Alzheimer’s Disease – Recent Data

Researcher’s gathered in Paris, France this month to present their data on new developments with Alzheimer’s disease.  In reviewing the meeting’s material, it is clear that much of what is “new” is old.

In the past we were taught that patients placed on medications for Alzheimer’s Disease would derive a benefit about 50% of the time. This benefit would last for six to twelve months.

One of the world’s authorities on this topic is Susan Rountree, M.D. of Baylor College of Medicine in Houston.  She has followed 641 patients since the late 1980’s.  In 2008 she reported that patients treated with medicines such as donepezil (Aricept) and rivastigmine (Exelon) survived about three years longer than patients who did not take these medications.  She re-analyzed that data, updated it and came to the conclusion that “using anti-dementia drugs doesn’t seem to prolong survival.”   She did however recommend continuing their use because her data showed that patients taking them had improved cognition and ability to function.

At the Paris event there was material presented that was not surprising but needs the legitimacy of a well planned study to turn theory into scientific evidence and fact.

The study showing that military personnel who suffered traumatic brain injuries during the Vietnam War were more likely to develop dementia has great implications for today’s veterans fighting in Iraq and Afghanistan where brain injuries are on the rise.  It will clearly help us as well in terms of long-term planning for the development of dementia in private citizens suffering from traumatic brain injuries.  It was not surprising either when certain medications were cited as being more likely to contribute to the development of Alzheimer’s Disease. This year’s culprits seem to be anticholinergic drugs which make a patient’s mouth dry and cause constipation.

What was not surprising were the studies that showed that elderly individuals who engaged in regular and vigorous physical exercise were less likely to develop cognitive impairment.  Those patients who get regular and vigorous exercise who show signs of cognitive problems declined at a slower rate than those who don’t.

While much of the material discussed confirmed the fact that healthy lifestyle is the best defense against this disease; there was also much hopeful discussion of research which is untangling the relationship between brain chemicals, development of plaques in the brain and its relationship to Alzheimer’s. On an encouraging note, we are much closer to early detection and therapeutic intervention than we were a decade ago.

Advertisements

Non Steroidal Anti-Inflammatory Drug (NSAID) Use and Heart Attacks

Most of us weekend warriors are used to reaching for the ibuprofen , naproxen or aspirin for relief from aches and pains after some strenuous gardening, yard work or recreational exercise. It helps alleviate the pains and allows one to go on with their life and perform the normal activities of daily living.

For many individuals with advanced osteoarthritis or the more severe types of immunological arthritis such as rheumatoid arthritis or psoriatic arthritis, these medicines are liberating and allow patients to live a normal life. For many years the major concern with these medications was their effect on the stomach causing irritation, inflammation and gastrointestinal bleeding. Then experts issued warnings about long term use and liver and kidney damage.  These side effects were listed on the product insert and were not unexpected.

What was unexpected was the association of NSAID’s and acute heart attacks. Drugs like Vioxx and Bextra, which were extraordinarily effective at relieving aches and pains, were pulled from the market after being determined to dramatically increase the number of acute myocardial infarctions users suffered. The NSAID’s reduced joint pain and inflammation by inhibiting chemicals called prostaglandins. Unfortunately the same inhibition of prostaglandins that produced less inflammation and joint pain also inhibited prostaglandins that kept our coronary arteries from going into spasm and cutting off the circulation to our heart muscle. For several years now pharmaceutical manufacturers have been looking for the perfect formula that inhibits joint inflammation without increasing heart attack risks.

A recent study from Denmark indicated that their search has not yet been successful. Denmark maintains detailed records of patient hospital admissions and medication usage as well as a central national death registry.  Using these data bases, the records of 84,000 patients admitted to a hospital for treatment of a myocardial infarction from 1997-2006 were reviewed and linked to pharmacy records. Researchers found that 43.3% of the MI patients received NSAID’s post MI and there were 35,257 deaths or repeat heart attacks.

“Overall NSAID treatment was related to a significantly increased risk of death at the beginning of the treatment and the risk persisted throughout the treatment. Patients taking Celebrex had an increased risk of death when the treatment lasted two weeks to a month.  All NSAID’s increased the risk of death or recurrent MI by 45% after a week.  Naproxen increased the risk of death or recurrent MI by 76% after a week. For treatment lasting 30-90 days the increased risk was 15%.  Ibuprofen had the lowest initial risk, just 4% increase for treatments lasting seven days or less.

In practical terms, we must limit NSAID use to the absolute minimum in patients with established cardiovascular disease.  Based on this article, ibuprofen seems to be the best choice for short term use in patients with known cardiovascular disease. Patients with cardiovascular disease and known previous MI should be talking to their doctor before they reach for the over-the-counter bottle of a NSAID.