AAP: Pharmacists Must Band Together and Advocate for a Seat at the Table

Christine Blank is a contributing editor. 

The use of antibiotics, regardless of class,was associated with an increased risk of older-onset Inflammatory bowel disease (IBD), according to new research presented at Digestive Disease Week (DDW) 2022, held May 21 to 24 in San Diego, California, and virtually.

Adam S. Faye, MD, MS, lead researcher on the study and assistant professor of medicine and population health at NYU Grossman School of Medicine presented the abstract,

 reviewing 2.3 million patient records that are part of Denmark’s national database, according to a DDW news release.

Faye and colleagues reviewed prescribing records for people aged 60 and older who were newly diagnosed with IBD from 2000 to 2018, evaluating the number of courses of antibiotics prescribed, how recently they had been prescribed in relation to the diagnosis, and specific classes of antibiotics used. 

Researchersfound that the more antibiotics prescribed to patients 60 and older, the more likely they were to develop IBD, suggesting antibiotic use could explain some of the growth in Crohn’s disease and ulcerative colitis in older people.

“In older adults, we think that environmental factors are more important than genetics,” Faye said. “When you look at younger patients with new diagnoses of Crohn disease and ulcerative colitis, there’s generally a strong family history. But that is not the case in older adults, so it’s really something in the environment that is triggering it.”

The study found any antibiotic use was associated with higher rates of IBD, and the risk went up substantially with each course. After 1 prescription, patients were 27% more likely than those with no antibiotic use to be diagnosed with IBD. With 2 courses, the risk rose by 55% and with 3 courses it skyrocketed by 67%.

With 4 courses, the risk soared by a significant 96% and with 5 or more, seniors were 236% more likely to receive a new IBD diagnosis than those with no antibiotics prescribed in the previous 5 years.

New diagnoses were highest when antibiotics were prescribed 1 to 2 years prior, but the risk remained elevated for prescriptions in the period 2 to 5 years before diagnosis.

The relationship was identifiedfor all types of antibiotics, except nitrofurantoin, which is commonly prescribed for urinary tract infections. Antibiotics usually prescribed for gastrointestinal infections were the most likely to be associated with a new IBD diagnosis.

The study has implications for diagnosing older adults with new gastroenterological symptoms, the researchers said; IBD, which can easily be overlooked in this age group, should be considered, especially when there’s a history of antibiotic prescriptions, Faye noted.

Judicious antibiotic use is crucial to preventing IBD, according to Faye.

“Antibiotic stewardship is important; but avoiding antibiotics at all costs is not the right answer either,” Faye said. “If you’re not sure what you are treating, I would be cautious. If patients are coming in with clear infections, and they need antibiotics, they should not be withheld because of these findings.”

1. Faye A. Antibiotics as a risk factor for older-onset ibd: population-based cohort study.Presented at: Digestive Disease Week 2022; May 21-24, 2022; San Diego, CA> Abstract 400. 

2. Antibiotic use associated with inflammatory boweldisease in olderadults. News release. Digestive Disease Week 2022. May 18, 2022. Accessed May 20, 2022. 

https://ddw.org/2022/05/18/antibiotic-use-associated-with-inflammatory-bowel-disease-in-older-adults/

Articles

Seniors prescribed multiple courses of antibiotics were at greater risk for IBD.  

Antibiotics Linked to Higher IBD Risk in Older Adults 

The American Diabetes Association (ADA), VSP Vision Care, and Regeneron are educating Americans about the relationship between diabetes and eye health in observance of Healthy Vision Month in May.

 program, a multi-year initiative from the 3 organizations, is highlighting the importance of prioritizing eye health and sharing resources available for individuals with diabetes and diabetes-related eye diseases. 

“Just as diabetes management is not a one-size-fits-all approach, neither is taking care of our eye health,” said Robert Gabbay, MD, PhD, chief scientific and medical officer for the ADA, in a news release.

 “This Healthy Vision Month, Focus on Diabetes is encouraging you to take control of your health.”

Gabbay noted that thereare easy ways to take care of eye health, including scheduling an annual dilated eye exam and taking or sharing the ADA’s 

.

