Anticholinergic medications may be linked to increased dementia risk

“Avoiding anticholinergic medications over the counter is a smart choice with this information. The list of common anticholinergic drugs is listed here in Wikipedia. . It surprised me.” Bill Chesnut, MD

To go back to New Health News:

Anticholinergic medications may be linked to increased dementia risk

ABC World News Tonight (4/18, story 10, 0:20, Muir) reported that “certain medications may increase the risk of dementia,” a new study warns. Medicines, “including tablets for cold and flu, allergies and heartburn,” appear to be linked to “memory problems.”

According to CNN (4/18, Tinker), the study “offers the most definite proof yet of what scientists have known for at least a decade: that anticholinergic” medications are associated with “cognitive impairment and an increased risk of dementia.” Such medicines “are sold over the counter and by prescription as sleep aids and for chronic diseases including hypertension, cardiovascular disease and chronic obstructive pulmonary disease.”

TIME (4/18, Oaklander) points out that researchers “analyzed already existing data from 451 people around ages 70-75 who had normal brains,” then “examined the results of memory tests, MRI brain scans and other neuroimaging data – all while paying particular attention to people who said they took anticholinergic” medications. Seniors “who regularly took at least one anticholinergic drug showed poorer cognition, lower brain volumes and less glucose metabolism in the whole brain and the temporal lobe” than seniors who did not. The study was published online in JAMA Neurology.


Surgery, Anesthesia Not Linked to Long-Term Cognitive Impairment in Older Adults

“Postoperative confusion does not mean there is long-term dementia because of the operation. The result is a significant finding. Many patients and providers discourage surgery in the elderly based on old data. Our techniques are now so improved that this study of 8,500 operated cases with general anesthesia found are no increased incidence of cognitive impairment in the Denmark. Research of this type from the Scandanavian countries has extra validly with me because they can track their patients more carefully. Patients return for follow-up care as directed better than in American” Bill Chesnut, MD

AAOS Now online edition _March 1, 2016  __SOURCE: American Society of Anesthesiologists

CHICAGO — March 1, 2016 — New research suggests that older patients should not feel reluctant to have quality of life enhancing surgeries due to concerns that undergoing anaesthesia may boost their risk of developing cognitive issues.

In a study of more than 8,500 middle-aged and elderly Danish twins published in Anesthesiology, researchers found no clinically significant association between major surgery and general anaesthesia with long-term cognitive decline.

“Our use of twins in the study provides a powerful approach to detect subtle effects of surgery and anaesthesia on cognitive functioning by minimising the risk that the true effects of surgery and anaesthesia are mixed-up with other environmental and genetic factors,” said lead author Unni Dokkedal, MD, University of Southern Denmark, Odense, Denmark. “We found no significant cognitive effects related to surgery and anaesthesia in these patients, suggesting that other factors, such as preoperative cognitive levels and underlying diseases, are more important to cognitive functioning in aging patients following surgery.”

The researchers examined the association between exposure to surgery and level of cognitive functioning in a sample of 4,299 middle-aged twins aged younger than 70 years and 4,204 elderly twins aged 70 years or older.

Results from cognitive tests of twins who had either major, minor, hip, and knee replacement or other surgery within 18 to 24 years before cognitive examination were compared with the cognitive results of a reference group, comprised of twins who had no surgical procedures. Test results were also compared in an intra-pair analysis of twins, one of whom was exposed to surgery while the other was not, to assess genetic and shared environmental confounding.

Twins who had undergone major surgery had slightly lower cognitive scores, compared with the reference group, but when compared to their twin, when genetic and shared environmental factors were adjusted, no association was observed.

Interestingly, twins who had undergone hip and knee replacement surgery had slightly higher cognitive scores, but the difference was not statistically significant.

No differences were found in the minor or other surgery group when compared with the reference group.

The authors also analysed data for patients who had undergone surgery from 3 months to 2 years before cognitive examination and found no effect of the short time interval between surgery and cognitive examination on cognitive function.

The results suggest preoperative cognitive functioning and underlying diseases are more important for cognitive functioning in mid- and late life than surgery and anaesthesia.

“It is important to know whether surgery and anaesthesia have any negative effects, especially with regard to preoperative counselling of the patient,” said Dr. Dokkedal. “This research has the potential to become a key piece of this very complex research puzzle.”

