Monthly Essentials May’16: Dementia

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The 3 essential articles on Dementia this month, selected from 758 peer-reviewed articles:

Ideal cardiovascular health index predicts dementia risk
Inappropriate prescribing among community dwellers with dementia
H.pylori infection and dementia

Ideal cardiovascular health index predicts dementia risk

Source: Stroke                                                     

Takeaway

  • Ideal cardiovascular health (CVH) index predicts risk for dementia and cognitive decline as well as risk for cerebrovascular disease.

Key results

  • Recent ideal CVH was associated with lower risk of vascular dementia (HR, 0.49; 95% CI, 0.30-0.81), frontal brain atrophy (P=.003), decline in visual memory and reasoning (P<.05), and stroke (HR, 0.80; 95% CI, 0.67-0.95).
  • Remote ideal CVH (6.9 y earlier) predicted vascular dementia, whole-brain atrophy, cognitive decline, and stroke and was associated with incidence of all-cause dementia (HR, 0.80; 95% CI, 0.67-0.97) and Alzheimer disease (HR, 0.79; 95% CI, 0.64-0.98).

Study design

  • 2750 Framingham Heart Study Offspring cohort participants (mean age, 62±9 y; 45% men), free of stroke and dementia at baseline, underwent measurement of 10-y risks of incident stroke and dementia, and ≈7 y risks of cognitive decline and MRI brain atrophy.
  • Ideal CVH determination was 0-7-points (1 point each for nonsmoking, ideal body mass index, regular physical activity, healthy diet, optimum blood pressure, cholesterol, and fasting glucose).

Why this matters

  • Following ideal CVH factors and behaviors, especially in midlife, may protect against dementia as well as cerebrovascular disease.

PubMed Abstract

Inappropriate prescribing among community dwellers with dementia

Source: J Alzheimers Dis                                                    

Takeaway

  • Potentially inappropriate prescribing (PIP) is highly prevalent among community dwellers with dementia.

Key results

  • Polypharmacy, defined as use of 4 or more repeat medications from different drug groups, occurred in 81.5% of the patients, and PIP in 64.4% (95% CI, 63.2%-65.5%).
  • The most prevalent PIP was use of anticholinergic/antimuscarinic medications (25.2%; 95% CI, 24.2%-26.2%).
  • Polypharmacy and female sex were associated with PIP (OR, 7.6 [95% CI, 6.6-8.7] and OR, 1.3 [95% CI, 1.2-1.4]), on the basis of multivariable analyses.
  • After adjustments for sex and polypharmacy, PIP was not associated with age, on the basis of logistic regression.

Study design

  • 6826 patients from the Northern Ireland Enhanced Prescribing Database were prescribed a medication indicated for dementia management during 2013.
  • Researchers applied a subset of 36 indicators from the Screening Tool of Older Persons Potentially Inappropriate Prescriptions criteria to the dataset.

Why this matters

  • Clinicians should be targeted for interventions to reduce PIP, particularly regarding polypharmacy and certain therapeutic categories.

PubMed Abstract

H.pylori infection and dementia

Source: J Alzheimers Dis                                                       

Takeaway

  • Helicobacter pylori (H. pylori) infection is associated with dementia risk.

Key results

  • Of 13 studies addressing cognition and/or dementia in association with H. pylori infection, 7 were included in the meta-analysis.
  • H. pylori infection was significantly positively associated with dementia (pooled OR, 1.71; (95% CI, 1.17-2.49; P=.01; no significant evidence of publication bias).

Study design

  • A Search on OVID-Medline, Institute of Scientific Information Web of Science, and EMBASE identified 260 studies in which the exposure variable was H. pylori infection and the outcome was incident dementia.

Why this matters

  • The underlying biological mechanisms and the effect of treating H. pylori on dementia risk and progression are still unknown. 

PubMed Abstract