ansiolíticos podrían vincularse con el riesgo de Alzheimer

Los adultos mayores que utilizan sedantes de forma habitual para la ansiedad o el insomnio podrían enfrentarse a un mayor riesgo de contraer la enfermedad de Alzheimer, sugiere un estudio reciente.
Los fármacos en cuestión son las benzodiacepinas, un grupo de sedantes que se recetan mucho y que incluyen el lorazepam (Ativan), diazepam (Valium) y alprazolam (Xanax). Los adultos mayores comúnmente toman los fármacos para la ansiedad o el insomnio, con frecuencia a largo plazo, según la información de respaldo del estudio.
Eso es a pesar de que las directrices solo aconsejan el uso a corto plazo de los medicamentos, como mucho. En 2012, la Sociedad Americana de Geriatría (American Geriatrics Society, AGS), incluyó a las benzodiacepinas en su lista de fármacos considerados como "potencialmente inadecuados" para los adultos mayores, debido a riesgos como la confusión, los mareos y las caídas.
El estudio actual no es el primero en vincular las benzodiacepinas al riesgo de Alzheimer, pero añade a las evidencias de que el uso a mayor plazo de esos fármacos (más allá de los tres meses) podría ser un factor de riesgo, según la investigadora líder, Sophie Billioti de Gage, candidata doctoral de la Universidad de Burdeos, en Francia.
"Para las personas que necesitan o que usan benzodiacepinas, parece esencial animar a los médicos a equilibrar con cuidado los beneficios y los riesgos al renovar la receta", apuntó Billioti de Gage.
Pero el estudio solo pudo hallar una asociación entre los fármacos y el riesgo de Alzheimer. No se diseñó para probar de forma definitiva que los medicamentos provocaban la afección, que acaba con la memoria, según una especialista en geriatría, la Dra. Gisele Wolf-Klein, que no participó en la investigación.
Un motivo es que los hallazgos se basan en los registros de recetas. "Sabemos que se recetaron los fármacos, pero no sabemos con qué frecuencia se los tomaban las personas, o incluso si se los tomaban", señaló Wolf-Klein, directora de educación en geriatría del Sistema de Salud North Shore-LIJ en New Hyde Park, Nueva York.
Pero a pesar de eso, las benzodiacepinas plantean suficientes riesgos conocidos como para ameritar preocupación, señaló.
"No hay ninguna duda de que esos medicamentos tienen efectos secundarios peligrosos", advirtió Wolf-Klein. "Es importante que las personas comprendan que pueden ser adictivas, y aumentar el riesgo de confusión y de caídas".
El estudio aparece en la edición en línea del 9 de septiembre de la revista BMJ.
Para el estudio, el equipo de Billioti de Gage examinó los expedientes de casi 1,800 adultos mayores con Alzheimer, comparando a cada uno con cuatro personas libres de demencia de la misma edad y del mismo sexo.
Hallaron que las personas a quienes se habían recetado benzodiacepinas durante más de tres meses tenían un 51 por ciento más de probabilidades de contraer Alzheimer que las personas que nunca habían usado los fármacos.
El riesgo casi se duplicó si habían tomado los medicamentos durante más de seis meses.
Según Billioti de Gage, las personas que están en las etapas iniciales de Alzheimer pueden tener síntomas como problemas del sueño y ansiedad. Eso plantea la posibilidad de que el uso de benzodiacepinas sea un resultado del Alzheimer, y no la causa de la enfermedad.
Pero dijo que el estudio se diseñó para contrarrestar esa posibilidad. Solo tomaron en cuenta las recetas que comenzaron al menos cinco años antes del diagnóstico de Alzheimer de la persona.
Billioti de Gage señaló que los medicamentos pueden resultar útiles a corto plazo. Y apuntó que el estudio no halló un mayor riesgo de Alzheimer entre los adultos mayores a quienes se recetaron los fármacos según las directrices internacionales, lo que significa usarlos no más de un mes para el insomnio, y no más de tres meses para los síntomas de ansiedad.
El Dr. Malaz Boustani, coautor de un editorial publicado junto con el estudio, dijo que los adultos mayores deben tener cuidado con el uso de los fármacos, o de cualquier medicamento que pueda afectar la función mental.
"Debemos tomar los efectos secundarios de estos fármacos con mucha más seriedad", enfatizó Boustani, investigador del Instituto Regenstrief del Centro de Investigación sobre el Envejecimiento de la Universidad de Indiana, en Indianápolis.
Según la AGS, varios medicamentos pueden hacer que los adultos mayores se sientan aturdidos y confusos. Incluyen otros tipos de somníferos, como zaleplon (Sonata) y zolpidem (Ambien); los antihistamínicos como la difenhidramina (Benadryl) y la clorfeniramina (AllerChlor, Chlor-Trimeton), y los relajantes musculares.
Tanto Boustani como Wolf-Klein sugirieron recurrir a terapias no farmacológicas para los problemas del sueño y la ansiedad, en parte porque los medicamentos no abordan los problemas subyacentes.
Cuando parece que una persona mayor tiene problemas para dormir, dijo Wolf-Klein, quizá solo se necesiten unos cambios en la rutina, como evitar la cafeína o limitar los líquidos de noche.
Cuando un trastorno de ansiedad es el problema, con frecuencia la terapia cognitivo conductual (terapia del habla) resulta efectiva, señaló Boustani.
"El mensaje más amplio es que debemos cuidar al cerebro", enfatizó Boustani. "Y el primer paso es no dañarlo".
FUENTES: Sophie Billioti de Gage, Ph.D. candidate, University of Bordeaux, France; Malaz Boustani, M.D., M.P.H., investigator, Regenstrief Institute, Indiana University Center for Aging Research, Indianapolis, Ind.; Gisele Wolf-Klein, M.D., director, geriatric education, North Shore-LIJ Health System, New Hyde Park, N.Y.; Sept. 9, 2014, BMJ online

