Commonly prescribed drugs are tied to nearly 50% higher dementia risk in older adults

(CNN) – Scientists have long found a possible link between anticholinergic drugs and an increased risk of dementia.

A study published in the journal JAMA Internal Medicine on Monday suggests that the link is strongest for certain classes of anticholinergic drugs — particularly antidepressants such as paroxetine or amitriptyline, bladder antimuscarinics such as oxybutynin or tolterodine, antipsychotics such as chlorpromazine or olanzapine and antiepileptic drugs such as oxcarbazepine or carbamazepine.

Researchers wrote in the study that “there was nearly a 50% increased odds of dementia” associated with a total anticholinergic exposure of more than 1,095 daily doses within a 10-year period, which is equivalent to an older adult taking a strong anticholinergic medication daily for at least three years, compared with no exposure.

“The study is important because it strengthens a growing body of evidence showing that strong anticholinergic drugs have long term associations with dementia risk,” said Carol Coupland, professor of medical statistics in primary care at the University of Nottingham in the United Kingdom and first author of the study.

“It also highlights which types of anticholinergic drugs have the strongest associations. This is important information for physicians to know when considering whether to prescribe these drugs,” she said, adding “this is an observational study so no firm conclusions can be drawn about whether these anticholinergic drugs cause dementia.”

She said that people taking these medications are advised not to stop them without consulting with their doctor first, as that could be harmful. The study involved analyzing data on 284,343 adults in the United Kingdom, aged 55 and older, between 2004 and 2016. The data came from QResearch, a large database of anonymized health records.

The researchers identified each adult’s anticholinergic exposure based on details of their prescriptions. The researchers found the most frequently prescribed anticholinergic drugs were antidepressants, drugs to treat vertigo, motion sickness or vomiting and bladder antimuscarinic drugs, such as to treat overactive bladder. The researchers also took a close look at who was diagnosed with dementia and found that 58,769 of the patients had a dementia diagnosis.

The researchers found no significant increases in dementia risk associated with antihistamines, skeletal muscle relaxants, gastrointestinal antispasmodics, antiarrhythmics, or antimuscarinic bronchodilators, according to the data, but associations were found among other classes of anticholinergic drugs. The researchers found that the odds of dementia increased from 1.06 among those with the lowest anticholinergic exposure to 1.49 among those with the highest exposure, compared with having no prescriptions for anticholinergic drugs.

The study had some limitations, including that some patients may not have taken their prescribed medication as directed, so anticholinergic exposure levels could have been misclassified. The researchers found only an association between anticholinergic drugs and dementia risk, not a causal relationship.

“However, if this association is causal, the population-attributable fractions indicate that around 10% of dementia diagnoses are attributable to anticholinergic drug exposure, which would equate, for example, to around 20,000 of the 209,600 new cases of dementia per year in the United Kingdom,” the researchers wrote in the study.Since the study shows only an association, more research is needed to “clarify whether anticholinergic medications truly represent a reversible risk factor” for dementia, wrote experts Noll Campbell, Richard Holden and Dr. Malaz Boustani in an editorial that published alongside the new study in JAMA Internal Medicine.

“Additionally, deprescribing trials can evaluate potential harms of stopping anticholinergic medications, such as worsening symptoms of depression, incontinence, or pain, as well as the potential unintended increase in acute health care utilization,” Campbell, Holden and Boustani wrote in the editorial.”With little evidence of causation, the next steps for research on anticholinergic medications in older adults must improve knowledge of the effect of deprescribing interventions on cognitive outcomes and important safety outcomes such as symptom control, quality of life, and health care utilization,” they wrote. “We propose deprescribing research as a high priority.”

It has been well known that anticholinergic agents and confusion or memory issues are linked, but the new study investigated this association over a long period of time, said Dr. Douglas Scharre, director of the division of cognitive neurology at the Ohio State University Wexner Medical Center in Columbus, who was not involved in the study.

