![](https://webarchive.library.unt.edu/eot2008/20081011170318im_/http://www.healthday.com/pics/pixel_dark_blue.gif) Metabolic Syndrome Foretells Diabetes in Elderly
![](https://webarchive.library.unt.edu/eot2008/20081011170318im_/http://www.healthday.com/Images/Editorial/33073.jpg) WEDNESDAY, May 21 (HealthDay News) -- Metabolic syndrome increases the risk of diabetes, but not cardiovascular disease, in the elderly, a new British study finds.
People with metabolic syndrome have at least three of the following five health problems: elevated blood sugar levels; high blood pressure; high waist circumference; decreased levels of "good" HDL cholesterol; and elevated levels of triglycerides (fats) in the blood.
While experts believed all people with metabolic syndrome are at increased risk for diabetes and cardiovascular disease (CVD), this University of Glasgow study suggests that's not the case in elderly people.
The researchers analyzed data from 4,812 non-diabetic people, aged 70 to 82, who took part in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER), and data from 2,737 non-diabetic men, aged 60 to 79, who took part in the British Regional Heart Study (BRHS).
In PROSPER, 772 cases of CVD and 287 cases of diabetes occurred in just over three years. Metabolic syndrome was not associated with CVD but was associated with a more than fourfold increased risk of diabetes.
In BRHS, there were 440 cases of CVD and 105 cases of diabetes over seven years. Metabolic syndrome was associated with a modest (27 percent) increased risk of CVD and a more than sevenfold increased risk of diabetes.
Results from both studies showed that body-mass index (BMI) or waist circumference, triglyceride levels and glucose cutoff point weren't associated with CVD risk, but all five metabolic syndrome components were associated with diabetes risk.
"Metabolic syndrome and its components are associated with type 2 diabetes but have weak or no association with vascular risk in elderly populations, suggesting that attempts to define criteria that simultaneously predict risk for both cardiovascular disease and diabetes are unhelpful," the study authors concluded.
Rather than having combined criteria, experts should establish optimum and separate risk factors for each disease, they recommended.
The findings were published online Wednesday by The Lancet and will appear in a future print edition.
More information
The American Academy of Family Physicians has more about metabolic syndrome .
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![](https://webarchive.library.unt.edu/eot2008/20081011170318im_/http://www.healthday.com/pics/pixel_dark_blue.gif) CDC Recommends Shingles Vaccine for Those Over 60
![](https://webarchive.library.unt.edu/eot2008/20081011170318im_/http://www.healthday.com/images/editorial/18314.jpg) THURSDAY, May 15 (HealthDay News) -- All adults aged 60 and older should be vaccinated against shingles, a condition that can cause debilitating chronic pain, the U.S. Centers for Disease Control and Prevention recommended on Thursday.
This new recommendation replaces the agency's provisional recommendation, made in 2006, after the ZOSTAVAX vaccine was approved by the U.S. Food and Drug Administration.
"The publication of these guidelines will give an impetus to the use of shingles vaccine," said Dr. William Schaffner, chairman of the Department of Preventive Medicine and a professor in the Division of Infectious Diseases at Vanderbilt University School of Medicine and vice president of the National Foundation for Infectious Diseases.
In addition, it may get health insurance companies to start covering the cost of the vaccine, Schaffner said. "Also, it will give physicians some stimulus to use this vaccine more extensively than they have to date," he said.
The new recommendation was published in the May 15 online edition of the Mortality and Morbidity Weekly Report.
Schaffner thinks getting vaccinated is very important. "There are about 1 million cases of shingles that occur each year in the United States," he said. "Half of these occur in people aged 60 and older."
Moreover, 50 percent of those who live to 85 will have shingles, Schaffner said. "Shingles is very common and ranges from mild to very severe and disabling," he said.
However, people who have an immunodeficiency disease should not be vaccinated, Schaffner added.
In evaluating the vaccine, known as ZOSTAVAX and manufactured by Merck & Co., researchers found that for those aged 60 and older, the vaccine reduced the occurrence of shingles by about 50 percent. For those aged 60 to 69 years old, the vaccine reduced the occurrence of shingles by 64 percent.
"The vaccine is about two-thirds effective," Schaffner said. "It will prevent about two-thirds of the cases of shingles and its consequent pain syndrome. Like most vaccines, it's not perfect, but it offers the promise of reducing the risk and occurrence of shingles by two-thirds, and that's not bad."
