Alzheimer's disease is the leading cause of dementia. However, neither Alzheimer's disease nor Alzheimer's dementia are an inevitable consequence of aging. This review provides an overview of the issues involved in a diagnosis of Alzheimer's disease before an individual meets the criteria for Alzheimer's dementia. It examines how Alzheimer's disease diagnosis rates can be improved, the implications of an early diagnosis for the individual, carer and society, and the importance of risk reduction to prevent or delay progression. Although no disease-modifying agents capable of reversing the initial pathological changes are currently available, it may be possible to prevent or delay the development of dementia in a proportion of the population by modifying exposure to common risk factors. In other individuals, diagnosing the disease or risk of disease early is still valuable so that the individual and their carers have time to make choices and plan for the future, and to allow access to treatments that can help manage symptoms. Primary healthcare professionals play a pivotal role in recognising individuals at risk, recommending lifestyle changes in mid-adult life that can prevent or slow down the disease, and in timely diagnosis. Early intervention is the optimal strategy, because the patient's level of function is preserved for longer.
Aim To conduct a systematic review and meta‐analysis to determine the risk of cardiovascular events and all‐cause mortality associated with sulphonylureas (SUs) vs other glucose lowering drugs in patients with T2DM (T2DM). Materials and methods A systematic review of Medline, Embase, Cochrane and http://clinicaltrials.gov was conducted for studies comparing SUs with placebo or other antihyperglycaemic drugs in patients with T2DM. A cloglog model was used in the Bayesian framework to obtain comparative hazard ratios (HRs) for the different interventions. For the analysis of observational data, conventional fixed‐effect pairwise meta‐analyses were used. Results The systematic review identified 82 randomized controlled trials (RCTs) and 26 observational studies. Meta‐analyses of RCT data showed an increased risk of all‐cause mortality and cardiovascular‐related mortality for SUs compared with all other treatments combined (HR 1.26, 95% confidence interval [CI] 1.10‐1.44 and HR 1.46, 95% CI 1.21‐1.77, respectively). The risk of myocardial infarction was significantly higher for SUs compared with dipeptidyl peptidase‐4 (DPP‐4) inhibitors and sodium‐glucose co‐transporter‐2 inhibitors (HR 2.54, 95% CI 1.14‐6.57 and HR 41.80, 95% CI 1.64‐360.4, respectively). The risk of stroke was significantly higher for SUs than for DPP‐4 inhibitors, glucagon‐like peptide‐1 agonists, thiazolidinediones and insulin. Conclusions The present meta‐analysis showed an association between SU therapy and a higher risk of major cardiovascular disease‐related events compared with other glucose lowering drugs. Results of ongoing RCTs, which should be available in 2018, will provide definitive results on the risk of cardiovascular events and all‐cause mortality associated with SUs vs other antihyperglycaemic drugs.
ObjectiveChronic cough (CC) is a debilitating respiratory symptom, now increasingly recognised as a discrete disease entity. This study evaluated the burden of CC in a primary care setting.DesignCross-sectional, retrospective cohort study.SettingDiscover dataset from North West London, which links coded data from primary and secondary care. The index date depicted CC persisting for ≥8 weeks and was taken as a surrogate for date of CC diagnosis.ParticipantsData were extracted for individuals aged ≥18 years with a cough persisting ≥8 weeks or cough remedy prescription, between Jan 2015 and Sep 2019.Main outcome measuresDemographic characteristics, comorbidities and service utilisation cost, including investigations performed and treatments prescribed were determined.ResultsCC was identified in 43 453 patients from a total cohort of 2 109 430 (2%). Median (IQR) age was 64 years (41–87). Among the cohort, 31% had no recorded comorbidities, 26% had been given a diagnosis of asthma, 17% chronic obstructive pulmonary disease, 12% rhinitis and 15% reflux. Prevalence of CC was greater in women (57%) and highest in the 65–74 year age range. There was an increase in the number of all investigations performed in the 12 months before and after the index date of CC diagnosis, and in particular for primary care chest X-ray and spirometry which increased from 6535 to 12 880 and from 5791 to 8720, respectively. This was accompanied by an increase in CC-associated healthcare utilisation costs.ConclusionOne-third of individuals had CC in the absence of associated comorbidities, highlighting the importance of recognising CC as a condition in its own right. Overall outpatient costs increased in the year after the CC index date for all comorbidities, but varied significantly with age. Linked primary-care datasets may enable earlier detection of individuals with CC for specialist clinic referral and targeted treatment.
Patients who were rapidly intensified achieved a maintained reduction in HbA1c faster than those with delayed intensification or no second-line therapy, despite a higher baseline HbA1c.
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