Hearing loss may push decline in memory, thinking

Older Americans who have hearing loss have an accelerated decline in thinking and memory abilities, compared to those with normal hearing, according to a study published in JAMA Archives of Internal Medicine.

Those with hearing loss experience a 30% to 40% greater decline in thinking abilities compared to their counterparts without hearing loss, according to the findings published Monday.
Hearing loss is common among old older adults, affecting about two-thirds of adults 70 and older, and about one-third of adults younger than 60, according to lead study author Dr. Frank R. Lin of Johns Hopkins University.  A large number of people with hearing loss are untreated, Lin explained, because they associate hearing loss with the stigma of getting older.
About two years ago Lin and his associates published a paper showing that hearing loss was associated with greater risk for developing dementia. “Fortunately most of us will never develop dementia, but most of us will experience some kind of cognitive decline over time,” explained Lin.
Rather than looking at hearing loss and dementia, the researchers studied people with normal cognitive function to determine whether people with hearing loss had different rates of memory and thinking decline compared to people with normal hearing. Dementia rates are projected to rise as the world's population ages, the study noted; identifying factors that may contribute to cognitive decline and dementia in older adults may lead to ways to slow and treat brain decline.
The researchers studied about 2,000 older adults enrolled in a long-term study which began in 1997. All subjects included in the study had no dementia or cognitive impairment.  Each subject went through an audiometric assessment performed in a sound-treated booth, which Lin described as “the gold standard” for hearing testing. Their memory, thinking abilities and decision-making were also tested. Both tests were repeated at three, five and six years, and researchers looked at average decline in memory and thinking abilities, comparing people with normal hearing to those with reduced hearing.
“We found that people with hearing loss had a faster rate of mental decline compared to people with normal hearing. ... And the greater the rate of hearing loss, the faster the decline of memory and thinking. It was dose dependent,” said Lin. People with hearing loss took 7.7 years to have a five-point drop in their thinking skills, compared to 10.9 years for people with normal hearing.
Why does this happen? Lin said there’s no definite explanation, noting that various explanations may apply. When people suffer from hearing loss, it’s not that they can’t hear. It’s that the cochlea, the part of the inner ear that converts a complex sound to a precise signal that goes to the brain for decoding, isn’t doing a good job converting, so people hear a garbled signal. Lin described it like a bad cell phone connection.
One theory is that "if the brain is dedicating extra resources to try and hear what’s going on, it's probably taking away from other brain resources like thinking and memory, “ explained Lin.
A second explanation, using the cell phone example, is that people experiencing lousy reception end up tuning out, because it’s so labor intensive to try to hear the call. This explanation plays into the idea of social isolation, which has been shown to have negative health effects including increased illness, death rates, and increased cognitive decline and dementia.
A third possible explanation is that some mechanism in the brain is affecting both hearing and brain function. Lin said it's likely that the hearing loss and brain decline are explained by all three factors. He also acknowledged that while his study tried to adjust for other factors affecting hearing and cognitive abilities, they did not account for factors including something in the inflammatory process or the age of mitochondria, the energy factories of cells.
Lin thinks the big public health question is whether treating hearing loss will have an impact on brain function and memory decline.

Hearing loss may push decline in memory, thinking

Don't judge that generic pill by its color

It's not the color, but what's inside that counts when it comes to medication. However, doctors suspect that's not exactly how patients see it.

According to a study published Monday in the medical journal Archives of Internal Medicine, changes in pill color significantly increase the odds that a patient will fail to take their medication as prescribed by their doctor.
First, the basics
Generic drugs are approved by the U.S. Food & Drug Administration’s Office of Generic Drugs.  These off-brand alternatives must be “bioequivalent” to the brand-name version, meaning they must be identical in terms of dosage form, strength, route of administration, quality, intended use, and clinical efficacy. But the FDA does not require that the two versions look alike.
Generics are big business worldwide.  In America, they account for more than 70% of prescriptions dispensed, but only 16% of spending. Generic prescriptions are expected to increase even more, as top-selling brand-name medications reach the end of their market  - and profit - exclusivity and go “off patent.”  In the United States, drug patents offer 20 years of protection for the pharmaceutical company, but they are applied for before clinical trials begin, so the effective life of a drug patent tends to be somewhere around 7-12 years.
The study
Dr. Aaron Kesselheim, assistant professor of medicine at Brigham and Women’s Hospital in Boston, wanted to investigate whether switching between brand-name and different generic versions of a drug could lead patients to neglect refilling their prescriptions.
“An estimated 50-75% of patients do not take their medications as prescribed,” says Kesselheim.  When patients don't adhere to prescribed drug regimens, it can can have serious medical, financial, and social consequences.  Kesselheim chose to study antiepileptic drugs, due to the fact that epilepsy is a common disease affecting up to 2% of the general population. Additionally, these types of drugs are prescribed off-label for psychiatric disease, chronic pain and other conditions.
Kesselheim and his team analyzed national data gathered between 2001 and 2006, and subsequently split patients into two groups: those who became “nonpersistent” (defined, in this study, as a failure to fill a prescription within five days of the elapsed days supplied) and those who exhibited no delay in refilling.  The groups were further matched by age, sex, number of refills and the presence of a seizure disorder diagnosis.
Results
Researchers found when patients with epilepsy refilled their prescriptions and received a different color pill than they were used to, they were  53% more likely to take a break from taking their drugs as prescribed.  Twenty-seven percent of patients taking antiepileptic drugs for other reasons also took a break from their prescribed drug regimen.  "Someone who knows it’s so important they take their medication to avoid a seizure is much more in tune with color... and (becomes) more stressed out with any potential switch,” says Kesselheim.
Conclusion
Patients and caregivers frequently remove pills from their original bottles to organize them in daily pill planners.  “Visual cues thus become paramount to identification of pills,” says Kesselheim.  Therefore, changes in appearance may be jarring or confusing, leading patients to delay pill-taking while seeking validation from a physician, pharmacist, or other health care provider.
Perhaps even more interesting, a pill’s physical attributes have been linked to expectations of efficacy of both placebos and prescription drugs.  Kesselheim says, “changes in appearance may not only deprive patients of these expectations of efficacy, but potentially even have the opposite effect."  It's something that's called the "nocebo" effect, a belief that the newly-substituted pill will be less effective than the previous dose.
Lastly, it’s important to note that a filled prescription does not necessarily indicate that the patient actually took his or her medication, and vice-versa. Additionally, says Kesselheim, “what we observed as nonpersistence may have been physician-directed changes in medication dosing frequency.”
What's next
As more widely used brand-name drugs face generic competition, the study’s authors suggest physicians warn their patients about the possibility of a change in pill color, and that pharmacists take greater care to alert patients when changes in suppliers might lead to new pill characteristics.
In the United States, the FDA has recently started rejecting generic drugs that are larger in size than their brand-name counterparts, citing safety and efficacy concerns, such as increased risk of choking and patient dissatisfaction.
“Based on our results,” says Kesselheim, “the FDA would be justified in taking a similar posture about new generic drugs that differ in color.”
“At a minimum,” Kesselheim says, “our results should clarify that manufacturers cannot protect their drugs’ physical characteristics through the principle of ‘trade dress,'" - physical attributes such as color, shape, size, texture, aroma, and flavor.  By definition, trade dress attributes legally cannot affect the impact of a drug on a consumer. But this study concludes that's exactly what's happening.