Alvin B. Lin, MD, FAAFP
Dr. Lin is an associate professor of family and community medicine at University of Nevada School of Medicine and an adjunct professor of family medicine and geriatrics at Touro University Nevada College of Medicine. He also serves as an advisory medical director for Infinity Hospice Care and as medical director of Lions HealthFirst Foundation. Dr. Lin maintains a small private practice in Las Vegas, NV. The posts represent the views of Dr. Lin, and in no way are to be construed as representative of the above listed organizations. Dr. Lin blogs about current medical literature and news at http://alvinblin.blogspot.com/.
One of the major issues we face as physicians, and family physicians in particular, is how to motivate our patients to do the right thing. As the saying goes, you can lead a horse to water, but you can't make him drink. Likewise, we only have so much power to inform and cajole our patient. Sure, they're more likely to take a pain pill if they're hurting or an antibiotic if they're running a fever.
But how do you motivate someone regarding relatively silent diseases like diabetes (high sugars), hypertension (high blood pressure) and hyperlipidemia (high cholesterol). When it comes to our health, most of us are more adolescent in our thinking. Oh, it won't happen to me, that only happens to the other guy. That's where motivation by carrot is less persuasive than by stick, but by then, it's too late. The patient has already had the heart attack, stroke or amputation. So we're back to the wake-up call.
Well, in an observational study published yesterday in Neurology, the authors concluded that both obesity and metabolic derangements, separately as well as together, were linked to greater cognitive decline. The latter was defined as two or more of (1) high triglycerides or use of cholesterol lowering medications; (2) high blood pressure or use or blood pressure lowering medications; (3) high glucose or use of diabetes medications; and/or (4) low HDL cholesterol.
Overweight and obesity was defined as usual by body mass index. Four different cognitive tests, each measuring different domains, were administered at baseline and then twice more, 5 years apart. The authors followed 6,401 participants, of whom almost 3 out 4 were men 39 to 63 years of age. Almost 1 out of 3 men had at least two metabolic abnormalities. Two out of 5 were overweight while 1 out of 10 were obese.
The authors noted that in the obese participants, cognitive decline was noted in both metabolically normal and abnormal patients over 10 years. For those with metabolic abnormalities, cognitive decline was noted first in the obese. Bottom line: both obesity and metabolic abnormalities were separately linked to cognitive decline. But more importantly, those participants with both obesity and metabolic abnormalities were noted to have the greatest cognitive decline.