Diabetes is the leading cause of new cases of blindness in adults aged 18 to 64, according to VSP Vision Care President Kate Renwick-Espinosa. “But it doesn’t have to be,” she said.“In fact, early detection, timely treatment, and appropriate follow-up care can reduce a person’s risk for severe vision loss from diabetes-related eye disease by 95%,”

Focus on Diabetes resources include information on diseases such as diabetic retinopathy, in which blood sugar levels can cause damage to blood vessels In the retina. The web site describes the symptoms as well as treatments, which include controlled blood glucose levels, medication via injections or eyedrops, laser treatment or surgery.

Focus on Diabetes will also feature Focus on Diabetes Champion patient advocates who are sharing their stores of diabetes and eye health on social media throughout the rest of the month.

1. The American Diabetes Association, with visionary partners VSP Vision Care and Regeneron, to address barriers to accessing resources to manageoneseye health. News release. American Diabetes Association. May 2, 2022. Accessed May 16, 2022. 

https://www.diabetes.org/newsroom/press-releases/2022/american-diabetes-association-with-visionary-partners-vsp-vision-care-regeneron-address-barriers-accessing-resources-manage-ones-eye-health

The Focus on Diabetes program will be sharing resources through the end of the month.  

Attention Turns to Diabetes for Healthy Vision Month 

Sleep deprivation negatively impacts corneal stem cells, which can increase the risk for eye disease over the long term, in addition to short-term problems such as dryness and itching.

The cornea, the transparent tissue layer covering the eye, is essential for assuring health and function of the eye, the International Society for Stem Cell Research (ISSCR) explained in a news release.

 The cornea is maintained by stem cells, which divide to replace dying cells and to repair small injuries.

“Corneal stem cell activity needs to be precisely tuned to assure an adequate output of new corneal cells, and dysregulation of corneal stem cells can lead to eye disease and impaired vision,” they said.

To that end, Wei Li, Zugou Liu and colleagues from Xiamen University in China and Harvard Medical School evaluated how sleep deprivation impacts corneal stem cells, in new research published in Stem Cell Reports.

Their experiments in mice showed that short-term sleep deprivation increased the rate at which stem cells in the cornea multiplied. At the same time, sleep deprivation altered the composition of the protective tear film, reducing the tear film antioxidants in sleep-deprived mice.

“The researchers found that the tear film composition had a direct impact on corneal stem cell activity and, encouragingly, application of tear drops containing antioxidants reversed the excessive stem cell activity,” Stem Cell Reports found.

In fact, the L-glutathioneeye drops the researchers used“may be a therapeutic strategy to maintain ocular surface health for those suffering from insufficient sleep,” the authors wrote. 

Further studies are needed to investigate whether administration of L-glutathione eye drops or inhibition of the PI3K/AKT signaling pathway improve the maintenance of the corneal stem cells and whether limbic stem cell deficiency (LSCD) syndrome can be reversed after the reintroduction of sufficient sleep, the researchers noted.

Notably, long-term sleep deprivation produced “serious effects” on corneal health, such as thinning and ruffling of the cornea and loss of transparency, ISSCR said.

In addition, the corneas of long-term sleep-deprived mice contained fewer stem cells, suggesting that persistent stimulation of stem cell activity over longer periods led to exhaustion and loss of corneal stem cells.

The results suggest that sleep deprivation negatively affects the stem cells in the cornea, possibly leading to vision impairment in the long run, ISSCR said.

Further studies are required, the authors noted, to confirm that similar processes are happening in human corneal stem cells and in patients, and to test whether local antioxidant therapy may overcome some of the negative effects of sleep deprivation on corneal health.

1. Study shows sleep deprivation impairs stem cells in the cornea. News release. International Society for Stem Cell Research. April 28, 2022. Accessed May 19, 2022. 

https://www.eurekalert.org/news-releases/951044

2. Li S, Tang L, et al. Sleep deprivation induces corneal epithelial progenitor cell over-expansion through disruption of redox homeostasis in the tear film. 

