Archive for August, 2015

Cognitive Decline Accelerates Years After Stroke

Stroke is associated with acute decline in cognitive function as well as a decline in new learning and memory, according to the first study to monitor cognitive function in a longitudinal manner before and after stroke.

About one-third of stroke patients have significant cognitive impairment within several months of the event.

In addition, silent strokes, experienced by 1 in 10 adults by their early 60s, are harbingers of both future stroke and cognitive dysfunction.

Downward Trajectory

Researchers led by Deborah A. Levine, MD, MPH, of the University of Michigan, Ann Arbor, tracked the trajectories of cognitive decline before and after incident stroke in a prospective study of 23,572 participants age 45 years or older without baseline cognitive impairment.

The participants were part of the Reasons for Geographic and Racial Differences in Stroke cohort.

Over a median follow-up of 6 years, 515 participants survived incident stroke and 23,057 remained stroke free.

All participants underwent cognitive function tests administered by telephone to assess their global cognition annually.

They also underwent a battery of cognitive tests administered twice a year.

The results show stroke was associated with acute decline in global cognition, new learning, and verbal memory.

Faster Decline in Cognition

“Participants with stroke, compared with those without stroke, demonstrated faster declines in global cognition and executive function, but not in new learning and verbal memory, compared with pre-stroke slopes,” they wrote.

Also, cognitive impairment was significantly faster post-stroke compared with pre-stroke.

As an example, the researchers note that for a 70-year-old black woman who had average values at baseline, stroke at year 3 was associated with greater incident cognitive impairment.

The absolute difference was 4% at year 3 and 12.4% at year 6.

The results suggest that stroke survivors should be monitored for years, they note.

In an accompanying editorial, Philip B. Gorelick, MD, MPH, and David Nyenhuis, PhD, from the Michigan State University College of Human Medicine, Grand Rapids, state that “acute cognitive decline was associated with incident stroke and accelerated and persisted over the approximately 6-year follow-up period.”

Tracking Pre-stroke Cognition

They note that a novel feature of the study was that it allowed for pre-stroke cognition to be tracked, allowing the researchers to acquire rates of cognitive change prior to incident stroke.

These results suggest that clinicians may have an opportunity to intervene immediately following stroke to prevent accelerated stroke-related cognitive decline.

They support screening for cognitive impairment over the long term following stroke.

More Research Links Sugary Drinks with Type 2 Diabetes

Despite Coca-Cola’s new effort to shift the blame for obesity away from bad diets, now there’s more evidence that shows continued consumption of sugar-sweetened beverages leads to a greater likelihood of developing type 2 diabetes.

An international team of researchers set out to assess whether habitual consumption of sugar-sweetened drinks, artificially sweetened drinks, or fruit juice was associated with the incidence of type 2 diabetes.

They conducted a systematic review and meta-analysis of 17 studies to estimate the 10-year risk attributable to sugar-sweetened drinks in the US and UK.

2 Million New Cases of Diabetes in US from Sugary Beverages

The researchers estimated that 2 million new cases of type 2 diabetes would occur in the US and 80,000 new cases in the UK between 2010 and 2020 related to the consumption of sugar-sweetened beverages.

After adjustments for body weight, even for thin or normal weight persons, 1 sugary drink per day was associated with a 13% increased risk of type 2 diabetes.

The association between artificially sweetened drinks or fruit juice and type 2 diabetes was less evident.

The researchers suggested that substituting sugar-sweetened drinks with artificially sweetened drinks or fruit juice is unlikely to be the best strategy in reducing the risk of type 2 diabetes.

So what drink should you choose?

Water or other unsweetened beverages are the better options.

Men Left Out of Weight-Loss Market

Even though men are more likely to be overweight than women, men are not getting the weight-loss services they need.

Recent data from Britain is easily applied to the US, and around the world.

Using a Freedom of Information request, the Men’s Health Forum in Britain asked local authorities how many people had been helped by their weight-loss programs in 2013-2014.

The results show 110,324 women as compared with 29,919 men, suggesting that a woman is 277% (3½ times) more likely to get help with weight loss than a man, according to a news release.

Two-thirds of men in Britain are overweight or obese as compared with 57% of women.

Shocking Figures

“These figures are pretty shocking,” said Martin Tod, CEO of Men’s Health Forum.

“We want to see local councils making much bigger efforts to design their services to work for men.

This is particularly important because men account for three-quarters of premature deaths from coronary heart disease—and middle-aged men are twice as likely as women to get diabetes.”

According to a recent publication from the Men’s Health Forum, How To Make Weight-Loss Services Work For Men, there are several reasons for the gender gap.

These include poor advertising or marketing, services that are inappropriate or unattractive to men, and unsuitable venues or times.

Here is a summary of the highlights from the forum guide on what works with weight-loss for men:

Key lessons

1. Obesity prevention and treatment should take into account sex and gender-related differences.

2. Weight reduction for men is best achieved and maintained with the combination of a reducing diet, advice on physical activity, and behavior change techniques.

Men prefer more factual information on how to lose weight and more emphasis on physical activity than women.

3. Men-only groups may enhance effectiveness.

Group-based interventions should also provide some individual tailoring and individual feedback to male participants.

4. Weight-loss programs for men may be better provided in social settings, such as sports clubs and workplaces, which may be more successful at engaging men.

No Strict Diets, Please

In general, men express a dislike of “strict” diets.

Intermittent periods of dieting may be more effective for men than regular periods of dieting.

► Men particularly enjoy the use of pedometers to monitor their physical activity.

► Men prefer interventions that are individualized, fact-based, flexible, use business-like language, and include simple to understand information.

► Men are less likely than women to do well using the drug Orlistat to help long-term weight-loss maintenance.

► Men differ from women when it comes to encouraging them and maintaining participation in weight-loss programs.

Men are significantly less likely than women to join a weight-loss program, but once recruited they are less likely than women to drop out.

► Middle-aged men in particular, are more motivated to lose weight once they become aware that they have a health problem, for example, being diagnosed as “obese” by a health care professional.

Understanding the health benefits of losing weight can act as a motivator for men, for example, knowing that weight loss may prevent the development of type 2 diabetes mellitus or that weight reduction may improve erectile function.