Posts tagged Memory Loss
Stroke Risk Increases Risk for Memory Loss
Jan 19th
A recent study in Neurology found a link between the risk of having a stroke and future development of memory loss or cognitive decline. The link was strongly tied to high blood pressure. The study, called REGARDS, involved 23, 752 older adults, average age 64, and followed them for 4 years. In those with a higher risk of stroke at the start of the study they had a higher incidence of cognitive issues. For every 10mmHg increase in systolic blood pressure (the upper number) there was a 4.1% increase in the risk of developing cognitive issues.
The upper number of blood pressure, also called systolic, is very important in older adults as it tends to rise with age, which was another risk factor from this study that was correlated with stroke risk. In my experience with helping older adults it is common to find isolated systolic hypertension, occurring in about 30% over the age of 80. Isolated systolic hypertension is where the upper number is elevated but the lower (diastolic) number is normal. Treatment of this type of high blood pressure is very effective at preventing strokes in which only 13-18 people need to be treated to prevent one stroke. What is also important to note is that “silent strokes”, in which you have very small strokes that go undetectable but contribute to cognitive decline, can be reduced by better management of your high blood pressure.
My advice, pay attention to your blood pressure and if that upper number is higher than 140, see your doctor and start a conversation. Also keep in mind that self-monitoring of your blood pressure and sharing those recordings with your doctor is more likely to catch high blood pressure, and is also known to be more accurate than the occasional blood pressure check in the doctor’s office.
My Statin Causes Memory Loss: Now If I Could Only Remember to Tell My Physician
Sep 8th
One of my first experiences in working with older adults, in a retirement community where I could engage with them and learn from them on a day-to-day basis, started me on my journey in learning how adverse drug events (ADEs) are more common and potentially life-altering in more ways than I could have imagined. I was talking with a resident at a diabetes support group I was leading and coaching him on the need to take a statin to lower his cholesterol, since he was at high risk for a cardiovascular event such as a heart attack or stroke. He said he could not take a statin since the one he tried caused him to be “goofy and loopy” and that he experienced “memory loss”. I said, “Balderdash”! I suggested he talk with his MD about trying another statin. Weeks later, at another meeting, he expressed the same symptoms after starting a different statin. I then started to listen to him, that is I started to take his complaint seriously, that he might actually be reporting a side-effect to a medication that is real. I then returned to the office and poured through the literature. What I found was interesting, to say the least.
One study was an accumulation of case reports of people who had experienced memory loss, amnesia, or other similar cognitive changes from taking a statin. Although case reports are not as strong as large, double-blinded, randomized trials, I started to believe there may be something to this reported adverse effect. As time has gone by there have been more studies on statins, with some saying there is no association with memory loss, and others stating a valid argument that there may be a problem in some individuals. One study struck particularly hard when it reported that several people had the diagnosis of Alzheimer’s disease removed from their medical record when the cause of their memory loss was verified as being from their statin. So let’s see, we can be falsely diagnosed with dementia all because of a drug, and worse yet, health care providers may not listen to the complaint nor believe that this association is real. What a shame.
Two studies I frequently refer to are based on patient reported symptoms of adverse drug events (side-effects warranting medical attention) and validate that people are fairly accurate in recognizing when an adverse effect is occurring. The first study, Adverse Drug Reactions in Elderly Patients as a Contributing Factor for Hospital Admission, BMJ Vol. 315, Oct. 25, 1997, measured that people are good at recognizing non-severe ADEs, but not severe ADEs, such as gastrointestinal bleeding. That would make sense, since a GI bleed can be without symptoms until it reaches the point at which life is in danger. However, when someone’s cognitive function is altered soon after starting a medication, that association is rather obvious. We need to listen and observe. In the above study, the measured sensitivity in people detecting ADEs was 0.70 and the specificity was 0.85, those numbers at the level found in many screening tools health care providers rely upon.
Referring to the second study, Patient Reported Medication Symptoms in Primary Care, Archives of Internal Medicine, Vol. 165, Jan. 24, 2005, researchers measured that physicians in this study, which included four primary care practices, failed to change therapy in 48 cases of patient-reported symptoms and that this resulted in 31 ADEs (65% of 48 cases). Also of interest is that patients reported medication-related symptoms to the physicians only 69% of the time. So what can be gleaned from these studies is that we need to take seriously any change in function or how we feel as possibly being related to a medication, and act accordingly.