. 2022;17(5):1105-1119. doi: 10.1016/j.stemcr.2022.03.017.

Researchers may have identified a potential solution. 

Examining the Impact of Sleep Deprivation in Eye Disease 

Results gathered from clinical trials do not always reflect the real-world patient population, but a new study using an electronic medical record (EMR) database has found that patients treated with Dupixent (dupilumab) in the real world achieved outcomes consistent with clinical trials.

The researchers sought to evaluate the real-world effectiveness of Dupixent in adults with moderate-to-severe atopic dermatitis (AD) over a time period that was comparable to clinical trials of Dupixent. The findings were 

While there have been other real-world studies on the effectiveness of Dupixent, they were either in small populations or from a limited number of study sites, the authors noted.

They used the Modernizing Medicine’s Electronic Medical Assistant (EMA) dermatology-specific EMR database, which contains structured, real-world data from more than 30% of the dermatologists in the United States. This database allowed the researchers to extract AD assessments, such as severity based on the six-point Investigator Global Assessment (IGA) scale (0 = clear to 5 = very severe), itch severity based on a numerical rating scale (NRS; 0 – no itch to 10 = most severe itch) and body surface area (BSA) affected.

There was a total of 1,466,601 patients with AD in the database, of which 22,914 were initiated on Dupixent during the study. After applying the inclusion criteria, there were 3 different cohorts, which partially overlapped:

The mostly widely used therapy prior to the index date was topical corticosteroids in 77.0% in the IGA cohort, 83.0% in the NRS cohort and 72.4% in the BSA cohort.

After 4 months of Dupixent, 72.0% of patients in the IGA cohort saw their score improve to ≤ 2 including 42.8% who achieved a score of IGA 0/1. At baseline, 41.6% of patients in this cohort had an IGA score of 3 and 58.4% had a score of 4/5.

Among the NRS cohort, the mean score was reduced to 2.8 after four months of treatment down from a mean score of 7.0 prior to starting Dupixent. “This reduction was driven by a shift in distribution from higher severity levels during the pre-index period, with 70.5% reporting scores in the ‘mild range’ at month 4, including almost one-quarter of the patients (24.1%) with no itch,” the authors wrote.

There was also a significant reduction in BSA affected. During the pre-index period, the reported BSA was 39.3%, which dropped to 16.3% after four months of treatment with Dupixent. When stratified by age, sex and treatment history, there were similar reductions observed.

“On all outcomes, the results showed that the majority of patients achieved benefits after initiation of dupilumab therapy that were statistically significant, clinically meaningful, and consistent with improvements in AD observed at similar time points in the dupilumab clinical trials and other real-world studies,” the authors wrote.

They noted several limitations. First, the data evaluated in the study are optional fields in EMRs and only a small proportion of patients had these data elements recorded both prior to and after initiating Dupixent. In addition, while clinical trials assessed itch severity using the average of daily scores for a week, this study only used a single time point.

Ultimately, the researchers reported that the study corroborated the findings from Dupixent clinical trials.

“These results showed that, in adults with moderate-to-severe AD treated with dupilumab in routine clinical practice, significant and clinically meaningful improvements in clinician-assessed global AD severity were consistently achieved by the majority of patients, with significant and substantial reductions in patient-reported itch severity as well as in BSA affected,” they concluded.

This article was originally published by Managed Healthcare Executive.

Eichenfield LF, Armstrong A, Guttman-Yassky E, et al. Real-world effectiveness of dupilumab in atopic dermatitis patients: analysis of an electronic medical records dataset. 

. 2022 May 11. doi: 10.1007/s13555-022-00731-z.  Online ahead of print. 

Data gathered from an electronic medical record found the results in a real-world patient population with atopic dermatitis were consistent with those found in clinical trials.

Dupixent Clinical Trial Results for Atopic Dermatitis Bolstered by Real-World Evidence

Burnout is a crisis hurting health care providers, other medical workers, patients and the U.S. health care system, and addressing it must become a top national priority, according to Surgeon General Vivek Murthy, MD, MBA.