In an accompanying editorial, Michael S. Avidan, MD, and Alex S. Evers, MD, Washington University School of Medicine, St. Louis, Missouri, wrote: “On the basis of a growing body of evidence, of which the study by Dokkedal et al is symbolic, older patients should today be reassured that surgery and anaesthesia are unlikely to be implicated in causing persistent cognitive decline or incident dementia. The large number of patients and the use of rigorous longitudinal cognitive testing in the study increased the reliability of the findings.”


Knitting and other crafting activities have also been linked with a reduced risk of cognitive impairment.

“This is true science. Using your mind to concentrate on a pleasurable task reduced the risk of cognitive impairment. You feel better, have less stress and less stress mean better health.” Bill Chesnut, MD

Crafters, take note: To help keep your brain sharp, hang up your “just gone knitting” sign.Cleveland Clinic Wellness newsletter_February 25, 2016

Knit one, pearl two, brain power, we love you! Sudoku and other paper puzzles aren’t the only activities that can help keep your neurons firing as you age. Knitting and other crafting activities have also been linked with a reduced risk of cognitive impairment. The calming, meditative effects of knitting have been shown to reduce stress, but there may be additional benefits as well. Knitting and other creative crafting activities also require the use of multiple parts of the brain, which may help keep you sharp. And don’t think it’s ever too late to learn or re-learn. Pshaw! Until relatively recently, conventional medical “wisdom” held that we couldn’t generate new brain cells, but we now know better. Research has shown that our nervous systems have endless “neuroplasticity,” meaning that they continue to form new connections and patterns throughout our entire lives. Find a knitting class or a friend who’s willing to teach you. If you’re an old hand at knitting or crocheting, challenge yourself with new patterns and skills. And with every click of your needles, imagine your brain cells doing a little happy dance.

Study shows decades-long decline in dementia rates

“This first of the two included studies shows a decades-long decline in dementia ratesEncouraging news about dementia trends in 5,200 participants. I like the AMA Wire newsletter because they include a link to the research they quote. Without a subscription or paying a fee you get the abstract of the original research by following that link.” Bill Chesnut, MD

Study shows decades-long decline in dementia rates

According to USA Today (2/10, Szabo), a 5,200-patient study published online in the New England Journal of Medicine reveals that “dementia rates fell steadily over the past four decades, most likely due to declining rates of heart disease.” The biggest decline was seen in rates of vascular dementia, “although rates of Alzheimer’s disease also fell.” The study’s findings were based on data collected from the Framingham Heart Study.

The New York Times (2/11, A14, Belluck, Subscription Publication) reports that the study “provides the strongest evidence to date that a more educated population and better cardiovascular health are contributing to a decline in new dementia cases over time, or,” at a minimum, are “helping more people stave off dementia for longer.” Both findings “suggest that the long-term cost of dementia care may not be as devastatingly expensive as policy makers had predicted.” Nevertheless, “the actual number of dementia patients will increase because” aging baby boomers are “living longer.”

The San Francisco Chronicle (2/10, Colliver) reports that in a separate study (pdf), published online in the journal Alzheimer’s & Dementia, investigators found that “the risk of being diagnosed with Alzheimer’s disease or other forms of dementia is significantly higher in some racial or ethnic groups than it is in others.” After tracking some 274,000 members of Northern California Kaiser Permanente for 14 years, the researchers found that “African Americans had the highest incidence of dementia-related disease.” In fact, “their risk was 65 percent higher than that of Asian Americans, who had the lowest rates” of dementia.


Prioritize Sleep!

“ This is so important for brain health and personality growth.” Bill Chesnut, MD

Cleveland Clinic Wellness newsletter_September 24, 2015

Total recall: Boost your brainpower by prioritizing sleep.
Get a good night’s sleep before, say, a family reunion and your second cousins’ names will be flowing from your tongue like water from a fountain. Sound slumber, known to protect long-term memory, also makes memories easier to access. On the flip side, poor sleep makes it harder to learn, to make decisions, and even to distinguish between friendly and unfriendly faces. Stay sharp by treating sleep like the health essential it is. Three steps to get started: 

Say hellooo to sunshine. Get out in the morning sun to normalize your circadian rhythm, which makes you alert during the day and sleepy at night (what a concept!). 

