Spotlight on dementia (for no particular reason)
Where would Biden be if he wasn’t president?
Are there effective drugs for dementia? The Biden team has been cagey about the President’s use of drugs, especially performance-enhancing drugs prior to big debates. By now, however, it’s obvious that there’s no drug that can overcome whatever it is that is currently ailing Biden.
For whatever reason, Biden’s aides are still closing ranks around him. That reputedly includes insulating him from bad news of any kind, for fear of how he’ll react. Those who care for elderly relatives stricken with dementia will be familiar with the image of a person who is difficult to please and easy to anger — and being President and accustomed to being obeyed is unlikely to help in such a scenario.
It’s interesting, however, to ponder how a man of his age with a diagnosis such as the one he is presumed to have, would be treated, were he not President of the United States of America.
Sedated, or dead?
Fortunately for Joe Biden, he was never hospitalized with COVID, but many thousands of people around the world in their late seventies and early eighties did have that misfortune, and often succumbed not to COVID or pneumonia, but to abusive administration of sedatives by nurses who were perhaps overwhelmed and almost certainly over-pressured into complying with protocols designed to make hospitals easier and more profitable to run.
Such practices have been documented by many observers and investigators such as Ken McCarthy, who authored, What the Nurses Saw: An Investigation Into Systemic Medical Murders That Took Place in Hospitals During the COVID Panic and the Nurses Who Fought Back to Save Their Patients. In this book, McCarthy describes how difficult it was for nurses to oppose policies that they knew could result in the demise of the patients.
Nurses who questioned dangerous, irresponsible practices were ruthlessly punished and often fired. Others quit their jobs rather than witness or participate in what amounted to abuse or even murder of patients.
Hospital protocols (crafted by the government) included the use of Remdesivir, which killed many, as well as banning the use of safe and effective (and cheap) treatments such as steroids, vitamin C, and ivermectin. Ventilator misuse is also believed to have resulted in thousands of deaths. But for the elderly, stranded in a sea of medical staff gowned and masked and denied access to their loved ones, perhaps the greatest danger was the use of midazolam.
Complaining will get you nowhere (or somewhere you don’t want to go)
McCarthy describes, based on first-person accounts, how many hospitals administered excessive amounts of midazolam (a sedative in the benzodiazepine class) in order to keep patients passive and docile. It was simply the easiest and most effective way of dealing with people in pain and fear who demanded things that couldn’t, or wouldn’t, be provided — such as effective treatment, visits from relatives, or even just minimal care and attention.
One of midazolam’s many side effects is difficulty breathing. In COVID patients, that often meant a hasty exit from the world and one less patient to worry about.
Writes McCarthy,
You couldn’t have created a better system if your goal was to use the doctors and nurses in hospitals to kill as many people as possible.
He also quotes nurse Kimberley Overton, who said:
It was the complete and total medical mismanagement of COVID that was killing all of our patients.
But what was the novelty in hospitals’ approach to the elderly during the COVID era? Was this really the first time that the elderly, on a large scale, had been sedated and managed rather than treated?
Nothing new under the sun
In April of this year, a new study was published on the effects of prescribing not midazolam but antipsychotics on the elderly with dementia. Perhaps the most disturbing aspect of the study was that it confirmed the results of scores of previous studies. That is, the dangers of prescribing antipsychotics to dementia patients have been known for decades, but the number of prescriptions has only risen, regardless.
The study, which followed over 35,000 people with a dementia diagnosis for at least several years between 1998 and 2018, compared each one of them with 15 matched elderly people with dementia but who did not take antipsychotics. The results showed a significantly increased mortality risk associated with antipsychotic use.
People who took antipsychotics had between a 1.3- and 2.2-fold increased risk of suffering various serious adverse events. The largest increase in absolute risk was for pneumonia. Around 7 percent of patients taking antipsychotics were diagnosed with pneumonia as opposed to around 3 percent of dementia patients who didn’t take such drugs.
The researchers concluded that,
Antipsychotic use compared with non-use in adults with dementia was associated with increased risks of stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury, but not ventricular arrhythmia. The range of adverse outcomes was wider than previously highlighted in regulatory alerts, with the highest risks soon after initiation of treatment.
Huge risks, dubious gains
It is unclear why the study failed to track weight gain among the elderly patients dosed with antipsychotics, as significant weight gain is a very common side effect of such drugs, and often leads to health issues such as diabetes and heart disease.
