LETTERS TO THE EDITOR The Relationship between Cancer and Alzheimer‘s Disease To The Editor:-A negative association between Alzheimer’s disease and cancer found at autopsy has previously been observed’ in this hospital. In that series, those with Alzheimer’s disease were older than those without. We have subsequently studied the relationship between cancer and Alzheimer’s disease in our current population using clinical diagnoses. Age-matching was achieved by using a lower cut-off age of 73 so that the mean age of those with clinically diagnosed Alzheimer’s disease was 88.5 and of those without Alzheimer’s disease was 88.3. The diagnosis of primary degenerative dementia of Alzheimer’s type was made by a team using DSM IIIR criteria. The cancer diagnoses were from chart review. Observations were not blind. Among 63 patients (57 female) with Alzheimer’s disease, seven (1 1%) currently had, or had undergone treatment for, cancer (1 meningioma, 3 breast, 2 colon, 1 basal cell of skin). Among 49 patients (45 female) without Alzheimer’s disease, 17 (35%) currently had, or had undergone treatment for, cancer (2 prostate, 3 breast, 3 colon and rectum, 1cervix, 1 tongue, 2 squamous cell of skin, 5 basal cell of skin). Chi square with Yates correction = 7.76; P = CO.01. We still suggest caution in attributing these differences to a biological factor. They may be due to some demographic peculiarity of this population. We should be most interested to hear of the experiences of your readers in this matter. A. LATE DESOUKY, MD Willard Psychiatric Center Willard, NY
certainly included many for whom immunization history was unknown. Patients who have served in the Armed Services are likely to have received at least a primary series of tetanus immunization and will require only a booster to achieve protective levels of immunity.’,’ Since most residents in nursing homes are elderly women, this population is much less likely to have served in the Armed Services, and a primary immunization series usually will be required. We recommend that all physicians consider tetanus-diphtheria immunization for their nursing home patient^.^,^ Lack of a documented history of incomplete immunization should not deter physicians from this health promotion activity. JAMES P. RICHARDSON, MD University of Maryland School of Medicine Baltimore, MD AUBREY L. KNIGHT,MD Roanoke Memorial Hospital Roanoke, VA
REFERENCE
Coexistence of Alzheimer‘s Disease and Diabetes Mellitus To the Editor-Wolf-Klein and associates’ reported a lower frequency of diabetes mellitus in patients with a clinical diagnosis of Alzheimer’s disease (AD), 3.5% for men and 4.2% for women, compared with those with an abnormal mental status attributed to other causes, 13.3%for men and 17.1%for women, and to clinic patients with normal mental status, 16.5% for men and 13.7% for women. They speculated that these results suggest a protective effect of hyperglycemia on the brain, ie, that higher blood glucose concentrations might overcome an impediment to the metabolism or transport of glucose in the aging brain. In order to confirm this intriguing result, we reviewed medical records of 51 patients with autopsy-confirmed AD and 18 nearly age-matched controls. Autopsy results and medical records were available through the National Neurologic Research Specimen Bank. All procedures were approved by the Research and Development Committee, the Human Use Committee, and the Radiation Safety Officer at the Department of Veterans Affairs Medical Center West Los Angeles. All patients met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’sDisease and Related Disorders Association (NINCDS-ADRDA) criteria for definite AD.’ Controls had neuropathological exams demonstrating no central nervous system disease and clinical histories showing no evidence of dementing illness. The mean age for the patient group (76.4 f 6.7 years) was sigruficantly (one-way ANOVA, df = 1,67; F = 12.95; P < 0.001) greater than that for controls (68.0 f 12.4 years). The proportion of women was greater in the AD group (female/
1. Tirumalsetti F, Han L, Birkett DPJ. The relationship befween cancer and Alzheimer’s disease. J Am Geriatr Soc 1991;39:840.
Tetanus-Diphtheria Immunizations in a Nursing Home Population To the Editor:-We are pleased to read of the favorable experience of Hagen-Coenen et al’ regarding tetanus-diphtheria immunizations in a nursing home population. Their demonstration of the safety and mild adverse effects of tetanus-diphtheria (Td) toxoid is consistent with our own experience and that described in the literature.*We applaud Hagen-Coenen and her colleagues for their attention to this health promotion activity for nursing home resident^.^ A few points are worthy of emphasis. Tetanus-diphtheria immunization is recommended for all adults without an upper age limit.2,4Accordingly,immunization with Td should be considered for all residents of nursing homes?5 Physicians may be concerned about the risk of adverse reactions in these patients because most nursing home residents arrive with incomplete records regarding immunization or are unable to recall previous tetanus immunizations. The Immunization Practices Advisory Committee (ACIP) for the Centers of Disease Control recommends that immunization with Td be given to patients who cannot recall any history of previous imm~nization.~ It would have been of interest if HagenCoenen and colleagues had reported the proportion of patients for whom Td vaccination history was available. Nonetheless, their study shows that there were no serious reactions associated with immunizing their population, which almost JAGS 40:1075-1076. 1992 0 1992 by the American Geriatrics Society
REFERENCES 1. Hagen-Coenen J, Drinka PJ,Siewert M. Tetanus-diphtheria vaccinations in a veterans nursing home. J Am Geriatr SOC1992;40:513-514. 2. Richardson JP, Knight AL. The prevention of tetanus in the elderly. Arch Intern Med 1991;151:1712-1717. 3. Richardson JP. Health promotion for the nursing home patient. J Am Board Fam Pract 1992;5:127-136. 4. Centers for Disease Control. Diphtheria, tetanus, pertussis: Guidelines for vaccine prophylaxis and other preventive measures. MMWR 1985;34: 405-426. 5. Richardson JP.Immunizing nursing patients against tetanus. Infect Med 1992, in press.