Exercise, but not too late. Evening exercise can rev you up just when you want to feel sleepy. But physical activity during the day helps you sleep longer and more deeply. 

Dim your devices at night. Blue wavelength light from electronic devices suppresses melatonin, your brain’s natural sleep-beckoning hormone. Stick with good old-fashioned paper books, or — even better — turn off the lights and practice meditation. 

You may also want to know:

Let Go of the Day to Enjoy Restful Sleep 

How’s your sleep hygiene

Stay sharp with 20% off our brain health products 


Effect of Early Adult Patterns of Physical Activity and Television Viewing on Midlife Cognitive Function.

“This is exceptional research of 3,247 adults studied prospectively while studying Coronary Artery Risk Development in Young Adults. Get up and dance everybody!”  Bill Chesnut, MD.

Midlife thinking ability and exercise. “Effect of Early Adult Patterns of Physical Activity and Television Viewing on Midlife Cognitive Function”

Tina D. Hoang, MSPH1; Jared Reis, PhD2; Na Zhu, MD, MPH3; David R. Jacobs Jr, PhD3; Lenore J. Launer, PhD4; Rachel A. Whitmer, PhD5; Stephen Sidney, MD5; Kristine Yaffe, MD6,7

JAMA Psychiatry. Published online December 02, 2015. doi:10.1001/jamapsychiatry.2015.2468

Importance Sedentary behaviors and physical inactivity are not only increasing worldwide but also are critical risk factors for adverse health outcomes. Yet, few studies have examined the effects of sedentary behavior on cognition or the long-term role of either behavior in early to middle adulthood.

Objective To investigate the association between 25-year patterns of television viewing and physical activity and midlife cognition.

Design, Setting, and Participants Prospective study of 3247 adults (black and white races; aged 18-30 years) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study (March 25, 1985, to August 31, 2011). Data analysis was performed June 1, 2014, through April 15, 2015.

Main Outcomes and Measures We assessed television viewing and physical activity at repeated visits (≥3 assessments) over 25 years using a validated questionnaire. A 25-year pattern of high television viewing was defined as watching TV above the upper baseline quartile (>3 hours/d) for more than two-thirds of the visits, and a 25-year pattern of low physical activity was defined as activity levels below the lower, sex-specific baseline quartile for more than two-thirds of the of the visits. We evaluated cognitive function at year 25 using the Digit Symbol Substitution Test (DSST), Stroop test, and Rey Auditory Verbal Learning Test.

Results  At baseline, the mean (SD) age of the 3247 study participants was 25.1 (3.6) years, 1836 (56.5%) were female, 1771 (54.5%) were white, and 3015 (92.9%) had completed at least high school. Compared with participants with low television viewing, those with high television viewing during 25 years (353 of 3247 [10.9%]) were more likely to have poor cognitive performance (<1 SD below the race-specific mean) on the DSST and Stroop test, with findings reported as adjusted odds ratio (95% CI): DSST, 1.64 (1.21-2.23) and Stroop test, 1.56 (1.13-2.14), but not the Rey Auditory Verbal Learning Test, adjusted for age, race, sex, educational level, smoking, alcohol use, body mass index, and hypertension. Low physical activity during 25 years in 528 of 3247 participants (16.3%) was significantly associated with poor performance on the DSST, 1.47 (1.14-1.90). Compared with participants with low television viewing and high physical activity, the odds of poor performance were almost 2 times higher for adults with both high television viewing and low physical activity in 107 of 3247 (3.3%) (DSST, 1.95 [1.19-3.22], and Stroop test, 2.20 [1.36-3.56]).

Conclusions and Relevance High television viewing and low physical activity in early adulthood were associated with worse midlife executive function and processing speed. This is one of the first studies to demonstrate that these risk behaviors may be critical targets for prevention of cognitive aging even before middle age.


Keep your brain sharp on the road ahead by moving your body now

“Going to the gymnasium every day has surprising benefits.  Your metabolism rate is higher, you have more energy, your balance improves and you may retain more IQ points in the coming years.” Bill Chesnut, MD 

This is from the Cleveland Clinic Wellness Newsletter January 25, 2016.