Even without this consideration, the researchers warned that,
Antipsychotic use is associated with a wide range of serious adverse outcomes in people with dementia, with relatively large absolute risks of harm for some outcomes,
and that therefore,
... these risks should be considered in future regulatory decisions.
Regulations but no regulating
That said, the study also noted that regulations limiting the use of antipsychotics seem to have helped very little to date. Despite increasing awareness of the dangers of these drugs, “the proportion of people with dementia prescribed antipsychotics has increased in recent years.”
In the UK, for instance, regulations are clearly being flouted given that official guidelines state that antipsychotics should only be used for people with dementia if other non-drug options have failed, if patients are at risk of self-harm or harming others, or if they are agitated or delusional and this causes them evident distress. Even then, the regulations caution, antipsychotics should only be prescribed at the lowest effective dose and for the shortest possible time.
In the United States, warnings regarding use of antipsychotics have been in place since at least 2003, when the FDA cautioned against prescribing such drugs due to the increased risk of stroke and other serious adverse events accompanying them.
Following their advisory, a meta-analysis of 17 trials of dementia patients on antipsychotics found a 1.6-1.7-fold increased risk of mortality with atypical antipsychotics compared with placebo, which led the FDA to issue a “black box” warning in 2005 for all atypical antipsychotics — which was extended to typical antipsychotics in 2008 after two observational studies found that the risk of death associated with their use among older people might be even greater than for atypical antipsychotics
Calm or content?
One interesting finding in the recent study was that, on average, elderly patients with dementia who are prescribed antipsychotics only started taking the drugs around two years after they were first diagnosed with dementia. The researchers do not comment on the significance of this, but it is perhaps reasonable to conclude that the decision to prescribe sedating drugs to such people is not one that is taken lightly, but more often out of desperation or exhaustion on the part of their carers.
Another point worth bearing in mind is that the drugs are not the panacea many believe them to be. The researchers noted that,
Our findings must be seen in the context of trial evidence of at best modest benefit on behavioral and psychological symptoms of dementia. The efficacy of antipsychotics in the management of behavioral and psychological symptoms of dementia remains inconclusive ... [and is] modest at best.
That is to say, by and large, elderly patients prescribed antipsychotics will become passive, lethargic, and sleepy, rather than easy-going, happy, and content.
What price a life?
Is there a better way? Many specialists believe so — but there’s a caveat. Non-drug therapies cost more: more money, more time, and more effort.
According to Prof. Charles Marshall, Professor of Clinical Neurology at the Queen Mary University of London,
This evidence should prompt renewed efforts to reduce the prescribing of antipsychotics to people living with dementia. There are rare circumstances where antipsychotics are genuinely required, and the benefits outweigh these risks, but for the majority of patients with behavioral symptoms that might lead to them being prescribed antipsychotics, we should be focusing on much safer behavioral management approaches.
The problem is that this type of intervention is quite expensive and resource-intensive. There is a risk therefore that patients might be prescribed harmful antipsychotics simply because trained staff who can safely manage their behavior are not sufficiently available.
It’s more than just brain fog
Given the increase in numbers of people with dementia, these findings are highly significant. Some estimates suggest that over the next 25 years, over 150 million people worldwide will be affected.
But that’s without taking into account another factor: COVID shots.
Professor Dr. Hiroto Komano is a renowned neuroscientist and professor in the Department of Neuroscience at Iwate Medical University. In a recent interview with Masako Ganaha (Japanese only) he discussed a recent study out of South Korea with extremely troubling findings related to the COVID shots and dementia.
The study followed over 500,000 people who had two COVID shots, comparing them to a similar number who didn’t get the shots. The study concluded that,
Preliminary evidence suggests a potential link between COVID-19 vaccination, particularly mRNA vaccines, and increased incidences of AD [Alzheimer’s Disease] and MCI [mild cognitive impairment]. This warrants the need for further research to elucidate the relationship between vaccine-induced immune responses and neurodegenerative processes, advocating for continuous monitoring and investigation into the vaccines' long-term neurological impacts.
Forty percent of the elderly with dementia?
The “potential link” showed up as over double the risk of MCI in people who took the shots, compared to those who didn’t. Furthermore, three months after the second shot, the number of people in the test group who developed dementia, including Alzheimer’s Disease, increased by over 20 percent compared to the control group.
Currently, “one in five people over the age of 65 already have dementia.” Dr. Kamano noted. “These results mean that this could become two in five people.”
