Cognitive function was measured using a series of tests at the start and throughout the course of follow-up.

The SPRINT study – designed to collect data for five years – was halted after slightly more than three years, when it became clear that intensively lowering blood pressure significantly reduced the risk for cardiovascular disease and death. Researchers continued to analyze the data collected to that point for the MIND portion of the study, which looked at how intensive blood pressure control affected dementia risk. They found that, compared to standard blood pressure control, intensive control did not reduce dementia risk but did have a significant impact on reducing MCI.

This latest research looked deeper into the relationship between intensive blood pressure control and dementia risk, with a focus on whether intensive control could harm cognitive function in people with very low diastolic blood pressure. It also looked at whether intensive control lowered blood flow to the brain, a condition associated with accelerated cognitive decline and higher dementia risk. Cerebral blood flow was measured in a subset of 348 participants (193 in the intensive group and 155 in the standard group) using magnetic resonance imaging at the time of enrollment and 48 months after people were assigned to their blood pressure-lowering groups.

There were 4,278 people in the intensive blood pressure control group and 4,285 in the standard group, with an average age of 68. Researchers further divided each group into four subgroups based on their diastolic pressure. Those in the lowest fourth had diastolic pressure levels less than or equal to 70 mmHg, and those in the highest group had diastolic levels 87 mmHg or higher.

The new analysis showed people with the lowest diastolic pressure levels had higher rates of cognitive decline than those with higher diastolic pressure. However, regardless of diastolic pressure, people in the intensive blood pressure-lowering group had lower rates of probable dementia or mild cognitive impairment than those in the standard group. There was no evidence that intensive blood pressure control harmed cerebral blood flow.

The findings suggest there may be greater cognitive benefit to intensive blood pressure control for people with very high diastolic pressure, compared to those with very low diastolic levels, Gottesman said. “But these are small numbers, so we don’t want to make too much of it.”

For one thing, people with very low diastolic pressure are different than those with higher pressure, Gottesman said. The authors noted that those in the lowest diastolic group were more likely to be older and have more health problems.

It’s also possible that people in the low diastolic group were already in the early stages of dementia, Gottesman said. “There is some evidence people with dementia will have a drop in blood pressure, and that’s why you see no benefit in the group with very low diastolic levels,” she said. “The ship may have already sailed for them.”

One weakness of the study, Gottesman said, is that because the SPRINT trial was halted early, there were less than four years of follow-up data to analyze. “When it stopped, it might have been too early for cognitive outcomes to show because they take longer to accrue,” she said. “If this went on for decades, I don’t know if it would show intensive blood pressure control was safe for these people.”

Source: American Heart Association