He encouraged any patients who might have questions about this association to talk to their physicians. “I spend a lot of my time in the memory disorder clinic seeing geriatric patients and taking people off medications, mostly ones that have anticholinergic properties, and many times there can be another drug out there that has less anticholinergic impact or is non-anticholinergic that may work,” Scharre said.

“Some of the medications that they list in the study may be quite critical and important and are well worth the person taking for their seizures or their psychosis, and so it’s a risk-benefit discussion,” he added. “So have a conversation with your doctor.”

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E-Cigarette Exploded in a Teenager’s Mouth, Damaging His Jaw

The Food and Drug Administration does not tally the number of e-cigarette explosions. Credit Steve Helber/Associated Press

Kailani Burton bought a vaping kit for her teenage son Austin, hoping he would use it to quit smoking.

In March of last year, she and her husband were sitting in the living room when they heard a loud pop.

Austin raced in, holding his bloodied jaw. An e-cigarette had exploded in his mouth.

“He was bleeding really bad,” Ms. Burton said in an interview. “It looked like a hole in his chin.”

Ms. Burton and her family rushed Austin, then 17 and still in high school, to the hospital in Ely, Nev., a remote mountain town. But realizing quickly that he needed treatment at a trauma center, they then drove the 200-mile, mountainous trek from eastern Nevada to Salt Lake City, arriving about 1:30 a.m. “I was so worried driving. I almost hit a wild horse,” Ms. Burton said.

Dr. Katie W. Russell, a pediatric surgeon at the University of Utah, and Dr. Micah Katz, a resident, part of the team who treated Austin, submitted the case, which was published on Wednesday, to The New England Journal of Medicine in an effort to warn the public about the dangers of vaping.

“I had no idea that these vape pens could blow up and cause serious injury,” said Dr. Russell, director of the trauma center at the Primary Children’s Hospital in Salt Lake City.

“This technology hit the market by storm and people are not aware,” she added. “But the fact is they can burn you. They can explode in your pocket. They can explode in your face. I think there’s a health concern.”

Dr. Russell said that Austin told her he saw a big flash, felt terrible pain in his lower jaw and quickly pulled the device out of his mouth. He had a major fracture of his lower jaw, including about a 2-centimeter piece that had exploded and was missing, and he was also missing multiple teeth. The surgeons had to put a plate under his gum. Dr. Russell said that she believed the injury was caused by an exploding battery but that she was not certain.

The family said Austin had been using a VGOD product. VGOD sells a range of vaping devices and liquid nicotine flavors, including Mango Bomb, Berry Bomb and Apple Bomb. VGOD markets its products to customers seeking a large vaping cloud, and promotes what it calls “tricking,” creating rings and unusual shapes with the smoky vapor.

A reconstructed computed tomography showing the injuries suffered by a teenager when an e-cigarette exploded in his mouth. Credit Primary Children’s Hospital

The Food and Drug Administration has expressed concern about e-cigarette and other vaping device injuries from overheating and exploding batteries. It is also exploring product standards to reduce battery problems. The agency does not tally the number of e-cigarette explosions or other mishaps.

On a web page offering tips to reduce such hazards, the agency wrote, “You may have heard that e-cigarettes, or ‘vapes,’ can explode and seriously injure people. Although they appear rare, these explosions are dangerous.”

A report in BMJ last year, using data from several federal agencies, found there were roughly 2,035 e-cigarette explosion and burn injuries in the United States from 2015 to 2017.

The authors, led by Dr. Matthew E. Rossheim of George Mason University, said the number was most likely higher because accidents were not thoroughly tracked. The report also said that e-cigarettes, commonly powered by a lithium-ion battery, could overheat to the point of catching fire or exploding, a phenomenon known as thermal runaway. This can be caused by product defects, or by a short circuit of the battery, when they are in contact with metal objects — for example, keys or coins, the authors said. The researchers also noted at least one death from an e-cigarette explosion and suggested the F.D.A. improve its monitoring of these injuries.

