Abstract:oncussions are a common cause of brain injury occurring in more than 1 million Americans each year and disproportionately involving older adults. 1-4 The subacute consequences vary widely and include fatigue, headache, irritability, insomnia, inattention, photophobia, vertigo, and cognitive difficulties. 5-9 Most patients recover from a concussion within weeks, although some can develop lingering mood disorders or chronic neuropsychiatric disorders. 10-14 The extent of complications after a concussion is uncer… Show more
Prof J Cohen-Mansfield), and Minerva Center for Interdisciplinary Study of End of Life (Prof J Cohen-Mansfield),should consider dementia in older people without known dementia who have frequent admissions or who develop delirium. Delirium is common in people with dementia and contributes to cognitive decline. In hospital, care including appropriate sensory stimulation, ensuring fluid intake, and avoiding infections might reduce delirium incidence.Acting now on dementia prevention, intervention, and care will vastly improve living and dying for individuals with dementia and their families, and thus society.
Prof J Cohen-Mansfield), and Minerva Center for Interdisciplinary Study of End of Life (Prof J Cohen-Mansfield),should consider dementia in older people without known dementia who have frequent admissions or who develop delirium. Delirium is common in people with dementia and contributes to cognitive decline. In hospital, care including appropriate sensory stimulation, ensuring fluid intake, and avoiding infections might reduce delirium incidence.Acting now on dementia prevention, intervention, and care will vastly improve living and dying for individuals with dementia and their families, and thus society.
“…Some studies have also shown that statins reduce periodontal inflammatory injury (Subramanian et al, 2013). In a population-based cohort study, the use of statins was associated with a reduced risk of stroke after a concussion (Redelmeier et al, 2019). It can be postulated that statins have a protective effect against stroke and therefore reduce the risk of dementia (Redelmeier et al, 2019;Subramanian et al, 2013).…”
“…They also do not cause hepatotoxicity, renal failure, cataracts11 or dementia 12. If anything, statins reduce the risk of dementia,12 13 as would be expected: cholesterol lowering prevents strokes, and preventing strokes is at present the best available way to prevent dementia 14 15. With the rare exception of autoimmune statin myopathy,16 probably the only valid causally related adverse effects are myopathy and a slight increase in the risk of diabetes,10 probably both due to impaired mitochondrial function resulting from depletion of ubiquinone 12…”
Section: Withholding Therapy In Patients Whose Subgroup Was Not Inclumentioning
BackgroundEvidence-based medicine (EBM) has no doubt resulted in great improvements in the practice of medicine. However, there are problems with overly zealous application of EBM, that for some amounts to religious practice. When good evidence exists, it should guide therapeutic and diagnostic choices. However, when evidence is lacking for a given patient, medicine is best practised by extrapolation from available evidence, interpreted in the light of the pathophysiology of the condition under consideration, and effects of various therapies in relation to that pathophysiology.ObjectiveTo assess ways in which the unthinking application of EBM can go wrong; these include withholding therapy in patients whose subgroup was excluded from clinical trials, blind acceptance of the numbers, reliance on studies with crucial design flaws and reliance on intention-to-treat analysis when it is not appropriate.Study selectionExamples assessed included withholding cholesterol-lowering therapy in the elderly, not using B-vitamin therapy for stroke prevention, not using revascularisation for true renovascular hypertension and avoiding statin therapy for fear of intracerebral haemorrhage.FindingsZealous application of EBM is often inappropriate.ConclusionsIn some instances, when there is a lack of evidence, or faulty interpretation of the evidence, clinical judgement should inform the application of EBM.
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