tag:blogger.com,1999:blog-67937899119408466562024-02-20T11:53:55.398-08:00Brain DrainThe ramblings of neurosurgeon/author Allen WylerAllen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.comBlogger90125tag:blogger.com,1999:blog-6793789911940846656.post-12708615945516362762011-09-13T14:21:00.001-07:002011-09-13T14:21:43.817-07:00Restless 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. <br />
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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." <br />
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.<br />
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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.<br />
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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. <br />
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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.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-24969338864670660772011-09-09T13:57:00.001-07:002011-09-09T13:57:45.995-07:00Cutting back on sodium might help older adults maintain their cognitive function, particularly in those who aren't physically active.<br />
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.<br />
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The study is published online August 19 in the Neurobiology of Aging.<br />
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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.<br />
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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.<br />
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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.<br />
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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."<br />
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.<br />
Additional studies, the researchers say, are needed to delineate underlying mechanisms at play in the link between sodium intake and cognitive function.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-64429900951653295562011-09-02T15:44:00.000-07:002011-09-02T15:44:52.180-07:00A 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.<br />
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"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."<br />
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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."<br />
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The study was published online July 14 in the American Journal of Geriatric Psychiatry.<br />
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"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.<br />
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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?"<br />
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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. <br />
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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."<br />
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"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.<br />
"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."<br />
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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.<br />
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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."<br />
Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-66947678175511192552011-08-29T17:59:00.001-07:002011-08-29T17:59:02.645-07:00Along 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.<br />
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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.”<br />
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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.<br />
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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.<br />
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Personally, I’m waiting for chocolate martinis to have all my bases covered. <br />
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Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-21014442452612986542011-08-26T14:40:00.000-07:002011-08-26T14:40:55.641-07:00Yippee: 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. <br />
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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 <br />
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.<br />
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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.<br />
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The next step is to figure out how moderate alcohol consumption exerts its protective effect.<br />
"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."<br />
Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-87576822861265259942011-07-23T14:43:00.000-07:002011-07-23T14:43:10.938-07:00Two new studies support the idea that regular exercise can cut the risk for subsequent cognitive decline and dementia risk.<br />
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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.<br />
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.<br />
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"This was equivalent to the difference in cognitive decline observed for women who were 5 to 7 years younger," the authors noted.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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Bottom line? Keep moving.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-34658897884176100592011-06-01T07:28:00.001-07:002011-06-01T07:28:36.758-07:00The 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. <br />
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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.<br />
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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.<br />
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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.<br />
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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. <br />
