dementia – Go Retire Psychiatrist

What’s the Skinny on a Vaccine that Might Prevent or Slow Down Dementia?

You don’t want to just take my word for it but there seems to be conflicting messages on a live, attenuated shingles vaccine called Zostavax.

One message is that “the live, attenuated herpes zoster (HZ; shingles) vaccine” might prevent or slow down dementia, especially in women according to a study in Wales and Australia. The article doesn’t mention the name Zostavax (the trade name for the live, attenuated herpes zoster vaccine), which according to a Wikipedia article was “discontinued in the U.S. in November of 2020.”

The other message is that partly because of several lawsuits against Merck (the manufacturer, which faced a lot of Zostavax lawsuits) regarding possible severe, potentially life-threatening side effects alleged to be associated with it, production and marketing of the vaccine was discontinued in the United States as of 2020. The other reason was that Shingrix, a recombinant form of the vaccine, was developed.

Shingrix is said to be superior to Zostavax, although it is also associated with some side effects.

I don’t know why I don’t find any FDA or CDC notifications that Zostavax is no longer available in the United States. Both agencies have archived approval notices still on their websites.

CIDRAP doesn’t mention that residents of the U.S. can longer get Zostavax (in other words, the live attenuated vaccine against shingles) as of 2020.

One of the problems I find with web-based information is that some of the entries can be confusing. I found several articles on line from law firms including one which posted a report on November 14, 2024 that two Black Box Warnings were published by the FDA about Zostavax. I could find only one safety warning on the FDA website (not labeled as “Black Box”) and it was about the new recombinant vaccine, Shingrix. It’s been associated with Guillain Barre Syndrome (GBS) and it’s dated March 24, 2021—a year after Zostavax was removed from the market in the U.S.

OK, as an old retired doctor, my bottom line on this issue of live, attenuated herpes zoster vaccine being touted as an agent that could delay or prevent dementia is that it would be a lot more helpful to me as a consumer to know the whole story about the product. It might be scientifically interesting but it’s moot because the product is not even available in this country and for good reason. And even if it were, would the potential risk and benefit assessment be favorable to recommend its use? And how does this affect the ongoing disagreement dividing the country about the safety and effectiveness of vaccines? Only about 20% of Iowans are even getting the flu shot this season so far.

One thing people could do which might slow down some of the cognitive impairment is to take up the game of cribbage. As far as I know, it has almost no detrimental side effects unless you insist on playing the muggins rule.

Music Therapy in End of Life Care Podcast: Rounding@Iowa

I just wanted to make a quick shout-out to Dr. Gerry Clancy, MD and Music Therapist Katey Kooi about the great Rounding@Iowa podcast today. The discussion ran the gamut from how to employ music to help patients who suffer from acute pain, agitation due to delirium and dementia, all the way up to even a possible role for Artificial Intelligence in the hospital and hospice.

87: New Treatment Options for Menopause – Rounding@IOWA

Join Dr. Clancy and his guests, Drs. Evelyn Ross-Shapiro, Sarah Shaffer, and Emily Walsh, as they discuss the complex set of symptoms and treatment options for those with significant symptoms from menopause. CME Credit Available: https://uiowa.cloud-cme.com/course/courseoverview?P=0&EID=81895 Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guests: Evelyn RossShapiro, MD, MPH Clinical Assistant Professor of Internal Medicine Clinic Director, LGBTQ Clinic University of Iowa Carver College of Medicine Sarah Shaffer, DO Clinical Associate Professor of Obstetrics and Gynecology Vice Chair for Education, Department of Obstetrics and Gynecology University of Iowa Carver College of Medicine Emily Walsh, PharmD, BCACP Clinical Pharmacy Specialist Iowa Health Care Financial Disclosures: Dr. Gerard Clancy, his guests, and Rounding@IOWA planning committee members have disclosed no relevant financial relationships. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 1.00 ANCC contact hour. Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 1.00 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.) References/Resources:

Hoofing it Around the Hospital

Again today, I hoofed it around the hospital. I put 43 floors and a little over 4 miles on my step counter.

I don’t like waiting for elevators so I take the stairs. And a Consult-Liaison Psychiatrist is like a fireman, running all over putting out fires.

I did other things today. I gave the usual lecture on delirium and dementia to the medical students. I notice that as I have gotten older, I tend to tell more anecdotes about my experiences managing delirium in patients on the medical side of the hospital.

I’m in my anecdotage, as I told the students today.

I also lamented the decision by the powers that be to copyright the Montreal Cognitive Assessment (MoCA). The medical students will be able to use it for free, but faculty won’t.

I think that’s ageism. I won’t pay so I won’t use the MoCA anymore.