Articles filed under 'COGNITIVE DISORDERS'
Since the last estimate five years ago from the Alzheimer’s Association, another 10% increase in the disease has occurred in this country. More than 5 million Americans are now living with Alzheimer’s. By the year 2030, some 7.7 million may be affected.
This alarming trend is expected to accelerate, as baby boomers begin turning 65 in 2011. The largest risk factor is age. Currently, 1 in 8 persons over age 65 has the mind-destroying disease. Over age 85, almost half have Alzheimer’s or another type of dementia.
While small drops in the death rates from heart disease and cancer make headlines, Alzheimer’s-related deaths have increased by 33%. Even more disturbing is the trend toward early-onset Alzheimer’s. The disease in those under age 65 is vastly underreported and is often difficult to recognize in its early stages, before full-scale memory problems are involved.
Despite years of research, the causes of Alzheimer’s progressive brain deterioration are still largely unknown, and there is no cure. Medications on the market only temporarily alleviate symptoms. The disease that gradually robs memories and the ability to provide self-care eventually kills Alzheimer’s sufferers.
Medicare spends nearly three times as much for dementia patients’ care as is does on the average beneficiary — $13,207 a year for Alzheimer’s patients compared to $4,454 annually for others. Medicare expenditures do not add in the expense of families and friends proving round-the-clock care, as most Alzheimer’s patients live at home. However, a new report indicates that close to $83 billion is spent annually on nursing home costs for patients in advanced stages of the disease.
Nine drugs for Alzheimer’s are in the final stages of clinical trials. If some of these drugs are successful in slowing or delaying the onset of Alzheimer’s symptoms by even a few years, millions of dollars could be saved in health care costs in future decades. The toll in human suffering could also be greatly alleviated. Experiencing “the long good-bye” in those you love can be excruciating.
Source: Yahoo News
March 22nd, 2007
The FDA warned in mid-March that all prescription sleeping pills have the potential to cause bizarre behaviors, such as “sleep-driving.” In extremely rare instances, patients have been known to get up in the night and drive, with no later memory of the event.
About one out of 1,000 persons on these medications has experienced unusual behaviors such as sleep driving, preparing and eating food, making phone calls, or even having sex while asleep. More common than middle-of-the-night excursions is driving while still feeling dangerously drowsy, for example, during an early morning commute.
Although extremely rare, another reported risk is a life-threatening allergic reaction and severe facial swelling. This side effect can occur with first use or anytime thereafter when the pills are taken. Seek immediate emergency treatment for such an occurrence.
Later this year, pharmaceutical companies that manufacture 13 prescription sleep medications will include new, extensive warnings in a special “medication guide” brochure. Some insomnia drugs may be riskier than others. The FDA has recommended clinical trials to compare their complications and frequencies with which they occur.
Ambien and a second drug Phenergan were implicated in sleep-driving headlines last year when Rep. Patrick Kennedy crashed into a barrier outside the U.S. Capitol building. Kennedy stated that he did not recall being behind the wheel.
To lower the risk of sleep-driving and other risky behaviors, patients are advised never to take any prescription insomnia drug with alcohol or another sedating drug. Also, never exceed the recommended dosage.
The thirteen drugs for insomnia, so-called “sedative-hypnotics,” which will carry the new warnings are: Ambien, Butisol sodium; Carbrital; Dalmane; Doral; Halcion; Lunesta; Placidyl; Prosom; Restoril; Rozerem; Seconal; and Sonata.
Source: CNN.com
March 17th, 2007
The FDA recently approved a new amphetamine-based drug for hyperactivity disorder that will be harder to abuse than older stimulants, according to pharmaceutical company Shire. Vyvanse remains inactive until swallowed, after which it gradually releases its active ingredient d-amphetamine. It is activated after coming into contact with enzymes in the digestive tract.
Vyvase is expected to stop the potential for abuse by individuals who snort or inject crushed pills. The newly developed drug will be listed as a Schedule II drug, a category including cocaine, methadone, methamphetamines, and other ADHD medicines such as Adderall and Ritalin. Vyvanse will carry a “black-box” warning because of safety concerns related to amphetamine abuse, as well as the risk of sudden death in patients with heart defects.
The FDA approval of Vyvanse took place in the same week when the agency required manufacturers of other ADHD drugs to warn patients and parents of potential mental and heart problems associated with these medications in a small percentage of users.
