Tuesday, September 13, 2011

Restless legs syndrome (RLS) has received much attention in the past year, particularly after the FDA approved ropinirole (Requip) for treatment of moderate to severe RLS. The clinically practical definition of moderate to severe RLS is the presence of symptoms that occur nightly and are severe enough to interfere with sleep quality. Most people who seek medical treatment of RLS would be classified as having moderate to severe RLS. RLS affects about 10% of the population in the West, yet it remains largely undiagnosed.

The sensation or urge to move is usually felt deep within the legs and is always unpleasant but usually not painful. RLS symptoms typically involve both legs, although one side may predominate, or they may alternate. Terms used by patients to describe the sensations vary and are dependent on educational level. Examples include "creepy crawlies," "need to move," "tingling," "restless," "cramping," "pulling," "painful," "electric," "tension," "discomfort," and "itching."
The underlying cause of primary RLS remains unknown, but current thought implicates dopamine and faulty iron metabolism. Iron may also represent a primary factor in the development of RLS, as suggested by recent research. However, the method by which dopamine and iron interact to generate the circadian pattern in the occurrence of RLS symptoms remains unknown. Secondary causes of RLS are associated with some drugs, end-stage renal disease, fibromyalgia, iron deficiency, discontinuation of opiates, pregnancy, use of spinal anesthesia, and uremia.

Non-drug approaches for treating RLS include avoiding alcohol and caffeine within several hours of bedtime, stretching, hot or cold baths, and massage of the affected limbs.

Historically, L-dopa, a drug commonly used to treat Parkinson Disease has been the mainstay for RLS therapy. However, L-dopa is no longer the preferred drug due to its extremely short duration of action and other problems.

Clinicians are now becoming more aware of RLS, and the disorder has even captured the attention of drug manufacturers. Drugs under investigation for RLS include the dopamine agonists pramipexole and rotigotine (transdermal delivery system), and XP13512, a gabapentin prodrug. With the heightened awareness of RLS in the medical community, pharmacists will become increasingly exposed to RLS patients and should be knowledgeable about the symptoms and treatment options. This will allow them to more confidently educate and advise patients on the proper use of medications.

Friday, September 9, 2011

Cutting back on sodium might help older adults maintain their cognitive function, particularly in those who aren't physically active.
In a study of more than 1200 older adults with normal cognitive function at the outset, researchers found that a high intake of sodium combined with low levels of physical activity was associated with a decline in global cognitive function over 3 years. "Importantly, this association was independent of hypertension and global diet quality," the researchers say. "The independent effect of sodium intake from other nutrient intakes, including energy and lipids, suggests that sodium intake alone may affect cognitive function in sedentary older adults above and beyond the effects of overall diet," they note.

The study is published online August 19 in the Neurobiology of Aging.

The well-established negative impact that high sodium intake has on cardiovascular health has led to the development of worldwide population salt-reduction strategies. Given the link between cardiovascular factors, such as hypertension, and brain health, Dr. Fiocco's team wanted to examine the effects of sodium intake on cognitive function.

After controlling for age, sex, education, waist circumference, diabetes, and overall diet, there was an association between sodium intake and cognitive change over time in those with low levels of physical activity. In the low physical activity group, those with low sodium intake displayed better cognitive performance over time than those with medium and high levels of sodium intake. The findings remained unchanged after additional adjustment for intakes of energy, calcium, cholesterol, and total lipids, and total Canadian Healthy Eating Index score, the researchers say.

They failed to see an association between sodium intake and cognitive health among the highly physically active adults. "One potential explanation for this finding is that the impact of physical activity outweighs the impact of sodium intake on cognitive function, making it more difficult to find an association," Dr. Fiocco said.

Dr. Fiocco and colleagues say it is important to note that people who experienced a decline in global cognitive function over the study period "displayed normal age-related decline and did not display clinically significant rates of decline."
According to previous research, a potential mechanism underlying the association between sodium intake and cognition is blood pressure levels, which are associated with white matter lesions observed in dementia patients, the investigators note.
Additional studies, the researchers say, are needed to delineate underlying mechanisms at play in the link between sodium intake and cognitive function.

Friday, September 2, 2011

A combination of brain exercises and healthy lifestyle changes can improve memory performance in healthy elderly adults, new research suggests. In a sample study of 115 participants from 2 live-in retirement communities, those who underwent a new educational program (that included memory training, physical activity, stress reduction, and better diet) showed significant improvements on a variety of measures after just 6 weeks, including word recognition and recall.

"I was very pleased with these significant results in a sample that was not huge," Gary Small, MD, professor of aging at UCLA, told Medscape Medical News. He noted that the investigators wanted to test whether this intervention improved both objective and subjective memory performance. "Subjective memory is a person's self-perception of how they're doing, and objective is how well they do on a pen-and-paper test. It was gratifying to see that this program seemed to be helping people in day-to-day memory challenges."

Karen Miller, PhD, associate clinical professor at UCLA, said in a release that "it was exciting" to see the subjects' participation, as well as their improvements in the memory fitness program. The study demonstrates that it's never too late to learn new skills to enhance one's life."

