Statin withdrawal in people with dementia

Background: There are approximately 24 million people worldwide with dementia; this is likely to increase to 81 million by 2040. Dementia is a progressive condition, and usually leads to death eight to ten years after first symptoms. End-of-life care should emphasise treatments that optimise quality of life and physicians should minimise unnecessary or non-beneficial interventions. Statins are 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors; they have become the cornerstone of pharmacotherapy for the management of hypercholesterolaemia but their ability to provide benefit is unclear in the last weeks or months of life. Withdrawal of statins may improve quality of life in people with advanced dementia, as they will not be subjected to unnecessary polypharmacy or side effects. However, they may help to prevent further vascular events in people of advanced age who are at high risk of such events.

Objectives: To evaluate the effects of withdrawal or continuation of statins in people with dementia on: cognitive outcomes, adverse events, behavioural and functional outcomes, mortality, quality of life, vascular morbidity, and healthcare costs.

Search methods: We searched ALOIS (medicine.ox.ac.uk/alois/), the Cochrane Dementia and Cognitive Improvement Group Specialised Register on 11 February 2016. We also ran additional searches in MEDLINE, EMBASE, PsycINFO, CINAHL, Clinical.Trials.gov and the WHO Portal/ICTRP on 11 February 2016, to ensure that the searches were as comprehensive and as up-to-date as possible.

Selection criteria: We included all randomised, controlled clinical trials with either a placebo or 'no treatment' control group. We applied no language restrictions.

Data collection and analysis: Two review authors independently assessed whether potentially relevant studies met the inclusion criteria, using standard methodological procedures expected by Cochrane. We found no studies suitable for inclusion therefore analysed no data.

Main results: The search strategy identified 28 unique references, all of which were excluded.

Authors' conclusions: We found no evidence to enable us to make an informed decision about statin withdrawal in dementia. Randomised controlled studies need to be conducted to assess cognitive and other effects of statins in participants with dementia, especially when the disease is advanced.

Women of an uncertain age: quantifying human capital accumulation in rural Ireland in the nineteenth century

Geary and Stark find that Ireland’s post-Famine per capita GDP converged with British levels, and that this convergence was largely due to total factor productivity growth rather than mass emigration. In this article, new long-run measurements of human capital accumulation in Ireland are devised in order to facilitate a better assessment of sources of this productivity growth, including the relative contribution of men and women. This is done by exploiting the frequency at which age data heap at round ages, widely interpreted as an indicator of a population’s basic numeracy skills. Because Földvári, van Leeuwen, and van Leeuwen-Li find that gender-specific trends in this measure derived from census returns are biased by who is reporting and recording the age information, any computed numeracy trends are corrected using data from prison and workhouse registers, sources in which women ostensibly self-reported their age. The findings show that rural Irish women born early in the nineteenth century had substantially lower levels of human capital than uncorrected census data would otherwise suggest. These results are large in magnitude and thus economically significant. The speed at which women converged is consistent with Geary and Stark’s interpretation of Irish economic history; Ireland probably graduated to Europe’s club of advanced economies thanks in part to rapid advances in female human capital.