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So what should cell phone users do? Well, one thing is to restrict use if you’re worried.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com1tag:blogger.com,1999:blog-6793789911940846656.post-61639512519653603162011-04-24T07:42:00.000-07:002011-04-24T07:42:37.480-07:00In a recent Neurology article (2011;76:1395-1402) a study showed that the measurement of the thickness of several areas of the brain’s gray matter may predict who will develop and who will not Alzheimer’s disease (AD) years later and are presently cognitively normal. MRI scans were done on a series of patients, measurement made of various regions of their cortex, and followed for 10 year. 55% in the lowest third of cortical thickness developed AD dementia during follow-up. In contrast, no individual with the highest cortical thickness at baseline developed AD during follow-up.<br />
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" Richard B. Lipton, MD, of Albert Einstein College of Medicine in the Bronx, New York, who was not involved in the study, said, "The most interesting finding is that persons in the highest third of cortical thickness never developed AD. If these findings are replicated, this would mean that we can identify a sizeable group of older adults and reassure them that they are very unlikely to develop AD.<br />
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"In a world where fear of AD is an enormous problem, this kind of reassurance would be valuable to older adults and their families. In addition, these individuals could be excluded from studies of preventive intervention since it is impossible to improve on such low risk," Dr. Lipton said.<br />
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"The study is limited by the small sample size, but the results are exciting because of their strength and consistency," Dr. Lipton commented. "It is worth noting," he said, "that even in those with thinnest cortices, AD did not develop for 4 years. This is likely related to the rigorous exclusion of dementia in the sample, but it suggests that if the goal is short-term prediction of risk, for prevention trials, for example, this is not the way to go," he said.<br />
Dr. Lipton also noted that cortical thickness could be a lifelong marker of brain reserve, a factor that protects against AD.<br />
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"Alternatively, cortical thinning could be a manifestation of unfolding disease, which could produce neuronal loss as illness develops, well before it becomes diagnosable," he said. "These 2 factors could each separately contribute to the findings."Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-71292175200265663332011-02-23T06:35:00.000-08:002011-02-23T06:35:14.837-08:00Cell phones and brain tumors? There has been a great deal of debate in past years about a possible link between cell phone radiation and the development of brain tumors, or more specifically, acoustic neuromas – small tumors that develop on the nerve between the middle ear and the brain. I think it’s fair to say the jury is still out. One criticism is that many of the reports that claim cell phone use is not deleterious have been supported by the device manufacturers, which always creates the specter of conflict of interest. <br />
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A new study reported in this week’s <i>Journal of the American Medical Association</i> (JAMA) measured changes in PET scans immediately after subjects used a cell phone for one hour. The results showed and increase in glucose metabolism in brain areas adjacent to where the cell phone was held. Interesting. Because this shows a direct effect that may be due to the electromagnetic radiation from the phone’s antenna. What is not known at this time is whether this effect is good or bad. That remains to be seen and was not clarified by the study. So, until the association is either proven or disproven, it might be wise to use hands-free earphones.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-35942405921750188272011-01-28T13:16:00.001-08:002011-01-28T13:16:32.728-08:00An interesting study was published this week in the <i>British Medical Journal</i>. For years it’s been known that sufferers of migraine headaches show small abnormalities on MRI scans that may indicate small strokes. This new study extends this finding to people who likely have tension-type headaches as well as older individuals. Until now, it was unclear whether such small structural brain lesions impair cognitive function. The findings show that they do not. <br />
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The study included 780 older adults (mean age, 69 years). Of these, 163 had a history of severe headache and 116 had migraine, of whom 17 reported aura symptoms. Subjects were given a battery of tests including Mini Mental Status Exam (a brief 30-point questionnaire test that is used to screen for cognitive impairment. It is commonly used in medicine to screen for dementia. It is also used to estimate the severity of cognitive impairment at a given point in time and to follow the course of cognitive changes in an individual over time, thus making it an effective way to document an individual's response to treatment).<br />
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The researchers had MMSE scores for 769 of the 780 subjects. There was no association between overall or specific headache types and impaired cognitive function on the MMSE, regardless of the presence of brain lesions. The researchers note in their report that the battery of cognitive function tests they used yielded similar association patterns, and they chose to report only findings from the MMSE in the current article and will be submitting the full cognitive data in a separate manuscript. Still, this is encouraging news for suffers of migraines and tension headaches.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-83599759050546293252011-01-12T06:43:00.001-08:002011-01-12T06:43:44.319-08:00I’ve not written much in this blog lately, because there wasn’t a great deal of breaking developments to comment on. However, the recent story on the fraud surrounding childhood vaccination is noteworthy. <br />
