COMMONLY USED MEDICINES MAY DELAY ALZHEIMER’S DISEASE

Regular use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the incidence of Alzheimer’s disease in elderly people, but only when taken for more than two years. Investigators sought to determine whether the use of these common drugs was associated with a reduced incidence of Alzheimer’s disease in the Cache County (Utah) Study and whether a reduction in risk was associated with the duration of the exposure to the drugs. The study was published in the September 23 Neurology.

The researchers assessed 5,092 elderly patients for dementia, while noting their current and former use of prescription and over-the-counter medications. The researchers focused on six classes of medicines: nonaspirin NSAIDs, H2 receptor antagonists, and aspirin compounds were the primary focus of the study; non-aspirin and non-NSAID pain relievers, antacids, and other stomach remedies were used as control medication because researchers anticipated that they would have no impact on Alzheimer’s disease. Patients were considered exposed to a particular medication class if they reported using a medicine from that class daily. Three years later, they obtained interval medication histories and identified 104 participants with Alzheimer’s disease among the 3,227 living participants.

Researchers determined that any use of NSAID was associated with a reduced risk of Alzheimer’s disease, whereas no evidence provided proof of the protective effects of aspirin or H2 receptor antagonists. When taking into consideration the duration of NSAID use, researchers found a 45% decrease in the incidence of Alzheimer’s disease among long-term users; there was a trend toward even greater risk reduction among those with the longest history of taking the medications. These results were similar for aspirin as well, but not for any other medicines examined. The researchers concluded that “sustained use of NSAID may delay or prevent [Alzheimer’s disease] only if they are taken during a critical window in the latent stages of the disease, before damage to the integrity of the brain is sufficient to provoke demonstrable cognitive symptoms.”

Suggested Reading
Zandi PP, Anthony JC, Hayden KM, et al. Reduced incidence of AD with NSAID but not H2 receptor antagonists: the Cache County Study. Neurology. 2002;59:880-886.

GINKGO FAILS MEMORY TEST

Ginkgo biloba provides no measurable benefit in memory or related cognitive function to healthy elderly adults, reported researchers from Williams College, Williamstown, Massachusetts. Additionally, those taking the herbal supplement did not differ from the control group in terms of self-reported memory function. The study appeared in the August 21 JAMA.

Two hundred three volunteers older than 60 and with a baseline Mini-Mental State Examination score of greater than 26 completed an initial telephone interview and provided consent and a thorough medical history. Participants were randomly assigned to receive ginkgo (40 mg/tid with meals) or a matching placebo for six weeks. One day prior to starting the trial and again at the end of the study, participants underwent neuropsychologic evaluations, including tests of learning, memory, attention and concentration, and expressive language. They also completed a questionnaire regarding subjective impressions of their memory. In addition, each participant had a companion (eg, spouse, relative, friend) complete a global questionnaire designed to provide an overall impression of the change in memory for the participant.

Researchers found no significant differences between the two groups on any of the objective neuropsychologic tests; they also saw no differences in terms of the subjective self-reports or on the global rating by companions. Interestingly, when asked whether they thought they had been taking ginkgo, 71% of the ginkgo group believed they were taking the supplement, while 75% of the placebo group felt they had been taking ginkgo as well. The investigators concluded that ginkgo offered no noticeable benefits to elderly adults with healthy cognitive function.

Suggested Reading
Solomon PR, Adams F, Silver A, et al. Ginkgo for memory enhancement: a randomized controlled trial. JAMA. 2002;288:835-840.

A SKIN TEST FOR SUBARACHNOID HEMORRHAGE RISK?

A skin test can detect a tissue disorder that may indicate risk of intracranial aneurysm, according to a pilot study published in the September Stroke. Researchers from the University of Heidelberg in Germany found defects in the structural matrix of skin tissue in 33% of study patients with intracranial aneurysms. “Our findings suggest that people with multiple aneurysms have a predisposing connective tissue disorder, leading to a weakness of the artery wall,” said lead author Caspar Grond-Ginsbach, PhD.

The study consisted of 21 patients (average age, 44) with intracranial aneurysms, who had no clinical signs of connective tissue disorder; 17 of these patients had survived a subarachnoid stroke. A control group of 10 age-matched patients with acute cerebral ischemia of different origins was studied. Because arterial wall biopsies are rarely available, researchers examined skin samples from the patients’ upper arms. The investigators analyzed only the deeper parts of the reticular dermis to control for factors that could increase the variability of the results, such as stress, aging, or exposure to ultraviolet rays.

