Both low and high levels of hemoglobin linked to increased risk of dementia

A new study has linked both low and high hemoglobin levels to an increased risk of developing dementia in the future.

The study involved 12,305 people with an average age of 65 who did not have dementia. Overall, 745 (6%) of the study subjects were found to have anemia. The participants were followed for an average of 12 years. During that time, 1,520 people developed dementia. Of those, 1,194 had Alzheimer’s disease.

Subjects who had anemia were 41% more likely to develop Alzheimer’s disease and 34% more likely to develop any type of dementia compared to those who did not have anemia. Of the 745 people with anemia, 128 developed dementia, vs 1392 of the 11,560 people who did not have anemia.

Similarly, participants with high hemoglobin levels were also more likely to develop dementia.

The study participants were divided into five groups based on their hemoglobin levels.

·         Compared to the middle group, the group with the highest hemoglobin levels was 20% more likely to develop dementia.

·         Those in the lowest group were 29% more likely to develop dementia than those in the middle group.

These findings reported in the July 31, 2019 online issue of Neurology may have important public health implications for the developing countries where the prevalence of anemia is high. These findings should ring a warning bell for these countries including India.

(Source: American Academy of Neurology, July 31, 2019)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

First practice guidelines for clinical evaluation of Alzheimer’s disease

The first practice guidelines for clinical evaluation of Alzheimer’s disease and other dementias has been released by the Alzheimer’s Association. The guideline addresses care of patients in both primary care and specialty care settings.

At their core, the guidelines recommend that all middle-aged or older individuals who self-report or whose care partner or clinician report cognitive, behavioral or functional changes should undergo a timely multi-tiered evaluation. Not just the patient and the doctor but, almost always, a care partner e.g., family member or confidant should always be involved.

Most importantly, concerns should not be dismissed as “normal aging” without a proper assessment. Not doing so delays the correct diagnosis and consequently, timely and appropriate care for persons with the disease.

The guidelines also emphasize on obtaining a history from the patient and also from someone who knows the patient well to:

·         Establish the presence and characteristics of any substantial changes, to categorize the cognitive behavioral syndrome.

·         Investigate possible causes and contributing factors to arrive at a diagnosis/diagnoses.

·         Appropriately educate, communicate findings and diagnosis, and ensure ongoing management, care and support

A broader category of “Cognitive Behavioral Syndromes” is described in the guidelines indicating that neurodegenerative conditions such as Alzheimer's disease and related dementias lead to both behavioral and cognitive symptoms of dementia. As a result, these conditions can produce changes in mood, anxiety, sleep, and personality together with interpersonal, work and social relationships, which become apparent earlier than the typical memory and thinking symptoms of Alzheimer’s disease.

The guidelines were previewed on July 22 at the Alzheimer's Association International Conference (AAIC) 2018, which concludes today in Chicago.

(Source: Alzheimer’s Association)