Medical Minutes
Combating the holiday blues
For some individuals the holidays can be a very difficult time emotionally. For some it is just the blues but for others it can result in serious depression. Recently a new study showed that in older adults a combination therapy was able to help those who were clinically depressed.
More than half of older adults with clinical depression don’t get better when treated with an antidepressant. However, results from a multicenter clinical has found that adding an antipsychotic medication to the treatment regimen helps many of those patients.
The study included 468 people over age 60 who were diagnosed with depression. Previous research in younger patients with depression showed that adding aripiprazole (Abilify) helped relieve symptoms of depression when an antidepressant alone wasn’t effective. But this new study is the first to show that the same strategy also works in older adults. The two-drug combination relieved depression in a significant number of patients and also reduced the likelihood that they would have suicidal thoughts.
“It’s important to remember that older adults may not respond to medications in the same way as younger adults,” said study author Dr. Eric Lenze, who is a professor of psychiatry at Washington University School of Medicine, St. Louis, Missouri. “There are age-related changes in the brain and body that suggest certain treatments may work differently, in terms of benefits and side effects, in older adults. Even when a strategy works for patients in their 30s, it needs to be tested in patients in their 70s before it can be considered effective in older patients.”
Each study participant received an extended-release formulation of the antidepressant drug venlafaxine (Effexor XR) for 12 weeks. About half of these patients still were clinically depressed after 12 weeks of treatment. So for the second phase of the study, patients who initially did not respond to the venlafaxine continued to receive the drug along with aripiprazole or a placebo.
A 2007 study estimated that about 7 million of the nation’s 39 million older Americans had clinical depression. However, up to 90 percent did not receive necessary care and 78 percent received no treatment at all.
Exercise and your brain
You may be able to significantly boost your brain power with more exercise. A new study is now linking physical activity to greater mental flexibility in older adults. In fact, one day doctors may determine how physically active you are simply by imaging your brain.
Physically fit people tend to have larger brain volumes and more intact white matter than their less-fit peers. Now, researchers have found that older adults who regularly engage in moderate to vigorous physical activity have more variable brain activity at rest than those who don’t. This variability is associated with better cognitive performance.
Researchers looked at 100 adults between the ages of 60 and 80 and they used accelerometers to objectively measure their physical activity over a week. The researchers also used functional MRI to observe how blood oxygen levels changed in the brain over time, reflecting each participant’s brain activity at rest. And they evaluated the microscopic integrity of each person’s white-matter fibers, which carry nerve impulses and interconnect the brain.
“We found that spontaneous brain activity showed more moment-to-moment fluctuations in the more-active adults,” said study investigator University of Illinois postdoctoral researcher Agnieszka Burzynska, who now is a professor at Colorado State University.
“In a previous study, we showed that in some of the same regions of the brain, those people who have higher brain variability also performed better on complex cognitive tasks, especially on intelligence tasks and memory,” Burzynska said.
The researchers also found that older adults who were more active had better white-matter structure than their less-active peers.
Diet soda may come with a high price tag
It may be time to rethink diet soda consumption. A study published in the Journal of the American Geriatrics Society shows that increasing diet soda intake is directly linked to greater abdominal obesity in adults 65 years of age and older. Findings raise concerns about the safety of chronic diet soda consumption, which may increase belly fat and contribute to greater risk of metabolic syndrome and cardiovascular diseases.
Metabolic syndrome is a combination of risk factors that may lead to high blood pressure, diabetes, heart disease and stroke. In an effort to combat obesity, many adults try to reduce sugar intake by turning to nonnutritive or artificial sweeteners, such as aspartame, saccharin or sucralose. Previous research shows that in the past 30 years, artificial sweeteners and diet soda intake have increased, yet the prevalence of obesity has also seen a dramatic increase in the same time period. Many of the studies exploring diet soda consumption and cardiometabolic diseases have focused on middle-aged and younger adults.
“Our study seeks to fill the age gap by exploring the adverse health effects of diet soda intake in individuals 65 years of age and older,” explains lead author Sharon Fowler, MPH, from the University of Texas Health Science Center at San Antonio. “The burden of metabolic syndrome and cardiovascular disease, along with healthcare costs, is great in the ever-increasing senior population.”
The San Antonio Longitudinal Study of Aging (SALSA) enrolled 749 Mexican- and European-Americans who were aged 65 and older at the start of the study (1992-96). Diet soda intake, waist circumference, height and weight were measured at study onset, and at three follow-ups for a total of 9.4 years. At the first follow-up there were 474 (79.1 percent) surviving participants; there were 413 (73.4 percent) at the second follow-up and 375 (71 percent) at the third follow-up.
Findings indicate that the increase in waist circumference among diet soda drinkers, per follow-up interval, was almost triple that among non-users: .80 inches for non-users, 1.83 inches for occasional users, and 3.16 inches for daily users over the total 9.4-year SALSA follow-up period.
“The SALSA study shows that increasing diet soda intake was associated with escalating abdominal obesity, which may increase cardiometabolic risk in older adults,” Fowler concludes.
The authors recommend that older individuals who drink diet soda daily, particularly those at high cardiometabolic risk, should try to curb their consumption of artificially sweetened drinks.
John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at medicalminutes@gmail.com.
John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute.
