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Lithium may decrease risk of developing dementia, study suggests

A drug usually prescribed for conditions such as bipolar disorder and depression may lower the risk of developing dementia, a new study suggests.

PA Archive Elderly Person

Researchers say the findings support the possibility that lithium could be a preventative treatment for dementia, and could be tested in clinical trials.

While previous studies have proposed lithium as a potential treatment for those diagnosed with dementia or early cognitive impairment, it is unclear whether it can delay or even prevent the development of the condition, as these studies have been limited in size.

Dementia is one of the leading causes of death in elderly people across Western populations, and there is currently no preventative treatment available.

It is thought that more than 55 million people worldwide have dementia, with Alzheimer’s disease the most common form.

Study author, Shanquan Chen from the University of Cambridge’s department of psychiatry, said: “The number of people with dementia continues to grow, which puts huge pressure on healthcare systems.

“It’s been estimated that delaying the onset of dementia by just five years could reduce its prevalence and economic impact by as much as 40%.”

The researchers, from the University of Cambridge, conducted an analysis of the health records of nearly 30,000 patients over the age of 50 from Cambridgeshire and Peterborough NHS Foundation Trust.

According to the study, the patients who received lithium were less likely to develop dementia than those who did not, although the overall number of patients who received lithium was small.

Lithium is a mood stabiliser usually prescribed for conditions such as bipolar affective disorder and depression.

Dr Chen said: “Bipolar disorder and depression are considered to put people at increased risk of dementia, so we had to make sure to account for this in our analysis.”

Researchers analysed data from patients who accessed mental health services from Cambridgeshire and Peterborough NHS Foundation Trust between 2005 and 2019.

They received at least a one-year follow-up appointment, and had not been previously diagnosed with either mild cognitive impairment or dementia.

Of the 29,618 patients, 548 patients had been treated with lithium. Their average age was just under 74 years, and around 40% of patients were male.

For the group that had received lithium, 53, or 9.7%, were diagnosed with dementia.

In the group that had not received lithium, 3,244, or 11.2%, were diagnosed with dementia, researchers found.

However, researchers say that since the overall number of patients receiving lithium was small and this was an observational study, larger clinical trials are needed to establish lithium as a potential treatment for dementia.

Another limitation of the study was the number of patients who had been diagnosed with bipolar disorder, which is normally associated with an increased risk of dementia.

There is a desperate need for new dementia treatments and where there is evidence that an existing, widely used, relatively safe and inexpensive drug could help, it is vital that researchers follow up on this as quickly as possible

Dr Chen said: “We expected to find that patients with bipolar disorder were more likely to develop dementia, since that is the most common reason to be prescribed lithium, but our analysis suggested the opposite.

“It’s far too early to say for sure, but it’s possible that lithium might reduce the risk of dementia in people with bipolar disorder.”

The research was supported in part by the UK Medical Research Council and the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre.

Dr Sara Imarisio, head of research at Alzheimer’s Research UK, said: “Alzheimer’s Research UK are now funding science at the University of Newcastle to see whether lithium could be a future treatment for Alzheimer’s disease using a new brain imaging technique.

“This project will help lay the groundwork for careful clinical trials, which are ultimately the only way to know if lithium could be an effective treatment for people with Alzheimer’s.

“There is a desperate need for new dementia treatments and where there is evidence that an existing, widely used, relatively safe and inexpensive drug could help, it is vital that researchers follow up on this as quickly as possible.”

The findings are published in the PLoS Medicine journal.

In separate research, published in Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association, researchers found extended napping in elderly people may signal dementia.

Researchers from UC San Francisco (UCSF) and Harvard Medical School together with Brigham and Women’s Hospital, also found that once dementia or mild cognitive impairment was diagnosed, they also started napping more, and for longer.

They suggest their findings depart from the theory that daytime napping in older people only compensates for poor night-time sleep.

Instead, it points to work by other UCSF researchers suggesting dementia may affect the key areas of the brain related to sleep.

Co-senior author Yue Leng, said: “I don’t think we have enough evidence to draw conclusions about a causal relationship, that it’s the napping itself that caused cognitive ageing, but excessive daytime napping might be a signal of accelerated ageing or cognitive ageing process.”

It's World Sleep Day! Here are 24 ways to improve your sleep

Today is World Sleep Day, so if you're reading this bleary-eyed and ready to pop back to bed, perhaps it's time to use this as the impetus you need to revamp your bedtime routine and improve the situation. "​​Your sleep is vitally important to your physical, mental and emotional health," explains independent sleep consultant Dr Neil Stanley. "You need to make time in your life to get the sleep you need. Prioritise sleep; it should not be the thing you do after everything else." 

