|
|
When Should Alzheimer’s Patients Stop Driving?
Researchers creating tests to help determine when
to
hand over the keys
April 6, 2009, Washington (Associated Press) — Scientists
are creating tests to show when it’s time for people with
early Alzheimer’s disease to stop driving.
It’s one of a family’s most wrenching decisions, and as
Alzheimer’s increasingly is diagnosed in its earliest stages, it
can be hard to tell when a loved one is poised to become
a danger.
Factor in that much of the country lacks public transportation,
and quitting too soon restricts independence for
someone who otherwise may function well for several years.
“That’s a real cost to the individual and family and
society,” says Jeffrey Dawson of the University of Iowa.
“You have to have some sort of trade-off between the
individual’s independence along with the safety of the
driver and with other people on the road.”
Typically, specialists say, patients gradually scale back
their driving, avoiding busy freeways or night trips or leftturn
intersections. Alzheimer’s Association adviser Sue
Pinder, 58, recently gave up big-city driving even though it
meant fewer visits to a daughter in Dallas.
Shortly after Pinder’s diagnosis in 2004, she signed a
form designating her husband to decide when she’ll quit
driving altogether. He gave her a GPS system for her last
birthday. It helped Pinder navigate unfamiliar streets when,
to be near another daughter, the couple recently moved to
West Monroe, La., from a nearby town.
“That’s helped a lot where I don’t have to worry, I can
concentrate on my driving and not the directions,” Pinder says.
The road test
Working on ways to help similar patients, Dawson’s team
in Iowa developed an intricate behind-the-wheel exam: A
35-mile drive through rural, residential and urban streets in
a tricked-out Ford Taurus able to record just about every
action the driver takes, much like an airplane “black box”
does. Lipstick-size video cameras were positioned to show
oncoming traffic, too.
Researchers recruited 40 people with early-stage
Alzheimer’s who still had their driver’s licenses to take the
road test, and compared how 115 older drivers without dementia handled the same trip.
The results, reported in the journal Neurology, are
striking. On average, the Alzheimer’s drivers committed 42
safety mistakes, compared with 33 for the other drivers.
Lane violations, such as swerving or hugging the center
line as another car approaches, were the biggest problem for
the Alzheimer’s drivers. They performed 50 percent worse.
Overall errors rose with increasing age whether or not
the driver had Alzheimer’s, an extra 2½ mistakes for every
five years of age.
But some Alzheimer’s patients drove just as well as
their healthier counterparts, stresses Dawson, a biostatistics
professor. Here’s the key: Researchers also checked whether
any of a battery of neuropsychological tests given beforehand
accurately predicted who would drive worse — and some did.
Multitasking skills
Flunking simple memory tests didn’t make a difference.
Standard neurologic tests of multitasking abilities did, ones
that assess if people’s cognitive, visual and motor skills work
together in a way to make quick decisions. Examples include
showing patients geometric figures for a few seconds and
having them draw the shape from memory, or drawing
paths between a sequence of numbers and letters.
Alzheimer’s patients who scored average or better on
those types of written tests were likewise no worse behind
the wheel than other older drivers — but those who scored
worse than average tended to commit about 50 percent
more errors on the road, Dawson says.
More research is needed but the ultimate goal is an easy
doctor’s-office exam to help guide when patients should
give up the keys.
But as Alzheimer’s worsens, patients often vehemently
deny that they’re a hazard, says Dr. Gary Kennedy, geriatric
psychiatry chief at New York’s Montefiore Medical Center.
“I can be the bad guy,” he tells families, sometimes
reporting patients to the Department of Motor Vehicles for
a driving test or advising relatives to disable the car.
“Giving up the car is not like going into the nursing
home,” Kennedy counsels patients, trying to recruit relatives
or friends to schedule rides. “If as a society we recognize
this as a danger, we need to help them compensate.”
Source Article (MS NBC).
Free Drug Discount Card Offered by New York State
April 17, 2009, New York Prescription Saver — Hit hard by the
economic downturn? Looking for relief from paying the full
cost of your prescription drugs? New York State announces
the New York Prescription Saver, a free prescription discount
card that will help save on the cost of prescription drugs. The
card is for New York State residents who are 50 to 64 years
old, or persons with a disability regardless of age. Income
eligibility limits are up to $35,000 single and $50,000
married. Those with Medicaid coverage are not eligible.
Visit https://nyprescriptionsaver.fhsc.com for more information.
Anti-inflammatory Drugs Don’t Cut Dementia Risk,
They Raise It
By Mary Brophy Marcus
April 27, 2009, USA TODAY — Millions of people
who use non-steroidal anti-inflammatory drugs (NSAIDs),
such as naproxen and ibuprofen, shouldn’t bank on the
drugs helping them ward off dementia.