 The U.S. Surgeon General’s Advisory on Building a Thriving Health Workforce.” The 76-page paper outlined challenges health care workers faced before the COVID-19 pandemic, and how the pandemic made things worse.

Murthy offered practices and policies that health care organizations, insurers, technology companies, lawmakers, academics, and communities can take to help the problem “so that health workers can thrive and better answer their call as healers.”

“The nation’s health depends on the well-being of our health workforce. Confronting the long-standing drivers of burnout among our health workers must be a top national priority,” Murthy said in a 

 about the advisory. “COVID-19 has been a uniquely traumatic experience for the health workforce and for their families, pushing them past their breaking point. Now, we owe them a debt of gratitude and action. And if we fail to act, we will place our nation’s health at risk. This Surgeon General’s Advisory outlines how we can all help heal those who have sacrificed so much to help us heal.”

Murthy offered topline recommendations to address health care worker burnout:

Transform workplace culture to empower health workers and be responsive to their voices and needs.

“We can begin by listening to health workers and seek their involvement to improve processes, workflows, and organizational culture,” Murthy said in the press release.

Eliminate punitive policies for seeking mental health and substance use disorder care.

Health care leaders must ensure on-demand counseling and after work hours care are more accessible to health workers to promote and preserve their well-being.

Protect the health, safety, and well-being of all health workers.

 should provide workers with living wages, paid sick and family leave, rest breaks, evaluation of workloads and working hours, educational debt support, and family-friendly policies including childcare and care for older adults. They must ensure adequate staffing, including surge capacity for public health emergencies, that is representative of the communities they serve.

“This is critical to protect and sustain health workers and communities,” Murthy said.

Reduce administrative burdens to help health workers have productive time with patients, communities, and colleagues.

One study showed that on average, for every hour of direct patient care, a primary care provider will spend two hours a day on administrative tasks. “That is time that could be spent with patients, in the community, and building relationships with colleagues, which is essential to strengthening the health and well-being of both health workers and patients,” the press release said.

Prioritize social connection and community as a core value of the health care system.

This includes peer and team-based models of care to strengthen collaboration and create opportunities for social support and community.

Federal, state, local, and tribal governments should diversify and expand the public health workforce and improve disease surveillance systems to help address social determinants of health and health inequities, counter health misinformation, and strengthen partnerships across clinical and community settings.

The problem has potential to get even worse due to current and projected shortages of physicians and other medical workers, Murthy said, citing the U.S. Bureau of Labor Statistics and the Association of American Medical Colleges.

The nation will need 1.1 million nurses to replace those retiring at the end of 2022. Within five years, there is a projected shortage of more than 3 million low-wage health workers, and by 2033, there is a projected shortage of up to 139,000 physicians.

This article was originally published on Medical Economics.

Medical staff, pushed past their breaking point, say something has to change.

Surgeon General Says Addressing Health Care Worker Burnout Must Be Top Priority

Axsome Therapeutics announced the publication of the results from the pivotal ASCEND phase 2 clinical trial of dextromethorphan-bupropion (AXS-05) in major depressive disorder (MDD).

 Dextromethorphan-bupropion is an oral, investigational N-methyl-D-aspartate (NMDA) receptor antagonist with multimodal activity.

“Major depressive disorder is highly prevalent, debilitating and potentially life-threatening. There is an urgent need for mechanistically new treatments that are effective and well tolerated,” said Dan Iosifescu, MD, professor of psychiatry at the New York University School of Medicine, Director of the Clinical Research Division at the Nathan Kline Institute for Psychiatric Research, and coauthor of the publication. “Due to its novel mechanism of action targeting glutamate and sigma-1 receptors, and to its robust antidepressant efficacy demonstrated in this study, AXS-05 has the potential to become an important and very useful new treatment for patients with major depressive disorder.”

The trial assessed the efficacy and safety of dextromethorphan-bupropion versus bupropion in 80 participants with moderate to severe MDD. Participants were randomized to receive dextromethorphan-bupropion (45 mg dextromethorphan/105 mg bupropion tablet) (n=43), or bupropion (105 mg tablet) (n=37), once daily for the first 3 days and then twice daily for the following 6 weeks. The primary endpoint was overall treatment effect on the Montgomery-Åsberg Depression Rating Scale (MADRS) score.

