A phase 2 study demonstrated that oxybutynin worked better than a placebo at reducing how often hot flashes occurred and how intense they were in men receiving hormone therapy for prostate cancer.
New research is showing that adults who engage in lifelong learning such as reading, writing and learning languages have a lower risk of Alzheimer's disease and slower cognitive decline. The study does not prove that lifelong learning decreases the risk of Alzheimer's. It only shows an association.
The study looked at 1,939 adults and examined cognitive enrichment including access to newspapers as children and having library cards in middle age. People in the top 10% of lifetime cognitive enrichment had a 38% lower risk of Alzheimer's and a 36% lower risk of mild cognitive impairment compared to those in the bottom 10%. Higher lifelong enrichment was associated with delays in dementia onset by up to five years, and mild cognitive impairment by up to seven years. Researchers say expanding access to enriching environments, resources and activities may help keep the brain healthier as we age.
"Our study looked at cognitive enrichment from childhood to later life, focusing on activities and resources that stimulate the mind," said study author Andrea Zammit, PhD, of Rush University Medical Center in Chicago. "Our findings suggest that cognitive health in later life is strongly influenced by lifelong exposure to intellectually stimulating environments."
The study involved 1,939 people with an average age of 80 who did not have dementia at the start of the study. They were followed for an average of eight years. Participants completed surveys about cognitive activities and learning resources during three stages. Early enrichment, before age 18, included the frequency of being read to and reading books, access to newspapers and atlases in the home, and learning a foreign language for more than five years. Middle age enrichment included income level at age 40, household resources like magazine subscriptions, dictionaries, library cards and the frequency of activities such as a trip to a museum or library. Later life enrichment, starting at the average age of 80, included the frequency of reading, writing and playing games, and total income from Social Security, retirement and other sources.
During the study, 551 participants developed Alzheimer's disease and 719 participants developed mild cognitive impairment. Researchers compared participants with the highest level of cognitive enrichment (the top 10%) to those with the lowest level of cognitive enrichment (the bottom 10%). Of those with the highest level of enrichment, 21% developed Alzheimer's. Of those with the lowest level, 34% developed Alzheimer's.
After adjusting for factors such as age, sex and education, researchers found that higher scores in lifetime enrichment were associated with a 38% lower risk of Alzheimer's disease and a 36% lower risk of mild cognitive impairment. They found that people with the highest lifetime enrichment developed Alzheimer's disease at an average age of 94, compared to age 88 for those with the lowest level of enrichment.
For mild cognitive impairment, researchers found that people with the highest lifetime enrichment developed mild cognitive impairment at an average age of 85, compared to age 78 for those with the lowest level of enrichment (a seven-year delay). Researchers also looked at a smaller group of participants who died during the study and had autopsies. They found those with higher lifetime enrichment had better memory and thinking skills and slower decline prior to death, even when researchers accounted for early brain changes linked to Alzheimer's, like the buildup of proteins called amyloid and tau.
"Our findings are encouraging, suggesting that consistently engaging in a variety of mentally stimulating activities throughout life may make a difference in cognition," said Zammit. "Public investments that expand access to enriching environments, like libraries and early education programs designed to spark a lifelong love of learning, may help reduce the incidence of dementia."
Treating hot flashes in men with prostate cancer
A medication commonly used to treat overactive bladder may significantly reduce hot flashes in men receiving hormone therapy for prostate cancer, according to a study published in the Journal of Clinical Oncology. A phase 2 study demonstrated that oxybutynin worked better than a placebo at reducing how often hot flashes occurred and how intense they were in men receiving hormone therapy for prostate cancer. Men who took oxybutynin also reported improvements in their day-to-day functioning and overall quality of life.
Hot flashes affect an estimated 60% to 80% of men receiving androgen-deprivation therapy and can interfere with sleep, mood and overall well-being. For some patients, these symptoms are severe enough to make it difficult to continue treatment. "Hot flashes are often underestimated in men, but they can have a real and lasting impact on quality of life during prostate cancer treatment," said Dr. Bradley Stish, who is a radiation oncologist at the Mayo Clinic in Minnesota and first author of the study. "This trial shows that oxybutynin can provide significant relief with a favorable safety profile."
The study enrolled 88 men with prostate cancer who were experiencing frequent hot flashes while receiving androgen-deprivation therapy. Participants were randomly assigned to receive oxybutynin at one of two doses or a placebo for six weeks. Men who received the higher dose of oxybutynin experienced the greatest benefit, with an average reduction of nearly seven hot flashes per day, compared with about two fewer hot flashes per day in the placebo group. More than 75% of men receiving the higher dose achieved at least a 50% reduction in hot flash severity.
Patients taking oxybutynin also reported less disruption to sleep, work, social activities and overall quality of life. No treatment-related serious adverse events occurred during the study. The most common side effect was dry mouth, which was more frequent at higher doses.
Oxybutynin has previously been shown to reduce hot flashes in women, but evidence in men had been limited. This trial is among the first randomized, placebo-controlled studies to demonstrate its effectiveness for men receiving androgen-deprivation therapy. "These results expand the options available to clinicians and patients who are trying to manage a challenging side effect of prostate cancer treatment," Dr. Stish said. "Having additional, well-tolerated choices matters."
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.
