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Medscape
2 days ago
- Health
- Medscape
‘Clear Advantage' of GLP-1s for IIH vs Conventional Therapy
GLP-1 receptor agonists (RAs) are associated with fewer headaches and visual symptoms, reduced medication use, and less need for procedures — including bariatric surgery — compared with conventional therapies in patients with idiopathic intracranial hypertension (IIH), results of a retrospective multicenter study showed. These outcomes were achieved without a significant change in BMI, which suggests GLP-1 RAs have therapeutic benefits aside from weight loss alone. The results reflect 'clear advantages' of GLP-1 RAs over current IIH management strategies, including surgical interventions and medications like acetazolamide, study investigator Dennis J. Rivet II, MD, professor, Department of Neurosurgery, Virginia Commonwealth University, Richmond, Virginia, told Medscape Medical News . 'These therapies belong in the armamentarium of medications used in IIH, and they should be considered prior to surgery,' he said. The findings were published online on July 14, 2025, in JAMA Neurology . Unknown Mechanism IIH is characterized by elevated intracranial pressure (ICP) without an identifiable cause. Obesity is present in about 90% of IIH cases, with the highest incidence in women with overweight of childbearing age. The exact mechanism linking obesity to IIH is unknown, but weight loss appears to be beneficial. Bariatric surgery, such as a gastric bypass or sleeve gastrectomy, can be an effective means of weight loss, which then may reduce the risk for IIH. Other treatments of IIH include pharmacological agents such as acetazolamide or procedural interventions such as cerebrospinal fluid (CSF) diversion to increase CSF drainage, optic nerve sheath fenestration, and venous sinus stenting (VSS). GLP-1 RAs, which have been around for more than a decade now, are gaining popularity for weight loss as well as type 2 diabetes. However, they're proving beneficial in other 'less obvious' disease states, including heart failure with preserved ejection fraction and liver cirrhosis. Rivet noted there's also growing interest in exploring them for addiction. These agents are also under investigation for IIH, but efficacy data are limited. The retrospective study analyzed deidentified electronic health records (EHRs) from adults with IIH who had not used GLP-1 RAs, using data from 67 healthcare organizations in the TriNetX US Collaborative Network. Researchers established two cohorts: patients who initiated a GLP-1 RA within 6 months of an IIH diagnosis and a control group who started conventional therapies without GLP-1 RAs. After propensity score matching, each group included 555 patients. Baseline characteristics were well balanced (mean age, approximately 43 years; 86% women; 54% White; about two thirds with overweight or obesity), with comparable rates of symptoms, signs, and medication use. Outcomes included the use of medications other than GLP-1 RAs; symptoms and signs such as headache, visual disturbances or blindness, dizziness, papilledema, tinnitus, and optic atrophy; procedures, including spinal puncture, shunt placement, VSS, optic nerve decompression, and bariatric surgery; and mortality. Both groups had a median follow-up of 365 days. Patients in the GLP-1 RA group were significantly less likely to require any medication than those in the control group (29.7% vs 56.4%; P < .001). Notable reductions were observed in the use of tricyclic antidepressants (6.8% vs 12.3%; P = .002), topiramate (11.2% vs 19.6%; P < .001), furosemide (6.8% vs 14.4%; P < .001), and acetazolamide (8.6% vs 24.0%; P < .001). Use of valproate did not differ significantly between the groups (2.7% vs 3.4%; P = .49). The GLP-1 group also had fewer headache symptoms (12.3% vs 27.4%; P < .001), visual disturbances or blindness (7.0% vs 11.7%; P = .007), and papilledema (2.2% vs 11.5%; P < .001). In addition, GLP-1 RA users had fewer procedures overall (6.8% vs 15.7%; P < .001). Bariatric surgery (5.4% vs 10.1%; P = .004) and CSF shunt procedures (≤ 1.8% vs 5.2%; P = .002) were significantly less frequently performed in the GLP-1 RA group. Mortality was significantly lower in the GLP-1 RA group (≤ 2.0% vs 5.0%; P = .003). Statistical comparisons could not be made for tinnitus, optic atrophy, spinal puncture, and VSS because of small sample sizes. 'Pleasantly Surprised' Rivet said he was 'pleasantly surprised' that the benefits of GLP-1 RAs were seen across the board. 