Incontinence Drugs Cause Memory Problems in New Study

Commonly used incontinence drugs may cause memory problems in some older people, a study has found. "Our message is to be careful when using these medicines," said Dr. Jack Tsao, a U.S. Navy neurologist who led the study. "It may be better to use diapers and be able to think clearly than the other way around."

Urinary incontinence sometimes can be resolved with non-drug treatments, he added, so patients should ask about alternatives. Exercises, biofeedback and keeping to a schedule of bathroom breaks work for many.

U.S. sales of prescription drugs to treat urinary problems topped $3 billion in 2007, according to IMS Health, which tracks drug sales. Bladder control trouble affects about 1 in 10 people age 65 and older, according to the National Institute on Aging, which helped fund the study. Women are more likely to be affected than men. Causes include nerve damage, loss of muscle tone or, in men, enlarged prostate.

The research began after Tsao met a 73-year-old patient. Shortly after starting an incontinence drug, she began hallucinating conversations with dead relatives and having memory problems. Her thinking improved when she stopped the drug for several months.

Tsao and his colleagues knew of similar reports. They decided to look at a large group of people to see if they could measure an effect of these and other medications that affect acetylcholine, a chemical messenger that shuttles signals through the brain and the rest of the nervous system. The drugs block some nerve impulses, such as spasms of the bladder.

The findings, released at the April 17, 2008 meeting of the American Academy of Neurology, come from an analysis of the medication use and cognitive test scores of 870 older Catholic priests, nuns and brothers who participated in the Religious Orders Study at Chicago's Rush University Medical Center. The average age was 75.

Researchers tracked them for nearly eight years, testing yearly for cognitive decline. They asked them to recite strings of numbers backward and forward, to name as many different kinds of fruit as they could in one minute and to complete other challenges during the annual testing.

Nearly 80 percent of the study participants took one or more of a class of drugs called anticholinergics, including drugs for high blood pressure, asthma, Parkinson's disease and incontinence drugs such as Detrol and Ditropan.

"The people who took the drugs had a 50 percent faster rate of cognitive decline compared with those who didn't take any."

The people who took the drugs had a 50 percent faster rate of cognitive decline compared with those who didn't take any. The researchers considered other risk factors for memory loss, such as age, and still found the link. The researchers found no increased risk for the memory-robbing disorder Alzheimer's in people taking the drugs.

The incontinence drugs were among the most potent and were the most frequently taken of all the anticholinergics in the study. That's why the researchers believe they are driving the memory problems, Tsao said.

Some experts said the research supports previous observations and is helpful because it measures the size of the effect.

"This paper adds important new data to the picture," said Dr. Elaine Perry of Newcastle University in England, who has done similar research but was not involved in the new study.

More research is needed on the effects of anticholinergic drugs on memory, Tsao said. Doctors should do baseline cognitive testing on patients before prescribing the drugs, he recommended.
A representative of Pfizer Inc., maker of the top-selling Detrol, said patients should always talk to their doctors about problems while taking medication.

"Detrol has been on the market since 1998. It has been prescribed more than 100 million times worldwide," said Ponni Subbiah, Pfizer's vice president of medical affairs, in an e-mail response to questions.

Source: Incontinence Drugs can Cause Memory Problems

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Natural Support for Enhanced Urinary and Bladder Control
One in four U.S. adults will experience incontinence at some point, a surprisingly high toll, and the condition is so embarrassing that many suffer silently. Women are most prone to incontinence, but everyone's risk rises as they get older. With the population rapidly graying, scientists convened by the National Institutes of Health have issued an urgent call for research to find better ways to prevent incontinence and to remove the stigma so more people will seek help.

"We as a society need to get over our discomfort with this subject so that incontinence sufferers receive the compassion, acceptance and care they need, and our aging population can take steps to prevent incontinence in the future," said Dr. C. Seth Landefeld, geriatrics chief at the University of California, San Francisco, who led the panel.