FDA statistics indicate that ADHD affects about 3 to 7% of schoolchildren and 4% of adults. The principal symptoms are hyperactive behavior, difficulty paying attention, and problems with impulse control. Medications approved to treat ADHD have major benefits for many patients but for some, they can also pose serious risks.
New warning instructions required for ADHD medications will be included for Adderall, Concerta, Daytrana, Dexedrine, Focalin, Metadate, Methylin, Ritalin, and Strattera. It is hoped these new cautionary guidelines will not keep people who need these drugs from taking them.
Sources: Yahoo News; Medical News Today
February 27th, 2007
Pharmaceutical companies who make Ritalin, Adderall, Strattera and other ADHD drugs have been advised to give patients and parents additional warnings about the potential for serious psychiatric and heart problems. Patients would be given a 2-page medication guide with each new prescription.
Drug companies are expected to comply with the new requirement within 30 days. The announcement covers 15 drugs, including those offered in extended-release, patch and chewable versions.
Serious side effects for ADHD drugs are rare. However, the new warnings advise calling a physician immediately in case of chest pain, shortness of breath, fainting or hallucinations. A sudden change in behavior should also be noted and promptly reported.
Of the 3.3 million children taking ADHD medications, more than 2,500 went to emergency rooms in 2004. About a fourth of them had serious heart or blood pressure problems, according the Centers for Disease Control. Of the 25 deaths thought to be linked to the drugs, 19 involved children. In the 54 patients who experienced serious heart problems, some had prior heart conditions.
Proposed guidelines are to state that these amphetamine-based drugs have been linked to stroke and heart attacks in adults and sudden death in patients with heart problems or defects. A few children and teens reported hearing voices, growing suspicious or becoming manic while on ADHD medication. About 1 child in 1000 may experience hallucinations.
It is vital that patients give doctors a full history of cardiovascular or mental problems. In addition, they should make it known if they take antidepressants, seizure medications or blood thinners. The FDA emphasizes that persons with heart disease, blood pressure problems, hyperthyroidism or glaucoma should not take ADHD medications.
The FDA emphasizes that new requirement for expanded warnings is precautionary and should not discourage patients from taking these drugs, which are safe in appropriate patients.
Source: San Francisco Chronicle; Feb. 22, 2007 (article from Baltimore Sun)
CNN.com
February 24th, 2007
Neither of my two children in public schools in the 1970s gave stellar performances. I knew that both were bright. Yet, their elementary school report cards failed to reflect their intelligence. My husband and I helped them with homework, gave them outside tutoring, and even moved them to a different elementary school where test scores were better. In the summers I gave my daughter and son “homework” of my own, with math and language drills and assigned book reports. My eight years as a public school teacher before my younger child was born motivated me to supplement their studies.
My son at age 8 could easily have been labeled a child with attention deficit disorder (ADD or ADHD) — a term not widely used in the late 1970s. His third grade teacher often sent me notes about his daydreaming or doodling in class. He was never placed on medication such as stimulants or antidepressants to influence his behavior. Away from school, absorbed in his own interests, he was clearly able to focus on what he liked to do. It took several years of mediocre grades before he was able to see the value of academic achievement.
My daughter came into her own in high school, when we enrolled her in a parochial school. The smaller school with a female-only student body and many extracurricular activities helped her learn to excel and to develop leadership skills.
After high school graduation, both youngsters were accepted at top colleges in California and have excelled in their post-graduate careers. My daughter is now in a doctoral program while working full-time as a high school vice principal. My son is a successful entrepreneur and computer programmer. Our family was fortunate. In some cases, a child’s early problems can extend into adulthood and without proper treatment, adversely affect the individual’s work and personal life.
My point is to not be too hasty in putting your child on drugs, unless there is truly a problem that cannot be dealt with through other resources. If your child is quite inattentive, hyperactive and/or disruptive, some behavior modification classes or techniques might be helpful initially. A good child/adolescent psychiatrist can help you discover the root of the problem, and medications can be prescribed when needed. Work closely with teachers, school counselors or administrators and your child’s physician to ensure that appropriate medication or other treatment is used.
My account is based on my perspective as a parent, teacher, and health care professional. Here are some wonderful resources from an authority in the field to help guide you:
I heard recently from Mohab Hanna, M.D., who visited my blog. Dr. Hanna is Board-certified in Child and Adolescent Psychiatry. His medical training was completed at the prestigious Johns Hopkins University School of Medicine. You can go to his blog (impressive!) at http://www.add-adhdtreatment.blogspot.com/. I found his initial entry to be especially helpful. Here are some highlights from Dr. Hanna’s entry of February 2, 2007:
AD/HD Medications: What is a Parent to Do?”
