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."