Keep your brain sharp on the road ahead by moving your body now.
“Use it or lose it” may have more than just one meaning. Staying physically fit doesn’t keep only your body strong, flexible and resilient. It may do the same thing for your brain. Research has linked cardiovascular fitness to both long-term memory and executive function — your inner CEO, the part of your brain that helps you reason, plan and prioritize. Scientists recently mapped brain activity in older men engaged in tests of attention and quick decision-making, and they found that the brains of the most aerobically fit functioned most like the brains of younger men. You don’t have to run marathons to reach the mental fountain of youth. Pick your favorite moderate-intensity activity — walking, swimming, dancing or biking — and do it for half an hour on most days of the week. It looks like we need to schedule exercise the way we plan for any important gathering, celebration or meeting. It‘s an investment in your future health, below the shoulders and above! Visit our Healthy Brains Initiative to learn more about how to stay sharp as you age.

Cleveland Clinic 1.25.16

Association of Seafood Consumption, Brain Mercury Level, and APOE ε4 Status With Brain Neuropathology in Older Adults

“About the safety of eating seafood: Seafood consumption has been a concern because of the increased levels of mercury in fish. This study shows that moderate intake of seafood may produce a decreased chance of developing Alzheimer’s disease.” 

The best way to absorb the several findings of this critical study is this YouTube video by one of the authors at Rush Medical Center in Chicago and published in the Journal of the American Medical Association Network. First rate research.  .” Bill Chesnut, MD


Martha Clare Morris, ScD1; John Brockman, PhD2; Julie A. Schneider, MD, MPH3,4,5; Yamin Wang, PhD1; David A. Bennett, MD3,4; Christy C. Tangney, PhD6; Ondine van de Rest, PhD7

JAMA. 2016;315(5):489-497. doi:10.1001/jama.2015.19451.

Importance  Seafood consumption is promoted for its many health benefits even though its contamination by mercury, a known neurotoxin, is a growing concern.

Objective  To determine whether seafood consumption is correlated with increased brain mercury levels and also whether seafood consumption or brain mercury levels are correlated with brain neuropathologies.

Design, Setting, and Participants  Cross-sectional analyses of deceased participants in the Memory and Aging Project clinical neuropathological cohort study, 2004-2013. Participants resided in Chicago retirement communities and subsidized housing. The study included 286 autopsied brains of 554 deceased participants (51.6%). The mean (SD) age at death was 89.9 (6.1) years, 67% (193) were women, and the mean (SD) educational attainment was 14.6 (2.7) years.

Exposures  Seafood intake was first measured by a food frequency questionnaire at a mean of 4.5 years before death.

Main Outcomes and Measures  Dementia-related pathologies assessed were Alzheimer disease, Lewy bodies, and the number of macroinfarcts and microinfarcts. Dietary consumption of seafood and n-3 fatty acids was annually assessed by a food frequency questionnaire in the years before death. Tissue concentrations of mercury and selenium were measured using instrumental neutron activation analyses.

Results  Among the 286 autopsied brains of 544 participants, brain mercury levels were positively correlated with the number of seafood meals consumed per week (ρ = 0.16; P = .02). In models adjusted for age, sex, education, and total energy intake, seafood consumption (≥ 1 meal[s]/week) was significantly correlated with less Alzheimer disease pathology including lower density of neuritic plaques (β = −0.69 score units [95% CI, −1.34 to −0.04]), less severe and widespread neurofibrillary tangles (β = −0.77 score units [95% CI, −1.52 to −0.02]), and lower neuropathologically defined Alzheimer disease (β = −0.53 score units [95% CI, −0.96 to −0.10]) but only among apolipoprotein E (APOE ε4) carriers. Higher intake levels of α-linolenic acid (18:3 n-3) were correlated with lower odds of cerebral macroinfarctions (odds ratio for tertiles 3 vs 1, 0.51 [95% CI, 0.27 to 0.94]). Fish oil supplementation had no statistically significant correlation with any neuropathologic marker. Higher brain concentrations of mercury were not significantly correlated with increased levels of brain neuropathology.

Conclusions and Relevance  In cross-sectional analyses, moderate seafood consumption was correlated with lesser Alzheimer disease neuropathology. Although seafood consumption was also correlated with higher brain levels of mercury, these levels were not correlated with brain neuropathology.