BMI was calculated and was categorized into four groups: underweight ( 25 to 30), and obese (> 30).
A total of 480 of the participants were classified with incident dementia during follow-up.
Subjects with midlife obesity were found to have an increased risk of dementia compared to normal weight subjects after adjustment for demographics (hazard ratio [HR], 1.39). Further adjustment for cardiovascular risk factors attenuated the association (HR, 1.36).
“In contrast, an inverse relationship between late-life BMI as a continuous variable and incident dementia was found independent of demographics (HR per BMI unit, 0.97),” Dr. Fitzpatrick and colleagues reported.
Specifically, being underweight in late life increased the risk of dementia by 60% (adjusted HR, 1.62) compared with being normal weight. No association was found with being overweight. Being obese was associated with a reduced risk of dementia (HR, 0.63).
“These results help explain the ‘obesity paradox’ as differences in dementia risk across time are consistent with physical changes in the trajectory toward disability,” the investigators concluded.
Arch Neurol. 2009;66(3):336-342.
Levodopa and Pramipexole Strategies Comparable for Parkinson’s Disease Disability
NEW YORK, March 12 (Reuters Health) — As a treatment strategy for early Parkinson’s disease, initial therapy with levodopa versus pramipexole appears to make little difference in terms of eventual disability, according to a report in the March 9 online issue of the Archives of Neurology.
However, each treatment has a different side effect profile, which may determine the best agent for a given patient. Levodopa is more likely to cause dopaminergic events, whereas pramipexole is more likely to cause somnolence and edema.
The findings come from an extended follow-up study of 301 patients who participated in the Comparison of the Agonist Pramipexole with Levodopa on Motor Complications of Parkinson’s Disease trial. As part of the study, clinicians were permitted to add levodopa or other antiparkinsonian drugs as needed for ongoing or emerging disability.
At six years’ mean follow-up, the Schwab and England Activities of Daily Living Scale scores were comparable in subjects initially treated with levodopa versus pramipexole.
Roughly 68% of initial levodopa patients experienced dopaminergic motor complications compared with 50% of initial pramipexole patients (P = .002). Still, disabling dyskinesias were uncommon with both treatment approaches.
By contrast, the average Epworth Sleepiness Scale score was higher with initial pramipexole versus levodopa therapy (P
The results suggest that the side effect profiles of the initial levodopa and pramipexole strategies, and not their efficacy on long-term disability, should guide treatment decisions, the investigators concluded.
Arch Neurol. 2009 Mar 9; [Epub ahead of print].
Polypharmacy Widespread in Epileptic Patients
NEW YORK, March 12 (Reuters Health) — Receipt of drugs not associated with therapy for epilepsy is common in epileptic patients and is by no means restricted to the elderly, according to researchers reporting in the February 3 issue of Neurology.
Dr. Barry E. Gidal, of the University of Wisconsin, Madison, and colleagues examined data on more than 11,000 patients who had been treated with an antiepileptic drug (AED) between 2001 and 2004.
Concomitant non-AED use was widespread in all age-groups. In men ages 18 to 34, the mean number of non-AEDs used was 2.41. For men older than 85, it was 7.67. Corresponding numbers for women were 4.04 and 7.05, respectively.
The most commonly used agents with potential for interaction with AEDs were statins, calcium channel blockers, and SSRIs. There was substantial use of SSRIs in all patients. For those ages 18 to 54, SSRI use was greater than for statins and calcium channel blockers. In addition, more than 10% of all patients used antipsychotics, tricyclic antidepressants, and warfarin.
“Our data confirm that polypharmacy with multiple prescription medications is common in both younger and elderly patients with epilepsy,” the investigators concluded. “Therefore, the potential for unanticipated pharmacokinetic interactions is not limited to elderly nursing home patients, but is possible for young, middle-aged men and women as well.”
Neurology. 2009;72(5):419-425.
Postanoxic Status Epilepticus May Not Be Fatal With Aggressive Treatment
NEW YORK, March 13 (Reuters Health) — Patients resuscitated from cardiac arrest who develop postanoxic status epilepticus may recover with a favorable outcome if their condition is treated aggressively, as if it were status epilepticus, a Swiss team reported.
“Postanoxic status epilepticus (PSE) is considered a predictor of fatal outcome and therefore not intensively treated,” noted Dr. Andrea O. Rossetti and colleagues at CHU Vaudois in Lausanne, Switzerland. However, some patients have had favorable outcomes.
To investigate favorable predictors, the team studied six patients with varying degrees of recovery from PSE. They were among a cohort of 181 patients with anoxic encephalopathy treated with hypothermia and various epileptic strategies. Three of the patients were studied retrospectively and three were observed prospectively.