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Journal of the American Geriatrics Society Research Summary

Alzheimer’s disease (AD) is a brain disorder that destroys memory and thinking skills over time. It is the most common form of dementia in older adults.  There is presently no cure for the condition, though treatment options are available. Today, some 5.3 million Americans live with AD, and it is now the sixth leading cause of death in the United States. The number of older adults who will develop AD is expected to more than triple by 2050.

Geriatrics experts have suggested that exercising can improve brain health in older adults. The World Health Organization (WHO) has recommendations for how much older adults should exercise. They suggest that older adults perform 150 minutes a week of moderate exercise (such as brisk walking), 75 minutes a week of vigorous aerobic training, or a combination of the two types. The WHO also recommends older adults perform muscle-strengthening exercises on at least two or more days a week.

However, not all studies of exercise and older adults have proven the benefits of exercise. We don’t know for sure whether exercise slows mental decline or improves older adults’ ability to think and make decisions.

A team of researchers designed a study to learn whether exercise could delay or improve AD symptoms. They reviewed 19 studies that examined the effect of an exercise training program on cognitive function in older adults who were at risk for or diagnosed with AD. The studies included 1,145 older adults, most of whom were in their mid-to late 70s. Of the participants, 65 percent were at risk for AD and 35 percent had been diagnosed with AD.

The researchers published their findings in the Journal of the American Geriatrics Society.

As the researchers examined the studies, they discovered that older adults who did aerobic exercise by itself experienced a three times greater level of improvement in cognitive function than those who participated in combined aerobic training and strength training exercises. The researchers also confirmed that the amount of exercise WHO recommends for older adults was reinforced by the studies they examined.

Finally, the researchers found that older adults in the no-exercise control groups in the studies faced declines in cognitive function. Meanwhile, the older adults who exercised showed small improvements in cognitive function no matter what type of exercise they did.

The research team concluded that this study may be the first to show that for older adults who are at risk for or who have AD, aerobic exercise may be more effective than other types of exercise in preserving the ability to think and make decisions.

The researchers note that their findings need to be confirmed in future studies.

This summary is from “Can Exercise Improve Cognitive Symptoms of Alzheimer’s Dementia? A Meta-Analysis.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Gregory A. Panza, MS; Beth A. Taylor, PhD; Hayley V. MacDonald, PhD; Blair T. Johnson, PhD; Amanda L. Zaleski, MS; Jill Livingston, MS; Paul D. Thompson, MD; and Linda S. Pescatello, PhD.

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Journal of the American Geriatrics Society Research Summary

A key feature of Alzheimer’s disease is memory loss and losing one’s ability to think and make decisions (also called “cognitive ability”). Those changes can begin slowly, during a phase called “mild cognitive impairment” (or MCI). A variety of diseases can cause MCI, but the most common is Alzheimer’s disease.

Not all people who have MCI develop Alzheimer’s disease—but if memory loss is a person’s key MCI symptom, and if that person’s genes (DNA) suggests they may be likely to develop Alzheimer’s disease, the risk for the condition can be as high as 90 percent.

Personality changes and behavior problems that come with Alzheimer’s disease are as troubling as memory loss and other mental difficulties for caregivers and those living with the condition. Mayo Clinic researchers wondered if personality changes that begin early, when MCI memory loss becomes noticeable, might help predict Alzheimer’s disease at its earliest stages. The researchers created a study to test their theory and published their findings in the Journal of the American Geriatrics Society.

Researchers recruited cognitively normal participants 21-years-old and older who were genetically more likely to develop Alzheimer’s disease. The recruitment period began in January 1994 and ended in December 2016. Researchers also recruited people without a genetic likelihood for developing Alzheimer’s disease to serve as a control group. All participants took several tests, including medical and neurological (or brain) exams. They were also screened for depression, as well as cognitive and physical function.

After analyzing results, the researchers concluded that personality changes, which can lead to changes in behavior, occur early on during the development of Alzheimer’s disease. The behavioral changes, however, may be barely noticeable, and can include mood swings, depression, and anxiety. They suggested that further research might be needed to learn whether diagnosing these early personality changes could help experts develop earlier, safer, and more effective treatments—or even prevention options—for the more severe types of behavior challenges that affect people with Alzheimer’s disease.