Investigators found definite morphologic alterations of the connective tissue in the reticular dermis in seven of the 21 patients with intracranial aneurysms. Similar alterations were not seen in the 10 control subjects or in a large series of diagnostic skin biopsies the investigators analyzed. In four of the seven patients with observed alterations, researchers noted that the abnormalities were characteristic of patients with the heritable connective tissue disorder Ehlers-Danlos syndrome type III; the three remaining patients had alterations similar to Ehlers-Danlos syndrome type IV. However, the seven patients were not diagnosed with Ehlers-Danlos syndrome because the other typical symptoms of the disease were not present.

The researchers stress that the results of the study should “not be generalized to the population of all patients with [intracranial aneurysms].” This study “merely documents that some patients with [intracranial aneurysms] without signs of known connective tissue disorder display alterations in the morphology of the connective tissue in the reticular dermis.” The researchers believe that a prospective study is needed to better estimate the prevalence of this disorder among all patients with intracranial aneurysms.

Suggested Reading
Grond-Ginsbach C, Schnippering H, Hausser I, et al. Ultrastructural connective tissue aberrations in patients with intracranial aneurysms. Stroke. 2002;33:2192-2196.

INCREASED INCIDENCE OF STROKE AND ENCEPHOLOPATHY AFTER CABG SURGERY

Encephalopathy and stroke are associated with significant increases in the length of hospital stay and mortality following coronary artery bypass grafting (CABG). In a study published in the September Archives of Neurology, researchers sought to determine the incidence, consequences, and predictive factors for encephalopathy and stroke following this surgery. Researchers assessed preoperative risk factors before the procedure, and postoperative outcomes were determined on a daily basis. The investigators believe that patients at a higher risk for encephalopathy or stroke can be identified prior to surgery.

Researchers evaluated 2,711 patients (average age, 64; 73% male) who underwent isolated CABG between 1997 and 2000. Data regarding a history of previous stroke, hypertension, or diabetes mellitus, the presence of carotid bruit, and age were collected from each patient prior to surgery. This information was used to determine the probabilities of stroke, encephalopathy, and the aggregate of their occurrence. The investigators followed up on the patients daily, measuring outcome variables such as length of hospital stay, mortality, and the diagnosis of encephalopathy or stroke.

Encephalopathy occurred in 186 patients (6.9%), and there were 72 incidents (2.7%) of stroke. For patients without these outcomes, the average length of stay in the hospital was 6.6 days, and the mortality rate was 1.4%. In contrast, patients with encephalopathy had an average length of stay of 15.2 days and a mortality rate of 7.5%, while those with stroke remained in the hospital for 17.5 days and had a mortality rate of 22%. The five preoperative factors the researchers assessed proved to be significant predictors for developing encephalopathy, while the predictive model for stroke involved only three of the risk factors: previous stroke, hypertension, and diabetes. The investigators believe that the ability to predict postoperative outcomes will enable patients to pursue alternate surgical procedures that will not put them at risk for encephalopathy or stroke.

Suggested Reading
McKhann GM, Grega MA, Borowicz LM Jr, et al. Encephalopathy and stroke after coronary artery bypass grafting. Arch Neurol. 2002;59:1422-1428.

DISABLING CONDITIONS A WEIGHTY MATTER

Obesity appears to be more prevalent in adults with sensory, physical, and mental health conditions than in the rest of the population, according to a report published in the September 11 JAMA. Researchers found that patients with disabilities were as likely to attempt to lose weight as were overweight adults without disabilities, and physician exercise counseling was reported as often among patients with disabilities, with the exception of those with upper and lower extremity mobility difficulties.

Researchers culled information from the 1994-1995 National Health Interview Survey, the 1994-1995 Disability Supplement, and the 1995 Healthy People 2000 Supplement; the surveys questioned the respondents about sociodemographic factors as well as specific sensory and physical limitations and psychiatric conditions. The researchers examined 145,007 cases and found that 25,626 individuals had one or more disabling conditions. These conditions were classified into six categories: blind/low vision, deaf/hard of hearing, lower extremity mobility difficulty, upper extremity mobility difficulty, hand dexterity difficulty, and serious mental illness. After adjusting for sociodemographic factors, the analysis found that 24.9% of the individuals with disabilities were obese, compared with 15.1% of adults without disabling conditions.

Adults with lower limb mobility difficulties were found to be at the highest risk for obesity. They were also the least likely to attempt to lose weight and were not likely to have received exercise counseling from their physicians. The researchers were troubled by the lack of counseling given to patients with mobility difficulties, fearing such patients will succumb to a “vicious cycle where inactivity contributes to obesity, obesity exacerbates disability, and disability impedes exercise.” However, the remaining adults with disabilities were as likely to attempt weight loss as obese adults without disabilities.

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Suggested Reading
Weil E, Wachterman M, McCarthy EP, et al. Obesity among adults with disabling conditions. JAMA. 2002;288:1265-1268.

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