Dementia patients could be better treated with painkillers such as paracetamol (acetaminophen in the U.S.) instead of ‘chemical cosh’ antipsychotic drugs, a study has found.
Scientists discovered that painkillers significantly reduced the agitation experienced by dementia patients – a common and distressing symptom of the condition.
Experts say every year 150,000 patients in the UK are given antipsychotics that they don’t need.
The drugs have a strong sedative effect, can cause dementia symptoms to worsen and even lead to a rise in the risk of stroke and death, they say.
Researchers from Kings College in London and Norway hypothesised that the agitation is actually linked with pain, and that dementia patients are incapable of expressing it in any other way.
Alzheimer's disease
They studied 352 patients in nursing homes in Norway suffering from moderate to severe dementia.
Half were given painkillers during every meal, while the other half continued receiving their usual treatments.
After eight weeks, agitation symptoms among the group who were given painkillers dropped by 17 per cent. This improvement was more pronounced that what would have been expected from antipsychotic treatment.
The team concluded from the study that proper management of patient pain could reduce the number of antipsychotic drug prescriptions.
Report author Professor Clive Ballard, from the Alzheimer’s Society, said the findings could help people living with dementia.
‘At the moment, pain is very under-treated in people with dementia, because it’s very hard to recognise,’ he told BBC News.
‘I think this could make a substantial difference to people’s lives.’
Care services minister Paul Burstow, said: ‘It should act as a further call for GPs to carefully examine the reason why those with dementia display agitated behaviour, rather than immediately resorting to antipsychotic medication,’ he said.
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Many more hospital patients and care home residents suffer strokes triggered by the antipsychotic medications they are given to keep them sedated.
New GP-led bodies that will purchase services under the reformed NHS are being told to review the prescriptions of all 180,000 dementia sufferers currently prescribed the drugs, and to do all they can to give them alternative treatment.
A Dementia Commissioning Pack published on Thursday by the Department of Health states: “Thousands of people across England who are living with dementia are taking antipsychotic medication that they do not need and that could possibly harm them.
“Evidence tells us that although there are clinical situations where a time-limited prescription of antipsychotic drugs may be appropriate, antipsychotic drugs are often overprescribed and continued when alternative therapies are more beneficial.
“There is an unambiguous case for a substantial reduction in their use alongside the wider adoption of alternative interventions which we know can help to maximise the quality of life for people with dementia and their carers.”
More than 600,000 people in England already have degenerative brain conditions such as Alzheimer’s but the figure is expected to rise to above 1million within a few decades as the population ages.
A Government-commissioned report published in 2009 estimated that 180,000 dementia sufferers are being prescribed anti-psychotic drugs but in as many as 150,000 cases they are unnecessarily being taken, often to keep patients quiet in hospital or nursing homes.
Because the “chemical cosh” drugs are feared to worsen other medical conditions and speed up mental decline, it is estimated that they lead to 1,800 needless deaths – five a day – every year. In addition, they are thought to cause 1,620 strokes, half of which are severe.
The new commissioning pack tells doctors to review all the prescriptions for anti-psychotics by next April; to ensure that they tell hospitals and care homes they work with to look for “therapeutic alternatives”; to publish data on their progress; and to use schemes that pay more to hospitals and other providers if they meet targets.
Sir Ian Carruthers, dementia champion for the NHS, said: “Dementia is one of the greatest challenges society faces today, and it is essential that we get commissioning right so that people can live well in their community, and access more support when they need it.”
Playing chess in old age and going jogging or swimming could be the best preventative measures against the development of the degenerative Alzheimer’s disease that affects one in 14 people aged 65 or over.
Along with five other factors – controlling weight, blood pressure and diabetes, avoiding depression and quitting smoking – keeping mentally and physically fit could dramatically cut the incidence of dementia, which is becoming a major human and financial burden around the globe. Mental and physical exercise are most important because they influence the others, by keeping weight and blood pressure down, reducing the risk of diabetes and depression.
