Medical Bulletin 25/ January/ 2025 - Video

A new study shows that only 3½ years of intensive blood pressure control continues to significantly reduce the risk of mild cognitive impairment or dementia long after stopping this treatment in adults with hypertension and high cardiovascular risk.

The findings are published online in Neurology, highlights the sustained benefits of aggressive blood pressure management in preventing cognitive decline.

The National Institutes of Health-supported Systolic Blood Pressure Intervention Trial (SPRINT) Memory and Cognition in Decreased Hypertension (SPRINT MIND) study involved 9,361 participants aged 50 years and older at more than 100 clinic sites in the United States and Puerto Rico. Participants were randomly assigned to a systolic blood pressure goal of either less than 120 mm Hg (intensive treatment) or less than 140 mm Hg (standard treatment).

Participants were followed for a median of seven years, with cognitive assessments conducted both in-person and via telephone. Participants were then classified as having no cognitive impairment, mild cognitive impairment or probable dementia. Researchers specifically found that participants in the intensive treatment group had a lower rate of mild cognitive impairment and a lower combined rate of mild cognitive impairment or probable dementia.

“Our study shows that intensive blood pressure control is an important strategy in the prevention of cognitive impairment, a major cause of loss of independence in older adults,” said Jeff Williamson, M.D., M.H.S, professor of gerontology and geriatric medicine at Wake Forest University School of Medicine. “Lowering your blood pressure to more aggressive targets can improve the quality of life and extend active life for individuals with hypertension.”

Reference: Reboussin, D. M., Gaussoin, S. A., Pajewski, N. M., Jaeger, B. C., Sachs, B., Rapp, S. R., ... & Williamson, J. D. (2025). Long-Term Effect of Intensive vs Standard Blood Pressure Control on Mild Cognitive Impairment and Probable Dementia in SPRINT. Neurology, 104(3), e213334.

Antibiotics, antivirals, vaccinations and anti-inflammatory medication are associated with reduced risk of dementia, according to new research that looked at health data from over 130 million individuals.

In a study published in Alzheimer’s and Dementia: Translational Research & Clinical Interventions, researchers led a systematic review of existing scientific literature to look for evidence of prescription drugs that altered the risk of dementia.

In total, the team examined 14 studies that used large clinical datasets and medical records, capturing data from more than 1 million dementia cases. Although they found a lack of consistency between studies in identifying individual drugs that affect the risk of dementia, they identified several drug classes associated with altered risk.

One unexpected finding was an association between antibiotics, antivirals and vaccines, and a reduced risk of dementia. This finding supports the hypothesis that common dementias may be triggered by viral or bacterial infections, and supports recent interest in vaccines, such as the BCG vaccine for tuberculosis, and decreased risk of dementia.

Anti-inflammatory drugs such as ibuprofen were also found to be associated with reduced risk. Inflammation is increasingly being seen to be a significant contributor to a wide range of diseases, and its role in dementia is supported by the fact that some genes that increase the risk of dementia are part of inflammatory pathways.

The team found conflicting evidence for several classes of drugs, with some blood pressure medications and anti-depressants and, to a lesser extent, diabetes medication associated with a decreased risk of dementia and others associated with increased risk.

Dr Ilianna Lourida from the National Institute for Health and Care Research Applied Research Collaboration South West Peninsula (PenARC), University of Exeter, said: “Because a particular drug is associated with an altered risk of dementia, it doesn’t necessarily mean that it causes or indeed helps in dementia. We know that diabetes increases your risk of dementia, for example, so anyone on medication to manage their glucose levels would naturally also be at a higher risk of dementia – but that doesn’t mean the drug increases your risk.

“It’s important to remember that all drugs have benefits and risks. You should never change your medicine without discussing this first with your doctor, and you should speak to them if you have any concerns.”

Reference: Underwood, BU & Lourida, I et al. Data-driven discovery of associations between prescribed drugs and dementia risk: A systematic review. Alz & Dem; 21 Jan 2025; DOI: 10.1002/trc2.70037

When children with obesity undergo weight-loss treatment, the effects have repercussions later in life and the risk of serious health problems and premature death is lower as they reach young adulthood. However, this is not the case for depression and anxiety, a study from Karolinska Institutet published in JAMA Pediatrics reports.

The study included over 6,700 individuals who had received treatment for obesity during childhood identified via the BORIS register (the Swedish Childhood Obesity Treatment Register) and who were then followed up as young adults in the Swedish Patient Register, the Prescribed Drugs Register and the Cause of Death Register. A control group from the general population was also used, matched by age, sex and place of residence.

The study shows that children and adolescents who respond well to obesity treatment are less likely to develop obesity-related diseases, such as type 2 diabetes, hypertension and dyslipidaemia (abnormally high levels of fat in the blood) as young adults.

The treatment studied involved support for children with obesity and their families designed to motivate healthy diets, exercise and sleep habits – what is known as “behavioural lifestyle therapy”.

However, the risk of depression and anxiety was not affected by the treatment outcomes in childhood, the paper shows. No matter the outcome of obesity treatment in childhood, the risk of anxiety and depression was unchanged in young adulthood.

Publication: ”Effect of Pediatric Obesity Treatment on Long-Term Health”, Resthie R. Putri, PhD; Pernilla Danielsson, PhD; Nils Ekström, PhD; Åsa Ericsson, PhLic; Louise Lindberg, PhD; Claude Marcus, PhD; Emilia Hagman, PhD. JAMA Pediatrics , online 21 januari 2025. doi: 10.1001/jamapediatrics.2024.5552

A study demonstrates the effectiveness of telephone-delivered acceptance and commitment therapy (ACT) in reducing fatigue’s interference with functioning and improving the quality of life for survivors of metastatic breast cancer. The findings are published in journal of clinical oncology.

Researchers also found that the remote acceptance and commitment therapy intervention has shown evidence of feasibility and promise in reducing sleep interference with functioning of the patients. Cancer-related fatigue is often exacerbated by the physiological consequences of inadequate sleep.

During the clinical trial, 250 survivors living with metastatic breast cancer were randomly assigned to six weekly telephone sessions of acceptance and commitment therapy or education/support. The results of the telephone-delivered acceptance and commitment therapy intervention suggest that brief remote conversations with a therapist help encourage the survivors to practice mindfulness in their daily lives, which leads to reduced fatigue interference with functioning.

This study informs clinical care by demonstrating that a novel, telephone-delivered acceptance and commitment therapy intervention can reduce fatigue interference with functioning in patients with metastatic breast cancer and shows promise in reducing sleep interference. Training in acceptance and commitment therapy is accessible to clinicians from various disciplines. Next steps include testing the intervention in culturally diverse cancer populations and disseminating the intervention.

“Breast cancer is one of the most common cancers affecting women throughout the world. We don't have effective medications for fatigue in advanced cancer,” said Regenstrief Institute Affiliate Scientist and first author Catherine Mosher, PhD. “I was drawn to acceptance and commitment therapy as a potential behavioral intervention to help reduce the negative impact of fatigue on functioning because it has shown evidence of effectiveness for patients with chronic pain as well as people with mental health conditions.

Reference: Catherine E. Mosher et al., Randomized Controlled Trial of Acceptance and Commitment Therapy for Fatigue Interference With Functioning in Metastatic Breast Cancer. JCO 0, JCO.24.00965, DOI:10.1200/JCO.24.00965