The field of family medicine is continuously advancing, making it challenging for members of the interprofessional team to stay aware of key developments. This article focuses on recent updates in neurology and gastroenterology, which may impact the management of patients by family medicine practitioners.

REGULAR NAPPING LINKED TO GREATER BRAIN VOLUME

Napping during the day is common among young children, but less so after the age of 6 and into adulthood. However, daytime napping may be beneficial to cognitive function.^[1] In a new study, researchers at University College London, United Kingdom, and the University of the Republic of Uruguay, Montevideo, aimed to explore the relationship between regular daytime napping, brain structure and cognition in adults.

They found that daily napping may help preserve brain health and that individuals genetically predisposed to regular napping had larger total brain volume, a surrogate of better cognitive health.^[1]

"Our results suggest that napping may improve brain health," first author Valentina Paz, MSc, a PhD candidate at the University of the Republic of Uruguay in Montevideo told Medscape Medical News. "Specifically, our work revealed a 15.8 cubic cm increase in total brain volume with more frequent daytime napping," she said.

The findings were published online June 19 in Sleep Health.^[1]

Higher Brain Volume

Previous studies examining the potential link between napping and cognition in older adults have yielded conflicting results.

To clarify this association Paz and colleagues used Mendelian randomization to study DNA samples, cognitive outcomes, and functional magnetic resonance imaging (fMRI) data in participants from the ongoing UK Biobank Study.^[1]  

Starting with data from 378,932 study participants (mean age 57), investigators compared measures of brain health and cognition of those who are more genetically programmed to nap with people who did not have these genetic variations. More specifically, the investigators examined 97 sections of genetic code previously linked to the likelihood of regular napping and correlated these results with fMRI and cognitive outcomes between those genetically predisposed to take regular naps and those who were not.^[1]

Study outcomes included total brain volume, hippocampal volume, reaction time, and visual memory. The final study sample included 35,080 with neuroimaging, cognitive assessment, and genotype data.^[1]

The researchers estimated that the average difference in brain volume between individuals genetically programmed to be habitual nappers and those who were not was equivalent to 15.8 cubic cm, or 2.6 to 6.5 years of aging. However, there was no difference in the other 3 outcomes — hippocampal volume, reaction time, and visual processing — between the 2 study groups.^[1]

Since investigators did not have information on the length of time participants napped, Paz suggested that "taking a short nap in the early afternoon may help cognition in those needing it." However, she added, the study's findings need to be replicated before any firm conclusions can be made. More work is needed to examine the associations between napping and cognition, and the replication of these findings using other datasets and methods," she said.

The investigators note that the study's findings augment the knowledge of the "impact of habitual daytime napping on brain health which is essential to understanding cognitive impairment in the aging population. The lack of evidence for an association between napping and hippocampal volume and cognitive outcomes (eg, alertness) may be affected by habitual daytime napping and should be studied in the future."

Strengths, Limitations

Commenting on the findings for Medscape Medical News, Tara Spires-Jones, PhD, president of the British Neuroscience Association and group leader at the UK Dementia Research Institute, said, "the study shows a small but significant increase in brain volume in people who have a genetic signature associated with taking daytime naps."

Spires-Jones, who was not involved in the research, noted that while the study is well-conducted, it has limitations. Because Mendelian randomization uses a genetic signature, she noted, outcomes depend on the accuracy of the signature. "The napping habits of UK Biobank participants were self-reported, which might not be entirely accurate, and the 'napping' signature overlapped substantially with the signature for cognitive outcomes in the study, which makes the causal link weaker," she said. "Even with those limitations, this study is interesting because it adds to the data indicating that sleep is important for brain health," said Spires-Jones.

NO LINK BETWEEN PPIS AND DEMENTIA IN NEW STUDY

Proton pump inhibitors (PPIs) are a class of medicines used in the treatment of a variety of stomach acid-related conditions. They are most commonly prescribed for conditions such as esophagitis, reflux disease, peptic ulcers, Helicobacter pylori infection, and to prevent drug-induced ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs)^[2] In addition, histamine-2 receptor antagonists (H2RAs) are widely used for the treatment of common gastrointestinal conditions such as acid-peptic disease, ulcers, reflux disease and heartburn.^[3] Some studies have suggested that use of PPIs can increase the risk of dementia. As such, investigators from the US conducted a post-hoc analysis of the ASPirin in Reducing Events in the Elderly (ASPREE) trial to determine the association between PPIs and H2RAs with dementia and cognitive decline.^[4]

