Health and Medical News and Resources

General interest items edited by Janice Flahiff

[News release] Researchers Probing Potential Power of Meditation as Therapy

From the 8 April 2015 Wake Forest Baptist Medical Center press release

“We’re coming to recognize that meditation changes people’s brains,” said Wells, an assistant professor of neurology at Wake Forest Baptist Medical Center. “And we’re just beginning to gain understanding of what those changes mean and how they might benefit the meditator.”

In separate clinical studies, Wells has looked into the effectiveness of a meditation and yoga program called mindfulness-based stress reduction (MBSR) as a therapy for mild cognitive impairment – problems with memory or other faculties without yet having dementia – and for migraine headaches.

In the first study, the participants were adults between 55 and 90 with mild cognitive impairment. Those who practiced MBSR for eight weeks had significantly improved functional connectivity in the brain’s network that is active during introspective thought such as retrieving memories, along with trends of less atrophy in the hippocampus (the area of the brain responsible for emotions, learning and memory) compared with the participants who received conventional care. These findings indicate that meditation may positively affect the areas of the brain most impacted by Alzheimer’s and thus may be capable of slowing the progress of the disease.

Wells’ second study found that adults with migraines who practiced MBSR for eight weeks had shorter and less debilitating migraines than those in the control group who received standard medical care. The members of the MBSR group also had trends of less frequent and less severe attacks, and reported having a greater sense of self-control over their migraines.

 

April 8, 2015 Posted by | Medical and Health Research News | , , , , , | Leave a comment

[Press release] Are medications’ adverse cognitive effects reversible?

Are medications’ adverse cognitive effects reversible?

From the 26 January 2015 University of Indiana press release

INDIANAPOLIS — Whether the adverse cognitive effects of medications can be reversed is of significant importance to an aging population, their caregivers and their families, as well as to an overburdened health care system.

In a commentary in JAMA Internal Medicine, Noll Campbell, Pharm.D., and Malaz Boustani, M.D., MPH, of the Regenstrief Institute and the Indiana University Center for Aging Research, probe the possibility of reversing the adverse cognitive effects of medications frequently prescribed to older adults for chronic conditions including depression, anxiety and incontinence and sold over the counter as allergy and sleep aids.

It is not unusual for older adults to take two, three or more drugs that have a negative impact on their brain function. Over the past decade, Drs. Boustani and Campbell and colleagues have conducted several studies that have found associations between exposure to anticholinergic medications, which block acetylcholine, a nervous system neurotransmitter, and the clinical diagnosis of mild cognitive impairment or dementia. Low levels of acetylcholine have long been implicated in patients with dementia.

In a 2013 study, they reported that drugs with strong anticholinergic effects were associated with a clinical diagnosis of cognitive impairment when taken continuously for as few as 60 days over a one-year period. A similar impact was seen with 90 days of continuous use over a year when taking multiple drugs with weak anticholinergic effect.

In “Adverse Cognitive Effects of Medications: Turning Attention to Reversibility” published in the Jan. 26, 2015, issue of JAMA Internal Medicine, Drs. Campbell and Boustani call for further research to determine whether cognitive impairment caused by the adverse effects of medications can be reversed and to establish the safety risks of discontinuing these medications.

Their commentary accompanies a 10-year observational study by Shelly Gray, Pharm.D., M.S., of the University of Washington and colleagues that reports a higher risk of dementia with increasing dose and duration of exposure to medications with strong anticholinergic activities.

“While the Gray study suggests that adverse cognitive effects of medications were permanent, this may represent the use of dementia as the outcome — a non-reversible condition — rather than a diagnosis of mild cognitive impairment which may be reversible in some older adults. Our previous studies have shown a stronger association of these harmful medications with the diagnosis of mild cognitive impairment than with dementia,” Dr. Campbell said.

“We also differed in populations studied. The Gray study was 91 percent Caucasian, and 66 percent were college educated. Fewer than half had hypertension, and only 8 percent were diabetic. Our study subjects were 60 percent African-American, and nearly all subjects were treated for hypertension, and 3 in 10 had a history of stroke. Higher rates of comorbid disease may explain some of the differences between these studies.”

According to the Alzheimer’s Association, 5 million people with dementia lived in the United States in 2013, accounting for an estimated $214 billion in care costs. With the growth of the aging population, the association estimates that the number of older adults with dementia will be approximately 16 million by 2050, with $1.2 trillion expected in costs of care.

“While the scientific community is actively engaged in the quest, no drugs currently exist to prevent Alzheimer’s disease and other dementing disorders. However, our IU and Regenstrief Institute group has focused on stopping cognitively harmful medications as a safe and cost-effective Alzheimer’s disease prevention,” said Dr. Boustani, who directs the Eskenazi Health Center Healthy Aging Brain Center.