The study was published online July 14 in the American Journal of Geriatric Psychiatry.

"Despite the effectiveness of memory training interventions in clinical trials, few community-based programs exist, and their effects have not been systematically tested," write the investigators.

The new memory training program uses a standardized curriculum consisting of brain exercises for association and visual imagery, education on a "healthy brain diet" and stress reduction, physical activity, and even assigned memory exercises to be performed at home. The investigators have previously offered this program in a number of settings, including the UCLA campus and senior centers. However, this is the first time it was offered in a retirement living community, which made participation easier because "users did not have to drive to a class off-site," said Dr. Small. "Our group tends to study memory training and healthy lifestyle techniques from the point of view of first developing a program that we think is user friendly and then testing it out. However, many times there's the approach where a scientific study is done first. So a program may be proven to be effective or not, but the question is: Will people use it? And will it be adaptable to a lot of communities?"

After testing, participants were randomly assigned either to undergo the memory fitness program, consisting of 12 twice-weekly, hour-long sessions (15 - 20 per class), or to be placed on a waiting list for the program and considered study controls. Objective cognitive measures during the pretesting phase, as well as at baseline and at study's end, assessed changes in immediate and in delayed verbal memory, retention of verbal information, memory recognition, and verbal fluency. Subjective measures evaluated domains of memory self-awareness, including frequency and severity of forgetting, mnemonics use, and retrospective functioning.

Results showed that the patients who underwent the memory fitness program showed significant improvements postintervention on recognition memory) and retention of verbal list learning. In addition, their retrospective functioning scores increased, "indicating a belief in having a better memory."

"These findings indicate that a 6-week healthy lifestyle program can improve both encoding and recalling of new verbal information as well as self-perception of memory ability in older adults," they write, noting that it may be generalizable to a real-world setting.
"As a community-based educational intervention, the program has the potential to meet the community's need for an affordable and sustainable memory program over time."

John Parrish, PhD, executive director of the Erickson Foundation, which oversees the retirement communities used in this study, said in a release that the foundation is now offering the program in all 16 of their communities across the country. "The study suggests that the memory fitness program may be a cost-effective means of addressing some memory-related concerns of healthy older adults," he said.

Dr. Small said that he hopes that clinicians will see from this study and others that mild, age-related memory complaints can improve with specific training. "There are a lot of ways to learn memory techniques. I think physicians should first ask people about their memory concerns and then try to refer them to get some help.It's important to empower people and teach them about healthy brain lifestyle. Although there's no absolute proof that you can prevent Alzheimer's disease, we know that physical exercise and healthy diet can prevent diabetes, which is itself a major risk factor for Alzheimer's. So it all seems to tie together."

Monday, August 29, 2011

Along with the beneficial effects of alcohol, here’s another health tidbit for you. In a presentation at the European Society of Cardiology (ESC) 2011 Congress, British investigators reported that individuals who ate the most chocolate had a 37% lower risk of cardiovascular disease and a 29% lower risk of stroke compared with individuals who ate the least amount of chocolate.

In the study, published online August 29, 2011 in British Medical Journal, Dr Adriana Buitrago-Lopez and colleagues state: “Although overconsumption can have harmful effects, the existing studies generally agree on a potential beneficial association of chocolate consumption with a lower risk of cardiometabolic disorders. Our findings confirm this, and we found that higher levels of chocolate consumption might be associated with a one-third reduction in the risk of developing cardiovascular disease.”

In this meta-analysis of six cohort studies and one cross-sectional study, overall chocolate consumption was reported, with investigators not differentiating between dark, milk, or white chocolate. Chocolate in any form was included, such as chocolate bars, chocolate drinks, and chocolate snacks, such as confectionary, biscuits, desserts, and nutritional supplements. Chocolate consumption was reported differently in the trials but ranged from never to more than once per day. Most patients included in the trials were white, although one study included Hispanic and African Americans and one study included Asian patients.

Overall, the pooled meta-analysis results showed that high levels of chocolate consumption compared with the lowest levels of chocolate consumption reduced the risk of any cardiovascular disease and stroke. There was no association between chocolate consumption and the risk of heart failure, and no association on the incidence of diabetes in women.

Personally, I’m waiting for chocolate martinis to have all my bases covered.

Friday, August 26, 2011

Yippee: Light to moderate drinking seems to reduce the risk for dementia and cognitive decline, according to a new study published in the August issue of Neuropsychiatric Disease and Treatment.

A meta-analysis of 143 studies on the effects of alcohol on the brain showed that moderate drinking, defined as no more than 2 drinks a day for a man and no more than 1 drink a day for a woman, reduced the risk for Alzheimer's disease and other forms of dementia by 23%. Light to moderate drinking conferred a similar benefit, but heavy drinking (more than 3 - 5 drinks/day) was associated with a nonsignificantly higher risk for dementia and cognitive impairment. Most of the studies did not distinguish between the different types of alcohol, but in a few studies, wine appeared to be more beneficial than beer or spirits. "It really seemed to
A number of explanations for the protective effect of moderate alcohol have been proposed. Some dementias are related to cardiovascular system problems, such as atherosclerosis, and alcohol may be protective because it raises the level of high-density lipoprotein (the good) cholesterol and might improve blood flow in the brain.