One drawback to the vaccine is its cost, which is about $150, Schaffner noted. In addition, the vaccine may not be covered by private insurance. For Medicare patients, it is currently covered under the Part D drug benefit, so its cost will vary by provider.
Schaffner hopes that the new CDC recommendation will make the vaccine more available.
Shingles is caused by the chickenpox virus, known as varicella zoster, which remains dormant in the body after being infected. Shingles causes blisters, which develop on one side of the body, including the face, and can cause severe pain that can last for weeks, months or years.
One potential consequence of shingles, if it appears on the face, is loss of some vision or blindness, should the virus infect the eye, Schaffner noted. Shingles can also result in hearing loss.
While mild cases of shingles usually disappear within a few weeks, severe cases can cause pain that lasts for years. This long-term nerve pain, called post herpetic neuralgia, is described as burning, stabbing, throbbing or shooting pain.
More information
For more information on shingles vaccine, visit the U.S. Centers for Disease Control and Prevention.
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![](https://webarchive.library.unt.edu/eot2008/20081011170318im_/http://www.healthday.com/pics/pixel_dark_blue.gif) Common Medications May Harm Memory in Older People
![](https://webarchive.library.unt.edu/eot2008/20081011170318im_/http://www.healthday.com/images/editorial/seniorsmeds_40125.jpg) THURSDAY, April 17 (HealthDay News) -- Common medications known as anticholinergic drugs -- used to treat ulcers, stomach cramps, motion sickness, Parkinson's disease and urinary incontinence -- may cause older people to lose their thinking skills more quickly than seniors who don't take the medicines, new research suggests.
"What we found is being on these drugs does worsen your cognitive performance," said Dr. Jack Tsao, an associate professor of neurology at Uniformed Services University in Bethesda, Md., who led the study of the effect of the medications on older adults who were, on average, 75. "In the course of a few years, there is a small slippage. It's a minor effect."
Medications for bladder problems and Parkinson's appear to have the worst effect on memory, he said.
Anticholinergic drugs are a class of medicines that work by blocking the binding of a brain chemical called acetylcholine to its receptor in nerve cells.
"You need acetylcholine for [good] memory," Tsao explained. Drugs used to treat Alzheimer's inhibit the enzyme which breaks down acetylcholine, he said, allowing more of it to be used by the brain.
Tsao was expected to present his research Thursday at the American Academy of Neurology annual meeting, in Chicago.
Tsao's study adds to the body of evidence on the effect of these drugs on memory. "We've known for a long time that in people with Alzheimer's disease, if you put them on drugs with anticholinergic activity, it clearly worsens their memory, without a doubt."
In the new study, he said, they looked at people who had normal cognitive function.
"Taking the drugs doesn't increase your risk of getting Alzheimer's. There was no change in the progression overall to the diagnosis of Alzheimer's," Tsao stressed. However, there was a decline in cognitive abilities.
Tsao's group evaluated the annual changes in thinking ability of 870 Catholic nuns and clergy members who are part of an ongoing study of older people called the Rush Religious Orders Study.
During the eight-year follow-up, 679 participants took at least one medicine that was an anticholinergic. Those who took the drugs had a rate of cognitive function decline that was 1.5 times faster than those not on the drugs.
Overall, those not on the drugs had a decline in cognitive performance of about 0.5 on the scale used, Tsao said. Those on the medicines showed a decline of 1.5.
When they looked more closely at individual drugs, they found those used for bladder problems and Parkinson's disease impaired memory about three times as much as those not taking anticholinergic drugs.
Another study, published in 2006 in the British Medical Journal, found that elderly people taking anticholinergics had poorer performance on memory and other tests than those who didn't take the drugs.
Another expert, Dr. Niall Galloway, a urologist and director of the Emory University Continence Center in Atlanta, said one strength of the study is that it includes relatively large numbers. Overall, however, he said, "this is not a strong study."
One major problem, he said is that the volunteers are "lumped together," regardless of what the indication is for taking an anticholinergic. It would be helpful to know more specific information, such as how many anticholinergics each patient was taking and how those taking one compared to those taking more than one.
Tsao agreed that more specific information would be better. Meanwhile, he said, "my recommendation is, if someone is having what they feel is a noticeable problem with their ability to remember things, they need to go see their doctor. And they need to mention if they are on one of these drugs."
Galloway agreed, saying that many patients may stay on medications longer than they need to, either because they forget to ask the doctor about it or the doctor doesn't re-evaluate. It's a fair question, he said, to ask your doctor if you need to continue a medication.
More information
To learn more about older adults and medications, visit the U.S. National Institute on Aging .
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