People who can do all this and avoid smoking substantially reduce their risk of developing Alzheimer’s. Worldwide, an estimated 33.9 million people have the condition and that number is expected to triple in the next 40 years.
In the UK, an estimated 500,000 people are affected, with one in six over-80s succumbing to the disease that strips sufferers of their dignity and personality.
A review of research presented at the International Conference on Alzheimer’s Disease in Paris yesterday, and published in the medical journal The Lancet, concluded that up to half of all Alzheimer’s cases worldwide are potentially attributable to the seven preventable risk factors. Of these, low education and lack of mental stimulation in old age are considered to be the most significant.
Deborah Barnes and Kristine Yaffe, of the University of California at San Francisco, who wrote the review, say that education and mental stimulation throughout life are believed to reduce the risk of Alzheimer’s and dementia “by helping to build a cognitive reserve that enables individuals to continue functioning at a normal level despite experiencing neurodegenerative changes”.
Post-mortem examinations have shown that people who were mentally active throughout their lives, with no sign of the symptoms of Alzheimer’s disease, nevertheless had the same degeneration of the brain seen in those who suffered serious dementia while alive. The implication is that the despite this neuro-degeneration, mentally active people manage to stave off the symptoms of Alzheimer’s.
Overall, the researchers estimate that the seven factors potentially contribute to more than 17 million cases of Alzheimer’s worldwide, or 250,000 in Britain. A 25 per cent reduction in all seven risk factors could prevent as many as three million cases.
In a report on the study, Laura Fratiglioni, of the Karolinska Institute in Sweden, said none of the seven factors were proven to cause Alzheimer’s but that “accumulated evidence from epidemiological research strongly supports a role for lifestyle and cardiovascular risk factors.” Large-scale trials to change these risk factors in populations at high risk, as has been done for heart disease, should now be implemented, she added.
Athletes involved in contact sports and soldiers are at greater risk of developing Alzheimer’s disease later if life, researchers warn.
A large study has found even mild brain injuries such as concussions can have a devastating impact years later.
It challenges the current view that only moderate or severe injuries could predispose people to dementia.
Scientists studying veterans found those who had suffered a head injury had double the risk of developing dementia.
The researchers, led by Dr Kristine Yaffe from the University of California, reviewed medical records on 281,540 veterans. The former soldiers had been cared for at Veterans Health Administration hospitals from 1997 to 2000 and had at least one follow-up visit from 2001-2007.
All were at least 55 and none had been diagnosed with dementia when the study began. This older group was chosen because dementia grows more common with age, and researchers needed enough cases to compare those with and without brain injuries.
Records showed that nearly 5,000 of the veterans had suffered a traumatic brain injury, or TBI, ranging from concussions to skull fractures.
Researchers don’t know how long ago the injuries occurred. Many participants were Vietnam War vets and their injuries were during active duty. None were due to strokes – those cases were weeded out.
Over the next seven years, more than 15 percent of those who had suffered a brain injury were diagnosed with dementia versus only 7 percent of the others – a more than doubled risk. Severity of the injury made no difference in the odds of developing dementia.
‘Even a concussion or a mild brain injury can put you at risk,’ said Laurie Ryan, from the U.S. National Institute on Aging, which part funded the research.
The study was presented at the Alzheimer’s Association International Conference in France on Monday.
The conclusions have worried Ryan Lamke, 26, a medically retired Marine who lives in Washington D.C. He suffered a traumatic brain injury from multiple blast exposures in 2005 in Iraq.
‘I’m diagnosed as a moderate (brain injury) but it feels like a mild,’ said Lamke, who relies on electronic calendars and other gadgets to stay organised.
‘I’ve not found a doctor so far who can give me a true understanding of what’s going to happen 20 or 30 years down the road.’
Troops will need close monitoring in the years ahead and treatment for post-traumatic stress, depression and other conditions that can lead to cognitive problems, experts said.
‘While we don’t want people frightened to think they’re going to be permanently impaired, a mild traumatic brain injury does not necessarily mean’ no long-term problems, said D. Gregory O’Shanick, from the Brain Injury Association of America.