A July 2017 report from the Federal Emergency Management Agency said that from January 2009 through December 2016, there were 195 reports of explosions involving e-cigarettes, 38 of which caused severe injuries. The report called the combination of an electronic cigarette and a lithium-ion battery a new and unique hazard.

“It is clear that these batteries are not a safe source of energy for these devices,” the agency said.

A blog post by the Massachusetts General Research Institute says that open systems — which use rechargeable batteries with reservoirs that can be filled with e-liquid — are generally less safe than closed systems, which use pre-filled, disposable cartridges that attach to a rechargeable battery, or single-use products that cannot be recharged.

“The closed-system e-cigarette, while generally safer, serves as a starter product that paves the way for the use of a more risky, unregulated open-system e-cigarette,” the institute wrote last fall.

In an interview, Ms. Burton said Austin recently graduated from high school and was doing well. She said that she regretted buying the vaping device, but that Austin had quit vaping altogether even if his friends had not.

“I just want people to know that it can be dangerous,” she said. “I bought it for him. I should have protected him.

Resource: New York Times

Recipe: Quinoa Toubbouleh – Salad

Quick, Simple, Fresh, and Healthy!

Adding quinoa to your green salad adds so much vital nutrients. Quinoa (pronounced “keenwah”) is one of few plant-based foods that is a source of complete protein that contains 9 essential amino acids. Our bodies can’t produce it, so this quality is especially important for vegans and vegetarians. Quinoa is gluten-free, high in iron, magnesium, B and E vitamins, calcium, phosphorus and potassium. Quinoa is also very high in fiber and has a low glycemic index. Low glycemic foods are slowly digested and absorbed. They produce only small fluctuations in blood glucose and insulin levels. This is especially important for diabetics because quinoa doesn’t hit their blood stream quickly like white rice. I usually make a medium size pot, and use it throughout the week to create all kinds of salads. It saves me a lot of time in the kitchen. Here a recent recipe to enjoy. This serves for two people.

INGREDIENTS

  • 1 cup uncooked quinoa
  • 1 lemon
  • 1 Tbs olive oil
  • 1 minced garlic
  • 1/4 cup of chopped parsley
  • 1/2 tsp salt
  • 1/2 yellow bell pepper
  • 1/4 cup green peas
  • 2 big radishes
  • 1 avocado
  • 1/2 pear
  • 2 cups of arugula

INSTRUCTIONS

  1. To cook the quinoa. Rinse the quinoa under cook water. Place quinoa in a pot with 1.75 cups of water. Place lid on top and bring to boil over high heat. Reduce the heat to low for 15 minutes. Let quinoa cook before making the salad. This is why I usually do a big batch once a week.
  2. While the quinoa is cooling, prepare the rest of the salad by cutting up the rest of the ingredients.
  3. Dressing: Squeeze the juice from the lemon into a bowl. Add olive oil, salt, minced garlic, and chopping parsley.
  4. Once quinoa is cooled, add all the vegetable ingredients together. Pour the dressing all over and stir to coat well. Serve immediately or store in the refrigerator until you’re ready to enjoy.

There’s no wrong or right ingredient with making a quinoa salad. You can easily add whatever vegetable, fruit, even legumes, nuts and leafy greens you like. The idea here is to simplify your life with quick options for a more healthier plant-based diet.

What I’m Reading Now?

I’m journeying on a new path to learn how to meditate. I need to bring calm, stillness, and peacefulness to my mind. I’ve heard and read about the many amazing benefits on practicing meditation, and I’m at the right stage in my life where I need it the most. With a full time career, three children, husband, and a dog; it’s a time much needed. I chose The Headspace Guide to Meditation and Mindfulness by Andy Puddicombe to kick start my journey because it came highly recommended by Bill Gates. No, I don’t know him personally, although I wish! I follow his blog, gatesnotes. If you don’t, you should. He’s brilliant, Google him. Bill is the reason why I researched Andy in the first place. Andy is 47 with many years of training in monasteries in India, Nepal, Myanmar, Thailand, Australia, Russia, and Scotland. He’s even an ordained Buddhist monk.

