Stroke Risk Increases With Antipsychotic Drugs

All types of antipsychotic drugs increase the risk of stroke.

All drugs used to treat psychosis are linked to an increased risk of stroke, and dementia sufferers are at double the risk, according to a study published in the British Medical Journal.

Concerns about an increased risk of stroke among people taking atypical antipsychotic drugs were first raised in 2002, particularly in people with dementia, prompting the UK’s Committee on Safety of Medicines to recommended in 2004 that these drugs not be used in people with dementia.

Previous research has shown that second generation (atypical) antipsychotic drugs can increase the chances of patients having a stroke. But the risk of stroke associated with first generation (typical) antipsychotics, and whether the risk differs in people with and without dementia, is not known.

A team of researchers from the London School of Hygiene and Tropical Medicine, examined data from the General Practice Research Database (GPRD), which contains the clinical information of more than six million patients registered at over 400 general practices in the UK.

They assessed the effect of exposure to antipsychotic medication on the incidence of stroke in 6 790 patients with a recorded incident of stroke and at least one prescription of any antipsychotic between January 1988 and the end of 2002.

The authors found that during periods when patients were receiving an antispychotic drug they were 1.7 times more likely to have a stroke, whereas people with dementia were 3.5 times more likely to have a stroke whilst taking any antipsychotic.

The likelihood of having a stroke was slightly higher for people taking atypical antipsychotics than people taking typical antipsychotics.
Previously, the risk of stroke associated with typical antipsychotics was unclear, say the researchers, but “we have established that all types of antipsychotics carry an increased risk, although the risk might be somewhat higher with the atypical drugs.”

They conclude: “We reaffirm that the risks associated with antipsychotic use in patients with dementia generally outweigh the potential benefits, and in this patient group, use of antipsychotic drugs should be avoided wherever possible.”

The study did not look at the specific mechanisms linking antipsychotics and stroke or why the risk is greater with atypical antipsycotics.

Source
British Medical Journal

Dementia Underestimated in Developing Countries

(HealthDay News) -- Rates of dementia in developing countries have been greatly underestimated, according to researchers who used a specially-developed method of calculating dementia prevalence.

Previous studies have suggested that rates of dementia in developing countries are much lower than in high-income countries. However, the quality and evidence base of these studies are poor, according to the authors of the new study, who are members of the 10/66 Research Group.

The group is named to reflect the global research community's neglect of dementia patients in developing countries. Just 10 percent of research is focused on the 66 percent of dementia patients living in low- and middle-income countries.

The standard DSM-IV criteria for dementia diagnosis are too restrictive, requiring memory impairment (which is not an early feature in some dementia subtypes), and clear evidence of social and occupational impairment (which can be difficult to establish in low- and middle-income countries), according to background information in the study.

The 10/66 group developed its own method of dementia diagnosis, based on an assessment at the person's home, including a clinical interview, cognitive tests, and interviews with family and friends. This approach may reveal more mild and moderate cases of dementia, according to the group.

Using DSM-IV criteria, rates of dementia in developing countries varied widely, from 0.3 percent in rural India to 6.3 percent in Cuba. The prevalence of dementia in urban Latin America sites was 80 percent of that in Europe, in China the prevalence was half of that in Europe, and in India and rural Latin American the prevalence was a quarter or less of that in Europe.

The 10/66 method revealed a higher prevalence of dementia in developing countries and was more consistent across sites, varying between 5.6 percent in rural China and 11.7 percent in the Dominican Republic.

While 847 of the 1,345 cases of dementia identified by the 10/66 method weren't confirmed as DSM-IV dementia, the validity of those 847 cases was supported by high levels of associated disability, the study authors said.

"We believe that our methods have drawn attention to a substantial prevalence of dementia that might have been missed. Prevalence differences between developed and developing countries might not be as large as previously thought," the study authors wrote.