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The British Medical Journal published a series of 3 articles and editorials charging that the study published in The Lancet in 1998 by Andrew Wakefield and colleagues linking the childhood measles-mumps-rubella vaccine to a "new syndrome" of regressive autism and bowel disease was not just bad science but fraud. According to the first article published in BMJ the study's investigators altered and falsified medical records and facts, misrepresented information to families, and treated the 12 children involved unethically. In addition, Mr. Wakefield accepted consultancy fees from lawyers who were building a lawsuit against vaccine manufacturers."<br />
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Although The Lancet published a retraction of the study last year right after the UK General Medical Council announced that the investigators acted "dishonestly" and irresponsibly," the BMJ editors note that the journal did not go far enough. "The Lancet retraction was prompted by the results from the hearing and was very much based on the concerns about the ethics of the study. What we found was that it was definite fraud and that is a very important thing for the world to know. This article shows that the science was falsified and should be discounted. This evidence "should now close the door on this damaging vaccine scare.<br />
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The study of only 12 patients (small, by any standard) faced almost immediate criticism by the scientific community, which only fueled the paranoia of those paranoid about organized medicine. And although the study was never validated, the media hyped it, setting off a panic among parents. As a result vaccinations decreased dramatically. The 2003 to 2004 vaccination rate of 80% has now recovered slightly in the United Kingdom, but it is still well below the recommended 95% level recommended to ensure "herd immunity."Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-21298375619036920752010-12-04T13:40:00.000-08:002010-12-04T13:40:30.094-08:00Many of us routinely use aspirin to decrease the risk of stroke from blood clots that form either on our heart valves or our carotid arteries. Some people also believe that aspirin also slows the progression of Alzheimer’s Disease (AD). However, a recent review in the journal Stroke suggests that the drug does not slow progression of the disease and may increase the risk for intracerebral hemorrhage (ICH). <br />
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"What we know is that there's no indication to prescribe aspirin in order to slow down cognitive decline, and there's a potential increased risk of hemorrhage, so if there's no clear cardiovascular indication, I think doctors should refrain from prescribing aspirin to Alzheimer's disease patients," said one of the study's authors, Edo Richard, MD, PhD. <br />
For this analysis, researchers searched PubMed and the Cochrane Library for randomized trials up that investigated the effect of aspirin for AD and registered complications of aspirin therapy, including ICH. They found only 2 relevant trials, neither of which had shown an effect of aspirin on progression of cognitive decline. But doctors are sometimes tempted to prescribe aspirin to AD patients if there is any indication of vascular damage, he added. "That, I think, is not a good idea." <br />
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Approached for a comment on the study, Ronald C. Petersen, MD, PhD, director of the Mayo Alzheimer's Disease Research Center, Rochester, Minnesota, called the results "important," "well founded," and "timely," especially with the growing concern about microbleeds and microhemorrhages in AD patients. "The study raises awareness of this complicated issue of blood vessels, hemorrhages, and Alzheimer's disease," said Dr. Petersen.<br />
He pointed out that it is possible aspirin may aggravate small bleeds in the brain. "If the micro bleeds are occurring because of a loss of integrity of the blood vessel wall, be it amyloid being deposited (a substance associated with causing AD) in the wall or whatever, the aspirin, being a blood thinner, would just increase the likelihood of a leak and a bleed," he added.<br />
The results should help convince physicians not to "throw aspirin out there as a panacea, like water, with the idea that it's just aspirin so don't worry about it," said Dr. Petersen. "No, aspirin could be a concern in the right situation. On the other hand, if the person has cardiovascular risk factor where aspirin may very well be important as a prophylaxis, don't be dissuaded from giving it."Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-66441664834031227112010-11-10T06:38:00.000-08:002010-11-10T06:38:23.712-08:00A study in the November issue of the British Journal of Psychiatry reports that participating in regular leisure-time physical activities of any intensity can lead to a decrease in depression. In a study of more than 40,000 Norwegian residents, investigators found that those who were not active during their time away from work were almost twice as likely to have symptoms of depression that those who were regularly active.<br />
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The investigators note that social benefits associated with exercise, such as increased number of friends and social support, may be more important contributors to this association than biological changes. However, there was no association found between workplace exertion (such as walking or heavy lifting) and decreased symptoms of depression. <br />
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Although many past studies have found lower rates of depression for people who are more active, "almost all of the published research on this topic has focused exclusively on intense leisure-time activity such as organized sports, jogging, and fitness classes," write the study authors. They note that results have been mixed when studies have considered other types of activities.<br />