This summary is from “Personality Changes During the Transition from Cognitive Health to Mild Cognitive Impairment.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Richard J. Caselli, MD; Blake T. Langlais, BS; Amylou C. Dueck, PhD; Bruce R. Henslin, BA; Travis A. Johnson, BA; Bryan K. Woodruff, MD; Charlene Hoffman-Snyder, DNP; and Dona E. C. Locke, PhD.

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Journal of the American Geriatrics Society Research Summary

Older adults are more likely than younger adults to develop critical illnesses that require hospitalization and intensive care. These illnesses include severe pneumonia and other serious respiratory conditions, congestive heart failure, heart attacks, and sepsis (a life-threatening complication from bacterial infections).

Until now, the role of strength before hospitalization has not been well-studied. Strength’s effects on how well older adults do following an intensive care unit (ICU) stay also have not been well-studied. To fill this knowledge gap, a research team created a study. The study wasto learn how older adults’ strength before they became ill affected how long they stayed in the hospital after being admitted to an ICU. They also learned whether or not the older adults died while in the hospital or within a year after discharge. Their study was published in the Journal of the American Geriatrics Society.

The researchers enrolled 575 people who had been admitted to the ICU one or more times. Participants were between the ages of 70 and 79 and lived in Memphis, TN, and Pittsburgh, PA, between March 1997 and July 1998. The participants had taken strength tests within two years before their admission to the ICU. Tests included walking 20 meters (about 64 feet), completing repeated chair stands, and assessing balance and grip strength.

The researchers learned that:

  • Participants with the slowest walk speeds had an 80 percent higher risk of dying within 30 days of their ICU admission. They had twice the risk of dying within one year of their ICU admission, compared to participants with the fastest walk speeds.
  • Participants with the poorest balance had a 77 percent higher risk of dying within 30 days of their hospital admission compared to participants with the fastest walk speeds.
  • Participants whose balance was rated as “moderate” had a 52 percent higher chance of dying within 30 days of their ICU admission.

What’s more, the researchers found that older adults who were weaker had longer hospital stays.

The researchers also noted that slower pre-hospital walk speed in particular was very strongly linked both to death and longer hospital stays.

This summary is from “The Influence of Pre-hospital Function and Strength on Outcomes of Older Critically Ill Adults.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are D. Clark Files, MD; Rebecca Neiberg, MS; Julia Rushing, MStat; Peter E. Morris, MD; Michael P. Young, MD; Hilsa Ayonayon, PhD; Tamara Harris, MD; Anne Newman, MD, MPH; Susan Rubin, MD; Eric Shiroma, MEd; Denise Houston, PhD; Michael E. Miller, PhD; and Stephen B. Kritchevsky, PhD.

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Journal of the American Geriatrics Society Research Summary

Cognition is the ability to think and make decisions. Medication-free treatments that maintain cognitive health as we age are attracting the attention of medical experts. Maintaining the ability to think clearly and make decisions is crucial to older adults’ well-being and vitality.

Mild cognitive impairment (MCI) is a condition that affects people who are in the early stages of dementia or Alzheimer’s disease. People with MCI may have mild memory loss or other difficulties completing tasks that involve cognitive abilities. MCI may eventually develop into dementia or Alzheimer’s disease. Depression and anxiety also can accompany MCI. Having these conditions can increase the risk of mental decline as people age.

A new, first-of-its-kind study was published in the Journal of the American Geriatrics Society by scientists from research centers in Montreal and Quebec City, Canada. They designed a study to learn whether cognitive training, a medication-free treatment, could improve MCI. Studies show that activities that stimulate your brain, such as cognitive training, can protect against a decline in your mental abilities. Even older adults who have MCI can still learn and use new mental skills.

For their study, researchers recruited 145 older adults around the age of 72 from Canadian memory clinics. The participants had been diagnosed with MCI, and were assigned to one of three groups. Each group included four or five participants, and met for eight weekly sessions for 120 minutes.