How Singing Can Help People With Alzheimer’s

People with Alzheimer’s disease often tend to speak less as the
disease progresses, and speech can become increasingly confused. Now a
small study suggests that singing familiar songs can boost positive
feelings and encourage speech and social interaction in those with
mid-to late-stage Alzheimer’s disease.


Many Alzheimer’s patients retain the ability to remember songs and
music from their earlier years. For the new study, researchers at
Bar-Ilan University in Israel gave group music therapy sessions to six
men and women, aged 65 to 83, with moderate to severe Alzheimer’s
disease. Participants joined in group therapy sessions twice weekly over
a one-month period.


Familiar songs were selected, including national anthems and songs
from the participants’ childhoods in the 1930s, ‘40s and ‘50s.
Conversations among group members were observed during and after the
music therapy sessions.


The researchers found that those who participated in these singing
sessions talked more during and after music therapy sessions. Many
reminisced about learning and enjoying the songs when they were young,
and they tended to express a sense of accomplishment and belonging. Some
complimented others on their singing, and most looked forward to
continuing the singing sessions.


The findings support earlier research showing that music and singing
can be beneficial for those with Alzheimer’s disease, helping to ease
agitation and encourage social connection. Familiar songs and music
appear to be particularly helpful for these individuals, especially if
they enjoyed singing and music in the past.


A study presented last year at a Society for Neuroscience meeting in
San Diego, for example, found that singing as part of a group led to
improvements in thinking and memory skills and boosted mood in elderly
men and women with dementia. Participants sang familiar songs over four
months, including familiar songs like “Somewhere Over the Rainbow” and
“When You Wish Upon a Star.”


At the end of four months, those who sang along during regular music
sessions scored far higher, over all, on tests of memory and thinking
skills than those who didn’t sing along. They also reported higher
scores of overall satisfaction and improved mood.


Music is known to boost mood and ease stress when used appropriately.
Many senior care centers and Alzheimer’s support groups hold music and
sing-along sessions in communities nationwide. And a growing body of
research suggests that music -- like art and other creative forms of
therapy -- can stir emotions and memories, enhance enjoyment and
self-esteem, and enrich the lives of people with dementia.