The study was released online by The Lancet to coincide with a presentation at the International Conference on Alzheimer's disease in Chicago.

More information
The American Academy of Family Physicians outlines common signs of dementia.

Filling in the Alzheimer's 'Race Gap'

(HealthDay News) -- A diagnosis of Alzheimer's disease is wrenching, especially for family members of the patient.

But certain races and ethnic groups, including Hispanics and blacks, are more likely to labor under misconceptions about the disease, often wrongly viewing it as a normal part of aging, researchers are learning.

And that often leads to delays in seeking care, when early treatment might make a difference in the progression of the mind-wasting disorder.

In a recent survey conducted for the Alzheimer's Foundation of America, researchers found that Hispanic and black caregivers were more likely to believe that the symptoms of Alzheimer's weren't a disease but just part of growing old. Thirty-seven percent of black caregivers and 33 percent of Hispanic ones thought that was the case, compared to 23 percent of caregivers from other racial or ethnic groups.

Black and Hispanic caregivers were also more likely to say they did not know much about the disease.

The results of the survey highlight the need for more education about the disease, so all Americans can be given the chance to get appropriate treatment, experts said.

Eric Hall, founding chief executive officer of the Alzheimer's Foundation of America, called the survey results "distressing," adding, "Lack of an early diagnosis leaves families at a point of chaos and crisis, wondering, 'How do I care for my loved one?' "

"In the absence of a cure, care becomes a critical issue to sustain the highest quality of life for the longest time," Hall said.

The impact of Alzheimer's affects different groups of people differently in many ways, explained Angela Geiger, vice president of constituent relations for the Alzheimer's Association. For instance, she said, the disease is more prevalent among blacks than whites, and Latinos are more likely to exhibit symptoms earlier.

Given these differences, organizations such as the Alzheimer's Foundation of America and the Alzheimer's Association have created programs and other resources to reach out to different populations. For instance, publications on warning signs and other information about the disease are available in Spanish and in English, Geiger said.

"We've created a series of culturally appropriate publications tailored to African-Americans and Latinos," she said.

Alzheimer's disease affects more than 5 million Americans, according to the Alzheimer's Foundation of America, and that number is expected to rise to 8 million by 2030 as the population ages. It's currently the seventh leading cause of death in the United States.

So, what can people do to recognize the disease earlier and get help for a loved one? Educating yourself about the symptoms is one way. Both the Alzheimer's Foundation of America and the Alzheimer's Association offer information about the disorder on their Web sites. That information includes specifics on the differences between normal aging -- for instance, forgetting a word now and then -- and symptoms of Alzheimer's -- forgetting the name for common objects and calling a toothbrush "the thing for my mouth," for example.

"I think, overall, that the nation at large has a very poor understanding of what dementia is," Hall said.

If you suspect a loved one is in the early stages of Alzheimer's, Geiger suggests that you reach out for assistance and guidance. Ask your loved one's health-care provider for an evaluation, for starters.

"Work with your health-care provider to get that diagnosis as early as possible, because there are things you can do," she said, adding that behavioral interventions and medicines are two options.

More information
To learn more about Alzheimer's disease, visit the Alzheimer's Foundation of America.

One-Third of Dementia Cases Laid to Small Blood Vessel Damage

(HealthDay News) -- Small blood vessel damage caused by hypertension and diabetes may be among the leading causes of dementia, according to new research.

The findings provide an additional reason to control these common conditions, according to Dr. Thomas Montine of the University of Washington, who was to present the study Sunday at Experimental Biology 2008 in San Diego.

The autopsied brains of a third of men and women with dementia or cognitive decline showed evidence of small vessel damage -- a cumulative injury that can result from multiple small strokes caused by hypertension and diabetes. The strokes are often so small that the person notices nothing until the cumulative effect reaches critical mass, the researchers said.