Today, fewer than half of the people with incontinence volunteer their symptoms to a doctor, the panel found. That is the case despite a variety of effective treatments, from exercises to medications and surgery.

Urinary incontinence (UI) affects millions of people, appearing as a slight release of urine while running or coughing, or as a sudden, strong urge to urinate leading to the voiding of a large amount of urine. Left untreated UI can develop into a debilitating condition and cause tremendous emotional distress that leads to withdrawal from normal social interactions out of fear of risking public embarrassment.

Women experience UI twice as often as men due to the physical changes brought about by pregnancy and childbirth, onset of menopause, and the structure of the female urinary tract. Incontinence in both men and women can result from neurologic injury, birth defects, stroke, multiple sclerosis, and physical problems associated with aging.

While older men and women experience UI more often than young people, incontinence is not inevitable with age.

 

Diabetes and Heart Disease:

ACCORD Trial Fails to Prevent Deaths Linked to Blood Sugar Levels

by Jim English

While diabetes is the leading cause of kidney failure, blindness and lower limb amputations not caused by accidents or trauma, the most serious threat facing diabetic patients is death from heart attack or stroke. Eighty percent of hospitalizations for patients with diabetes are for macrovascular disorders, such as coronary disease, cerebrovascular disease and peripheral vascular disease, and 75 percent of deaths in diabetics are cardiovascular death, mostly in patients with Type 2 diabetes. To put these numbers in perspective, while a 50-year-old patient with “average” blood pressure and cholesterol levels has a 7 percent chance of experiencing a heart attack in the next 10 years, a 50-year-old diabetic patient faces up to a 50 percent chance of having a heart attack in the next ten years.

ACCORD Trial Fails to Protect Diabetic Patients
In 2001 the National Institutes of Health (NIH) launched a trial to lower blood glucose levels in diabetic patients to reduce their risk for heart attack, stroke, or death from cardiovascular disease. The trial, called Action to Control Cardiovascular Risk in Diabetes, or ACCORD, involved over 10,000 Type 2 diabetic patients who had either been previously diagnosed with heart disease or had two or more risk factors for heart disease when they entered the study.

Participants were randomly assigned to one of two treatment groups. The first group of 5,123 participants was treated with standard drugs and insulin at levels generally approved as the standard for Type 2 diabetes. The second group, consisting of 5,128 participants, was assigned to receive a much more aggressive form of treatment involving higher doses of the standard therapy. For both groups, study clinicians were permitted to use all major classes of FDA-approved diabetes medications, including metformin, thiazolidinediones (TZDs, primarily rosiglitazone), insulins, sulfonylureas, exanatide, and acarbose. Treatment goals in both groups were determined throughout the study by regular blood tests that measured patient A1C levels.

The A1C blood test allows diabetic patients an accurate way of monitoring glucose levels to better manage their blood sugar control. A1C, also known as glycosylated hemoglobin (HbA1c), is produced when glucose molecules become attached to hemoglobin — the oxygen-carrying protein found in red blood cells – in a process called glycosylation. The percentage of glycated hemoglobin in the blood stream increases as blood cells are exposed to elevated sugar levels over time. Since red blood cells can live for up to 120 days in the body, testing for A1C levels can aid patients and practitioners in looking back to accurately gauge average blood sugar levels for the previous 2 to 3 months.

While healthy people commonly have A1C levels as low as 5 percent (i.e., only 5 percent of their hemoglobin is glycated), diabetics frequently with have A1C levels as high as 8 or 9 percent. According to the American Diabetes Association, in extreme cases A1C levels can go as high as 25 percent when diabetes is poorly controlled for long periods.