'If you told me that it was only beneficial in reducing surgeries or only beneficial in reducing medications, that would still be important and it would be a victory, but it was beneficial for both,' he said. He was particularly encouraged by the reduction in symptoms among GLP-1 RA users. Patients are mostly concerned about feeling better and getting their headaches under control, he said. While it's too early to routinely recommend GLP-1 RAs for IIH without randomized controlled trials, as a surgeon Rivet said he would discuss these agents as a viable alternative to surgery with patients. Interestingly, mean BMI remained similar between treated and control groups, suggesting benefits beyond weight loss, which appears to suggest there are alternative mechanisms for GLP-1 RA therapy. Rivet referenced a pilot study showing a rapid reduction in ICP within 2.5 hours of GLP-1 RA administration, indicating mechanisms other than weight loss. Potential effects may include metabolic actions on the choroid plexus or hypothalamic appetite control. GLP-1 RAs have relatively milder side effects, mainly gastrointestinal effects, than bariatric surgery. Economically, GLP-1 RAs may be less costly upfront than surgery, and prices could decrease as newer medications emerge and older agents go off-label, he noted. Limitations of the study included potential diagnostic coding errors, lack of blinding, no differentiation among GLP-1 RA types or doses, and limited generalizability. Additionally, the study did not address whether patients discontinued GLP-1 RAs due to side effects. Need for Further Validation In an accompanying editorial, Nancy J. Newman, MD, of the Departments of Neurology and Neurological Surgery at Emory University School of Medicine in Atlanta, and colleagues described the findings as 'encouraging' but emphasized that well-designed studies are 'essential' given the limited data on GLP-1 RAs as monotherapy or in combination regimens for IIH. 'It is time for industry to recognize that the IIH patient population is unfortunately rapidly growing and a market worth testing with an appropriately designed clinical trial of GLP-1 RAs for IIH treatment,' they noted. IIH is particularly challenging to study retrospectively using EHR data because it is frequently misdiagnosed — especially in women with obesity and chronic headaches, the editorialist added. The 'extremely low' reported prevalence of papilledema among study participants raises concerns that a significant proportion of included patients may not have had true IIH. However, the editorialists acknowledged that this finding could also reflect the undercoding of papilledema, as well as IIH itself. They expressed similar concerns about the reporting of headaches and visual disturbances, noting that systematic or consistent documentation of such symptoms in EHR data is unlikely. The fact that participants experienced beneficial effects without a change in BMI is remarkable and supports the premise that GLP-1 RAs may offer greater therapeutic benefits beyond weight loss, Newman and colleagues noted. They also addressed cost considerations, noting that other medications used for IIH — as well as surgical procedures, many of which fail and require repetition — are often as expensive, if not more so, than GLP-1 RAs. Moreover, these alternatives generally carry a higher risk for serious complications, they wrote.
CBC
10-07-2025
- Health
- CBC
Researchers retract, then re-publish study linking wildfire smoke and dementia
Last year, researchers said they had identified a link between wildfire smoke and increased risk of dementia. Now, they're retracting the study, published last November in the journal JAMA Neurology, after discovering a mistake in how they coded the data. "It was a very small error. We had a single 'or' symbol, where we should have had an 'and' symbol in thousands of lines of code," said Joan Casey, one of the co-authors of the study. They've corrected the error, crunched the data again and republished their paper. Now, the authors say their findings suggest a much more subtle link between wildfire smoke and dementia. "We now have a nuanced finding in the corrected result," said Casey, who is a professor in the school of public health at the University of Washington. Initially, Casey and her colleagues had found when the three-year average concentration of wildfire PM2.5 (the average concentration of fine particulate matter in the air due to wildfires in the region) went up by just one microgram per cubic metre of air, there was an associated 18 per cent of increase in the odds of a dementia diagnosis. Now, Casey believes the increase to be closer to 12 per cent. The finding is also no longer statistically significant, meaning there is some possibility the result is due to chance. But that doesn't mean the researchers were wrong to identify the possible link, says Scott Weichenthal, a professor in the department of epidemiology, biostatistics and occupational health at McGill University. It just means the link needs to be studied further. "The data still suggests there's a positive association there for sure. It's just not quite as strong as it was in their original paper," said Weichenthal, who was not involved with the study. A growing body of research already links long-term exposure to air pollution with an increased risk of dementia. What's less established, is whether specific sources of air pollution — like wildfire smoke — affect the risk of dementia. There's been a limited number of studies, like this one, suggesting wildfire smoke from agriculture and wildfires were associated with higher rates of dementia. Weichenthal says researchers have a long way to go in understanding the long-term effects of wildfire smoke, especially on peoples' brains.