The three groups were:

  • Cognitive training group. Members of this group participated in the MEMO program (MEMO stands for a French phrase that translates to “training method for optimal memory”). They received special training to improve their memory and attention span.
  • Psycho-social group. Participants in this group were encouraged to improve their general well-being. They learned to focus on the positive aspects of their lives and find ways to increase positive situations.
  • Control group. Participants had no contact with researchers and didn’t follow a program.

During the time the training sessions took place, 128 of the participants completed the project. After six months, 104 completed all the sessions they were assigned.

People in the MEMO group increased their memory scores by 35 to 40 percent, said Sylvie Belleville, PhD, a senior author of the study. “Most importantly, they maintained their scores over a six-month period.”

What’s more, the improvement was the largest for older adults with “delayed recall.” This means memory for words measured just 10 minutes after people have studied them. Because delayed memory is one of the earliest signs of Alzheimer’s disease, this was a key finding.

Those who participated in the MEMO group said they used the training they learned in their daily lives. The training gave them different ways to remember things. For example, they learned to use visual images to remember names of new people, and to use associations to remember shopping lists. These lessons allowed them to continue maintaining their memory improvements after the study ended.

The people in the psycho-social group and the control group didn’t experience memory benefits or improvement in their mood.

This summary is from “MEMO+: efficacy, durability and impact of cognitive training and psychosocial intervention in MCI.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Sylvie Belleville, PhD; Carol Hudon, PhD; Nathalie Bier, PhD; Catherine Brodeur, MD; Brigitte Gilbert, PhD; Sébastien Grenier, PhD; Marie-Christine Ouellet, PhD; Chantal Viscogliosi, PhD; and Serge Gauthier, MD.

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Journal of the American Geriatrics Society Research Summary

When older adults arrive at a hospital’s emergency department (ED), they may face unexpected challenges. For example, they may become less able to function independently. They may develop difficulties thinking and making decisions during or following a visit to the ED. This makes transitions in care to and from the ED an important area for improvement in our health care as we age.

To address these challenges, geriatrics experts have developed special programs such as the “Geriatric Emergency Department Innovations in Care through Workforce, Informatics, and Structural Enhancements” (GEDI WISE) program. GEDI WISE is an award-winning program that serves as a model for excellence in emergency care for older adults in three large urban hospitals: Mount Sinai Medical Center in New York, NY; St. Joseph’s Regional Medical Center in Paterson, NJ, and Northwestern Memorial Hospital in Chicago, IL.

One piece of the GEDI WISE program includes an ED-based geriatrics transition care nurse (TCN). The TCN identifies patients who have health needs specific to older adults. This nurse works to help people transition to their homes so that they can avoid hospital admission whenever possible.

A team of researchers designed a study to learn how effective the GEDI WISE TCNs were for reducing hospital admissions, later admissions, and revisits to the ED. They published their findings in the Journal of the American Geriatrics Society.

The study took place in 2013-2015 in all three hospitals in the GEDI WISE program. They studied more than 57,000 people aged 65 or older who made more than 120,000 visits to the three participating hospitals’ EDs.

The TCN nurses gave the older adults several different screenings, including tests for:

Informed by these screenings, the TCN used various geriatrics resources to help patients. Some people required only a little support, while others needed extensive help.

Older adults who saw the TCN at least once during the study period were included in the “intervention group.” Older adults who didn’t see the TCN during the study period were included in the “control group.”

Compared to the control group, people who saw the TCN had lower rates of inpatient (hospital or healthcare facility) admissions over 30 days at two of the three hospitals.

The researchers concluded that programs focusing on improving care transitions for older people seen in the ED may help reduce the risk for hospital admission.

This summary is from “Geriatric Emergency Department (ED) Innovations: ED transitional care nurses & hospital utilization.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Ula Hwang, MD, MPH; Scott M. Dresden, MD; Mark S. Rosenberg, DO, MBA; Melissa M. Garrido, PhD; George Loo, DrPh; Jeremy Sze, BS; Stephanie Gravenor, MBA; D. Mark Courtney, MD; Raymond Kang, MA; Carolyn Zhu, PhD; Carmen Vargas-Torres, MS; Corita R. Grudzen, MD, MSHS; Lynne D. Richardson, MD; and the GEDI WISE Investigators.