Dextromethorphan-bupropion demonstrated rapid, statistically significant improvement in depressive symptoms and remission compared with bupropion. The mean change from baseline in MADRS score over weeks 1 to 6 was significantly better with dextromethorphan-bupropion than with bupropion (-13.7 points vs. -8.8 points; least-squares mean difference=-4.9; 

<0.001). Remission rates were significantly greater with dextromethorphan-bupropion at week 2 and every time point thereafter (week 6: 46.5% vs 16.2%; least-squares mean difference=30.3%; 

“We are very pleased with the publication of the ASCEND trial results in 

, the most widely read psychiatric journal in the world,” said Herriot Tabuteau, MD, Chief Executive Officer of Axsome. “ASCEND is one of the pivotal efficacy trials that forms the basis of our NDA for AXS-05 in depression, which is currently under review by the FDA. Axsome is positioned to move expeditiously to make this product available to patients as quickly as possible, should it be approved.”

AXS-05 was generally well tolerated in the trial. Common adverse effects included dizziness, nausea, dry mouth, decreased appetite, and anxiety. AXS-05 was not associated with psychotomimetic effects, weight gain, or sexual dysfunction.

The article, “Effect of AXS-05 (Dextromethorphan-Bupropion) in Major Depressive Disorder: A Randomized, Double-Blind, Controlled Trial,” can be found in 

This article was originally posted by Psychiatric Times.

1. Tabuteau H, Jones A, Anderson A, et al. 

Effect of AXS-05 (dextromethorphan-bupropion) in major depressive disorder: a randomized double-blind controlled trial.

. 2022;appiajp21080800. Online ahead of print.

2. Axsome Therapeutics announces publication of pivotal ascend phase 2 trial of AXS-05 in major depressive disorder in the American Journal of Psychiatry. 

 News release. May 18, 2022. Accessed May 19, 2022. 

https://axsometherapeuticsinc.gcs-web.com/news-releases/news-release-details/axsome-therapeutics-announces-publication-pivotal-ascend-phase-2

Axsome Therapeutics announced the robust antidepressant efficacy demonstrated in this latest study.

ASCEND Phase 2 Clinical Trial for Dextromethorphan-Bupropion Produces Positive Results

Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

Examining the Professional Landscape for Pharmacy Techs

The scope of practice for pharmacy techs has changed in recent years, allowing for greater responsibilities, and the current labor shortage poses some challenges.

New Formulation Approval Patterns Indicate “Evergreening” by Drugmakers

Findings in show that new formulations were more likely for blockbuster drugs and drugs that received accelerated approval. Proxy measures of clinical usefulness and other elements of therapeutic value were not associated with new formulations.

Favorable Response to Third Dose of Pfizer-BioNTech Vaccine Noted for Kids 6 Months to 5 Years

Pfizer-BioNTech reports strong immune response, high efficacy, and favorable safety in third dose of the COVID-19 vaccine.

Examining the Impact of Sleep Deprivation in Eye Disease

Researchers may have identified a potential solution.

Antibiotics Linked to Higher IBD Risk in Older Adults

Seniors prescribed multiple courses of antibiotics were at greater risk for IBD.

Your weekly roundup of the latest news from Drug Topics®.

News Roundup: May 23 to May 27

Arterial stiffness has been identified as a better predictor of future risk of Type 2 diabetes (T2D) than blood pressure, according to a major new study.

Individuals with a combination of high blood pressure and stiffer arteries had the highest risk of developing diabetes, according to the study, published in 

Anxin Wang, PhD, senior study author and a researcher at the China National Clinical Research Center for Neurological Diseases at Beijing Tiantan Hospital in Beijing, China, and colleagues examined health data from 11,156 participants of the Kailuan Study,

 an ongoing, prospective study of more than 100,000 adults aged 18 to 98 years in Tangshan, China.

In 2017, 6 years after the cohort began being tracked, approximately 7% of the study participants had developed T2D.

Researchers found that study participants with elevated arterial stiffness combined with high blood pressure had the highest risk of developing T2D.

