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Hearing loss associated with accelerated cognitive decline in older adults

MD-FM Thursday January 24, 2013





GENERIQUE
Carillon
 
Sarah:
MD FM — Medical News from around the world with Peter Goodwin.

P1

PETER:

Hello, and with me is Sarah Maxwell. To begin, for older adults there appears to be a link between hearing loss and accelerated cognitive decline…

SARAH:
Yes, a study — published in JAMA Internal Medicine — carried out a series of cognition tests over six years and saw a 30 to 40% faster decline in cognitive ability for people with hearing loss, than for those with normal hearing. They adjusted for factors such as age, sex, diabetes, smoking or hypertension, and saw the declining levels of brain function appeared directly related to the amount of hearing loss:

Bob-Lin-1: “We basically that see that the greater your hearing loss at baseline, the faster your rate of thinking and memory abilities over time. So it very much appeared to be what we call a dose dependent effect in many ways”

SARAH:
That was lead study author doctor Frank Lin, from Johns Hopkins’ Center on Aging and Health, in Baltimore Maryland. He added that, all 2000 people entered into the trial, had normal brain function when the study began in 2001:

Bob-Lin-2: “One way of thinking about it is that: generally when you decline by about 5 points or more on the Modified Mini-Mental State (3MS) exam, which is basically a global measure of mental status –that’s considered a very clinically significant change in cognition, and what you can estimate on average is that for someone with hearing loss it would take them on average 7.7 years to decline by 5 points versus someone with normal hearing it would take about 10.9 years, right? So basically about a little more than 3.3 years difference between how fast it would take to decline on the 3MS by 5 points ”

SARAH:
Frank Lin from Baltimore, who said the big question now for the future is: Can treating hearing loss delay cognitive decline?


VIRGULE MUSICALE


P2

PETER:
Also published in JAMA Pediatrics, the number of children diagnosed with  Attention Deficit Hyperactivity Disorder in the USA has risen dramatically in the past decade — especially among African American and Hispanic children…

SARAH:
Yes, there was 24% increase overall in the rate of ADHD diagnosis between 2001 and 2010, according to findings from Kaiser Permanente Southern California in Los Angeles.

PETER:
And the rate of diagnosis varied significantly across different ethnic groups didn’t it?

SARAH:
Well yes, the highest rate was in white children, it went from 4.7% in 2001 to 5.6% in 2010. But the greatest relative increase was in African American children: they had a 70% rise in the diagnosis over time, and for Hispanic children it climbed  60%. Study author Michael Fassett:

Bob Fassett: “It seems like what might explain this the best is that there’s an increased awareness of the ability to diagnosis someone with ADHD and that sometimes with a diagnosis come ressources for treatment. So that may be why the rate of white children that had sort of the least significant increase of 30%, because maybe they were already having their diagnosis made. But maybe with increased awareness, perhaps that’s why the African American children have more of an increase and also with the hispanic group --as awarness increases the diagnosis can be made more frequently.”

SARAH:
There was no change in the rate of ADHD diagnosis for children of Asian pacific-island descent during the study, and Michael Fassett said his team’s results suggest cultural factors might influence some group’s treatment-seeking behaviour.


P3

PETER:
Children of mothers who took the antiepileptic drug valproate during pregnancy — at six years old, had lower IQ scores than children exposed to other drugs in a multivariate analysis, published in The Lancet Neurology. The effects were dose dependent and valproate was also associated with worse verbal and memory abilities. But, the findings also suggest these children’s IQ might get better with age, and folic acid supplementation could help improve IQ scores.


VIRGULE MUSICALE
 
P4

PETER:
Mobile health technologies  — like sending patients text messages — have so far only been proven beneficial in two areas of disease management: adherence to antiretroviral therapy and smoking cessation, according to a study published in PLOS Medicine…

SARAH:
Yes and for other areas of disease management — the jury’s still out. Caroline Free and her team from London reviewed literature on different types of health interventions, that use mobile technologies:

Bob-Caroline-Free: “In other areas there was some promising evidence... So interventions looked promising in term of people making short term changes in their physical activity, for example. But obviously for behavior it’s the long term effects that really matter, and so we found that actually further trials need to be done to establish the long term effects of some of these interventions... And there was also very promising evidence in a number of areas supporting doctors in providing the right treatment --that’s all very promising but again, we found as much as we did, in the interventions delivered to lay people, that further trials really were needed to establish the effects on important clinical outcomes to establish the effects on the long term or to run a trial that was a very high quality so that we could be clear of the results, that it was a large enough trial to establish what the effects were. So again there was a bit more work needed in that area.”

SARAH:
That was Caroline Free, from the London School of Hygiene & Tropical Medicine in the UK. She added that there’s also a lack of rigorous studies carried out in developing countries, where mobile health initiatives could have tremendous potential to help manage disease.


VIRGULE MUSICALE

P5

PETER:
Women who get pregnant through in-vitro fertilization have greater risk of pulmonary and venous thrombo-embolism than women who get pregnant naturally…

SARAH:
Yes, a study published in the British Medical Journal found that, women who had IVF were seven times more likely to develop pulmonary embolism during the first trimester of their pregnancy, and four times more at risk of venous thrombo-embolism than women who had a natural pregnancy. Lead study author, Peter Henriksson:

Bob-henriksson-1: “ I have no evidence why it is like that but my suggestion is that this is due to the increase in oestrogen levels during the follicule stimulating phase of the IVF procedure”

SARAH:
Professor Peter Henriksson, from Karolinska Institute in Stockholm. His team analyzed Sweden’s patient registries and had this advice for practitioners:

Bob-henriksson-2: “What you should learn from this is that you should have your mind open to the possibility that a woman who has had IVF and who presents with symptoms of breathlessness or edema in the legs or something like that should pass some examinations to find out if she has thrombosis or pulmonary emboli because pulmonary emboli is a potentially fatal disease and it’s of course important that you avoid such a result, even if it’s a rare event, it’s very important to have an open mind and be very active with diagnostic procedures.”

SARAH: Peter Henriksson, from Sweden.



BREVE 1 Sur fond musical
 
PETER:
Finally, in brief:

For people with recurrent C. difficile infection, infusing donor feces into their duodenum was significantly more effective than treatment with antibiotics. That’s from an open-label, randomized study — published in the New England Journal of Medicine — that compared donor-feces infusion, vancomycin alone and vancomycin with bowel lavage and saw an overall cure rate of 94% for patients who had the infusion.

And...
 
BREVE 2

Exposure to bisphosphonates — which are widely used for treating and preventing osteoporosis — was not associated with a greater risk of gastrointestinal cancers, such as oesophageal, gastric, or colorectal cancer. That’s according to results — published in the British Medical Journal — from a series of case-control studies, on two, large population databases carried out in the UK.

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then, from me Peter Goodwin, goodbye!
 
JINGLE FIN     
 

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