“A thorough evaluation is the first and most essential step in the process. It is impossible to treat any condition without knowing what you are treating. It is not prudent to ‘try a medicine to see if it works.’ That is an inappropriate way to proceed and can actually be harmful. Many children who appear to have some ADHD symptoms actually have a different condition, such as anxiety or depression. Furthermore there are some kids who have anxiety in addition to the ADHD. In either scenario, it is essential to determine the diagnosis prior to initiating any kind of medication trial…
“…Every medication has potential side effects. It is important to understand the different potential negative effects. In order to proceed with a medication trial, the potential benefit should outweigh the potential negative effects. Once the diagnosis of ADHD has been established and it has been determined that the potential benefit outweighs the potential negatives, the parents need to understand the risks of not treating the ADHD. Many studies have been conducted to examine the consequences of untreated ADHD. It is clear that there are numerous potential consequences such as academic failure, peer rejection, depression, accidents, substance abuse, etc…These consequences are significant and are typically not transient; they tend to continue to manifest into adolescence and adulthood.”
Dr. Hanna has also written a book titled Making the Connection: A Parent’s Guide to Medication in AD/HD
.
“My goal with the book and the blog is to empower patients to be proactive in the decisions that are made,” says Dr. Hanna. “I also hope to provide them with balanced (non-marketed), unbiased information.” Dr. Hanna lives in Maryland and may be reached by telephone at 410-583-2623, ext. 3, or fax at 410-583-2949.
Source: Dr. Mohab Hanna;
February 18th, 2007
Researchers are trying to determine whether the virus that causes cold sores can somehow play a role in bringing on Alzheimer’s disease in later years. A study published recently in the journal Neurobiology of Aging is looking at interaction between the ApoE-4 gene and herpes as a risk factor for the brain-robbing disease.
According to one researcher at the University of Manchester, Alzheimer’s patients who have the ApoE-4 form of the gene contain more herpes DNA in brain regions than others without that version of the gene. The team found that the herpes virus infiltrates brain cells and is associated with cellular tangles and amyloid plaques in Alzheimer’s patients.
The oral herpes virus (herpes simplex 1), known to infect 80% of Americans, hides in the body’s nerves in its predominately latent phase. An outbreak is rarely triggered by factors such as stress, fatigue, or sunlight. HPV1 then becomes active, damaging cells and causing cold sores.
Scientists have long known that the ApoE-4 gene is a player in Alzheimer’s, but the idea that it can work in concert with the herpes virus is new. A group at the University of Rochester Medical Center recently found that this particular gene causes a fertile environment for herpes in the brain.
One theory is that the body’s immune response against herpes somehow damages the brain. The damage can be worse in those with the ApoE-4 copy of the gene than in those with another form of the gene, such as ApoE-2 or ApoE-3. No research is conclusive at this point.
In 2006, the Manchester research team published a study that showed inflammation to be the earliest change detected in a brain affected by Alzheimer’s disease, before the hallmark plaques or tangles appear and long before any behavioral changes are seen. Such inflammation can be a byproduct of the body’s immune system fighting an infection.
Much research is being conducted in the field of Alzheimer’s Disease. It is hoped that one day it may be prevented, especially if treatment begins in the early stages before symptoms become obvious.
Source: Medical News TODAY
January 27th, 2007
When used even the first time in small amount, the drug called “ecstasy” or MDMA can harm the brain through its neurotoxic effects, according to a recent study. Ecstasy has long been used as a recreational drug, but users may not realize the negative effects it can have on them.
Researchers have discovered through neuroimaging studies that blood circulation can become impaired or decreased in some areas of the brain of first-time users of this psychedelic or stimulant drug, illegal in the U.S. Ecstasy targets brain neurons that use serotonin to regulate a number of mental processes, including mood and memory.
Several earlier studies have shown that heavy use of Ecstasy can damage neurons, resulting in depression, anxiety, confusion, difficulty in sleeping and memory loss. However, recent findings presented in November 2006 at the annual meeting of the Radiological Society of North America confirm for the first time that small, initial doses can be damaging to the brain.
Medical investigators initially looked at 188 volunteers with no history of ecstasy use. Eighteen months later, they compared 59 of the first-time ecstasy users (who took an average of six tablets initially) with 56 non-users. All were retested with the same psychological tests as administered before the study began. In addition, cellular structure and blood flow measurements in the brain were re-examined.