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Journal of the American Geriatrics Society Research Summary

Researchers suspect that having Metabolic Syndrome makes it harder for older adults to respond to therapies for depression. (Metabolic Syndrome is a mix of conditions like increased blood pressure, high blood sugar levels, excess body fat around the waist, and abnormal cholesterol levels). In a new, first of its kind study, published in the Journal of the American Geriatrics Society, researchers examined whether Metabolic Syndrome in depressed older adults affects their response to antidepressant treatment.

Older adults who have major depressive disorder (MDD, also known as depression) are at higher risk for having problems thinking and making decisions. They are more likely to have trouble performing their regular daily activities and managing their personal care. These problems can lead to poorer health in general and a higher risk of death compared to older adults who are not depressed.

The study included adults aged 60 and older with Metabolic Syndrome and depression (confirmed by two separate assessments). Researchers treated participants with the antidepressant venlafaxine. After six weeks of treatment, the dose was increased if participants’ depression scores were still high. Participants had follow-up visits every one to two weeks. Participants were evaluated for their response to treatment again after 12 weeks.

The researchers noted three key findings in people with Metabolic Syndrome:

  • Their life history of depression was more chronic.
  • Their depression symptoms at the beginning of the study were more severe.
  • They took longer to respond to antidepressant therapy.

What does this mean? The researchers said that older adults with Metabolic Syndrome may be an important group of people for healthcare providers to pay close attention to when screening for and treating depression.

This summary is from “Impact of Metabolic Syndrome on Late-Life Depression: Associations with Disease Severity and Treatment Resistance.” It appears online ahead of print in the September 2017 issue of the Journal of the American Geriatrics Society. The study authors are John S. Mulvahill, MD; Ginger E. Nicol, MD; David Dixon, PhD; Eric J. Lenze, MD; Jordan Karp, MD; Charles F. Reynolds III, MD; Daniel M. Blumberger, MD; Benoit H. Mulsant, MD.

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Journal of the American Geriatrics Society Research Summary

Experts say that a lack of physical activity leads to age-related weakness and poor health in older adults. Official guidelines suggest that healthy older adults spend at least 2.5 hours every week doing moderate activity (such as brisk walking), or at least 1.25 hours per week doing vigorous exercise (such as jogging or running).

Unfortunately, many older adults are not physically able to perform either moderate or vigorous intensity exercise. Researchers created a study to learn more about how much exercise older adults are able to perform, and how that exercise affects their health.

The research team studied 6,489 female participants aged 63 to 99 years old. The researchers published their findings in the Journal of the American Geriatrics Society.

The participants agreed to take in-home exams, answer health questionnaires, and wear accelerometers (devices similar to fitness trackers). The participants also kept sleep logs.

The study was conducted between 2012 and 2013. The researchers reviewed death certificates as of September 2016 to learn how many participants had died.

At the beginning of the study, most participants were in their late 70s and most were considered overweight according to BMI standards (a ratio comparing height to weight). Nearly 30 percent were considered obese.

Most participants scored 8.2 out of a possible 12 points on physical function assessments. Based on accelerometer measurements of the participants:

  • 1 percent performed “low” light-intensity physical activity
  • 29 percent performed “high” light-intensity physical activity
  • 15 percent performed moderate to vigorous physical activity

After examining the deaths in the women according to their activity levels, the researchers learned that older women with higher levels of physical activity were less likely to die than women with lower levels of physical activity, no matter the cause of death.

The researchers concluded that their findings support encouraging older women to increase the amount of time they spend every day in light-intensity activity, and reduce the amount of time spent sitting.

This summary is from “Accelerometer-Measured Physical Activity and Mortality in Women Aged 63 to 99.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Michael J. LaMonte, PhD, MPH; David M. Buchner, MD, MPH; Eileen Rillamas-Sun, PhD; Chongzhi Di, PhD; Kelley R. Evenson, PhD, MS; John Bellettiere, PhD, MPH; Cora E. Lewis, MD, MSPH; I-Min Lee, MD, ScD; Lesly F. Tinker, PhD; Rebecca Seguin, PhD; Oleg Zaslovsky, PhD; Charles B. Eaton, MD, MS; Marcia L. Stefanick, PhD; and Andrea Z. LaCroix, PhD, MPH.