Provided by T3 Woman stretching and smiling in bed

If you're thinking it might be time to upgrade your bed, our best mattress guide will set you off in the right direction (chances are we'll see a range of strong cheap mattress deals in honour of the event). While your mattress is a vital ingredient in getting a great night's sleep, it's also important to establish a healthy bedtime routine.

Neil has teamed up with sleep brand Piglet in Bed to share his top tips – based on 40 years of sleep research – to help you sleep better. There are 24 different techniques to try, so chances are you'll find something in there that works for you.  

1. Fix your daily wakeup time 

Having a set time that you wake up every day – not just on weekdays – will help ensure you wake up feeling refreshed. "Your body and brain start preparing to wake up approx 90 minutes before you actually do, so if you have a fixed wake up time, the body and brain know when they are going to wake and can thus prepare accordingly," explains Neil. 

2. Get some sunlight during the day

"Sunlight is the most powerful regulator of our biological clock," says Neil. "This is why we have evolved to sleep during the night and be awake during the day." Lean into this by making sure your bedroom is as dark as possible when you're trying to sleep, and focus on getting out in sunlight during the day.

3. Dedicate your bedroom to sleep

"Your bedroom should be devoted to sleep," says Neil. "If you are not asleep, you should not be in your bedroom, and you should only sleep in your bedroom. It is not your office, gym, games, room or cinema."

4. Figure out if you are a lark or an owl

Feeling refreshed in the day is not just about how many hours of sleep you have – it's also when you have that sleep. Whether you're more of a 'lark' (morning person) or an 'owl' (evening person) is largely down to genetics, says Neil, but it can have a big impact on how awake you feel during the day. "Suppose you are an evening person and you wake up before your natural propensity to wake," he explains. "In that case, you may experience 'sleep inertia', that feeling of grogginess, for between 15 minutes and 2 hours after waking."

5. Wait until you're sleepy to go to bed

If you're not sleepy yet, find something else to do until you are – for example reading a book or listening to some calming music. "Find something relaxing but not stimulating to take your mind off of worries about sleep," suggests Neil.

6. … and if you can't sleep, get out of bed

"If you are tossing and turning for more than 30 minutes at the start of the night or 20 minutes during the night, it may be helpful to get out of bed and do something else, only going back to bed when you feel sleepy again," says Neil. Similarly, if you're up before your alarm, perhaps start your day then rather than stressing about getting back to sleep again.

7. Know that not everyone needs 8 hours

We have been led to believe we should all be striving for eight hours of sleep a night, but Neil says that in reality, anywhere between four and 11 hours could be enough for you. "Your sleep need is genetically determined, so; if you are a nine hour a night person, you need to endeavour to get nine hours," he says. "Also, if you are naturally a four hour a night person, you will essentially be wasting your time if you are trying to get what you have been led to believe is the ideal eight hours a night."

He stresses, though. that "there is a big difference between getting four hours' sleep a night and actually needing only four hours". How do you know how much you need? Easy – if you feel awake and able to function at a high level the day, you've had enough sleep for you. 

8. Follow this process to quiet your mind

"The number one prerequisite for getting to sleep is a quiet mind," says Neil. "You cannot fall asleep if your mind is whirring with the care of the day." To help ensure you're in the right mindset for sleep, he suggests starting a wind-down routine two hours before you actually want to go to sleep. Use this as the cutoff for any potentially stress-inducing tasks (checking your work email, launching into a political debate with your partner, that kind of thing). Then 45 minutes before bedtime, take things down another notch by putting any devices away and doing something you find relaxing. "For some people, this can be reading a book or listening to music, for others it can be a warm bath or a mug of a hot milky drink," he suggests. 

9. Put down your devices before bed

This one's well known: the blue light you get from your smartphones, laptop and so on, isn't great for sleep. "Blue light has been shown to suppress melatonin production," explains Neil. "Melatonin is a key signal to the body that it is time to fall asleep, so it is important to avoid exposure to blue light before lights out." He recommends avoiding devices for 45 minutes before bed.

10. Buy an alarm clock rather than using your phone

Related to that last point – most people use the alarm on their phone to wake them up in the mornings. That means your phone needs to be right next to your bed, which means there's a temptation to play on it directly before bed, or even check it if you wake up in the night. Instead, Neil recommends picking up a dedicated alarm clock, and leaving your phone in the next room, or at the very least away from your bedside. For a gentler wakeup, you could even try one of the best sunrise lamps, which rouse you slowly from your slumber with a gradually brightening light.