Researchers found subtle changes in cell architecture and decreased blood flow in some brain regions, although no severe damage to the serotonergic neurons that affect mood. First-time, low-dose users demonstrated a decrease in verbal memory when compared with nonusers. It is not yet known whether these effects are temporary or permanent changes.
The National Institute on Drug Abuse (NIDA) survey in 2004 found that 450,000 people in the U.S. who are age 12 and over had tried ecstasy in the past 30 days. NIDA estimated in 2005 that 5.4% of American 12th graders had taken Ecstasy at least once.
This research project is part of the Netherlands XTC Toxicity study which also examines high-dose ecstasy users and is attempting to provide information on long-term effects of ecstasy use in the general population.
Source: Science Daily
December 12th, 2006
We have known for some time that steroid abuse causes behavior changes such as aggressiveness, uncontrollable rages and suicidal tendencies. A recent study using brain cells in lab dishes showed that too much testosterone can kill brain cells through a process called apoptosis.
Testosterone in large doses can cause cells to self-destruct and produce a process similar to brain deterioration in Alzheimer’s Disease or Huntington’s Disease.
Athletes or others who resort to steroids may risk incurring damage to their minds and body functions that can’t be reversed. High levels of steroids are converted to extra testosterone in the body, and large doses of testosterone can destroy nerve cells.
Athletes who wish to gain a competitive advantage through steroid use should have second thoughts, even though it can build muscle mass and aid in quicker recovery after exertion.
Source: CNN.com
November 14th, 2006
Often, a person with symptoms of early Alzheimer’s disease is reluctant to get medical care, for fear of being labeled “crazy” or incompetent. A recent survey found that 57% delayed seeking a formal diagnosis for 2 to 3 1/2 years after onset of their symptoms.
Delay in seeking help is counterproductive and unnecessary, as the disease becomes harder to treat in more advanced stages. In addition, not knowing for certain can cause heightened anxiety and depression in patients and their caregivers.
Alzheimer’s progresses at different rates in individuals, but the patient may live with the condition for 8 to 20 years. Early diagnosis and treatment is believed to slow its progression and alleviate much of the stress of the patient and family members. In addition, early recognition gives time to put one’s affairs in order. Wills, durable powers of attorney, financial matters, and treatment preferences are better dealt with early in the disease.
Structured activities such as participation in psychotherapy groups, painting classes or musical activities can help patients live more fully after diagnosis. Despite cognitive decline, some Alzheimer’s patients show amazing ability to express themselves in art or musical performance. Support through group therapy also helps many patients bolster their self-image and accept their disease with grace.
As for medical treatments, three cholinesterase inhibitors are FDA-approved and available to treat Alzheimer’s. Razadyne and Aricept are thought to delay mental decline and symptoms in those with mild to moderate Alzheimer’s. Namenda is approved for treatment of later stages of the disease.
Facing the diagnosis early helps patients and caregivers to challenge the stigma of Alzheimer’s by seeking proper care in timely fashion.
Source: Johns Hopkins Health After 50 Medical Newsletter, August 2006
October 21st, 2006
Until recently it was thought that Alzheimer’s patients could not feel pain. Now it is understood that they feel pain as powerfully as others, maybe more so, but are unable to verbalize their feelings. This may be so especially for those in the later stages of the mind-robbing disease. Because they have lost communication skills, their pain may be under-treated by physicians and caregivers.
An Australian study using MRI real-time brain scans to check the brain’s major pain channels gave clear evidence that pain may still be intensely felt in the Alzheimer’s patient. The study compared Alzheimer’s patients who could still describe their pain to other study participants who were volunteers without the disease.
In this study appearing in an online edition of the journal Brain, study authors concluded that dealing with pain became problematic because diseased patients were unable to divert their attention from it, as healthy volunteers were able to do. If patients in the study who could still communicate found pain to be bewildering, it might be even more so for those with Alzheimer’s.
When words can no longer adequately express pain, doctors and other caregivers can look for facial expressions and body movements that show discomfort. Often, the Alzheimer’s patient’s caregiver has a greater capacity to understand these signals of pain than even their physicians. They look for signs of agitation, altered eye contact, grimacing, or other indications.
It is generally impossible to totally eliminate pain in Alzheimer’s patients or in other persons with chronic pain. The goal for those with Alzheimer’s Disease or other dementias should be to find greater levels of comfort and pain management.
Source: Web MD
October 1st, 2006
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