Andy’s approach to meditation is clear and easy to understand. He teaches amazing techniques, and they’re easy to apply to your everyday busy lifestyle. Andy also believes all you need is 10 minutes a day. Obviously, if you have the ability and time to meditate longer, by all means meditate. When you think of 10 minutes, it’s actually not that long; however, it’s hard for the average person to sit still with a clear mind. More importantly, the practice of meditation is about much more than simply sitting down for a set period of time each day. Andy says, “it’s about training in awareness and understanding how and why you think and feel the way you do, and getting a healthy sense of perspective in the process.” His book also looks deeper in the differences between understanding mindfulness and headspace. He even have an app called, Headspace available on IOS. I haven’t downloaded it yet, but I intend to. Let’s take a look at mindfulness, Andy explains it as the temptation to judge whatever emotion that comes up, and therefore neither opposing or getting carried away with a feeling. And headspace is the result of applying this approach. Headspace delivers a sense of ease with whatever emotion is present.

How many times you’ve been in a situation where someone pissed you off? It angers you, and you feel like you just want to explode. Then you move through your day retelling that scenario over and over to everyone you possibly can share it with. Instead of moving forward productively with your day, you dwell and relive that situation over and over again transferring that negative energy to your friends, love ones, and even into your workplace. This behavior is toxic and becomes debilitating to your mind, body and soul. Who wants to go through life this way? Surely not me! Knowing how to let go and release these toxic thoughts and energy is my goal.

Andy’s book offers four steps to help you achieve meditation. His Take10 summary is recommended to follow each and every time before you meditate.

  1. Getting Ready
  2. Checking-in
  3. Focusing the mind
  4. Finishing-off

The book explains in detail what you need to do in each step to get your mind and body ready. I’m almost midway finish reading the book. I feel more confident than ever. This book has already taught me about the layers of my thoughts, dealing with my emotions, and how to tackle each one as they come to mind. I’ve re-read many chapters and made side notes. It’s definitely a page turner. If you’re interested in learning how to meditate, this book may help you. I would love to hear about your journey or any suggestions on meditation.

How to Care for Your Hair … Down There

#pubichaircare #nytimes #well
Are your products helping, hurting or are at all necessary? Credit Credit Phillipp Arnold/Getty Images

There are several pubic hair products on the market, but they seem to offer a solution to a nonexistent problem.

How do I care for my pubic hair without giving myself a yeast infection? Is there anything I can do besides washing in the shower? I’ve noticed there are now oils and creams on the market, but I am wary based on past experience.

 Franny

[Have a question about women’s health? Ask Dr. Gunter yourself.] 

There is no need for any special pubic hair care regimen. There are several pubic hair care products on the market, but all seem designed as a solution to a nonexistent problem.

How to care or not care for pubic hair has not been studied. We know that removing pubic hair is associated with injuries — burns from hot wax, for example, or lacerations from razors. Infections from injuries or ingrown hairs can also happen. There is also data that suggests pubic hair removal may be associated with an increased risk of transmission of some sexually transmitted infections, or STIs. It is possible that the infection risk rises because the removal of pubic hair creates an easier portal of entry for some bacteria and viruses. It is also possible that pubic hair removal could change the microenvironment of the vulva in a way that reduces natural defense mechanisms. This association between pubic hair removal and STIs could also be correlation and not cause and effect. Basically, we don’t know what we don’t know.

There is no data linking pubic hair grooming of any kind with vaginal yeast infections. Remember, the vagina is inside your body and the areas of the vulva that have pubic hair are on the outside (where clothes touch the skin). The labia minora, the part of the vulva that is closest to the vaginal opening, does not have pubic hair. Biologically, it seems improbable that pubic hair care regimens or removal would contribute to vaginal yeast infections.