11. Make sure your bedroom is dark

"Darkness is essential for sleep; even small amounts of light can be disruptive to sleep and the lighter your bedroom, the worse the problem," says Neil. To create the perfect environment for sleep, sufficiently dark curtains or blackout blinds are a good idea (or pop on an eye mask if that's not possible – we like this one from Ostrichpillow). Don't forget to cover up any internal light sources too, such as a phone charging LED, for instance. 

12. Don't count sheep 

"Recent research has shown that even something as simple as counting sheep can actually keep you from sleeping," says Neil. "Counting engages the brain. Imagining a static, tranquil scene is more effective."

13. Sharing? Consider 'sleep divorce'

If you find your partner's sleep habits – snoring or wriggling, for example – are regularly preventing you from having an undisturbed night's sleep, consider sleep divorce. This is essentially where you opt to sleep separately, and it's becoming increasingly popular. If you automatically baulk at the idea, consider this: "If it works for you both, not sleeping together is a mature, pragmatic solution to a problem," says Neil. "[It] has no bearing on the strength, or otherwise, of your relationship. Lack of 'intimacy' would be much more suggestive of a problem."

14. … or just buy a bigger bed

If there are two of you sleeping in a standard UK Double bed, you have less space allocated to you per person than a Single. Opt for a King or even, if you have space, a Super King, and you'll be much less likely to end up disturbed by a fidgety partner or fighting over space. Head to our best mattress guide for our top recommendations, or check out this guide to the different mattress sizes in the EU, UK and US if you're not quite sure.

15. Avoid napping in the day

"If you nap throughout the day, it is probably not surprising that you will not be able to sleep at night," says Neil. If you really, really need a nap, he recommends limiting it to 20 minutes in the mid-afternoon – this is enough to give you a mental boost. 

16. Time your evening meal right

This one is a balancing act. Chow down on a heavy meal right before bedtime and your body will be working to burn the calories consumed, raising your body temperature when actually it need to drop during the night if you want to get a good sleep. Eat too early, and you'll end up going to bed feeling hungry, which can be just as disruptive, though.

17. Lay off the booze  

"Alcohol works on the same receptors as sleeping tablets, so it will help put you to sleep," says Neil. However, the issues will kick in later in the night – you might get a headache from dehydration; you might end up overheating as your body burns off the calories. "However, a small sherry before bed has never done anyone any harm," he caveats.

18. … in fact, stop drinking (anything) right before bed

To avoid having your sleep disturbed by bathroom breaks, Neil recommends restricting the amount of fluids you're taking in during the hour before you go to sleep, and going to the loo right before you switch the lights off (here's some more detail on when to stop drinking before bed). 

How important this is can depend on your age. "As we get older, the more prevalent are these night-time awakenings," he explains. If you're regularly having to get up to wee more than once in the night, you should speak to your

19. Consider earplugs or pink noise

If you're finding your sleep disrupted by nighttime noises, pop in some earplugs. And if that doesn't work, try a white or pink noise machine. "Some people also find that the drone of an electric fan or relaxing music can be helpful in masking other more disruptive sounds," says Neil. "If you are going to use a noise app or a sound machine, 'pink noise' is better than white noise." 

20. Keep a pen and paper next to your bed

"If you are worried about something, then write your worries down. They will still be there in the morning, so you don't have to worry about them during the night," suggests Neil. "If your mind is racing with everything you have to do tomorrow, make a list of things to be tackled the next day."

21. Get active during the day

"Being physically and/or mentally active during the day is one of the best ways of ensuring good sleep at night," says Neil. Don't time that activity to just before bed though, or you'll likely have trouble switching off. Leave time to wind down and prepare your mind and body for sleep.

22. Don't stress about sleep

"Don't over-complicate getting to sleep; remember, you cannot find sleep; you have to let sleep find you," says Neil. 

23. Adjust your caffeine consumption

Different people react to, and process caffeine in different ways. Some some people will be perfectly fine to have a cup of coffee in the evening and it won't affect their sleep, while others might still be feeling the effects of their morning cuppa at the time. "If you have problems falling asleep or your sleep isn't restful, it may be useful to avoid caffeinated drinks and see if your sleep improves," suggests Neil. 

24. Establish a bedtime routine

Having some kind of wind-down routine is a good idea, says Neil, but what it consists of is up to you. "Your bedtime routine should be easy to do and a pleasure, not a chore; whatever works for you is correct," he explains. "It does not matter if you have a few different routines that you use; the most important thing is that they are something that you want to do each night." 

Reference: T3: Ruth Hamilton

When Is It Time for a Knee Replacement?

Provided by HealthDay

SATURDAY, March 19, 2022 (HealthDay News) -- Knee replacement surgery is one of the most common procedures in the United States, with more than 790,000 performed each year.