TOPLINE:

A new study provides reassurance about the long-term safety of PPI and H2RA use in older adults, finding no increased risk for dementia or cognitive changes.^[4]

METHODOLOGY:

• Post hoc observational study within the ASPREE clinical trial^[5]
• 18,934 adults aged 65+ from the US and Australia without dementia at baseline
• 4667 (25%) PPI users and 368 (2%) H2RA users at baseline
• PPI and H2RA use, dementia incidence, and cognitive changes were tracked

TAKEAWAY:

• In multivariable analysis, baseline PPI use was not associated with incident dementia (hazard ratio [HR], 0.88) or cognitive impairment (HR, 1.00)
• PPI use was not linked to changes in overall cognitive test scores over time (β -0.002)
• No associations were found between H2RA use and cognitive endpoints

IN PRACTICE:

"Long-term use of PPIs in older adults is unlikely to have negative effects on cognition," the study team concludes.

STUDY DETAILS:

The study was led by Raaj Mehta, MD, PhD, with Massachusetts General Hospital and Harvard Medical School in Boston. The study was published online June 12 in Gastroenterology.^[4] Funding was provided by grants from the National Institute on Aging, the National Cancer Institute, and other institutions.

LIMITATIONS:

Potential for residual confounding and underestimation of PPI and H2RA use, lack of data on medication dose and duration, and the absence of APOE4 allele status.

INFLAMMATORY BOWEL DISEASE TIED TO INCREASED STROKE RISK

Studies have shown that individuals with inflammatory bowel disease (IBD) have an increased risk for thromboembolic events. However, evidence on long-term risk is lacking. In a new study, researchers looked into the relationships between confirmed IBD and long-term stroke risk in more than 85,000 patients.^[6]

TOPLINE:

Patients with IBD are at increased risk for stroke, especially ischemic stroke, for at least 25 years after diagnosis.

METHODOLOGY:

• IBD, which causes chronic intestinal inflammation, encompasses Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U)
• The population-based cohort study included 85,006 patients with biopsy-confirmed IBD between 1969 and 2019, a matched reference group drawn from the general population and IBD-free siblings
• Covariates included country of birth, socioeconomic status, healthcare-seeking behavior, and cardiovascular-related comorbidities and medication use prior to the index date
• The primary outcome was incident overall stroke; secondary outcomes were incident ischemic and hemorrhagic stroke (including intracranial hemorrhage and subarachnoid hemorrhage)

TAKEAWAY:

• During a median follow-up of about 12 years, there were 3720 incident strokes in IBD patients (incidence rate [IR] 32.6 per 10,000 person-years) compared with 15,599 in the reference individuals (IR, 27.7)
• After multivariable adjustment, IBD patients were at increased risk for overall stroke (adjusted hazard ratio [aHR], 1.13; 95% CI, 1.08, 1.17) and ischemic stroke (aHR, 1.14; 95% CI: 1.09, 1.18), but not hemorrhagic stroke (aHR, 1.06; 95% CI: 0.97, 1.15)
• The aHR for overall stroke remained increased even 25 years after diagnosis, corresponding to one additional stroke case per 93 IBD patients until then
• Individuals with different subtypes of IBD were also at significantly increased risk for overall stroke
• The sibling comparison also showed IBD patients had significantly higher risk for overall stroke and ischemic stroke but not hemorrhagic stroke
• In subgroup analyses, the aHR for overall stroke was higher in women (1.20, vs 1.06 in men), in those with younger onset IBD, and those diagnosed from 2010 to 2019

IN PRACTICE:

These results along with earlier data "indicate that ischemic stroke is one of the most clinically important CVD-related outcomes in IBD patients" write the authors, who urged screening and management of stroke risk factors in IBD patients and development of relevant guidelines.

STUDY DETAILS:

The study was conducted by Jiangwei Sun, PhD, Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden, and colleagues. It was published online June 14 in the journal Neurology.^[6]

LIMITATIONS:

The matched references may have included patients with undiagnosed stroke, which may dilute the real association. Changes in the diagnostic criteria for IBD and stroke over the study period may affect the associations. The study lacked complete data on all protective and stroke risk factors, such as diet and other lifestyle factors, that may confound the association, and data on inflammatory markers.

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