Additional tips for music and the person with Alzheimer's include:


--Pick songs or music that is familiar and enjoyable for the person
with Alzheimer's disease. Tapes, CDs, radio programs, even live music
may be beneficial. But avoid music that may be too loud or interrupted
by noisy commercials; too much stimulation can cause confusion and
agitation.


--Turn off the TV, and close the door or curtains to avoid over-stimulation.


--Choose music to set the mood you're hoping to create: Quiet music
may be suitable before bedtime, while soft but upbeat tunes may be
appropriate for a special birthday celebration.


--Encourage those with Alzheimer's to clap or sing along or play a musical instrument.


--Supplement music with fond reminiscences and family photos.


The American Music Therapy Association can provide a list of qualified music professionals in your area. And never be afraid to sing a song or hum along on your own.





Sources: Ayelet Dassa, PhD, and Dorit Amir: “The Role of Singing
Familiar Songs in Encouraging Conversation Among People with Middle to
Late Stage Alzheimer’s Disease.” Journal of Music Therapy, Volume 51, Issue 2, pages 131-153.

By www.ALZinfo.org,

People With Alzheimer’s More Likely to Get Pacemakers

People who have Alzheimer’s disease and other forms of dementia are
more likely to get pacemakers than their peers with similar health
issues but without dementia, a new study shows. The study raises
questions about whether patients with Alzheimer’s may be getting overly
aggressive medical care in some cases.


Pacemakers are typically implanted in the chest in people with heart
rhythm disorders like atrial fibrillation, or A-fib. The metal devices,
about the size of a pocket watch, keep the heart beating in a normal
rhythm and can help to avert a potentially fatal heart attack.


But as with all medical procedures, pacemaker implantation carries
side effects and risks, which must be carefully weighed against benefits
when deciding whether someone should receive a pacemaker. Some question
the appropriateness of implanting devices like pacemakers in frail and
elderly individuals who have advanced dementia or other serious medical
problems, when quality of life is poor.


For the study, researchers at the University of Pittsburgh School of
Medicine analyzed health records from 16,245 people who had been treated
at least once at one of 33 Alzheimer’s treatment centers in the United
States. Patient records were assessed from 2005 to 2011.


At the start, about a third of the study participants had been given a
diagnosis of dementia; 21 percent had mild cognitive impairment, a form
of memory loss that sometimes progresses to dementia; and 48 percent
had no problems with thinking and memory. Rates of atrial fibrillation
and congestive heart failure were similar among the groups.


The researchers found that the likelihood of getting a pacemaker was
lowest for those who had no memory problems, and highest for those with
dementia. The findings were published in JAMA Internal Medicine, a journal from the American Medical Association.


"Participants who had dementia before assessment for a new pacemaker
were 1.6 times more likely to receive a pacemaker compared to
participants without cognitive impairment, even after clinical factors
were taken into account," said Nicole Fowler, the study leader, who is
now at Indiana University. "This was a bit surprising, because
aggressive interventions might not be appropriate for this population,
whose lives are limited by a severely disabling disease.”


People with mild cognitive impairment were 1.2 times more likely to
get a pacemaker than those with no memory problems. There was no
difference among the groups on whether someone received an implantable
cardiac defibrillator, another device that can re-set the heart beat if
it stops beating.


The study raises interesting questions about the kind of medical care
that those with Alzheimer’s or other serious cognitive problems
receive. Pacemakers can be lifesaving devices and are appropriate in
many cases. But family members and other caregivers, as well as doctors
who treat dementia patients, should carefully weigh whether a pacemaker
is the right option for a patient with dementia.


“Future research should explore how doctors, patients and families
come to make the decision to get a pacemaker," Dr. Fowler said. “The
risks and benefits of device implantation should be weighed carefully by
patients with cognitive impairment, family members, and clinicians
given the potential of these devices to have an impact on the quantity
and quality of life,” the authors note.





