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Press releases Saturday 25 January 1997
Embargo: Friday 24 January 00.01 Hrs

Neuroleptic drugs may worsen dementia

[Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow up]

Neuroleptic drugs that are sometimes used to treat behaviour problems in people with dementia may worsen their dementia. A study in this week's BMJ reports that the rate of decline in mental function in patients taking neuroleptics was double that in those not taking the drugs.

Researchers at Warneford Hospital, Oxford, Department of Psychiatry, looked at 71 patients with dementia - many of them with Alzheimer's disease - and followed them over a two year period. Every four months the men and women were interviewed and measurements taken to note any change in cognitive ability - "thinking" processes - and behaviours such as aggression, persecutory ideas or disturbed night and day (diurnal) rhythms. Results for patients taking neuroleptic drugs were compared with those for patients not taking them. The authors state "The rate of cognitive decline in patients taking neuroleptics was twice that in those not taking neuroleptics." The start of neuroleptic treatment was linked with an increase in the rate of decline. Dr Rupert McShane, the author, comments:"The results suggest that neuroleptics may make things worse, but do not prove it."

The men and women who were taking neuroleptics were more aggressive and had more severe disturbances of diurnal rhythm. In the United States, anxiety about the overuse of neuroleptics has led to federal legislation prohibiting their use as a treatment for wandering, restlessness, or insomnia. A paper published in the BMJ last year found that nine out of ten patients taking neuroleptics in Glasgow nursing homes might be receiving them inappropriately.

Contact:
Dr Rupert McShane

e-mail: rupert.mcshane@psych.ox.ac.uk

Gulf war illness

[Editorial]

Six years after the Gulf War, many fundamental questions regarding illness among the troops remain unanswered. Researchers at Kings College Hospital, London, writing an editorial in this week's BMJ, examine new research from America on the long term health of Gulf War veterans.

Four papers in JAMA (Journal of the American Medical Association) reached differing conclusions. One study of all veterans from Iowa provided strong evidence of a health problem associated with service in the Gulf. Three other papers concluded that reported syndromes were evidence of subtle brain, spinal cord and nerve damage induced by organophosphates - but not stress. The authors warn that symptoms alone are not diagnostic of any single condition. "These papers are an important start, but some of the conclusions reached may be a bridge too far....It is premature to assume that all the findings necessarily result from a specific exposure to Gulf service." They add that we should take care before generalising the results of the US studies to the United Kingdom Gulf War veterans.

"The scientific case for large scale epidemiological studies remains overwhelming" writes the Kings College team. They will be carrying out part of the research commissioned in the UK by the Ministry of Defence, the Medical Research Council and the US Department of Defence.

Contact:
Professor Simon Wessely

Journalists: contact Public Affairs Division for telephone/fax numbers
or
Professor Tony David

e-mail: spjuasd@iop.bpmf.ac.uk

Going blind for want of an eye test

[Editorial: Time to look again at eye tests]

There is no formal screening programme for glaucoma in Britain and many cases of this eye disorder remain undiagnosed. Without treatment the condition - a common major eye disorder in older people - can lead to blindness. An editorial in this week's BMJ says the people most at risk are not the most likely to go for an eye test.

Mr Richard Wormald, Director of Glaxo Department of Ophthalmic Epidemiology at Moorfields Eye Hospital, London, writes that the present system is "clearly failing to detect large amounts of preventable blindness". Options that need to be explored include free eye tests for elderly people, and a campaign to increase public awareness of the need for regular glaucoma checks. "The fact that those aged over 65 are at a higher risk of incident glaucoma but are not the most likely to seek eye testing must be a matter of some concern for a government which has proposed to offer free sight tests to those at risk of blinding diseases" states the editorial.

The condition is four or more times commoner in people of African origin than in white Europeans and while "making special provision for ethnic minorities may be politically difficult" the editorial says some attempt at rationalising the detection of glaucoma is required. Locally based initiatives in areas with high proportions of Afro-Caribbean people might be an option.

Contact:
Mr Richard Wormald

e-mail: r.wormald@ucl.ac.uk

Combination treatment leads to more live births in women with recurrent miscarriage

[Randomised controlled trial of aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies)]

Giving the anticoagulent drug heparin along with low dose aspirin leads to a significantly higher rate of live births in a specific group of women suffering from recurrent miscarriages compared with treating with aspirin alone, says a report in this week's BMJ.

The women who benefit from the combination drug treatment suffer from recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). Phospholipids are integral building block of all our body cells. The BMJ paper reports that 71 per cent (32 out of 45) of the women taking aspirin with heparin gave birth to a live baby. Among women with similar miscarriage histories taking aspirin alone, only 42 per cent (19 out of 45 pregnancies) gave birth to a live baby. More than 90 per cent of the miscarriages that did occur took place in the first three months of pregnancy. Once the pregnancies in either treatment group continued beyond 13 weeks gestation there was no difference in outcome between the groups.

Nearly a quarter of the successful pregnancies were delivered prematurely (before 37 weeks) so close surveillance is necessary, say the authors.

Contact:
Professor Lesley Regan

e-mail: l.regan@ic.ac.

Genetic counselling - a need for advance information

[Women's need for information before attending genetic counselling for familial breast or ovarian cancer: a questionnaire, interview and observational study]

Genetic counselling services are coming under increasing pressure as more women are referred to them because of a family history of breast or ovarian cancer. A paper in this week's BMJ reports that many women feel they have been inadequately prepared for the counselling sessions.

Researchers in Cambridge contacted 46 women before and after genetic counselling for cancer. Although most of the women looked on their counselling positively, 65 per cent felt they had been inadequately prepared and 28 per cent felt their lack of preparation meant they could not be given an accurate assessment of their risk of cancer. A written leaflet describing the counselling process and giving some basic genetic facts could be a cost effective way of giving women the information they want before they attend the genetic counselling clinic, say the authors.

Contact:
Dr Nina Hallowell

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EMBARGO: 00.01 HRS Friday 18 January 1997

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