Generic Amaryl (Glimepiride) Information

Elderly adults with poor vision, particularly untreated vision problems, may have a higher risk of developing dementia than those with better vision, a new study suggests.

Researchers found that among 625 older Americans with initially normal cognition, those who said they had poor vision even with corrective lenses were more likely to develop dementia over the next 8.5 years.

During the study period, 168 participants developed Alzheimer’s disease or other forms of dementia. Of those men and women, less than 10 percent had rated their vision as “excellent” at the start of the study. That compared with almost 31 percent of participants who maintained normal brain function over the study period.

On the other hand, about one-quarter of the study participants who went on to develop dementia had rated their vision as “fair” or “poor” at the outset, versus 11 percent of those whose memory and thinking remained intact.

When the researchers looked at the effects of treatment, they found that the highest odds of dementia were among people with poor vision left untreated. The risk was lower when they received some form of eye care.

The findings, published in the American Journal of Epidemiology, do not prove that vision problems contribute to dementia — or that eye care can help slow cognitive decline.

But they do suggest that could be the case, according to lead researcher Dr. Mary A.M. Rogers, a research assistant professor of internal medicine at the University of Michigan in Ann Arbor.

It has long been known that there is an association between dementia and vision disorders, Rogers noted in an interview with Reuters Health. But in practice those problems are often detected and treated after a dementia diagnosis.

The current findings, Rogers said, show that vision problems may precede a dementia diagnosis by years.

It’s not clear why eye disorders and poor vision would contribute to dementia. One possibility, Rogers explained, is the fact that limited vision could keep older adults from being active — whether it’s getting out and walking, reading, doing crosswords or socializing. All of those things, she noted, have been linked to a decreased risk of dementia in older adults.

The findings are based on 625 older U.S. adults who were part of a larger health study begun in 1992.

Overall, Rogers’ team found, study participants who reported “very good” or “excellent” vision were 63 percent less likely to develop dementia over the next 8.5 years than those with poor vision.

The researchers then looked at the combined effects of vision problems with or without treatment on the risk of Alzheimer’s disease specifically. Compared with people who had good vision and at least one visit to an ophthalmologist during the study period, those with poor vision and no visits were more than nine times as likely to be diagnosed with Alzheimer’s.

By comparison, among study participants who had poor vision and at least one ophthalmologist visit, the risk of Alzheimer’s was not significantly increased.

Similarly, men and women with poor vision who had received no eye procedures, such as cataract removal, had a five-fold increase in the risk of Alzheimer’s. That risk was elevated by 2.5 times among people with poor vision who had received such procedures.

According to Rogers, the findings imply that older adults with vision problems should seek treatment — if for no other reason than to improve their sight.

“If you have poor vision, don’t sit on it. Go and see your doctor,” she said. It’s best, Rogers added, to see an ophthalmologist, a medical doctor who can diagnose the range of problems common in elderly adults, such as cataract, glaucoma, macular degeneration and diabetes-related retinopathy.

More studies are needed to replicate the current findings and determine whether vision problems are an actual risk factor for dementia, according to Rogers. With the number of people with Alzheimer’s disease increasing, she said, it is becoming even more important to “take a look at the things we can do to either delay or prevent dementia.”

SOURCE: American Journal of Epidemiology

Women who experience depression during pregnancy may have another treatment option, new research suggests.

The study found that women treated with depression-specific acupuncture had a 63 percent response rate compared to a 44 percent response rate in women treated with control acupuncture or massage.

“We tested acupuncture as a standalone treatment, and the results are very positive,” said study author Rachel Manber, a professor at the Stanford University School of Medicine Sleep Medicine Center in Redwood City, Calif. But, she added, because this is the first study of its kind, and the acupuncture protocol used was specifically designed for this study, “you always need replication of the findings.”

Dr. Shari Lusskin, director of reproductive psychiatry at the New York University Langone Medical Center, echoed that sentiment. “It’s encouraging to see alternative treatments being studied in a scientific manner, and this study should generate further studies. It needs to be replicated on a larger scale,” she noted.

“This is one treatment, and perhaps it will become another possible treatment tool in our therapeutic toolbox,” said Lusskin. But, she cautioned that “acupuncture is not a substitute for the appropriate use of antidepressant therapy especially in women with a prior history of response to antidepressants.”

As many as 20 percent of women may experience depression during pregnancy, according to the March of Dimes. Symptoms include sad, hopeless feelings that persist, generally for more than two weeks, Lusskin said. Women may also experience severe anxiety or feel disconnected from the baby. And, she cautioned, suicidal thoughts are never normal and are a sign that you should seek help.

Many women are cautious about using medications during pregnancy, reports the study. Interpersonal psychotherapy is an option for women who are depressed during pregnancy, but this type of therapy isn’t always available, according to the study.

For the study, Manber and her colleagues recruited 150 pregnant women who were diagnosed with a major depressive disorder. All were between 12 and 30 weeks of gestation.

The women were randomly assigned to one of three groups: depression-specific acupuncture (52 women), control acupuncture (49 women) or massage (49 women). The depression-specific protocol was designed just for this study, and the control acupuncture was specifically designed to avoid using acupuncture needles in any areas known to affect depression.

The treatments lasted for eight weeks. Women received treatment twice a week for the first four weeks, and then once a week for the next four weeks. The treatments lasted an average of 25 minutes.

The researchers found a 63 percent response rate in women who received the depression-specific acupuncture, while the response rate was 44.3 percent in the control acupuncture and massage groups. A response rate was defined as a 50 percent reduction in depression symptoms, Manber said.

Results of the study are scheduled to be published in the March issue of Obstetrics & Gynecology.

“We found our acupuncture protocol was helpful, but that does not mean that any acupuncture for depression treatment will be effective. The quality of what you get can differ from one practitioner to another,” said Manber.

“Our goal is always to find treatments that have the maximum benefits and minimum risk,” said Lusskin. “Many women think it’s safer for the baby to go off antidepressants, but there’s a real risk to the baby for untreated depression in pregnancy. And, we have enough safety data about antidepressant use in pregnancy that we can make informed choices about managing treatment during pregnancy.”

The bottom line, she said, is to talk with your doctor to find the right combination of treatments that can help you. “Depression is not a one-size-fits-all illness, and treatment won’t be one-size-fits-all either. If acupuncture ends up being helpful for you, that’s great, but make sure you’re treated into remission.”

SOURCES: Rachel Manber, Ph.D., professor, Stanford University School of Medicine Sleep Medicine Center, Redwood City, Calif.; Shari Lusskin, M.D., director, reproductive psychiatry, New York University Langone Medical Center, and clinical associate professor, psychiatry and obstetrics and gynecology, New York University School of Medicine, New York City;