Individuals with normal blood pressure and stiffer arteries also had an increased risk of T2D, vs the group with ideal vascular function. Conversely, participants with high blood pressure and normal arterial stiffness had the lowest risk of T2D.

“Identification of individuals at high risk of developing [T2D] is of utmost importance since early intervention can help prevent the onset and slow the progress of the condition,” Wang said in a news release

 from the American Heart Association, which publishes 

According to Wang, the research team was surprised to find that people with increased arterial stiffness were more likely to develop T2D, whether they had high blood pressure or not. “These results provide strong evidence that measuring arterial stiffness may be a better predictor than blood pressure in determining an individual’s future risk of [T2D].”

The analysis also found that the combination of high blood pressure and stiffer arteries was more likely in men, people who were older, had a higher body mass index (BMI) and higher heart rate, and reported smoking cigarettes and drinking alcohol.

People with increased arterial stiffness also had higher fasting blood glucose and cholesterol levels compared to participants who did not. Adjusting the analysis to consider BMI did not change the association between arterial stiffness and T2D, however.

“This finding that arterial stiffness increases the risk for developing Type 2 diabetes supports our existing understanding of cardiovascular disease and Type 2 diabetes,” said Eduardo Sanchez, MD, MPH, chief medical officer for prevention at the American Heart Association and clinical lead for Know Diabetes by Heart, a collaborative initiative between the American Heart Association and the American Diabetes Association.

“We look forward to future investigations about the mechanisms between arterial stiffness and [T2D] risk,” Sanchez said.

More studies are needed to further investigate the underlying mechanisms involved in the associations for arterial stiffness, high blood pressure and T2D risk, and to determine the optimal range of arterial thickness and blood pressure for preventing T2D, Wang noted.

Hypertension, arterial stiffness, and diabetes: A prospective cohort study.

. Published online May 16, 2022. Doi:10.1161/HYPERTENSIONAHA.122.19256

Cumulative exposure to ideal cardiovascular health and incident diabetes in a Chinese population: The Kailuan Study

. 2016;5(9):e004132. Doi:10.1161/JAHA.116.004132

3. Artery stiffness may predict type 2 diabetes risk better than BP and standard risk factors. News release. American Heart Association. May 16, 2022. Accessed May 24, 2022. 

https://newsroom.heart.org/news/artery-stiffness-may-predict-type-2-diabetes-risk-better-than-bp-and-standard-risk-factors-6871750

Identifying these risk factors can help with early detection of T2D.  

Artery Stiffness a Better Predictor of T2D Than Blood Pressure 

Diabetes is 1 of the most important risk factors for developing dementia in middle-aged and older individuals, according to new research published in Neurology.

Researchers from the National University of Ireland (NUI) Galway, Boston University, and the University of Texas health Sciences Center in San Antonio examined data from 5000 people in the United States-based Framingham Heart Study, measuring risk factors for dementia, including age, sex, blood pressure, use of blood pressure lowering medication, a history of cardiovascular disease, atrial fibrillation and diabetes mellitus, NUI Galway said in a news release.

Risk factors were measured at age 55 and again at ages 65, 70, 75 and 80 years.

The researchers found that the most important vascular risk factors for dementia were high blood pressure, diabetes at age 55, and cardiovascular disease at age 65.

At ages 70 and 75, diabetes and previous stroke were the top risk factors,and at age 80, diabetes, previous stroke, and not taking blood-pressure lowering medication were the top risk factors.

“We found that people who had diabetes at the age of 55 were four times more likely to go on to develop dementia than people who did not have diabetes at that age,” said Emer McGrath, associateprofessor at the College of Medicine Nursing and Health Sciences at NUI Galway and consultantneurologist at Saolta University Hospitals.

In addition, people with heart disease at age 65 were nearly twice as likely to later develop dementia as those who did not have a heart condition, while people with a stroke at age 70 were over three times as likely to develop dementia compared to those with no stroke, McGrath noted.