0002-8614/92f U S 0
certainly included many for whom immunization history was unknown. Patients who have served in the Armed Services are likely to have received at least a primary series of tetanus immunization and will require only a booster to achieve protective levels of immunity.’,’ Since most residents in nursing homes are elderly women, this population is much less likely to have served in the Armed Services, and a primary immunization series usually will be required. We recommend that all physicians consider tetanus-diphtheria immunization for their nursing home patient^.^,^ Lack of a documented history of incomplete immunization should not deter physicians from this health promotion activity. JAMES P. RICHARDSON, MD University of Maryland School of Medicine Baltimore, MD AUBREY L. KNIGHT,MD Roanoke Memorial Hospital Roanoke, VA
REFERENCE
Coexistence of Alzheimer‘s Disease and Diabetes Mellitus To the Editor-Wolf-Klein and associates’ reported a lower frequency of diabetes mellitus in patients with a clinical diagnosis of Alzheimer’s disease (AD), 3.5% for men and 4.2% for women, compared with those with an abnormal mental status attributed to other causes, 13.3%for men and 17.1%for women, and to clinic patients with normal mental status, 16.5% for men and 13.7% for women. They speculated that these results suggest a protective effect of hyperglycemia on the brain, ie, that higher blood glucose concentrations might overcome an impediment to the metabolism or transport of glucose in the aging brain. In order to confirm this intriguing result, we reviewed medical records of 51 patients with autopsy-confirmed AD and 18 nearly age-matched controls. Autopsy results and medical records were available through the National Neurologic Research Specimen Bank. All procedures were approved by the Research and Development Committee, the Human Use Committee, and the Radiation Safety Officer at the Department of Veterans Affairs Medical Center West Los Angeles. All patients met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’sDisease and Related Disorders Association (NINCDS-ADRDA) criteria for definite AD.’ Controls had neuropathological exams demonstrating no central nervous system disease and clinical histories showing no evidence of dementing illness. The mean age for the patient group (76.4 f 6.7 years) was sigruficantly (one-way ANOVA, df = 1,67; F = 12.95; P < 0.001) greater than that for controls (68.0 f 12.4 years). The proportion of women was greater in the AD group (female/
1. Tirumalsetti F, Han L, Birkett DPJ. The relationship befween cancer and Alzheimer’s disease. J Am Geriatr Soc 1991;39:840.
Tetanus-Diphtheria Immunizations in a Nursing Home Population To the Editor:-We are pleased to read of the favorable experience of Hagen-Coenen et al’ regarding tetanus-diphtheria immunizations in a nursing home population. Their demonstration of the safety and mild adverse effects of tetanus-diphtheria (Td) toxoid is consistent with our own experience and that described in the literature.*We applaud Hagen-Coenen and her colleagues for their attention to this health promotion activity for nursing home resident^.^ A few points are worthy of emphasis. Tetanus-diphtheria immunization is recommended for all adults without an upper age limit.2,4Accordingly,immunization with Td should be considered for all residents of nursing homes?5 Physicians may be concerned about the risk of adverse reactions in these patients because most nursing home residents arrive with incomplete records regarding immunization or are unable to recall previous tetanus immunizations. The Immunization Practices Advisory Committee (ACIP) for the Centers of Disease Control recommends that immunization with Td be given to patients who cannot recall any history of previous imm~nization.~ It would have been of interest if HagenCoenen and colleagues had reported the proportion of patients for whom Td vaccination history was available. Nonetheless, their study shows that there were no serious reactions associated with immunizing their population, which almost JAGS 40:1075-1076. 1992 0 1992 by the American Geriatrics Society
REFERENCES 1. Hagen-Coenen J, Drinka PJ,Siewert M. Tetanus-diphtheria vaccinations in a veterans nursing home. J Am Geriatr SOC1992;40:513-514. 2. Richardson JP, Knight AL. The prevention of tetanus in the elderly. Arch Intern Med 1991;151:1712-1717. 3. Richardson JP. Health promotion for the nursing home patient. J Am Board Fam Pract 1992;5:127-136. 4. Centers for Disease Control. Diphtheria, tetanus, pertussis: Guidelines for vaccine prophylaxis and other preventive measures. MMWR 1985;34: 405-426. 5. Richardson JP.Immunizing nursing patients against tetanus. Infect Med 1992, in press.
0002-8614/92f U S 0