Pushing Patients to the Brink of Disaster
The treatment goal for the standard treatment group was to maintain a target A1C of 7 to 7.9 percent, similar to A1C levels normally seen in diabetic patients following current diabetes protocols (see Side Bar). By contrast, the goal of the intensive drug treatment test group was to increase insulin and drug dosages to aggressively push blood sugar levels down to A1C levels of less than 6 percent, similar to levels normally seen in healthy adults without diabetes. In addition to increasing deaths in the intensive drug treatment group, less than half of the participants succeeded in getting their A1C level below 6.4 percent.

The decision to halt the ACCORD trial 18 months prior to its scheduled completion became necessary after an interim NIH review revealed a 26 percent increase in deaths in the aggressively treated patient group (257 deaths), versus the standard drug therapy group (203 deaths). Additionally, while the agency noted a 10 percent drop in heart attacks among aggressively treated patients when compared to the general diabetic population (likely due to the extra level of health care and monitoring the patients received while taking part in the program), when a heart attack did occur it was more likely to be fatal in the study group. According to Dr. William Friedewald of Columbia University, who helped monitor the study, "In addition, the intensive treatment group had more unexpected sudden deaths, even without a clear heart attack.”

Rush to Calm Fear Over Diabetes Drugs
Even as the NIH cautioned that it didn’t know the reason for the unexpected deaths, the agency moved with impressive speed to calm patient fears over the use of multiple diabetic medications, stating, “Based on analyses conducted to date, there is no evidence that any medication or combination of medications is responsible.” In their announcement the NIH also addressed the use of the drug rosiglitazone (Avandia), claiming, “Because of the recent concerns with rosiglitazone, our extensive analysis included a specific review to determine whether there was any link between this particular medication and the increased deaths. We found no link.”

The rush by the NIH to exonerate drugs for any causative role in the unanticipated deaths strikes some observers as odd, given that the only notable difference between the two treatment groups was the quantity of FDA-approved diabetic medications given to the participants. Even more troubling was the suggestion by lead investigators from the ACCORD trial that the concept of glucose control in patients with Type 2 diabetes may not even be desirable.

While the ACCORD trial aimed to save lives, the study continues to come under criticism from clinicians and patients for its intense focus on pharmaceutical intervention and lack of support for less dangerous options. While study participants were closely monitored to insure that they adhered to the rigorous treatment plan that, in some cases, had patients checking blood sugar levels throughout the day and taking four or five shots of insulin, there was no similarly stringent requirement or support system in place to encourage alternative, non-pharmaceutical strategies for controlling blood glucose levels, and inclusion of moderate exercise or dietary control were left up to the patients.

Overreliance on Drug Intervention
Commenting on the outcome of the failed ACCORD trial in the peer-reviewed, online journal Nutrition and Metabolism, Eric Westerman, Department of Medicine, Duke University Medical Center states, “From our perspective of familiarity with dietary carbohydrate-restriction and diabetes, these results are not surprising–in fact, they are predicted. We believe that it is unlikely that the increased mortality was due to the tight glucose control but rather due to the particular method for trying to achieve it. When high carbohydrate diets are consumed and intensive medication therapy is used to "cover the carbohydrate," it is very difficult to achieve normal glycemic control without hypoglycemic reactions. In our clinical practices, we frequently see individuals who are instructed to eat high carbohydrate diets and use intensive injectable hypoglycemic therapy, and they are susceptible to hypoglycemic reactions. Severe hypoglycemic reactions are associated with an increased morbidity and mortality.”

Despite widespread media reports to the contrary, the ACCORD trial was a large-scale human drug experiment that tragically backfired. And while diabetic patients and physicians await a final report from the NIH, the most obvious lesson of the trial appears to be that piling increasingly high dosages of blood-sugar lowering drugs and insulin on already weakened, at-risk patients is a bad idea. The outcome of the study is especially tragic, since many, if not most, Type 2 diabetic patients can achieve the same health goals targeted by ACCORD by adopting a broader, integrative approach that includes reduced intake of dietary carbohydrates, regular physical exercise, and when necessary, moderate use of drugs and insulin.

For more information on Jim English and his products go here

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