A study in this week’s Neurology suggests that NSAID
users do not have lower rates of dementia and that increased
use of the pain relievers may actually raise the risk of
cognitive decline.
“We had high hopes that these non-steroidal arthritis
drugs might play a role, in part because other studies had
been promising,” says study author Eric Larson, executive
director of Group Health Center for Health Studies, a
Seattle-based HMO.
Researchers followed 2,736 members of Group
Health who were an average age of 75 at the study’s
start. Participants were tracked for 12 years to see if
they developed dementia, including Alzheimer’s disease.
Participants’ pharmacy records were evaluated for use of
prescription and over-the-counter pain relievers, and they
were questioned about their NSAID use as well.
Results showed 351 people had a history of heavy
NSAID use at the study’s start, while 107 people became
heavy users during the follow-up period. Heavy users
took at least one NSAID a day for at least 16 months of a
two-year period.
During the study, 476 people developed dementia, and
heavy NSAID users had a 66% higher risk of developing
the condition than those with low or no use.
Larson says he was surprised at the outcome because
inflammation is thought to play a role in dementia and
because other studies suggested anti-inflammatory pills lowered dementia risk.
“We have years and years of drug exposure data that
was extremely accurate. We did not expect these findings,”
Larson says.
Duke aging expert Murali Doraiswamy says that the
latest results aren’t a revelation to him and that previous
trials evaluating Vioxx, aspirin and prednisone, among
other anti-inflammatory medications, did not show
reduced risks cognitive decline. “Any benefits noted in
prior studies were likely due to an epiphenomenon — the
people taking NSAIDS were younger, healthier and better
educated, all of which biased the results.”
The study doesn’t disprove the theory that inflammation
is a factor in Alzheimer’s, though, says Jason Karlawish,
associate director of the Penn Memory Center at the
University of Pennsylvania. “Negative studies like this that
fail to prove the hypothesis leave thousands of questions to
be answered,” Karlawish says.
The new data highlight the need for early detection
and better biomarkers, says Alzheimer’s Association vice
president Bill Thies. “If you could tell who’s going to need
dementia drugs at age 40 and study them, you may have a
totally different result.”
Source Article (USA Today).
Early Alzheimer’s Diagnosis Reduces Costs
May 25, Madison, Wis. (UPI) — The way to fight
Alzheimer’s disease is to intervene decades before someone
demonstrates symptoms, U.S. researchers suggest.
“The future of this disease is to intervene decades
before someone becomes symptomatic. This analysis says
you can save literally billions of dollars in long-term care
costs if you can intervene at an earlier stage,” study coauthor
David Weimer of the La Follette School of Public
Affairs said in a statement. “What you don’t know costs a
lot of money when it comes to this disease.”
The researchers analyzed two types of interventions
following diagnosis — patient drug treatment and caregiversupport
programs.
The study, published in Alzheimer’s & Dementia: The
Journal of the Alzheimer’s Association, found each intervention
provides positive net savings, with the greatest benefits
achieved using a combination of both.
Currently, Medicare does not support caregiver-intervention
programs and even accounting for implementation
costs, the analysis suggests it would result in net savings to
governments by reducing the care burden on medical systems.
The Wisconsin Medicaid program spends almost $500
million each year on nursing home care for 11,000 dementia
patients — a tiny fraction of the estimated 160,000 affected
people in the state, but caregiver support is sparse, Mark
Sager of the University of Wisconsin-Madison School of
Medicine and Public Health said.
Source Article (UPI).
Low Blood Sugar a Dementia Risk for Diabetics
By Julie Steenhuysen
April 14, 2009, Chicago (Reuters)
— Older diabetics whose blood sugar drops to dangerously
low levels have a higher risk of developing dementia, U.S.
researchers said on Tuesday.
The study by researchers at Kaiser Permanente in
Oakland, California, suggests that aggressive blood sugar
control resulting in blood sugar so low it requires a trip to
the hospital may increase dementia risks in older adults with
type 2 diabetes.
“We know that having blood sugar that is too high
is not good,” Rachel Whitmer, a Kaiser research scientist
whose study appears in the Journal of the American Medical
Association, said in a telephone interview.
“You want to keep that blood sugar at a good level, but
you don’t want to go too low,” she said.
Several studies have found that diabetics have a higher
risk of developing Alzheimer’s disease — the most common
form of dementia — than do the general population. And
others have shown that diabetics who take insulin and pills
to help control their disease have a lower Alzheimer’s risk.
“The very current issue here is balance of blood sugar
control,” Whitmer said.
She said a number of things such as a missed meal can
cause severe low blood sugar in diabetics, but the chief
cause is too much insulin, which can happen in people who
take insulin injections or with oral diabetes drugs such as
sulfanylureas or glimepiride that cause the body to make
more insulin.
Read Full Article (UK Reuters).
|
Previous