Accurately predicting a person’s future risk of dementia could inform personalized approaches to risk factor and lifestyle modification to help reduce that risk, according to McGrath. "However, predicting this is challenging as the relationship between dementia and vascular risk factors such as diabetes, blood pressure, heart disease and stroke varies with age.”

“Our study shows that predicting a person’s risk of dementia needs to be very much tailored towards the individual, taking into account their age, sex, vascular risk factors and evidence of organ damage, such as previous heart attack or stroke,” McGrath added.

The research has “important implications for dementia prevention at a population-level,” according to McGrath. “Controlling vascular risk factors such as high blood pressure and diabetes mellitus, adopting healthier eating habits and following an active lifestyle, particularly at the early to mid-life stage, could significantly reduce a person’s risk of developing dementia down the line.”

An estimated 64,000 people are living with dementia in Ireland, according to the Alzheimer’s Association of Ireland, The number of people with the condition will more than double in the next 25 years to more than 150,000 by 2045, according NUI Galway.

“Diabetes has been identified as 1 of 7risk factors responsible for up to one-third of cases of Alzheimer’s disease dementia and represents an important modifiable target for dementia prevention at a population-level,” said Professor Sudha Seshadri, co-author of the study, professor of neurology and director of the Glenn Biggs Institute for Alzheimer’s & Neurodegenerative Diseases at the University of Texas Health Sciences Center, San Antonio, and senior investigator with the Framingham Heart Study. 

1. McGrath ER, Beiser AS, O’Donnell A, et al. 

Determining vascular risk factors for dementia and dementia risk prediction across mid- to later-life: The Framingham Heart Study.

Neurology. Published online May 18, 2022. Doi:10.1212/WNL.0000000000200521

2. International study identifies most important vascular risk factors for dementia. News release. National Unviersity of Ireland Galway. May 19, 2022. Accessed May 24, 2022. 

https://www.eurekalert.org/news-releases/953299

Other risk factors include high blood pressure and cardiovascular disease. 

Diabetes Identified as a Top Risk Factor for Dementia 

Substance misuse has become increasingly common in the 21st century, especially among students enrolled in colleges and universities. It has social, economic, psychological, and physiological consequences among adolescents, especially with the emergence of the COVID-19 pandemic and its societal complications. The most used substances on college campuses include alcohol, cannabis, cocaine, prescription opioids, recreational drugs (eg, MDMA), and nicotine, and, more recently, e-cigarettes (vaping). Behavioral addictions (eg, internet gambling) are also very common.

Not only have substance use trends increased in the past 2 decades among university students, but negative perceptions and societal attitudes toward the use of illicit substances have also lessened. The adolescent brain is in a unique period of development at this age, leaving students at a heightened susceptibility to abnormalities on measures of brain functioning, including neurocognition

 which are risk factors for the initiation and maintenance of substance use disorders.

Substance misuse is a strong predictor of student well-being, as it is associated with worsened mental health outcomes, poorer grades, and chronic health problems. According to the National Survey on Drug Use and Health (NSDUH), of the students aged 18 to 22 years, 5.9 million young adults smoked cigarettes in the past month (26.7%), 12.0 million drank alcohol (54.8%), almost 7.8 million engaged in binge drinking (35.3%),

 more than 4.5 million young adults used cannabis (20.7%) and 299,000 used cocaine (1.4%).

Substance use trends for alcohol use, binge drinking, and cocaine use in the past month were higher in full-time college students aged 18 to 22 years compared with their counterparts who were not enrolled in college.

 Between 2007 and 2014, the percentage of students who used cannabis daily nearly doubled.

 Recent results from the NSDUH published in 2020 have reported that cannabis use has continuously increased over the past 5 years in college students, reaching the highest level in more than 3 and a half decades in 2020 at 44%.

Trends in lifetime vaping rose from 26% of college students to 36% between 2015 and 2017. In 2020, the increase in vaping had leveled off, with only a 1% increase in lifetime users from 2019.

 E-cigarettes have become increasingly popular among university students for multiple reasons, including accessibility, a perception of low risk, and the appeal of e-cigarette flavoring in comparison to other smoking methods.