January 28, 2015 Posted by | Medical and Health Research News | , , , , , , , | Leave a comment

9-part series on over-diagnosis (short reads from a health care journalist)

3nxtbh93-1347162429

Over-diagnosis happens when people are diagnosed with diseases or conditions that won’t actually harm them. 

www.shutterstock.com

 

From the 3 October 2012 blog article by Gary Schwitzer at HealthNewsReview.org

Ray Moynihan, a terrific health care journalist who is now pursuing his PhD on overdiagnosis and working as a Senior Research Fellow at Bond University in Australia, kicks off the first of a nine-part series, “Over-diagnosis Epidemic” on TheConversation.edu.au website.

The first part is an introduction, “Preventing over-diagnosis:  how to stop harming the healthy.”

“To put it simply, over-diagnosis happens when people are diagnosed with diseases or conditions that won’t actually harm them. It happens because some screening programs can detect “cancers” that will never kill, because sophisticated diagnostic technologies pick up “abnormalities” that will remain benign, and because we are routinely widening the definitions of disease to include people with milder symptoms, and those at very low risk.”

Other colleagues author the subsequent parts in the series:

Part two: Over-diagnosis and breast cancer screening: a case study

“…But what we found was that the greatest relative reduction in breast cancer mortality (44%) occurred in the youngest age group. These women (aged 40 to 49 years) are not invited for screening. In contrast, women aged 60 to 69 years, who areinvited to screen, had the smallest relative reduction in mortality (19%).

Given that three times as many women aged 60 to 69 (about 60%) participated in Breastscreen (compared to 20% of women aged 40 to 49 years), our finding is not consistent with screening having a major impact on the reduction in breast cancer mortality since 1991.”…

Part three: The perils of pre-diseases: forgetfulness, mild cognitive impairment and pre-dementia

“…Most studies show that only one in ten cases of mild cognitive impairment progress to dementia each year, and many improve. One study that followed outcomes for ten years concluded – “The majority of subjects with MCI do not progress to dementia at the long term.”…

Part four: How genetic testing is swelling the ranks of the ‘worried well’

“..A major concern with such tests is that they’re the beginning of a path toward over-diagnosis, where the potential to develop a disease or being at risk for the disease is strong enough to constitute a label of sickness.

Over-diagnosing includes, but is not limited to, widening disease definitions, early detections of abnormalities that may or may not cause symptoms or death and the use of increasingly sensitive technologies that detect “abnormalities,” the causes and consequences of which are unknown at this time…”

Part five: PSA screening and prostate cancer over-diagnosis

Part six: Over-diagnosis: the view from inside primary care

“..The most common reason general practitioners are sued is because of missed diagnoses. Missed diagnoses also invoke a strong sense of professional failure. So how can general practitioners manage in this sea of uncertainty?

One way is to perform more tests. This is also popular with patients, who perceive that tests ensure nothing serious is missed. What is not well understood by patients (and sometimes also by clinicians) is the potential harm from testing.

The most obvious harm is the cost and resources required; we would quickly overwhelm the health system if we performed an MRI on every patient with back pain. A strong system of primary care results in a health-care system that’s both more efficient and less costly because primary-care physicians are skilled at filtering those with severe disease needing further tests, from those with self-limiting illnesses…

The greatest harm from the increased use of testing, however, is not costs, resources or false positives. Rather, it’s the problem of over-diagnosis.

Clinicians and patients both believe that finding a disease earlier in its process means it will be more successfully treated. But there’s increasing evidence that finding disease early or at a milder stage has paradoxical harmful effects, even reducing survival and quality of life.

Wider availability of more sophisticated tests results in “incidentalomas”, incidental findings that would not have otherwise been diagnosed. The detection of thyroid cancers, for instance, has more than doubled in the past 30 years. But most of these diagnoses are incidental findings from imaging…”

Part seven: Moving the diagnostic goalposts: medicalising ADHD

Part eight: The ethics of over-diagnosis: risk and responsibility in medicine

Part nine: Ending over-diagnosis: how to help without harming

 

 

 

October 13, 2012 Posted by | Uncategorized | , , , , , , , , , | Leave a comment

Mild Alzheimer’s Might In Fact Be Mild Cognitive Impairment

 

Alzheimer's Disease

Alzheimer's Disease (Photo credit: AJC1)

From the 7 February Medical News Today article

New revised criteria could mean that a considerable number of patients currently diagnosed with mild or very mild Alzheimer’s, might in fact be reclassified as having MCI (mild cognitive impairment), John C. Morris, M.D., of Washington University School of Medicine in St. Louis, wrote in Archives of Neurology.

The Alzheimer’s Association, along with the NIA (National Institute of Aging) revised the criteria for MCI after convening a work group. The new criteria have considerably widened the meaning of functional independence, Dr. Morris explained. Mild problems are now permissible for an MCI diagnosis, such as some daily chores and activities, which may include paying bills, cooking and shopping. Needing assistance or aids to perform such tasks are also permissible in the criteria for an MCI diagnosis.

Morris evaluated the functional ratings of 17,535 individuals who had been enrolled at federally funded Alzheimer’s Disease Centers – their clinical and cognitive data were stored at the National Alzheimer’s Coordination Center. They had been diagnosed with either Alzheimer’s disease, MCI or normal cognition. Their average age was 74.6 years…..

 

February 8, 2012 Posted by | Consumer Health | , | Leave a comment

   

%d bloggers like this: