Objective We evaluated dementia and Alzheimer's disease (AD) risks after a cancer diagnosis in a population-based prospective cohort, the Adult Changes in Thought (ACT) study. Methods We followed community-dwelling people aged ≥65 years without dementia at study entry for incident dementia and AD from 1994–2015. We linked study data with cancer registry data and categorized cancer diagnoses as prevalent (diagnosed before ACT study enrollment) or incident (diagnosed during follow-up). We used Cox regression to estimate cause-specific hazard ratios (HRs) with 95% confidence intervals (CIs) for dementia or AD risk comparing people with a cancer diagnosis to people without cancer. We conducted sensitivity analyses restricted to people surviving beyond age 80, and stratified by cancer stage, type, and whether the cancer was smoking-related. Results Among 4,357 people, 756 (17.4%) had prevalent cancer; 583 (13.4%) developed incident cancer, 1,091 (25.0%) developed dementia, and 877 (20.1%) developed AD over a median 6.4 years (34,482 total person-years) of follow-up. Among complete cases (no missing covariates) with at least one follow-up assessment, adjusted HRs for dementia following prevalent and incident cancer diagnoses were 0.92 (95%CI: 0.76, 1.11) and 0.87 (95%CI: 0.64, 1.04), compared to no cancer history. HRs for AD were 0.95 (95%CI: 0.77, 1.17) for prevalent cancer and 0.73 (95%CI: 0.55, 0.96) for incident cancer. In sensitivity analyses, prevalent late-stage cancers were associated with reduced risks of dementia (HR = 0.51, 95%CI: 0.30, 0.89) and AD (HR = 0.50, 95%CI: 0.27, 0.94). When limited to people who survived beyond age 80, incident cancers were still associated with reduced AD risk (HR = 0.69, 95%CI: 0.51, 0.92). Conclusions Our results do not support an inverse association between prevalent cancer diagnoses, which were primarily early-stage, less aggressive cancers, and risk of dementia or AD. A reduced risk of AD following an incident cancer diagnosis is biologically plausible but may reflect selective mortality.
Oxidative pathways may have an important role in the etiology of Alzheimer's disease (AD) and vascular dementia. Studies of dietary or supplemental antioxidant vitamins as potential interventions for prevention of dementia have produced conflicting results. To examine whether use of vitamins C or E, alone or in combination, is associated with reduced incidence of dementia and AD in a community-based prospective cohort study. 2969 members of the Group Health Cooperative, Seattle, Washington, aged 65 or older, were recruited as participants in the Adult Changes in Thought study. Participants were without evidence of cognitive impairment at enrollment. They were then examined biennially to identify incident dementia and Alzheimer's disease diagnosed by standard criteria. At each examination participants were asked whether they had taken vitamins C, E, or multivitamins (MVI) for at least one week during the preceding month (“users”). During a mean follow-up of 6.4 (SD 2.3) years, 405 participants developed dementia (289 attributed to Alzheimer's disease). Use of vitamin E was not associated with dementia (adjusted hazard ratio [aHR] 0.98, 95% confidence interval [CI] 0.77–1.25) or AD (aHR 1.04, CI 0.78–1.39). Comparable results were noted for vitamin C alone (dementia aHR 0.90, CI 0.71–1.13; AD aHR 0.95, CI 0.72–1.25) and for concurrent use of vitamins C and E (dementia aHR 0.93, CI 0.72–1.20; AD aHR 1.00, CI 0.73–1.35) or E with MVI (dementia aHR 1.01, CI 0.57–1.81; AD aHR 1.03, CI 0.44–2.39). Similar results were found when we excluded participants with low screening scores at baseline (who might therefore have begun using vitamins to slow progression of prodromal symptoms). These data provide no evidence that use of supplemental vitamins E or C, either alone or in combination, is associated with reduced risk of dementia or AD over 6 years of follow-up. The contrast of these results with others may reflect different population nutritional intake, or dosage of supplements, or methods of exposure classification.
When head injured children undergo head computed tomography (CT), radiation dosing can vary considerably between institutions, potentially exposing children to excess radiation, increasing risk for malignancies later in life. We compared radiation delivery from head CTs at a level 1 pediatric trauma center (PTC) versus scans performed at referring adult general hospitals (AGHs). We hypothesized that children at our PTC receive a significantly lower radiation dose than children who underwent CT at AGHs for similar injury profiles.We retrospectively reviewed the charts of all patients younger than 18 years who underwent CT for head injury at our PTC or at an AGH before transfer between January 1 and December 31, 2019. We analyzed demographic and clinical data. Our primary outcome was head CT radiation dose, as calculated by volumetric CT dose index (CTDIvol) and dose-length product (DLP; the product of CTDIvol and scan length). We used unadjusted bivariate and multivariable linear regression (adjusting for age, weight, sex) to compare doses between Children's Hospital Los Angeles and AGHs.Of 429 scans reviewed, 193 were performed at our PTC, while 236 were performed at AGHs. Mean radiation dose administered was significantly lower at our PTC compared with AGHs (CTDIvol 20.3/DLP 408.7 vs. CTDIvol 30.6/DLP 533, p < 0.0001). This was true whether the AGH was a trauma center or not. After adjusting for covariates, findings were similar for both CTDIvol and DLP. Patients who underwent initial CT at an AGH and then underwent a second CT at our PTC received less radiation for the second CT (CTDIvol 25.6 vs. 36.5, p < 0.0001).Head-injured children consistently receive a lower radiation dose when undergoing initial head CT at a PTC compared with AGHs. This provides a basis for programs aimed at establishing protocols to deliver only as much radiation as necessary to children undergoing head CT.Care Management/Therapeutic, level IV.
Our institution saw three cases of moderate to severe injury in children under 7 years of age caused by falls from mechanical bulls at private parties. Injuries sustained included long bone fracture, skull fracture and intracranial haemorrhage. The circumstances of these injuries led our institution’s injury prevention team to investigate the safety protocols of local vendors, revealing limited regulation of safety equipment, rider age or height minimums and training for the operation of mechanical bulls. This information was reported to the US Consumer Product Safety Commission in order to reduce instances of these serious injuries in young children.
Background/Aims: Studies have demonstrated conflicting results about the association between anesthesia exposure and subsequent dementia risk. However, prior studies were retrospective, collecting data on anesthesia exposure after determining dementia status. We used prospectively collected data to evaluate the associations between anesthesia and risk of dementia or Alzheimer's disease (AD).