Could pubic hair removal contribute to vulvar yeast infections? These infections, much less common than vaginal yeast infections, produce intense external itching as well as redness of the vulva. It is possible that pubic hair removal could, through microtrauma, allow yeast that is normally on the skin to cause a vulvar yeast infection, although this hypothesis has not been studied.

Resource


Strong Bones Or Osteoporosis – Well Being Journal

In “Strong Bones or Osteoporosis” you will learn about the herbs, teas, and other nutrients that will reverse osteoporosis, keep your bones strong, and give you all the absorbable calcium you need—no matter your age! You might think you need lots of calcium or wonder about the best kind! In the first of this series by Earl Staelin you will learn about that and how hormones and light play a role, and why people who consume the highest amounts of calcium experience higher rates of osteoporosis and fractures than those who consume lower amounts.

Resource: Strong Bones Or Osteoporosis – Well Being Journal
— Read on www.wellbeingjournal.com/strong-bones-or-osteoporosis/

Healthy Start to Your Day

Quick oats!

What do you start your day off with? For me it’s sometimes a green smoothie, an almond butter toast with flaxseeds and chia seed toppings. Today, it’s my oatmeal. Midway through devouring my breakfast, I just had to snap a picture and blog about it. This was so simple to make. It didn’t require any frying. I literally just added hot water and waited 10 minutes. Then I topped it with cinnamon, ground up flaxseeds, blueberries, blackberries and half of a banana. This is what a healthy breakfast should look like. People often say, “oatmeal is boring!” I could see that, but then you should jazz it up. Be creative! Add cocoa nibs, which are cocoa bean pieces with nothing added to them. This would be for those chocolate lovers. Shredded coconuts and raisins are delicious too, or even some nuts. I added bananas for some sweetness because I don’t use sugars.

I think oatmeal is one of the healthiest most nutritious meal you can start your day off with. It’s packed with so many vitamins, fiber, and minerals. It’s also cheap, and easy to prepare. If you were to have a cup of basic quick oats everyday, it would cost you $.043. Can’t beat that!

Tell me what you think!

Enjoy & Eat Organic for Life!

For Valentine’s Day, Try Being Nice to Yourself

Sending love to others is easy. Being kind to yourself can be surprisingly difficult.

Valentine’s Day prompts many of us to send messages of love to the special people in our lives. But I’d like to propose a new tradition. Why not use this day to start being kinder to ourselves?

Read on…

nyti.ms/2UZt0bV

Government Shutdown Curtails F.D.A. Food Inspections

Government Shutdown Curtails F.D.A. Food Inspections

WASHINGTON — The Food and Drug Administration has stopped routine food safety inspections of seafood, fruits, vegetables and many other foods at high risk of contamination because of the federal government’s shutdown, Dr. Scott Gottlieb, the agency’s commissioner, said on Wednesday.

— Read on www.google.com/amp/s/www.nytimes.com/2019/01/09/health/shutdown-fda-food-inspections.amp.html

Opinion | Padma Lakshmi: I Was Raped at 16 and I Kept Silent – The New York Times

When I was 16 years old, I started dating a guy I met at the Puente Hills Mall in a Los Angeles suburb. I worked there after school at the accessories counter at Robinsons-May. He worked at a high-end men’s store. He would come in wearing a gray silk suit and flirt with me. He was in college, and I thought he was charming and handsome. He was 23.

When we went out, he would park the car and come in and sit on our couch and talk to my mother. He never brought me home late on a school night. We were intimate to a point, but he knew that I was a virgin and that I was unsure of when I would be ready to have sex.

On New Year’s Eve, just a few months after we first started dating, he raped me.

I have been turning that incident over in my head throughout the past week, as two…

— Read on www.nytimes.com/2018/09/25/opinion/padma-lakshmi-sexual-assault-rape.html