Day: 01/10/2011

Hormone Therapy and Dementia Risk: A Critical Window?

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A prospective cohort study reveals a decreased risk for dementia in women taking HT in midlife but an increased risk for those taking HT in later life.

Several observational studies have demonstrated a reduced risk for dementia in women who use hormone therapy (HT). However, well-designed interventional trials of estrogen–progesterone combinations have revealed an increased risk for dementia, cancer, and vascular events associated with HT use. This prospective cohort study was designed to further investigate the critical window theory that estrogen is beneficial only immediately before and immediately after menopause and may have deleterious effects in later life. More than 5000 women without dementia at baseline had been screened between ages 40 and 55 and reported whether they used HT (i.e., midlife use). Thirty years later, the authors identified participants’ HT use (i.e., later-life use) from pharmacy databases. Starting when the cohort reached a median age of 80, the authors identified dementia from ICD-9 coding of diagnoses by neurologists, neuropsychologists, and internists; dementia assessment lasted 7.5 years.

During dementia assessment, 27% of the cohort received a diagnosis of dementia. Women who reported taking HT at midlife but had no evidence of later-life HT use had a significantly decreased risk for dementia diagnosis (adjusted hazard ratio, 0.74). In contrast, those who did not report midlife HT use but had evidence of later-life use had a significant increase in risk (AHR, 1.48). Women who had used HT in both midlife and later life had similar risks to those of women who had no evidence of HT use.

Comment: This study is potentially confounded by self-report data in its early phase and by the limitations inherent in the accuracy of pharmacy records and diagnostic coding in its later phase. Nonetheless, the findings unify data from observational and interventional studies of women using hormone therapy. Moreover, the findings are consistent with animal modeling of a critical window of estrogen-related neuroprotection, which is reportedly associated with improved cerebral blood flow and glucose use and with reduced amyloid deposition in the brain. The bottom line clinically is that HT use around menopause may help protect against dementia, but later use may increase risk.

— Brandy R. Matthews, MD

Published in Journal Watch Neurology January 4, 2011

Treatment of paediatric TB: revised WHO guidelines

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Graham SM – The World Health Organization has recently revised the recommended dosages of the main first–line anti–tuberculosis drugs for use in children. The recommended dosages and range of isoniazid, rifampicin, pyrazinamide and ethambutol have been increased from the previous recommended dosages. Ethambutol is now recommended for use in children of all ages including those of less than 5 years of age. This review explains the rationale for these recent revisions. Children require higher dosages than adults to achieve the same serum concentrations. Available data in HIV–uninfected children suggest that the revised dosages are within limits that have a very low risk of toxicity. An important challenge will be to examine the impact of higher dosages on clinical response, drug–drug interactions and risk of toxicity in HIV–infected children.

Use of Honey in Wound Care: An Update

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Song JJ et al. – To enhance the clinician’s competence in interpretation of research studies related to use of honey for wound healing. In human trials, there is currently not enough strong evidence to fully support the use of honey in wound care; however, use in minor burns and prevention of radiation mucositis appear to be 2 areas where honey shows therapeutic promise.

Fluoxetine After Stroke May Limit Motor Disability

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The selective serotonin reuptake inhibitor fluoxetine might reduce motor disability after stroke, a study in the Lancet Neurology suggests.

Researchers in France randomized more than 100 patients with moderate-to-severe motor disability to take placebo or fluoxetine (20 mg) daily for 90 days, starting 5 to 10 days after a stroke. All patients had the standard physiotherapy and rehabilitation offered at their center.

Fluoxetine recipients had significantly greater motor improvements than placebo recipients, even after adjusting for such factors as baseline function, acute use of thrombolysis, and presence of depression.

The authors hypothesize that fluoxetine’s benefits derive from neuroprotection and hippocampal neurogenesis, seen in previous studies. They note that the overall functional benefit of fluoxetine and the duration of benefit after treatment stops remain to be seen.

source: Lancet Neurology