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These participants (50.9% female; mean age, 45.9 years) were asked how often they engaged in light or intense physical activity during their leisure time and how active they were in their workplace. Light activity was defined as any activity not leading to being sweaty or out of breath.<br />
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They also underwent a physical examination and completed the Hospital Anxiety and Depression Scale questionnaire regarding symptoms of depression and anxiety. Social factors were also collected, including age, sex, marital status, education, social class, cigarette or alcohol use, any mental illnesses in immediate relatives, any somatic diseases, and level of social support.<br />
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Results showed that 10.1% had case-level symptoms of depression, 15.2% had symptoms of anxiety, and 5.6% had comorbid depression and anxiety. Those who participated in both light and intense leisure-time activities had decreasing rates of both depression and comorbid depression and anxiety symptoms based on amount of time spent on the activities.<br />
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In other words, "there was an inverse relationship between the amount of leisure-time physical activity and case-level symptoms of depression," investigators write. Although those who participated in light leisure activity had a slightly lower prevalence of anxiety, there was no association found with intense leisure-time activity. There were also no associations found between workplace activity and decreasing symptoms of any of the disorders studied.<br />
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However, the take-home message is that "we know from different sets of data that, at least for depression, some level of physical activity is helpful as opposed to not having activity." There is a large proportion of people who think exercise is too hard or that they do not have time for it. "For that population clinicians should be thinking about recommending that they should at least be engaging in the amount of physical activity that they think they're capable of. So again, little is better than nothing — which is actually a very good message.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-31606200231693929572010-11-07T16:48:00.001-08:002010-11-07T16:48:59.223-08:00A recent article in New York Times pointed out that one of the first signs of impending dementia is an inability to understand money and credit, contracts and agreements.<br />
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The Financial Industry Regulatory Authority, the largest nongovernmental regulator for securities firms doing business in the United States, recently met with individual financial services companies and the Alzheimer’s Association to formulate guidelines on how to deal with clients who have trouble remembering and reasoning, a problem that is not new but is increasing as the population ages.<br />
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The issue promises to become more complicated as doctors diagnose Alzheimer’s earlier and earlier. If tests indicate that a person is developing dementia, does that mean the patient should be watched, or that should limits be placed on his or her abilities to make financial or legal decisions?<br />
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Financial firms are in “a dicey situation” if they have to decide whether a client can make major decisions about finances or future plans, said John M. Gannon, senior vice president for investor education with the financial regulatory agency. And yet, according to research by Daniel C. Marson, a neuropsychologist at the University of Alabama, Birmingham, confusion over money and finances is perhaps the most important and most predictable early functional change as people descend into dementia.<br />
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This makes sense because managing finances requires long range planning, risk evaluation, a varying degrees of arithmetic skill, all of which are brain functions lost with the varying forms of dementia.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-40298200603122287112010-10-28T06:44:00.001-07:002010-10-28T06:44:57.721-07:00Alzheimer’s Disease is only one cause of dementia. Until recently the diagnosis was based on the clinical symptoms along brain images the brain showing atrophy. The diagnosis was confirmed with a brain biopsy. Now there is an assay of proteins in the cerebrospinal fluid (CSF) can help specify the diagnosis. <br />
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Despite more than 5 million Americans with Alzheimer's disease, and millions more at risk, these CSF tests have yet to be widely adopted by neurologists. In part because the ability to make an improved early diagnosis raised the question: does this matter? The argument in favor of earlier diagnosis is being able to treat the disease and thus slow the progression. However, not only is there no "magic bullet" for the prevention of Alzheimer's disease, there is no bullet at all. The current treatments offer modest, temporary, and symptomatic improvement at best. <br />
A more persuasive argument in support of the CSF test is this provides more accurate diagnosis when testing new, possibly effective, treatments. The success of clinical trials requires not only that the treatment be effective, but that all subjects be correctly diagnosed. Subjects who have other diseases contaminate the sample and confound results. <br />
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At present, CSF and other biomarker Alzheimer's testing should be reserved for patients who present a diagnostic dilemma and patients entering clinical trials.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-85270926605712146112010-10-15T14:49:00.000-07:002010-10-15T14:49:37.051-07:00Walking at least 6 miles per week appears to maintain brain volume and preserve memory in old age, according to new research. Kirk I. Erickson, PhD, with the University of Pittsburgh, Pennsylvania, and colleagues reported the findings in the October 13 online issue of Neurology.<br />