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Journal of the American Geriatrics Society Research Summary

Oral health issues are common among older adults. These issues include tooth loss, gum disease, tooth decay, and dry mouth. These conditions can also affect an older adult’s well-being because they may make it harder to eat, swallow, speak, get adequate nutrition, and even smile.

Oral health issues like tooth loss and gum disease are also linked to increased risks of frailty. Frailty is the medical term for becoming more vulnerable to declining health or the inability to perform the activities of daily living. Frailty is a major healthcare challenge for older adults and caregivers. Someone who is frail can be weak, have less endurance, and be less able to function well. Frailty increases the risk for falls, disability, and even death.

Over a three-year period, researchers from the United Kingdom examined the relationship between poor oral health and older adults’ risks for becoming frail. They published their findings in the Journal of the American Geriatrics Society.

The researchers studied information from the British Regional Heart Study. This study included 7,735 British men. They were first examined in 1978 to 1980 when they were 40- to 59-years-old. In 2010 to 2012, researchers invited 1,722 surviving participants to be re-examined. During that time period, the participants were 71- to 92-years-old.

Participants were given physical exams, which included height, weight, and waist measurements. They also took timed walking tests and had their grip strength measured. They answered questions about their medical history and lifestyle. They also answered a questionnaire asking about medical, social, and health-related information.

The exam included a dental exam. Dental health professionals counted the participants’ natural teeth and measured the health of their gums. Participants answered questions about their dental health, including if they had dry mouth.

Researchers also noted the participants’ frailty status. Participants were considered frail if they had at least three of these issues: exhaustion, weak grip strength, slow walking speed, weight loss, or low levels of physical activity.

The researchers found out the following facts about the participants’ dental issues:

  • 20 percent had no teeth
  • 64 percent had fewer than 21 teeth
  • 54 percent had gum disease
  • 29 percent had at least two symptoms of dry mouth
  • 34 percent rated their oral health as “fair to poor”
  • 11 percent said they had trouble eating

The researchers said that men with dental issues were more likely to be frail than men without those issues. These dental issues included having no teeth, having trouble eating, having dry mouth symptoms, or rating oral health as “fair to poor.”

The researchers also noted that complete tooth loss, dry mouth, and additional oral health concerns were especially linked to developing frailty.

The researchers concluded that these findings highlight the importance of oral health for older adults, suggesting that poor oral health contributes to frailty.

 This summary is from “Influence of poor oral health on physical frailty: a population-based cohort study of older British men.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Sheena E. Ramsay, PhD; Efstathios Papachristou, PhD; Richard G. Watt, PhD; Georgios Tsakos, PhD; Lucy T. Lennon, MSc; A. Olia Papacosta, MSc; Paula Moynihan, PhD; Avan A. Sayer,PhD; Peter H. Whincup, PhD; and S. Goya Wannamethee, PhD.

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Journal of the American Geriatrics Society Research Summary

People with dementia often have behavioral symptoms. These include problems with memory, language, and decision-making abilities. People with dementia can also experience changes in mood, such as increased irritability, depression, and anxiety. They often need assistance with their daily activities, such as feeding, dressing, using the toilet, and bathing themselves. These symptoms are often troubling for people with dementia, as well as for their caregivers.

These dementia symptoms can reduce quality of life for people as they age. This can make them dependent on other people, which can lead to caregivers feeling distressed. It may also lead to people with dementia being hospitalized or placed in a nursing home, even if it is not what they would prefer for their care.

There are no effective drug treatments for dementia or its symptoms. Therefore, researchers have been exploring treatment options to improve symptoms that don’t involve using medication. A team of researchers studied one of those programs, called the Tailored Activity Program (TAP). TAP matches activities to the interests and abilities of people with dementia. Then it teaches caregivers how to use those activities daily.

The researchers initially reported positive results in a small study of 60 people. They then studied TAP in a larger group of veterans living with dementia. They reported their results in the Journal of the American Geriatrics Society.

The researchers studied 160 veterans diagnosed with dementia and whose average age was 80. The study also included 160 of the veterans’ caregivers, who were mostly women around 72-years-old.

