Reactivation of herpes zoster (shingles) infection associated with an increased risk of death in immunocompetent older persons.

OBJECTIVES: To determine whether cutaneous herpes zoster infection in immunocompetent older people is correlated with an increased risk for death. SETTING: Primary care clinics associated with West Virginia University, Morgantown West Virginia. DESIGN: Case-control study PARTICIPANTS: Immunocompetent outpatients born from 1903 through 1931, seen from 1994 through 2001; 102 patients diagnosed with herpes zoster (HZV) infection and 201 controls. The median age of both groups was 75 and the sample size was approximately 5,000. MEASUREMENTS: Three-year mortality, risk, and age of death after first clinic visit for herpes zoster. RESULTS: Fourteen deaths occurred in the control group with a mean age of death of 83.4 and 26 deaths among the subjects with HZV with a mean age of death of 79.6. This age difference was not statistically significant, however the age adjusted risk of dying in three years after reactivation of HZV was 4.9 times the adjusted odds of dying without HZV, controlling for age. (95% confidence intervals for the ratio of adjusted odds: 2.4-10.44) CONCLUSION: In this study reactivation of herpes zoster infection was associated with an increased risk for death in the three years following an infection; deaths were not directly correlated with such an infection, but occurred for various other reasons. This suggests that herpes zoster infections may be a marker for early mortality.

Pharmacologic treatment of Alzheimer's disease: an update.

Alzheimer's disease is characterized by the development of senile plaques and neurofibrillary tangles, which are associated with neuronal destruction, particularly in cholinergic neurons. Drugs that inhibit the degradation of acetylcholine within synapses are the mainstay of therapy. Donepezil, rivastigmine, and galantamine are safe but have potentially troublesome cholinergic side effects, including nausea, anorexia, diarrhea, vomiting, and weight loss. These adverse reactions are often self-limited and can be minimized by slow drug titration. Acetylcholinesterase inhibitors appear to be effective, but the magnitude of benefit may be greater in clinical trials than in practice. The drugs clearly improve cognition, but evidence is less robust for benefits in delaying nursing home placement and improving functional ability and behaviors. Benefit for vitamin E or selegiline has been suggested, but supporting evidence is not strong. Most guidelines for monitoring drug therapy in patients with Alzheimer's disease recommend periodic measurements of cognition and functional ability. The guidelines generally advise discontinuing therapy with acetylcholinesterase inhibitors when dementia becomes severe.