"These findings are really quite astonishing," Dr. Erickson said. "Other studies have previously shown that exercise is related to brain function, but the fact that we found that walking as little as 1 mile a day is related to brain volume 9 years later, and dementia 13 years later, is truly novel and really quite impressive," he said.<br />
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According to the researchers, the volume of gray matter shrinks in late adulthood and often precedes cognitive impairment. Participation in physical activity and exercise has been "hypothesized to protect against the deterioration of brain tissue, but this hypothesis has not been tested in longitudinal studies." <br />
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In the current study, 299 dementia-free people from the Cardiovascular Health Cognition Study were assessed for physical activity, as measured by the number of blocks they walked in 1 week. Nine years after the physical activity assessment, magnetic resonance imaging (MRI) scans were used to measure brain size. Four years later, the participants were tested for cognitive impairment and dementia.<br />
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Participants who walked at least 72 blocks — approximately 6 to 9 miles — per week had more gray matter than people who walked less; however, walking more than 72 blocks did not appear to increase gray matter volume any further.<br />
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In the 4-year follow-up, 116 of the participants, or 40%, had developed cognitive impairment or dementia. Greater gray matter volume with physical activity was associated with a 2-fold reduced risk for cognitive impairment.<br />
"Based on our results, we can conclude that there is a relation between the amount of walking earlier in life and brain volume in later adulthood and that greater volume of tissue related to walking is associated with a reduced risk of cognitive impairment," the study authors suggest.<br />
Dr. Erickson added that much more work is needed from randomized trials that assign people to an exercise treatment for long periods. "Only under these conditions will we be able to determine the extent to which exercise augments brain function in late life," he said.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-54192011919993083882010-10-08T06:58:00.001-07:002010-10-08T06:58:28.128-07:00Here’s an interesting finding: the relation between the ability to lose weight and lack of sleep. According to the October 5 issue of the <i>Annals of Internal Medicine</i>, lack of sleep appears to compromise the efficacy of dieting to lose weight. <br />
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The study of 10 people conducted in a sleep laboratory showed that there are multiple hormonal changes associated with sleep and these may affect the ability of dieters to lose weight. Not getting enough sleep increased the subjects’ hunger, and affected their leptin and ghrelin serum concentrations (ghrelin is a hormone that reduces metabolism and promotes retention of fat). The study found that the reduced sleep decreased the proportion of weight lost as fat by 55%. Subjects who slept 8.5 hours per night lost a mean of 1.4 kg, and those who slept 5.5 hours per night lost a mean of 0.6 kg.<br />
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The major limitation to the study is that the number of subjects was quite small, so the results may not be generalized to the majority of dieters. However, I use any excuse I can to get my 8 hours of sleep.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-4972168561405161072010-09-24T14:42:00.001-07:002010-09-24T14:42:31.766-07:00A new study of high-dose B vitamins suggest the rate of brain shrinkage may be slowed by treatment in elderly people with mild cognitive impairment (MCI). Overall, B vitamins given at a dose high enough to reduce homocysteine (an amino acid) by 31.7% in this trial had a "pretty dramatic effect" on the rate of brain atrophy also of about 30% compared with placebo.<br />
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The effect was greater among those subjects with the highest homocysteine levels. "The treatment actually reduced the rate of shrinkage by 53%, which is a huge effect," said Dr. Smith, the study leader. "We were absolutely delighted with this strong result."<br />
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Neuroimaging studies have established that even in the healthy elderly, the brain shrinks at a rate of about 0.5% per year. In those with Alzheimer's disease, the rate is accelerated to about 2.5% per year, and those with MCI fall somewhere in between, with an intermediate rate of about 1%.<br />
Homocysteine has been confirmed a risk factor for brain atrophy, as well as cognitive impairment and dementia. "Since homocysteine levels can be regulated by B vitamins, because they are the main cofactors in the enzymes involved in metabolizing homocysteine, the question is, 'If you lower homocysteine by giving B vitamins, will you reduce the rate of shrinkage of the brain?'"<br />
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Of course, the big question is whether this reduction in the rate of brain atrophy translates into maintaining cognition. The trial was not big enough to answer that question statistiaclly. However, another study, NORVIT also looked at cognitive outcomes, and showed no effect of B vitamins in improving cognitive performance over 2 years in otherwise healthy elderly subjects (N Engl J Med. 2006;354:2764-2772, 2817-2819). <br />
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For now, I’m going to continue taking vitamins.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-51465392776489082442010-09-16T07:08:00.001-07:002010-09-16T07:08:13.868-07:00At a recent meeting, neurologists described resting-state connectivity of brain regions associated with introspection. This network is chronically hyperactivated and hyperconnected in patients with schizophrenia. When healthy people are at rest, parts of the frontal lobes are not correlated, but in patients with schizophrenia and bipolar disorder, they are linked. This may help explain cognitive dysfunction in both disorders.<br />
