Mid-life stress 'precedes dementia'

30 September 2013 Last updated at 20:02 ET

The study only looked at women, not men

Mid-life stress may increase a woman's risk of developing dementia, according to researchers.

In a study of 800 Swedish women, those who had to cope with events such as divorce or bereavement were more likely to get Alzheimer's decades later.

The more stressful events there were, the higher the dementia risk became, BMJ Open reports.

The study authors say stress hormones may be to blame, triggering harmful alterations in the brain.

Stress hormones can cause a number of changes in the body and affect things such as blood pressure and blood sugar control.

And they can remain at high levels many years after experiencing a traumatic event, Dr Lena Johansson and colleagues explain.

But they say more work is needed to confirm their findings and ascertain whether the same stress and dementia link might also occur in men.

Stress link

In the study, the women underwent a battery of tests and examinations when they were in either their late 30s, mid-40s or 50s, and then again at regular intervals over the next four decades.

At the start of the study, one in four women said they had experienced at least one stressful event, such as widowhood or unemployment.

A similar proportion had experienced at least two stressful events, while one in five had experienced at least three. The remaining women had either experienced more than this or none.

During follow-up, 425 of the women died and 153 developed dementia.

When the researchers looked back at the women's history of mid-life stress, they found the link between stress and dementia risk.

Dr Johansson says future studies should look at whether stress management and behavioural therapy might help offset dementia.

Dr Simon Ridley, of Alzheimer's Research UK, said that from this study, it was hard to know whether stress contributed directly to the development of dementia, whether it was purely an indicator of another underlying risk factor in this population of women, or whether the link was due to an entirely different factor.

"We know that the risk factors for dementia are complex and our age, genetics and environment may all play a role. Current evidence suggests the best ways to reduce the risk of dementia are to eat a balanced diet, take regular exercise, not smoke, and keep blood pressure and cholesterol in check.

"If you are feeling stressed or concerned about your health in general, we would recommend you talk this through with your GP."

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Memory problems, emotional stress result in early readmissions of heart patients

Sep. 17, 2013 — Heart patients' mental state and thinking abilities may help predict whether costly and potentially dangerous early hospital readmission will follow their release after treatment, according to the results of a significant new study by Henry Ford Hospital researchers.

The findings have important implications for the health care industry as it struggles to contain unnecessary costs, according to the study's lead author, Mark W. Ketterer, Ph.D., a psychologist and administrator for Henry Ford.

The study is published online in Psychosomatics.

"Wasted resources have become a central concern in American health care, including readmission soon after a patient has been released from hospital care," Dr. Ketterer says.

"Because heart failure has one of the highest readmission rates of all conditions that have been studied in Medicare and Medicaid populations, we decided to focus on it and try to identify predictors for early readmission."

What was found, Ketterer explains, was that a psychiatric history of depression, anxiety and other mood disorders, as well as impairments in a patient's ability to think, remember and reason, may well be such predictors.

"Given both the exorbitant fiscal costs and known health risks of hospitalization, including exposure to drug-resistant infections and medical errors, it could be well worth further study to test our findings." he adds.

Currently, Medicare is penalizing hospitals for what it considers excessive readmission rates. Last month, Medicare said it will access $227 million in fines against hospitals in 49 states as part of an initiative to reduce the number of patients readmitted within a month. Medicare said that 2,225 hospitals will see payments reduced for a year. Henry Ford Hospital is one of hospitals that will see a reduction in payments starting Oct. 1.

In the study, the researchers chose 84 patients who were admitted to Henry Ford Hospital for treatment of acute congestive heart failure. Each was interviewed for basic clinical and demographic information and asked to complete several questionnaires measuring depression, anxiety and spirituality.

Their medical risk factors -- including other illnesses and their severity -- and behavioral risk factors -- including depression and such cognitive impairments as loss of reasoning, planning, forgetfulness and other reduced mental functions -- as well as admissions during the past year and readmissions during the previous 30 days were recorded.

The patient group was 62 percent male with an average age of 66. Central nervous system disorders -- including Alzheimer's, dementia, closed-head injury and others -- were present in 21 percent. Nearly 70 percent lived with a family member, 24 percent acknowledged a psychiatric history, 36 percent used or had used antidepressants, 40 percent had coronary artery disease, 43 percent had diabetes, 86 percent had hypertension, 20 percent had chronic obstructive pulmonary disease, 48 percent had chronic kidney disease and 24 percent were alcohol or drug abusers.

The researchers found that depression, a history of substance abuse, and a history of coronary artery disease were related to hospital admissions during the previous year. Factors in 30-day readmission rates included immediate memory problems and a history of psychiatric treatment and/or the use of an antidepressant. The severity of congestive heart failure, however, was not a factor in either admission or readmission rates.

"Our results agree with several recent studies in finding an adverse impact of depression on admission and readmission rates," Ketterer says. "In addition, substance abuse and chronic kidney disease may also adversely impact these rates in congestive heart failure patients.

"Even severe heart disease, except in the extreme, appears to be manageable after release from the hospital unless it's complicated by one or more of the behavioral factors."

But perhaps most important in these findings is the relationship between emotional stress and/or cognitive impairment and early readmission to the hospital. "Both suggest a possible way to predict readmission and avoid it," Ketterer says.

Educating patients about their mental illness, as well as involving live-in family members in helping with the patient's medications, and keeping medical appointments may also help reduce hospital readmissions, the study concluded.

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