The concept that there is a strong probability that an ADE is being experienced based on reported symptoms is one principle used in the Naranjo Adverse Drug Reaction Probability Scale (Naranjo Scale). The strength of the probability that an ADE is occurring is strengthened as various criteria are met. For example, if the ADE starts soon after drug initiation, then there are assigned points. If the ADE subsides after the drug is stopped, there are more points assigned. If the ADE reappears after the drug is restarted, there are more points assigned. And there are other criteria, when met, that further increase the probability that and ADE is occurring. The final outcome is that an ADE is either definite, probable, possible or doubtful. This is what we have to work with in verifying likelihood of ADEs. What’s paramount in feeding this screening tool is the patient-reported symptoms, or those observed or measured. So where else can we find patient-reported symptoms of memory loss?
I sometimes visit the website www.askapatient.com. The reason I do is as stated above- I wish to listen and gather information so I can get as close to the truth as is possible. The website gives me a large number of people that are reporting adverse effects, or medication-related symptoms, that I can measure in terms of incidence, although there are limitations to these data. First about this website- People go to this site and report their experience under the specific drug name, whether it be positive, neutral or negative, on a scale of 1 to 5, 5 being the best experience. they can also enter their comments about their experience. This is where I went into two statins on this site, simvastatin and Lipitor, and searched the pages for “memory loss”.
There were 819 patient reviews for simvastatin and of those, 97 (11.84%) reported memory loss as a symptom. That doesn’t mean that is the incidence of memory loss because most everybody on this site has experienced a side-effect of some type and many do not report memory loss as an issue with statins. When searching Lipitor I found 996 reports and 122 (12.25%) had reports of memory loss. What does this mean? Can all these people be wrong? According to the literature, a large number are probably correct. In fact, many of these reports had people stopping the drug with memory loss resolving, kind of like strengthening the case as in the Naranjo Scale as stated above. When referring to other “studies”, since the incidence of memory loss from statins is probably “rare”, about 1% or less, studies that are not powered high enough, that is to say, with enough participants, are most likely not going to detect memory loss, but it appears that this may be a real problem.
So what to do? In geriatric pharmacy practice we play the role of “Colombo” the detective and suspect a drug as guilty until proven otherwise. Hence, it is appropriate to suspect a statin as causing memory loss until we prove otherwise. The potential negative outcome of not performing that due diligence is permanently altering someone’s life beyond their worst nightmare- being diagnosed with Alzheimer’s disease.
Statin Use in Older Adults: Benefit or Unnecessary Risk?
Jul 2nd
Statins have proven their worth in the fight against heart disease and stroke over many years. Statins can be used in either primary prevention (to prevent the first occurrence of a cardiovascular event), or secondary prevention (to prevent recurrence of a cardiovascular event). The benefits in people who are at high risk for an event is well supported in the literature, where high risk can be considered secondary prevention, or primary prevention in those with significant risk for a cardiovascular event, such as those with diabetes, strong family history of stroke or heart attack, or history of transient ischemic attack. In older adults over 80 years old, there are no data to support use of statins in primary prevention. So what if you are taking a statin for primary prevention and you are over 80? The simple answer: It’s on a case-by-case basis in which an informed decision needs to be made by the person taking the drug and physician, understanding the benefits, and what side-effects to expect and monitor for. There is mounting controversy surrounding the risks of these drugs in older adults since these drugs are not without significant side-effects, such as muscle weakness leading to falls, muscle pain advancing to a potentially life-threatening condition called rhabdomyolysis, and memory loss, among others. My intent is to paint a picture that can assist you in having a more thoughtful conversation with your physician when considering use of one of these drugs, or when you are suspecting a side-effect.
FALLS- Older adults are less likely to tolerate a medication since, as the body ages it loses capacity to cope with potential side-effects, which can be referred to as the “loss of reserve capacity”. Since muscles lose mass and strength with age, and the brain actually shrinks with age, we are less likely to have the “reserve capacity” to tolerate an insult from a medication. This was proven in one study where statins were correlated with an increased risk for falls in older adults, with an odds ratio (OR) of 1.5. That means a 50% greater risk of falling when taking a statin.