 As with the consumption of tobacco products, there are negative health effects associated with e-cigarettes. The use of nicotine during development increases the risk of long-term addiction and long-lasting consequences toward cognitive development.

In another cluster sample by Primack et al, 114,245 individuals from 158 institutions were sampled from the 2008 to 2009 National College Health Assessment conducted by the American College Health Association to evaluate smoking behaviors.

 There were 6 clusters gathered, and smoking trends in the past 30 days were evaluated. These clusters included individuals who abstain from all substances (54%); individuals who use hookah but dislike cigars (5.5%); users of marijuana who will smoke cigarettes and drink (9.3%); frequent users of cigarettes with some 

 (6.9%); frequent consumers of alcohol with no smoking behaviors (17.1%); and cigar users in combination with other substances (7.3%).

 These results showcased the changes in trends over the past 10 to 15 years, with a rise in the use of tobacco and nicotine products. There is also concern from this study about combining various substances, a common practice among university students.

Alcohol is widely available through North America with the legal drinking age 21 in the United States and 19 in Canada. Not only is the perceived risk of alcohol consumption lowest in individuals aged 19 to 22 years as of 2020, but the prevalence of annual consumption is also highest in full-time college students 1 to 4 years after high school.

 High-risk populations that are more prone to alcohol consumption include fraternity and sorority members and students who used alcohol heavily in high school.

 As mentioned, alcohol is the most used substance among NSDUH survey respondents, with 54.8% of participants reporting use in the past month.

Alcohol consumption has many impacts on the body, contributing to more than 200 diseases and injury-related health conditions, both acute and chronic.

 Of the most prevalent, alcohol use disorder, liver cirrhosis, cancers, and physical injuries are included. Other notable effects can be observed on a student’s mental health, as alcohol misuse may be associated with an increase in depressive symptoms, attempted suicide and self-harm behaviors, and aggression.

Alcohol misuse, like any other substance misuse, is a public health concern. Because of the wide range of effects on physical, psychosocial, and mental health outcomes, monitoring alcohol use trends is essential as current use continues to increase. In 2020, both annual alcohol use (77% versus 67%) and 30-day use (56% versus 49%) were higher among college students than noncollege students.

 More alarmingly, the prevalence of binge drinking, which is defined as having 10 or more drinks in a row, was 12% for both college and noncollege respondents.

 It seems as though the drug epidemic that arose in the early 2000s paralleled a decreased perception of risk for alcohol, as well as increased consumption trends for individuals aged 18 to 22 years.

Cannabis use reached an all-time high in 2020.

 Recreational cannabis is legal in 18 states, the District of Columbia, and Guam, as well as Canada. University students are at an age when they are at a higher predisposition to behavioral effects with frequent cannabis use.

 The regular use of cannabis during adolescence places individuals at a higher risk of developing cannabis use disorder (CUD).

 Frequent use of cannabis has also been associated with compromised university performance, including lower grade point average, delayed high school completion rates, and truancy.

The perceived risk of cannabis has also significantly decreased in the last decade with all individuals between ages 18 and 30 years having the lowest recorded perception of risk for occasional marijuana use in the last 30 years.

 The annual prevalence of cannabis use is slightly higher in full-time college students compared with noncollege students in the first 4 years after high school; however, both groups report that more than 40% of individuals have used cannabis in the past year.

 On most indices of cannabis use including 30-day use and daily use, use by men was significantly higher than by women.

 CUD risk factors include living alone, recent negative life experiences, and using cannabis as a means of coping.

The use of cannabis during brain development can have profound effects on cognitive performance after just 4 weeks of regular cannabis consumption.

 The use of cannabis during adolescence has been associated with higher gray matter volumes in the brain, which was associated with poorer verbal and attentional performance.

The use of cocaine and stimulants (eg, prescription stimulants and methamphetamine) poses great risk for university students. In 2016, it was noted that 4% of full-time college students used cocaine in the past year, 1.4% used cocaine in the past month, and 20% were exposed to opportunities for cocaine in the past year.

The prevalence of annual alcohol consumption is highest in full-time college students 1 to 4 years after high school.

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College Students and Misuse of Substances