Meanwhile, 45 percent of the risk for dementia was associated with pathologic changes of Alzheimer's disease. Another 10 percent risk was linked to Lewy bodies, which are neocortical structural changes that indicate a degenerative brain disease known as Lewy Body Dementia, a possible variant of Alzheimer's and/or Parkinson's disease, the study found.

The finding about small vessel disease challenges conventional wisdom and conclusions from most autopsy studies of brain aging and dementia, Montine said in a prepared statement.

The broader population sample on which the autopsy study was based may be reason for the differing results, he said. Most previous research had focused on participants in Alzheimer's disease center studies, or was limited to one gender, ethnic or professional group. The individuals in the new study were part of a large managed care program and representative of the Seattle urban and suburban area they came from: white, Asian, African-American and Hispanic, with a range of educational and professional levels.

In the study, which ran from 1994 to 2006, some participants suffered cognitive impairment and dementia, while others did not. Roughly a third of all 3,400 participants died, and autopsies were performed on the 221 who had given permission for this to be done.

More information
The American Heart Association has more about controlling high blood pressure.

Abdominal Fat Boosts Dementia Risk

(HealthDay News) -- A potbelly in middle age more than triples the risk of senility decades later, according to a large study that pinpoints a new link between obesity and dementia.

"The take-home message is that it's not only what you weigh, but it's where you carry your weight in midlife," said study author Rachel Whitmer, a research scientist with the Kaiser Permanente Division of Research, in Oakland, Calif.

The good news? Lose weight, and you may be able to reduce the increased risk, she said.

Researchers have been tracking the mental fallout of obesity for years. In 2005, Whitmer and her colleagues reported that people who were fatter in middle age were as much as 74 percent more likely to develop dementia as senior citizens.

An estimated 10 million American baby boomers will develop Alzheimer's disease in their lifetime, according to research released earlier this month, while another study found that more than 20 percent of seniors have memory loss not classified as dementia.

In the new study, researchers looked specifically at belly fat, checking to see if it posed a risk in people even if they were otherwise not overweight.

The study examined 6,583 Kaiser Permanente health-care plan members between the ages of 40 and 45 who had their abdominal fat measured in the late 1960s and early 1970s. The researchers followed up to see what happened to them between 1994 and 2006, when they reached their 70s and beyond.

The findings were published in the March 26 online issue of Neurology.

Overall, 16 percent of those studied developed dementia, also known as senility. Researchers found that obese people who had the most abdominal fat in their 40s were 3.6 times more likely to develop dementia than those with the least amount of abdominal fat.

People who were overweight -- a step below obese -- and had large bellies in their 40s were 2.3 times more likely to develop dementia.

Overall, 21 percent of those with high levels of belly fat developed dementia, compared to 15 percent of others, Whitmer said.

The effects of belly fat remained even when researchers adjusted their statistics to take into account the effect of conditions such as stroke and diabetes.

It's still possible that a factor other than abdominal fat may cause the higher rate of dementia. The study doesn't confirm a direct cause-and-effect relationship. Still, the findings suggest that something about abdominal body fat affects the brain independently of cardiovascular disease or diabetes, Whitmer noted.

It's not clear, however, exactly how obesity translates into reduced brain function. It may have something to do with how belly fat surrounds the body's organs and secretes hormones and toxic substances that could disrupt the way the brain functions, Whitmer speculated.

William Thies, vice president of medical and scientific relations with the Alzheimer's Association, said another theory is that the physical presence of belly fat and its compression of abdominal organs could burden the entire body, affecting the brain by increasing blood pressure and cholesterol. However, "whether there's a direct biological link between body fat and Alzheimer's has yet to be established," he said.

Whatever the cause for the connection, all hope is not lost.

"Even with moderate exercise, you can reduce that visceral fat, the fat around the organs," Whitmer said, adding that there's a lot of evidence that the roots of dementia develop years before it becomes obvious, so a change now could spell a big benefit later.

More information
To learn more about proper weight loss, visit the National Women's Health Information Center.