TAP included up to eight in-home sessions led by occupational therapists (health professionals who focus on helping us participate in the activities of everyday life). During the first two sessions, these health professionals evaluated the veterans’ risk for falls, their daily routines and habits, and their previous and current interests. They also examined the veterans’ home environment, including lighting, seating, clutter, and noise. They looked as well at the interests and abilities of the veterans’ caregivers. Based on the assessment, the therapists provided an “assessment report” and offered three “activity prescriptions.”

The therapists showed the veterans and caregivers how to set up the activities and use them every day. They also provided written instructions for the caregivers. The instructions covered activity goals for the individual veteran and communication strategies for the caregiver. They also instructed caregivers on ways that they could modify the home environment to help the veteran participate in the activity. The therapists worked with the veterans to show the caregivers how to use activities. They had caregivers practice recommended communication strategies. They also provided on-going education to help caregivers understand dementia and its behavioral symptoms.

During the last two sessions, caregivers learned how to simplify activities as the veterans’ abilities declined. They also learned strategies to make care challenges like bathing easier.

A control group of caregivers received eight telephone sessions with a trained research team member who offered caregiver education about home safety and dementia. The researchers did not offer information about activities or behavioral symptoms to this group.

After four months, nearly 70 percent of the veterans in the TAP group either eliminated or reduced the frequency and severity of their dementia-related behaviors. This is compared to 46 percent of the veterans in the control group. Also, caregivers in the TAP group reported that the veterans were less dependent on them as they performed their daily activities. Caregivers in the TAP group reported less distress due to the veterans’ behaviors, too.

The researchers concluded that TAP offers immediate benefits to the veterans and their caregivers.

This summary is from “Targeting Behavioral Symptoms and Functional Decline in Dementia: A Randomized Clinical Trial.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Laura N. Gitlin, PhD; Paul Arthur, PhD, OTR/L; Catherine Piersol, PhD, OTR/L; Virginia Hessels, BA; Samuel S. Wu, PhD; Yunfeng Dai, MS; and William C. Mann, PhD, OTR.

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Journal of the American Geriatrics Society Research Summary

Proton pump inhibitors (PPIs) are medicines commonly prescribed to treat acid-related digestive problems, including gastroesophageal reflux disease (or GERD).  As of 2011, up to 1 in 5 older adults reported using a PPI. Although healthcare practitioners have long believed that PPIs are safe, recent studies have linked PPIs to potential risks, including fractures and kidney disease. Some studies also have linked PPIs to an increased risk for dementia among older adults. However, several experts have suggested that these studies may not correctly measure the connection.

In a new research article published in the Journal of the American Geriatrics Society, scientists were able to conclude that developing dementia or Alzheimer’s disease (the most common form of dementia) did not appear to be linked to taking PPIs.

The researchers reviewed information from the Adult Changes in Thought (ACT) study, which included 3,484 adults aged 65 and older. Participants did not have dementia at the beginning of the study and were followed for an average of about 7.5 years.

Researchers tested participants for dementia at the beginning of the study and then every two years. Those who tested positive were given complete evaluations to measure their abilities to think and make decisions. Researchers gave the participants who were diagnosed with dementia follow-up tests to confirm the diagnosis.

Researchers used information from the ACT study to learn how many participants took PPIs and for how long. Overall, almost 24 percent of study participants developed dementia. Of these individuals, just 670 people developed possible or probable Alzheimer’s disease. While other safety concerns with long-term PPI use exist, the researchers conluded that results from this study suggest that dementia is not linked to taking a PPI.

If you’re concerned about these or any other risks associated with PPIs or your other medications, make an appointment with your healthcare provider to review your treatment routines. You and your care team can work together to determine whether any changes are in order. Just remember: Never change your medication or discontinue a treatment before speaking to a healthcare provider first. If you’re worried you may be experiencing a serious side effect, seek medical attention by calling 911 immediately.

This summary is from “Proton Pump Inhibitor Use and Dementia Risk: Prospective Population Based Study.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Shelly L. Gray, PharmD, MS; Rod L. Walker, MS; Sascha Dublin, MD, PhD; Onchee Yu, MS; Erin J. Aiello Bowles, MPH; Melissa L. Anderson, MS; Paul K. Crane, MD, MPH; and Eric B. Larson, MD, MPH.

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