Medscape Medical News asked Anton P. Porsteinsson, MD, the William B. and Sheila Konar professor of psychiatry at the University of Rochester School of Medicine to comment on this study. "This is a well-done meta analysis. The findings are consistent with other meta analyses that have been done. Am I tremendously surprised at the findings? No, because they are looking at the same pool of studies," Dr. Porsteinsson said. "The fact that they approach it in slightly different ways and yet find similar outcomes makes me confident that this is what the data are actually signaling to us: that very modest alcohol consumption is protective," he said.

The next step is to figure out how moderate alcohol consumption exerts its protective effect.
"Is it some direct effect of the alcohol on the brain? Are people who consume moderate amounts of alcohol different in some way, in their diet, or their level of exercise? Are low concentrations of alcohol neuroprotective? Is it through some metabolic impact?" Dr. Porsteinsson said. Also interesting was that alcohol appeared to protect against all types of dementia, he said. "This makes it less likely to have a direct effect on beta amyloid or tau (a suspected cause of Alzheimer's Disease), but more of a global effect. It is an interesting review. They made it a pleasure to read."

Saturday, July 23, 2011

Two new studies support the idea that regular exercise can cut the risk for subsequent cognitive decline and dementia risk.

In the first study, researchers used data from the Women's Antioxidant Cardiovascular Study (WACS), a cohort of women with prevalent vascular disease or 3 cardiovascular risk factors.
They report a significant trend toward decreasing rates of cognitive decline with increasing energy expenditure. Compared with women in the bottom forth of total physical activity, significant differences in the rates of cognitive decline were seen for those in the fourth and the fifth quintiles.

"This was equivalent to the difference in cognitive decline observed for women who were 5 to 7 years younger," the authors noted.

Specifically, regularly walking was "strongly related" to slower rates of cognitive decline. However, significant associations were seen only with the top quartile of walking, with a minimum of 30 minutes of walking daily. However, the benefit was not limited to vigorous exercise.

In a separate report, Laura E. Middleton, PhD at Sunnybrook Health Sciences Center, Toronto, Canada, and colleagues used data from the Health, Aging and Body Composition (Health ABC) Study to examine this same question. They looked at the relationship between exercise and incident cognitive impairment using activity energy expenditure (AEE), an objective measure. Physical activity questionnaires usually focus on moderate or vigorous activity related to exercise but don't capture other aspects of activity, such as moving around the house or even fidgeting, the authors note.

The authors report that after adjustment for baseline mental status scores and a variety of other factors, adults in the highest sex-specific third of AEE had lower odds of incident cognitive impairment than those in the lowest third.

In an interview, Dr. Middleton pointed out that there are now a number of studies that have confirmed this relationship, but the vast majority of those have used self-report of physical activity, an approach that carries inherent errors. Those with preclinical dementia may have issues with accurately recalling exercise, for example, and even those who have no such problems tend to over report how much they exercise.

The other issue with self-report is that it doesn't capture activity that is not actual exercise, such as housework, "and in older adults that type of activity makes up a fairly large portion of your total physical activity, especially in someone who doesn't do purposeful exercise." When they did this comparison using only self-report, there was still a relationship, she notes, but it was much clearer using the objective evidence of total energy expenditure.

Bottom line? Keep moving.

Wednesday, June 1, 2011

The World Health Organization (WHO) announced yesterday that cell phone radiation can possibly cause cancer. The key word here is “possibly,” not probably. This announcement is based on an extensive review of studies on cell phone safety by a group of 31 scientists who meet regularly to evaluate the potential carcinogenic hazards from exposure to radiofrequency electromagnetic fields.

Some of the strongest evidence supporting a link between brain tumors and cell phone use comes from a series of Swedish studies, led by Lennart Hardell, MD, PhD, from the Department of Oncology, Orebro Medical Center. These studies showed that risk increased with the number of cumulative hours of use, higher radiated power, and length of cell phone use. The issue of cell phone safety was to have been settled once and for all by the huge 13-nation industry-funded Interphone study. But to date, the industry-funded Interphone studies found no increased risk for brain tumors from cell phone use, with only 4 exceptions. The findings contradicted the Swedish studies, which were independent of industry funding.

There is no consensus among physicians and scientists about the severity of risk, or if one even exists. One issue in attempting to evaluate the potential connection between brain tumors and cell phone use is the relatively short period of time that these devices have been heavily used in a large population and the long latency period for many tumors.

The National Cancer Institute, for example, has stated that although a consistent link has not been established between cell phone use and cancer, "scientists feel that additional research is needed before firm conclusions can be drawn." In a similar fashion, the American Cancer Society points out that even though the weight of the evidence has shown no association between cell phone use and brain cancer, information on the potential health effects of very long-term use, or use in children, is simply not available.

As Dr. Nancy Schneiderman, NBC Medical Correspondent pointed out last night, cell phone use had climbed over the past decade yet the incidence of glioma (the brain tumor alleged to result from exposure) has not.

So what should cell phone users do? Well, one thing is to restrict use if you’re worried.