Scottish Sun
10-07-2025
- Health
- Scottish Sun
Looking after grandchildren on a regular basis could significantly lower your risk of dementia, say scientists
Plus, other lifestyle changes to make to reduce your dementia risk MIND MATTERS Looking after grandchildren on a regular basis could significantly lower your risk of dementia, say scientists Click to share on X/Twitter (Opens in new window) Click to share on Facebook (Opens in new window) GRANDPARENTS who care for their grandchildren on a frequent basis could be at lower risk of developing dementia, say researchers. The findings add to a growing body of research that suggests practical and social engagement in older age boosts cognitive health. Sign up for Scottish Sun newsletter Sign up 1 Grandparents who frequently look after their grandchildren have been found to be at lesser risk of dementia Credit: Getty While there's no guaranteed way to prevent dementia, certain lifestyle changes can significantly reduce your risk. A new study, published in Jama Network Open, found grandparents who cared for their grandchildren on a frequent but noncustodial basis had a statically significant lower risk of developing dementia, when compared to those who didn't engage in such roles. Scientists also noted grandparents who were caregiving were more likely to have a mobile phone, which kept them more connected and also helped lower the risk. The study analysed the experiences of more than 10,000 older adults in China and tracked cognitive outcomes in relation to their caregiving activities. In China, roughly 17 million people were living with dementia in 2019, according to a report published in JAMA Neurology in February 2020. "Dementia is a pressing public health concern, with a substantial burden in China, which accounts for nearly 25 per cent of worldwide cases and great socioeconomic costs," the authors wrote. The findings of the new study support previous research suggesting staying socially active and engaged can help preserve brain health, particularly in elderly adults. "The protective association of nonintensive caregiving with dementia odds supports the use-it-or-lose-it hypothesis, which posits that engaging in mentally and socially stimulating activities—such as interacting with grandchildren—can preserve cognitive reserves and delay cognitive decline," the researchers concluded. But the study did caution more intense caregiving duties could have a negative impact. "These benefits, however, appear to have a threshold, as intensive caregiving, often accompanied by heightened stress and caregiving burden, was not associated with reduced dementia odds," the authors warned. Five simple tests that could indicate dementia Social isolation can lead to an increased risk of developing dementia, says the Alzheimer's Society. This is related to whether a person lives alone, and whether they see friends and family regularly or engage in social or community activities. As well as staying in touch with loved ones, finding activities or groups that align with your interests, such as book clubs, walking groups, or sports teams, can help maintain social connections. Embracing new experiences, such as learning new skills or taking up new hobbies can also help. And finding opportunities to connect, such as being open to meeting new people and forming new connections, may also be beneficial. Alongside staying socially connected, experts recommend the following lifestyle changes to stave off dementia...
The Sun
10-07-2025
- Health
- The Sun
Looking after grandchildren on a regular basis could significantly lower your risk of dementia, say scientists
GRANDPARENTS who care for their grandchildren on a frequent basis could be at lower risk of developing dementia, say researchers. The findings add to a growing body of research that suggests practical and social engagement in older age boosts cognitive health. 1 While there's no guaranteed way to prevent dementia, certain lifestyle changes can significantly reduce your risk. A new study, published in Jama Network Open, found grandparents who cared for their grandchildren on a frequent but noncustodial basis had a statically significant lower risk of developing dementia, when compared to those who didn't engage in such roles. Scientists also noted grandparents who were caregiving were more likely to have a mobile phone, which kept them more connected and also helped lower the risk. The study analysed the experiences of more than 10,000 older adults in China and tracked cognitive outcomes in relation to their caregiving activities. In China, roughly 17 million people were living with dementia in 2019, according to a report published in JAMA Neurology in February 2020. "Dementia is a pressing public health concern, with a substantial burden in China, which accounts for nearly 25 per cent of worldwide cases and great socioeconomic costs," the authors wrote. The findings of the new study support previous research suggesting staying socially active and engaged can help preserve brain health, particularly in elderly adults. "The protective association of nonintensive caregiving with dementia odds supports the use-it-or-lose-it hypothesis, which posits that engaging in mentally and socially stimulating activities—such as interacting with grandchildren—can preserve cognitive reserves and delay cognitive decline," the researchers concluded. But the study did caution more intense caregiving duties could have a negative impact. "These benefits, however, appear to have a threshold, as intensive caregiving, often accompanied by heightened stress and caregiving burden, was not associated with reduced dementia odds," the authors warned. Five simple tests that could indicate dementia Social isolation can lead to an increased risk of developing dementia, says the Alzheimer's Society. This is related to whether a person lives alone, and whether they see friends and family regularly or engage in social or community activities. As well as staying in touch with loved ones, finding activities or groups that align with your interests, such