NEW YORK, March 1, (RTRS): 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.”
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Radiation: The US government needs to establish national guidelines for controlling the amount of radiation a patient gets from diagnostic exams and treatments and the level of training required by a medical technician who delivers it, experts have told a congressional panel.
Radiation exposure from medical scans and treatments became a major concern for patients and lawmakers last fall after patients at hospitals in Los Angeles and Philadelphia were exposed to toxic levels of radiation.
High doses of radiation can cause skin burns, cataracts and other injuries, and in extreme cases, cancer and death.
With diagnostic exams, the concern has largely been excess radiation from CT or computed tomography — an advanced type of X-ray that delivers a much higher radiation dose than conventional X-rays.
“Oversight for CT radiation dosing is currently very fragmented,” Dr. Rebecca Smith-Bindman, a professor of radiology at the University of California, San Francisco, told the House Committee on Energy and Commerce subcommittee on health in Washington.
“The Food and Drug Administration oversees the approval of the CT scanners as medical devices, but does not regulate how the test is used in clinical practice,” she told lawmakers.
Earlier this month, the FDA said it would seek manufacturing changes to add safety measures to imaging devices including more prominent displays of the radiation dosages or alarms that sound when the dose is too high. The agency has also called for a public meeting on the issue March 30-31.
Earlier this week, Medical Imaging & Technology Alliance, an industry group, said they would voluntarily begin phasing in such safeguards — including the addition of a color-coded system to give health care providers clear warning when scans could harm patients.
The new safeguards would affect machines made by General Electric, Toshiba Corp, Hitachi Ltd, Siemens and Philips.
Smith-Bindman said part of the problem is there are few national guidelines that govern how studies using CT scanners are done, leaving open the potential for wide variation in the radiation dose delivered.
“It’s imperative that we make CT scanning as safe as possible,” Smith-Bindman said.
To do that, she said doctors should lower the radiation dose on routine CT scans and only conduct them when necessary.
“There is evidence that for many types of CTs the radiation dose can be reduced 50 percent or more without reducing quality,” she said.
But many experts said adding safeguards to the technology would not be enough to protect patients.
“The technology is not ... our fundamental problem,” Cynthia McCollough of the Mayo Clinic in Rochester, Minnesota, told the panel, citing poor education and training programs for radiologists who order the tests, radiation technologists who perform them and medical physicists who test the equipment.
“The single most important contribution we can make to patient safety is to ensure that all personnel involved in the operation of CT systems meet nationally prescribed, minimum levels of training and competency,” McCollough said.
The American College of Radiology has called for an accreditation program for facilities that deliver radiation therapy to cancer patients, something the medical equipment industry group AdvaMed supports as a way to enhance patient safety.
Committee Chairman Representative Frank Pallone said in a statement the point of the hearing was not to scare patients, but to look for ways to keep them safe. He said more hearings may be needed.
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Fibromyalgia: Acupuncture may provide some temporary pain relief for people with fibromyalgia, but does not help with fatigue, sleep problems, or physical function, according to a new research review. However, the results are too inconsistent to recommend acupuncture as a treatment fibromyalgia, the reviewers conclude.
Fibromyalgia, a debilitating pain syndrome that affects an estimated 2 to 4 percent of the population, is characterized by chronic pain, fatigue and difficulty sleeping. It’s a somewhat mysterious condition with no clear-cut cause.
Winfried Hauser of the Klinikum Saarbrucken in Germany and colleagues reviewed seven randomized controlled trials of acupuncture that included a total of 385 people with fibromyalgia. The study subjects were mostly white middle-aged women.
All of the studies used traditional Chinese acupuncture, where fine needles are inserted into specific points in the skin. In addition, two of the studies used electroacupuncture, where the practitioner fits the needles with clips that are attached to a small device that delivers a continuous electrical impulse to stimulate the acupuncture point. Three of the studies used control groups with various kinds of sham or simulated acupuncture, and one compared simulated acupuncture to no treatment.
While the investigators found “strong evidence” that acupuncture relieves fibromyalgia pain, they caution that the results were too inconsistent to recommend it for the management of the condition.
They came to this conclusion mainly because, in one of the seven studies, sham and simulated acupuncture yielded better results than real acupuncture treatment. Furthermore, the authors found that acupuncture-related pain relief only occurred right after treatment, and did not last until the next follow-up.
“Choosing appropriate control conditions in clinical acupuncture trials on chronic pain syndromes is a particularly difficult problem,” Hauser noted in an email to Reuters Health.
“Acupuncture is an effective treatment for several painful conditions, and most acupuncture therapists achieve good results for treatment. However, in most studies on acupuncture and pain, there is no difference between acupuncture and the control condition (often sham or minimal acupuncture),” the investigator added.
Despite this lack of strong evidence for acupuncture in treating fibromyalgia, the authors acknowledge that the treatment is still popular among patients.
They therefore recommend that further studies be undertaken, including larger, multi-center studies; studies involving comparisons with traditional medical treatments; and different forms and intensities of stimulation (i.e., manual vs. electric stimulation).