MEMORY LOSS- In several studies, statins have been correlated with memory loss, and in some individuals, the diagnosis of Alzheimer’s disease was removed from their health record when memory loss resolved after discontinuation of a statin. Some references debate the validity of these cumulative case reports, yet the evidence continues to mount. My best interpretation is you should be persistent in seeking a medication-related cause when memory loss develops while using a statin, to the point that the drug as a cause should be ruled out. Your physician can evaluate if stopping the statin for a few weeks will have any effect on your risk for a cardiovascular event, of which a brief holding of a statin most likely will not have any impact on risk.
GERIATRICIAN PERSPECTIVE- As taken from an article written by a geriatrician, David G Le Couteur, Pharmaco-epistemology for the prescribing geriatrician, Australasian Journal on Ageing, Vol 27 No 1 March 2008, 3–7, he states that no physician can actually measure whether medication effects are beneficial in their practice. He says, “It is not feasible for a clinician to have any personal experience or insight into whether many, if not most medications, have any efficacy or usefulness. Many medications are designed to reduce the risk of developing illness and it is almost impossible for a clinician to detect the absence of an illness. Furthermore, the numbers needed to treat (NNT) for many medications are so large that no individual clinician has enough patients to be aware of any impact on outcomes.” So let’s see what other way we can look at this: If we need to treat 80 people with a statin to prevent one negative event, yet memory loss develops in 1 or 2 in a hundred, and muscle pain develops in as high as 5 to 8 out of a hundred, we have a conundrum in which the benefits may not be measurable, yet the risk for an adverse event (side-effect) can be significant and may exceed the chances of any benefit. This then leads to the need to evaluate risk vs. benefit.
In conclusion, just adding a drug to your regimen to reduce risk sounds like it may benefit you, but there is also risk for adverse effects. So if you really want to take a statin, you may want to consider knowing more about what you should monitor for in terms of adverse effects. Should you do memory screening annually to measure any changes in cognition? Or should you also do balance testing each year to measure your risk for falling? Answer: Yes, whether you’re taking a statin or not. Measuring function in key areas may pick up on subtle changes in the body, where early detection may lead to action and prevent an adverse drug event , or lead to early intervention that can help maintain independence.
Falls, incontinence and memory loss: Is that normal aging or can something be done to help me?
Mar 28th
Falls, urinary incontinence, and memory loss are just a few of what are classified as geriatric syndromes. A geriatric syndrome is a condition that is not a disease entity itself but is known to increase our risk of losing independence by affecting function and quality of life. When talking with someone who is experiencing one or more of these syndromes, I first need to know if this person is ageist. You see, many people, even older adults, are ageist and assume that these syndromes are a normal part of aging and accept them without a challenge, thereby living a poorer quality of life. But let’s get past that and come to understand that we can alter the course of aging and improve our function and quality of life.
Falls, for example, can be caused by a number of risk factors such as medications, leg weakness, protein malnutrition, vitamin D deficiency and urinary incontinence, all of which can be altered with a little knowledge and effort. If we are protein malnourished we can always eat more protein, and that combined with the proper exercise regimen can improve our leg strength. We can also do balance exercises that help reduce our risk of falling, along with altering some of those medications known to cause falls, such as blood pressure medications, medications for insomnia among many others. Incontinence can be managed with behavioral modifications thereby avoiding medications that can affect our memory and cause falls. Vitamin D deficiency, known to be associated with poor balance, falls, and memory loss in some, can be corrected with the right replenishment of vitamin D. All of these are easy to identify when screened for and easily altered to improve function and quality of life. We all know our body’s organ systems decline with aging but we can slow down that decline and alter the trajectory with these interventions.
What I recommend is to go to the National Institute of Aging web site at: www.nihseniorhealth.gov or www.nia.nih.gov, and go to the Publications section, Age Pages, and search for the condition that affects you or your loved one. The brochures can be printed in PDF format or can be read on line with altering text size for those with low vision. It’s a great way to continue your life-long learning and age well. One other point is that medications themselves can cause geriatric syndromes which are assumed to be a normal part of aging. A medication review with an experienced pharmacist can help identify medications associated with geriatric syndromes and help you age in place. Don’t subscribe to the stereotype that falls, urinary incontinence and memory loss are always a normal part of aging. They may not be in your case!
