Markers of B12 insufficiency all predicted lower global cognitive scores over nearly five years of follow-up, Christine C. Tangney, PhD, of Rush University Medical Center in Chicago, and colleagues found.
Lower Cognitive Scores – Low B12?
older age
Older Women Have 2X Mortality Risk First Year Post Hip Fx
Older women who experience a hip fracture have a twofold increase in mortality risk in the first year after the fracture, researchers found.
During the 12 months following the fracture, 16.9% of the women died, compared with 8.4% of controls, for an odds ratio of 2.3 (95% CI 1.9 to 2.8), according to Erin S. LeBlanc, MD, of Kaiser Permanente Northwest in Portland, Ore., and colleagues. They researchers adjusted for potential confounders such as age, bone mineral density (BMD), and coexisting conditions such as diabetes, hypertension, and stroke.
And the increased mortality risk during the first year remained after further adjustment for specific hip fracture risk factors such as total hip BMD (OR 2.4, 95% CI 1.9 to 3.1), the researchers reported online in Archives of Internal Medicine.
MKSAP – Memory Loss in an 81 Year Old Male
Mild cognitive impairment denotes abnormal cognitive decline
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
I actually got this one right.
NEJM Teaching Topic – MCI
The NEJM Resident e-Bulletin is one of the ways I keep up with medical information. While it will not be possible for me to reproduce every email that comes from this service, on occasion I will post topics of interest. Copyright remains vested with the NEJM so don’t try and steal this to make money.
Teaching Topic
Mild Cognitive Impairment
Clinical Practice
Mild Cognitive Impairment
R.C. Petersen
MCI represents an intermediate state of cognitive function between the changes seen in aging and those fulfilling criteria for dementia, often Alzheimer’s disease (AD).
Clinical Pearls
What is the estimated prevalence of MCI?
The estimated prevalence of MCI in population-based studies ranges from 10 to 20%. In the Mayo Clinic Study of Aging, a prospective, population-based study of non-demented persons ages 70 to 89 years at enrollment, the prevalence of amnestic MCI was 11.1% and of nonamnestic MCI, 4.9%.
How can the “worried well” be differentiated from patients with MCI?
Neuropsychological testing may be necessary to corroborate a history of decline in cognition, usually memory. At times, the “worried well” can give a convincing history for memory loss, but neuropsychological testing reveals normal performance.
Figure 1. Diagnostic Algorithm for Amnestic and Nonamnestic Mild Cognitive Impairment.
Morning Report Questions
Q. What factors predict a more rapid progression of cognitive impairment among patients with MCI?
A. As compared with the incidence rate for dementia in the general population of 1 to 2% per year, the incidence of dementia in patients with MCI is significantly increased, with an annual rate of 5 to 10% in community-based populations and 10 to 15% in clinic-based populations. The degree of cognitive impairment at presentation is a clinical predictor of progression; those with greater baseline impairment appear more likely to progress more rapidly. The presence of the apolipoprotein E ε4 allele is also predictive of progression rate. Several MRI measures have also been reported to predict a faster rate of progression, including atrophic hippocampi, dilated ventricles, reduced total brain volume, and the presence of white matter hyperintensities.
Q. How can patients with MCI be managed?
A. Limited data support the potential benefit of cognitive rehabilitation approaches. Several clinical trials that treated persons with MCI with cholinesterase inhibitors used for AD (donepezil, galantamine, and rivastigmine) at standard AD treatment doses for 2 to 4 years have shown no significant reduction in the rates of progression to dementia.
More EVO = Lower Stroke Risk
Medical News: Olive Oil Protects Against Stroke – in Neurology, Strokes from MedPage Today
Observational study on French people.
I wonder if the researchers controlled for red wine consumption.
Think Positive Thoughts
Why We Don’t Take Care of Ourselves
Negative stereotypes about aging lead to the adoption of less healthy lifestyle choices that turn the negative stereotypes into a self-fulfilling prophecy.
Take Home Message:
Watch for signs of negative belief systems about aging in medical records.
Especially in the older population.
Namenda in the News
Alcohol and Seniors
NIHSeniorHealth: Alcohol Use and Older Adults – Table of contents
This is a nice little informational website from the NIH. The first video features a 77 year young woman who developed alcoholism late in life after a lung cancer diagnosis. She got up to a liter of wine daily when it became a problem.
Social Security Retirement Age Should Go Up – American Academy of Actuaries
Posting of this link does not imply agreement with the stated position.
I try to avoid politics at all costs.
But these guys must not be French.
If Your Leg Breaks Stop Taking Biphosphonates
The highlighted bold is me. I keep reading this FDA recommendation just to make sure I understand what they are trying to say. I think the recommendation says the FDA found no cause and effect between the use of biphosphonates and leg fractures so keep taking your medication. But if your leg breaks, your physician will instruct you to stop taking the medication she prescribed for you to help prevent bone loss and fractures.
I’m glad the FDA cleared up this issue, don’t you?
BACKGROUND: Atypical subtrochanteric femur fractures are fractures in the bone just below the hip joint. Diaphyseal femur fractures occur in the long part of the thigh bone. These fractures are very uncommon and appear to account for less than 1% of all hip and femur fractures overall. Although it is not clear if bisphosphonates are the cause, these unusual femur fractures have been predominantly reported in patients taking bisphosphonates.
RECOMMENDATIONS: Patients should continue to take their medication unless told to stop by their healthcare professional. FDA recommends that healthcare professionals should discontinue potent antiresorptive medications (including bisphosphonates) in patients who have evidence of a femoral shaft fracture. See the FDA Drug Safety Communication below for additional information.
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