January 28, 2009

Things You Can Do To Preserve Brain Function

I ran into two different studies today that concerned factors that lead to brain dysfunction, a.k.a. dementia.

What was nice about these dementia studies, compared to most, is that they involved humans not mice, and that those subjects who had happy outcomes were not necessarily those who had made fortunate choices of grandparents. Both studies suggest things you and I can do to keep our brains functional.

The first study was published in this month's Diabetes Care. It looked at data from the notorious ACCORD study and concluded two things: "Higher A1C levels are associated with lower cognitive function in individuals with diabetes" and "FPG was not associated with [mental functioning] test performance."

Relationship Between Baseline Glycemic Control and Cognitive Function in Individuals With Type 2 Diabetes and Other Cardiovascular Risk Factors.
(ACCORD-MIND) trial. Tali Cukierman-Yaffe et al.

The study found that a 1% rise in A1c (i.e. from 6.0% to 7.0%) was associated with a significant decline in scores on three different tests of mental functioning.

Though this is depressing news if you have a high A1c, people with diabetes lower their A1cs dramatically all the time. For some examples (and these are just a very few examples drawn from public postings and emails I get) visit The 5% Club: They Normalized Their Blood Sugar and So Can You.

Note, that this finding would explain why another study that is getting some press linked getting diabetes before age 65 with a higher risk of Alzheimer's.

Be very clear about this: The risk factor is not a Diabetes diagnosis. It is high blood sugars--the high blood sugars too many doctors consider "good control" for people with diabetes--blood sugars that result in A1cs near 7.0%.

It is very likely that if you are diagnosed with diabetes at any age, but control your blood sugars to a normal level--A 5% A1c, for example--you can have the same health as anyone else would who had not gotten the diagnosis.

The other study was published in The Journal of the American Geriatrics Society.

Cumulative Anticholinergic Exposure Is Associated with Poor Memory and Executive Function in Older Men. Journal of the American Geriatrics Society, Han et al. 2008; 56 (12): 2203

You can read a detailed summary of this password protected study in Science Daily:

Science Daily: Common Medication Associated with Cognitive Decline in the Elderly.

This study linked anticolinergic medications to a significant loss of memory and found, in the words of Science Daily, The degree of memory difficulty and impairment in daily living tasks also increased proportionally to the total amount of drug exposure, based on a rating scale the authors developed to assess anticholinergicity of the drugs."

Anticholinergic drugs are used for many conditions. The drugs used to treat overactive bladders are strong anticholinergics. So are some drugs used to treat cold symptoms, breathing difficulties, digestive difficulties and a host of other symptoms.

Here is a list of anticholinergic agents:

Anticholinergic Agents

I have had doctors recommend drugs on this list to me. You may be taking them too. Because they block a class of chemicals that naturally decline as we age, and which are associated with memory function, you might want to review the medications you are taking to make sure you aren't taking one of these drugs. The drugs that are currently used to treat dementia work by increasing acetylcholine, the substance that these anticholinergic drugs decrease.

While following some references about anticholinergic drugs online, I ran accross a list of drugs called the Beers List/ This turns out to be a list of drugs that mainstream medical professionals have identified based on peer-reviewed research as being potentially dangerous for people older than 65 years old.

While I have some quibbles with some of the drugs on the list--estrogen for example, where the evidence that it is harmful seems to confined to women who started taking it after 65, not those who have taken it since the beginning of menopause, this list is well worth a look.

You can read the latest update, published in Annals of Internal Medicine in 2003.

Updating the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults Results of a US Consensus Panel of Experts. Donna M. Fick et al.

Here is a link to the list of these potentially dangerous drugs from the above article, along with the brief explanations of why they may be dangerous.

...Potentially Inappropriate Medication...

Here is a table which lists the dangerous drugs linking them to specific medical conditions for which they are a poor choice:

Drugs and Conditions

Follow up studies citing this study all point out that these drugs continue to be overprescribed to people over 65. Given my own experience, where doctors repeatedly prescribe inappropriate drugs to me despite my being clear about my medical history, it is very likely that, if you are an older person and are taking prescription medications for a variety of conditions, you may also be taking some of these inappropriate drugs, too.

Given its mainstream origin, this list is highly conservative. There are other drugs whose side effects may also be dangerous to brain function in the elderly. Of most concern is some evidence that statin drugs contribute to memory problems in older people. Cholesterol is a vital component of the brain and lowering it inappropriately may harm the aging brain. Research backing this finding is documented here:

Other Dangerous Drugs for People with Diabetes

Clearly, all of us who are approaching a certain age, and especially those of us who may have family histories of dementia, need to pay attention to these findings. Keeping our blood sugar as normal as possible is a first step. Keeping blood pressure normal is also vital to preserving brain function, as high blood pressure leads to the "mini-strokes" which cumulatively become vascular dementia. Vascular dementia is probably an even more frequent cause of dementia than is Alzheimer's Disease.

Once you've lowered your blood sugar and blood pressure, you aren't done. Don't let yourself become the victim of prescription drug-induced brain damage--and don't trust that your overly busy family doctor has kept up with the research connecting brain damage in the elderly with the use of common prescription drugs.

Sometimes you might have no choice, if the dangerous drug is one, like a chemotherapy agent, that you need to take to keep alive. But before you assume this is the case, grill the doctor who tells you that you need a potentially harmful drug about whether there are other, safer, drugs available. Often, it turns out that there are.

Bottom line: The older we are, the more exposed we are to brain damage. Vigilance about what we put in our bodies--both food and drugs--may make a huge difference in the quality of our later decades.


Anonymous said...

Are you going to put permanent links somewhere for these lists? As always I appreciate these updates. I still am finding new people to And a question there, have you thought out a procedure for updating that book? It is, to my mind, along with Bernstein's the two essentials for dealing with diabetes. RobLL

Jenny said...


I'll put these links into my "Dangerous Drugs for People with Diabetes" page.

As far as the book goes, I keep the web site updated continually, but a book can't be updated like that, for several reasons, one of which is that new editions need a new ISBN and when you change the ISBN you can lose your ranking in Amazon as it treats it as a new book. Amazon is helping a lot of people find the book, so I won't touch it for a while.

When there is enough new material to make a new edition worthwhile, I'll redo the book. Typically publishers only do new editions every 4 years or so.

But when John Wiley did a 2nd edition of my most successful book, it clobbered sales. The first edition of that book had 5 copies, displayed face out, in every single Barnes & Noble. When the second edition came out, it was treated as a new book by the stores and they only stocked one copy which was not faced out, so the second edition sold much more poorly.

I was very careful with my other books to avoid putting out new editions that would harm sales in that way!

Life With Lewy said...

Wow, this is something I asked my Dad's Doctors about...he had type II diabetes and just passed away on the 5th from Lewy Body Dementia. I thought there may be some correlation, and what you added here definitely raises a lot more red flags.

Jenny said...

Life with Lewy,

Condolences for your sad loss.

I am pretty sure that Lewy dementia is a separate condition from the vascular dementia caused by high blood sugars. I have read up on the condition as it has affected a relative of a friend. In that case there doesn't appear to be any connection with blood sugar.