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Geriatric Psychiatry Research Update: April 2017

Geriatric Psychiatry Research Update: April 2017


  • Three recent studies show vitamin E and selenium do not prevent dementia in asymptomatic older men; an autoimmune disease hospitalization appears to raise the risk of future dementia; and a cognitive stimulation program can improve cognition and decrease the length of stay in a post-acute care facility for dementia patients, but does not reduce delirium.[1-3] Scroll through the slides for the latest findings and take-home messages.
  • 1. Vitamin E and Selenium Supplements, Either Alone or in Combination, Do Not Appear to Prevent Dementia in Asymptomatic Older Men: A study randomized 7540 men (mean age, 67.5 years) to vitamin E, selenium, vitamin E and selenium, or placebo; the men took the supplements for an average of about 5 years. Results showed the incidence of dementia was not different among the 4 study arms. The study had limitations: it was underpowered, included only men who had a short exposure to supplements, and relied on real-world reporting of incident cases. Also, about half of the participants were lost to long-term follow-up.[1]


  • Clinical Implications for Study 1: Vitamin E and selenium supplements may not forestall dementia and probably should not be recommended as preventive agents.

  • 2. Patients Admitted to the Hospital for Autoimmune Disease Appear More Likely to Develop Dementia: A retrospective, record-linkage cohort study using national hospital care and mortality administrative data in the United Kingdom found more than 1.8 million people were admitted to the hospital with an autoimmune disease. A history of an autoimmune disease-related admission was linked to a 20% higher likelihood of a dementia-related admission; the relative risk was even higher (28%) for vascular dementia. Of 25 autoimmune diseases studied, 18 showed significant positive associations with dementia.[2]


  • Clinical Implications for Study 2: Be aware of the possible coexistence of autoimmune disease and dementia, particularly vascular dementia, which may be tied to the association between autoimmune disease and cardiovascular disease risk factors.

  • 3. Cognitive Stimulation Does Not Decrease Delirium Duration or Severity But Has a Small Effect on Executive Function in Patients With Dementia and Delirium: A single-blind randomized clinical trial enrolled 283 patients with dementia and delirium from 8 post-acute care facilities. Each participant received a daily 30-minute session of individualized cognitively stimulating activities. The mean percentage of delirium-free days and delirium severity were similar in both treatment and control groups. However, executive function improved and the length of stay in the facility was shorter in the treatment group.[3]


  • Clinical Implications for Study 3: For patients with dementia, it may take more intense nonpharmacological treatment to resolve delirium.

Editor's note: This article was published on April 3, 2017, and has since been updated.

References: 

1. Kryscio RJ, Abner EL, Caban-Holt A, et al. Association of antioxidant supplement use and dementia in the Prevention of Alzheimer’s Disease by Vitamin E and Selenium Trial (PREADViSE) JAMA Neurol. Published online March 20, 2017. doi:10.1001/jamaneurol.2016.5778. Accessed March 27, 2017.

2. Wotton CJ, Goldacre MJ. Associations between specific autoimmune diseases and subsequent dementia: retrospective record-linkage cohort study, UK. J Epidemiol Community Health. Published online March 1, 2017. doi:10.1136/jech-2016-207809. Accessed March 27, 2017.

3. Kolanowski A, Fick D, Litaker M, et al. Effect of cognitively stimulating activities on symptom management of delirium superimposed on dementia: a randomized controlled trial. J Am Geriatr Soc. 2016;64:2424-2432.

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