Deciding the time for knee replacement needs to be determined by you and your doctor, but certain factors make it more likely, according to experts at Keck Medicine of the University of Southern California.

• Bad arthritis. "Osteoarthritis, rheumatoid arthritis and post-traumatic arthritis affect the knee through different mechanisms, however, these different conditions are similar in that they all result in loss of cartilage, which causes pain and loss of motion," Dr. Nathanael Heckmann, orthopedic surgeon at Keck Medicine, said in a Keck news release. “When these symptoms become severe, knee replacement surgery may provide considerable symptom relief by replacing the worn-out surfaces of the knee."
• When nonsurgical treatments such as medications, steroid injections and physical therapy are no longer effective. "As time passes, these arthritic conditions tend to progress in severity, rendering these types of treatments less and less effective," Heckmann said.
• Your knee pain prevents you from doing normal activities or caring for yourself. "In general, the timing of a total knee replacement is determined by the impact the knee is having on your quality of life," said Dr. Jay Lieberman, chief of orthopedic surgery at Keck Medicine. "If conservative treatments are not working and you have significant pain while walking, you may be a good candidate for surgery."
• Severe knee pain. Especially if it happens even when resting and you can't sleep.
• Swollen knees. Particularly if your knee is always swollen.
• Your knee has become deformed. If you have advanced arthritis, it can affect the way you walk, which can also lead to further problems elsewhere in your body.
• You're of a certain age. While knee replacements are done in people of all ages, they're most common in those older than 60. That's because younger people's more active lifestyles may place too much strain on the artificial knee and shorten how long it lasts, and second replacement surgeries may not be as successful.

If you're thinking about knee replacement surgery, you need to know that you may have to avoid high-impact activities.

"Total knee replacement is quite successful in enabling patients to return to an active lifestyle -- patients can perform all types of recreational activities, including hiking, bicycling, skiing, surfing, tennis and golf," Lieberman said in the release. "In general, we do not limit activities but suggest that patients avoid impact activities on a consistent basis to reduce wear on the prosthesis."

''It took 15 years for me to get a diagnosis for my constant pain but I'm one of the lucky ones'

Sanchia Alasia has been suffering from excruciating pain for as long as she can remember. At first, the pain occurred when the 41-year-old was on her period but as time went on she began to experience it in between her periods. After a minor operation to find out what was wrong, doctors diagnosed her with Stage 4 endometriosis in 2010.

JayBright Media Ltd. Sanchia Alasia has been suffering with constant pain due to her endometriosis

“The pain manifested itself in different ways over the years. I experience low level daily pelvic pain which is something that I just have to manage and get on with my life. But when I get my period, the pain is severe and I’m bed-bound. If I’m lucky I can just about make it to the supermarket. But there are so many other symptoms including a loss of appetite and struggling to sleep," she said.

One in ten women suffer from the condition and there’s currently no cure, according to charity Endometriosis UK. Endometriosis is a condition where tissue that is similar to the womb lining is found outside the womb. This tissue behaves in the same way as it would inside the womb but cannot be flushed out in the same way a normal period would which leads to horrendous pain. If left untreated, endometriosis can attach itself to organs in the body and eventually cause them to shut down, leading to organ failure.

"Growing up I always knew something was wrong. It bothered me that people at school didn't have to take time off when they got their periods and I was suffering. I remember thinking 'why is this happening to me, nobody else is going through this. I just thought I was unlucky," she added.

Sanchia, from Romford, said that she had been to the doctors a few times but was told that she just had heavy periods. Despite taking 20 years to get a diagnosis, Sanchia considers herself one of the lucky ones as the doctor she eventually saw referred her to a specialist, but many other women don’t have the same experience.

“So many other women are not taken seriously when they go to their GP," she said. "They’re saying they’ve got severe pain but nothing is being done about it. They’re told it’s a psychological thing but of course, you’re going to start to feel depressed if you’re in pain and not believed.”

For Sanchia, the endometriosis has spread to her ovaries, bladder and bowel which means she has issues with urination. She stressed that there needs to be more awareness within GPs and that ignorance cannot be used as an excuse for abandoning women's health.

“I had an operation in February 2020 and some of it has grown back," she said. "It can be and is a constant battle. I’ve been offered a few treatment options but they all sounded expensive and overwhelming. The pain is intermittent now between my periods which means I have to plan around it. If I know I'm coming on my period then I know I won't be able to go out for the first couple of days.

“Over the years there has been a lot of work to raise awareness, especially when you compare it to when I was first diagnosed. It’s come a long way but there’s still a long way to go. We need to come up with a national strategy to put more funding into research to find a proper cure because it’s too common a problem.”

Reference: My London: Gabriella Clare