as book clubs, walking groups, or sports teams, can help maintain social connections. Embracing new experiences, such as learning new skills or taking up new hobbies can also help. And finding opportunities to connect, such as being open to meeting new people and forming new connections, may also be beneficial. Alongside staying socially connected, experts recommend the following lifestyle changes to stave off dementia... Other ways to reduce your dementia risk There are a number of things you can do to reduce your risk of developing dementia. Alzheimer's Society offers the following tips: Do regular physical exercise Regular physical activity is considered one of the best ways to reduce your risk of dementia. There are two main types - aerobic activity and strength-building activity. Aerobic activity includes activities like brisk walking, running and swimming. Strength-building include exercises like squats and push-ups. A combination of both types of activity is best. Drink less alcohol Drinking too much alcohol exposes your brain to high levels of harmful chemicals. You should avoid drinking more than 14 units of alcohol each week. This is the equivalent of one pint of beer and a small glass of wine each day. Don't smoke Smoking harms the circulation of blood around, particularly blood vessels in the brain. The earlier you stop smoking, the more brain damage you'll avoid. Manage long-term health conditions Certain health conditions, such as high blood pressure, high cholesterol and diabetes can increase the risk of getting dementia. Going for a health check to see if you have any of these is advised. Eating well and regularly exercising can help prevent and manage these conditions. Protect your eyesight and hearing Uncorrected vision loss can increase the risk of dementia. Similarly, hearing loss is tied to increased risk of dementia and could be an early symptom. The use of hearing aids has been shown to reduce the risk of dementia to the level of a person with normal hearing. Protect your head Traumatic brain injuries caused by a blow or jolt to the head, particularly when a person is knocked unconscious, can start a process in the brain where the substances that cause Alzheimer's disease build up around the injured area. If you're in a situation where there's higher-than-normal risk of head injury, such as riding a bike or playing cricket, make sure to wear protective headgear.
Time of India
08-07-2025
- Health
- Time of India
Anxiety, depression and sleep medicines linked to higher risk of neurological disease
Commonly prescribed medicines for anxiety, depression and sleep disorders may pose a heightened risk of developing amyotrophic lateral sclerosis ( ALS ), a progressive and fatal neurological disorder, according to a new study recently published in JAMA Neurology. The study researched the use of anxiolytics (used to relieve anxiety), hypnotics and sedatives (used to aid sleep or calm the body), and antidepressants (which work by altering brain chemistry to improve mood) and found that individuals who were prescribed such medications were more likely to be diagnosed with ALS in the later stages of life. The study further found that people who used these medication before being diagnosed with ALS had a poorer prognosis, which means that their disease progressed quickly and survival rate is minimal. However, experts caution that this finding is based on association, not causation. by Taboola by Taboola Sponsored Links Sponsored Links Promoted Links Promoted Links You May Like Join new Free to Play WWII MMO War Thunder War Thunder Play Now Undo "These medications are often prescribed for symptoms such as anxiety, sleep disturbances, or depression, which may appear during the early (prodromal) phase of ALS - well before a formal diagnosis," explained Dr M S Panduranga, senior consultant (neurology), Dharamshila Narayana Super-specialty Hospital. "So, the link may reflect early, subtle neurological changes rather than the harmful effect of the drugs themselves," the doctor added. Live Events The study, which was conducted in Sweden, analysed nationwide data from over 1,000 ALS patients and more than 5,000 healthy individuals using the Swedish Motor Neuron Disease Quality Registry. The average age of participants was 67.5 years, and just over half (53.1%) were male. Dr Manjari Tripathi, professor and head of neurology at AIIMS, told TOI that such neuropsychiatric medications act on the brain's inhibitory pathways, which could interfere with motor neuron activity. "There could also be a toxic effect, especially with long-term, consistent use - not just occasional doses," she said. "Motor neuron disease leads to slow but steady progression of muscle weakness. Patients begin to struggle with everyday tasks - buttoning a shirt, combing their hair, walking. Eventually, they become wheelchair bound. Swallowing and speech become difficult, and muscles visibly shrink," she said, adding that one type of ALS was the same condition renowned physicist Stephen Hawking lived with for decades. However, the exact timeline between the medication and the onset of ALS remains unfound. Dr Madhukar Bhardwaj, director and head of neurology, Aakash Healthcare, said that a longer history of psychiatric symptoms and prolonged medication use appears to be associated with increased ALS risk. "In some observational studies, individuals using anxiety or depression medications for more than 10 years showed a stronger link with ALS, especially in younger patients. It's not yet certain whether this reflects a true biological risk or simply earlier diagnosis due to more medical attention," he said. "While there's no definitive proof that these medications cause ALS, we need to be cautious, especially when prescribing them to individuals with signs of neurological disease," Dr Anshu Rohatgi, vice-chairperson (neurology), Sir Ganga Ram Hospital told TOI. Meanwhile, doctors say patients must not stop medications on their own and should speak with their healthcare providers if they have concerns. (With TOI inputs)
