Tamsulosin Causes Dementia?

Yesterday, I saw my urologist for my annual checkup with him.  PSA looked great.

We also reviewed my meds.  I've been taking Tamsulosin for BPH for a decade or more, but he said that Tamsulosin is now being correlated with dementia.  He said a team had come from Chicago (or somewhere) to explain this new finding.

I was a bit alarmed, because I am very dependent on Tamsulosin to get through the night.  Life has been hard enough when I forget to refill the prescription.  What if I need to give it up altogether?  So I went home and looked up the research.  I found this.  Not good news.

The doctor has been bugging me to do surgery (again) to fix the problem and get off the drugs.  It means kicking the can down the road, because this surgery is only good for 5-10 years, at least for me.  Last time I had a catheter in for two weeks, and I kind of hated carrying a bag around wherever I went.  (I had clever ways of hiding it.)  And it was pretty painful. 

So this leaves me wondering if Tamsulosin has played a role in my Alzheimer's disease.  No cause/effect relationship has been established for the correlation, and no reason for the correlation has been identified.  It's not even clear if this has anything to do with Alzheimer's disease.  There's no indication of what kind of dementia is being correlated.

There is one thought that the drug is not affecting the progress of the disease, just that it's "unmasking" the effects.  This would be the opposite of what Donepezil (Aricept) and similar drugs do.  Donepezil does nothing to slow the progress of the underlying disease--the disease will still kill you at the same time--but it will hide to some extent the cognitive decline.  So maybe the Tamsulosin is exaggerating the cognitive decline in people who already had undiagnosed Alzheimer's disease?  No one knows, at least not yet.

Another Study on Diet and Alzheimer's Disease

A doctor friend of mine shared with me a study that correlated larger hippocampal volume with good dietary habits.  You will see from my earlier post of December 17 that I discussed a Finnish study of diet, and this new study referenced the Finnish study.  The new study is Effect of Diet on Hippocampal Volume in a Population at Risk for Alzheimer's Disease.  It found a strong correlation between scores on the Alternative Healthy Eating Index 2010 (AEHI) and hippocampal volume.

The "alternative" AEHI is an alternative to the earlier Healthy Eating Index.  The AEHI emphasizes low carb eating over low fat eating.  A Mediterranean diet gets you pretty close to the top of the AEHI, but maybe not so much with the earlier index.

This study caught my attention because hippocampal volume is an important biomarker for Alzheimer's disease.  My care team at Harborview in Seattle used it to diagnose my own Alzheimer's disease.  You will recall from Beating the Dementia Monster that an MRI in 2015 measured my hippocampal volume in the 36 percentile of the general population, but two 2017 MRIs found it at the one percentile.  The radiologist in the 2017 MRIs said that the decrease might be due to differences in technique, but, taken together with the changes in the size of my ventricles, even the 2015 reading was sufficient biomarker evidence for the diagnosis.  (Biomarker evidence must be taken together with cognitive testing evidence to produce a diagnosis of Alzheimer's disease.)

The researchers in the new study studied a cohort 459 British civil servants with an average age of 60 years.  Nineteen percent were female.  Subjects were evaluated every five years over an 11 year period.  They were followed with respect to diet and other possible confounding factors, such as physical activity.  (They didn't say "exercise."  Not sure what that means.)  Hippocampus volumes were measured by MRI once near the end of the study.  Volumes were compared between study subjects. 

The study drew from an earlier cohort of about 10,000 subjects that was selected in the 1985-1988 time frame.  The earlier cohort was used by the same researchers to study long-term outcomes with respect to cardiovascular disease.  The study explained little about the earlier study, but I speculate that the large cohort formed a rich population of subjects with similar characteristics who were already known to the researchers.  

The results were remarkable.  Each 8.7-point increase in the AEHI score (one standard deviation for you statistics nerds) correlated with an eye-popping 92.5 cc increase in hippocampal volume.  I want that kind of increase in my hippocampal volume.  Do I need to wait 11 years to get it? 

An important Large Study on Diet and Cognitive Improvement

Alzheimer's and Dementia, the Journal of the Alzheimer's Association, recently posted an article regarding a two-year study of diet intervention and its influence on cognition.  It was called the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER).  It studied a population of 1,260 at-risk patients over a period of two years.  (It wasn't clear to me how big the control population was vs. the study population.)  "At-risk patients" were 60 to 77 years of age and carried a higher risk of dementia based on a recognized risk scoring system.  

The study found that adherence to dietary guidelines predicted subsequent improvement in executive function among older adults, but not improved memory or processing speed.  The researchers suggested that longer periods of time or different diet approaches might produce results with respect actual improvement in memory and processing speed.  They said that cognitive improvement requires "intensive" dietary change.

The diet in the study followed Finnish national diet guidelines.  The guidelines were consistent with the Mediterranean and DASH diets we discuss in Beating the Dementia Monster.  The researchers acknowledged the MIND diet (also discussed in Beating the Dementia Monster), but they don't relate it to their study.  The study controlled for exercise, relaxation periods, social activity (including volunteer work), and other factors we discuss in Beating the Dementia Monster. 

While there have been a number of "longitudinal studies" correlating risk for developing neurodegenerative disease (like AD) with diet, the researchers say their "prospective study" is the first to correlate improved cognition with dietary interventions.  (But only the executive function component of cognition improved.)  A longitudinal study observes behaviors and resulting health consequences in a large population of subjects (e.g. the famous Framingham Heart Study), while a prospective study evaluates what happens as a consequence of purposefully changing behaviors (like diet).  A prospective study must compare results with the intervention population and a control population.

I had several takeaways from the report:

• You can't eat your way to good brain health in two years.  It's good that you can improve executive function (and preserve your socially appropriate behavior), but memory and processing speed are just as important.
• If you control diet studies for exercise their results are less impressive than you would hope.  We discuss this as well in Beating the Dementia Monster.  This underscores the importance of physical exercise if you want to do something about cognitive decline.
• The researchers underlined that no dietary supplement has been shown to improve cognition.  They cited one optimistic review of the literature concerning a range of potential supplements and other interventions that nevertheless failed to find hope for any supplement.