Source: Nicole R. Fowler, PhD. Jie Li, M.S., Charity G. Moore, Ph.D.,
et al: Use of Cardiac Implantable Electronic Devices in Older Adults
With Cognitive Impairment. (Research letter.) JAMA Internal Medicine, July 21, 2014.

By ALZinfo.org,

Veterans With Brain Injuries at Increased Alzheimer’s Risk

Veterans who have survived traumatic brain injuries are 60 percent
more likely to develop Alzheimer’s disease and other forms of dementia
later in life, a new study found. Those who developed dementia also
tended to develop it about two years earlier than veterans who hadn’t
had brain injuries, the study found.


The findings add to growing evidence that serious head injuries may
contribute to brain problems like Alzheimer’s years down the road.


“These findings suggest that a history of traumatic brain injury
contributes risk for dementia in later life in veterans,” said study
author Deborah E. Barnes of the University of California, San Francisco
and the San Francisco Veterans Affairs Medical Center.


The findings, published in Neurology, show only a
correlation between brain injury and Alzheimer’s; they cannot prove a
cause and effect relationship. But “if we assume that this relationship
is causal,” said Dr. Barnes, “it seems likely that the same increased
risk probably occurs with traumatic brain injury in the civilian
population as well.”


The study involved 188,784 veterans aged 55 and older who were free
of dementia at the study’s start. Their average age was 68. All had
visited at a V.A. hospital when the study began, and again about nine
years later. They were given tests to look for signs of dementia and
assessed for other mental health and medical problems.


Of the veterans, 1,229 had suffered a traumatic brain injury, or TBI,
during service. During the study’s nine-year follow-up period, 196, or
16 percent, developed Alzheimer’s or another form of dementia. In
comparison, about 10 percent of those without a brain injury were given a
dementia diagnosis.


The researchers controlled for factors like diabetes, high blood
pressure, depression and alcohol abuse, all of which can increase
dementia risk. They determined that veterans who had had brain injuries
were 60 percent more likely to develop dementia than those without a
brain injury.


Of course, many of the veterans who had had traumatic brain injuries
never developed dementia. And some of those who had never had a serious
brain injury developed dementia. But over all, veterans with TBI tended
to develop dementia about two years earlier, around age 78, than those
without a TBI.


The researchers also found that the risk of dementia was higher in
veterans with TBI who also had depression, post-traumatic stress
disorder or blood vessel disease than in those with either TBI or these
other conditions alone. The study was supported by the U.S. Department
of Defense and the National Institutes of Health.


Other research has shown that brain injury is linked to a variety of
health problems, including an increased risk of seizures, memory and
thinking problems and early death. It has long been known that boxers,
for example, may suffer from cognitive problems later in life, and
similar deficits have been documented in football players and other
athletes. Genetics and other factors may predispose some people to
memory problems after head trauma.


This study looked at head injuries in veterans in particular,
including related risk factors like post-traumatic stress disorder and
depression. The injuries were far more severe than the kinds of
concussions seen on the playing field.


“The authors convincingly showed that mild trauma has a role in
increasing the risk of dementia and sheds light on the more complex
relationship between medical and psychiatric diseases with TBI in the
development of the future risk of dementias,” wrote Dr. Rodolfo Savica
of the University of Utah School of Medicine in an editorial
accompanying the study. He cautioned that the relationship between head
trauma and Alzheimer’s disease is complex and that more study is needed
to determine how injuries might prime the brain for dementia onset.
“Head trauma is just one piece of a big puzzle,” he said.


Alzheimer’s researchers have become concerned that brain injuries,
possibly even mild to moderate concussions, can cause brain inflammation
that then triggers the development of Alzheimer’s in those who may
already be at increased risk of the disease.





Source: Deborah E. Barnes, PhD, MPH, Allison Kaup, PhD, Katharine A.
Kirby, MA, et al: “Traumatic Brain Injury and Risk of Dementia in Older
Veterans.” Rodolfo Savica, MD, MSC: “Head Trauma and Neurodegeneration
in Veterans: An Additional Piece of the Puzzle.” Neurology Vol. 83, No. 1-8, 2014.

By www.ALZinfo.org,