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Michael Greicius, MD also addressed the default-mode network of the brain during his talk on Alzheimer's disease. The posterior regions of the default-mode network tend to overlap considerably with brain regions that show reduced metabolism in the earliest stages of Alzheimer's disease. “Using these functional connectivity approaches, our group and others have demonstrated reduced functional connectivity in the default-mode network in Alzheimer's disease, mild cognitive impairment, healthy older controls with prominent amyloid plaque burden, and healthy older carriers of the ApoE4 allele,” he said. In addition to functional changes, this brain network also appears to undergo structural changes and overlap with maps of amyloid plaque distribution (amyloid causes brain cell death in Alzheimer’s Disease).<br />
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Classically, neurologists study and describe brain anatomy whereas psychiatrists are concerned with human behavior. As new brain imaging techniques become more robust, the distinction between these fields of medicine blur.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-83675978328700851072010-09-15T13:38:00.001-07:002010-09-15T13:38:15.299-07:00There’s not been a lot of new information to discuss. But there was a recent review of the various factor believed to contribute to the delay or prevention of cognitive decline. To be included, studies had to have adult participants who were 50 years or older, drawn from general populations, and followed for at least 1 year. 127 observational studies and 22 randomized control trials (RCT), and 16 systematic reviews were reviewed. There was limited evidence to supported the benefits of selected nutritional factors or cognitive and physical activities. Factors associate with an increased risk were current tobacco use, a gene associated with Alzheimer’s Disease, and certain medical conditions. One RCT found a small, sustained benefit from cognitive training and another RCT reported that physical exercise helps to maintain cognitive function. Although the review concluded that there were few potentially beneficial factors in preventing cognitive decline, the overall quality of the evidence is low.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-32580685718074013722010-09-10T07:44:00.000-07:002010-09-10T07:44:13.203-07:00Cell phone use has increased dramatically since being introduced in the early 1980s. But its use has raised questions as to whether repeated low-level exposure to radiofrequency (RF) energy can damage human tissue to the point of causing malignancy. Because most users hold the cell phone against their ear, there is concern usage may cause tumors to either the ear (acoustic neuromas), salivary glands, adjacent brain (gliomas), or the tissue lining of the skull (meningiomas). <br />
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To address this question, an international study, INTERPHONE, was conducted. The study included users with at least 10 years of exposure. In addition it contained users with the greatest cumulative hours of use of any prior study, making it the largest study to date addressing this controversy. The data analysis was quite extensive, but overall the results indicate that cell phone users did not appear to have an increase in risk of either glioma or meningioma. However, there was a suggestion of an increased risk of glioma for those users who had the highest exposure levels of RF energy. This higher exposure could be from either in an increased number of calls or prolonged calls.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-54910345733075570902010-09-01T12:45:00.000-07:002010-09-01T12:45:08.523-07:00The August 19 issue of the New England Journal of Medicine reported that Tai chi may be a helpful intervention for patients with fibromyalgia. "Previous research has suggested that tai chi offers a therapeutic benefit in patients with fibromyalgia," wrote Chenchen Wang, MDl. "...[Tai chi] combines meditation with slow, gentle, graceful movements, as well as deep breathing and relaxation, to move vital energy (or qi) throughout the body. It is considered a complex, multicomponent intervention that integrates physical, psychosocial, emotional, spiritual, and behavioral elements."<br />
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66 participants were randomly assigned to receive classic Yang-style tai chi or a control intervention consisting of wellness education and stretching. In both groups, participants received 60-minute sessions twice weekly for 12 weeks. Fibromyalgia Impact Questionnaire score at the end of 12 weeks was the main study outcome, with higher scores indicating more severe symptoms. There were additional test to measure other aspects of outcome. To assess durability of the response, these tests were performed again at 24 weeks.<br />
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Improvements in the FIQ total score and quality of life in the tai chi group were clinically important. The tai chi group also fared better than the wellness intervention group in physical component scores of the Short-Form Health Survey and mental component scores. These improvements were still present at 24 weeks with no reported adverse events. Limitations of this study include lack of double blinding, lack of generalizability because treatment was delivered by a single tai chi master at a single center, and follow-up limited to 24 weeks.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-2197013741604510932010-08-23T07:07:00.001-07:002010-08-23T07:07:16.282-07:00The September issue of the Journal of Neuropathology and Experimental Neurology reports the first pathological evidence that repetitive brain trauma in contact sports may be associated with motor neuron disease (MND) or ALS — popularly called Lou Gehrig's disease. <br />
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The suspicion that traumatic head and neck injury might trigger ALS began more than 100 years ago. One recent study showed the incidence of ALS among 7325 professional Italian soccer players was 6.5 times higher than expected. In addition, the risk for ALS for veterans of the 1991 Gulf War was 2-fold 10 years after the conflict. Repetitive concussions are associated with chronic traumatic encephalopathy (CTE), a degenerative brain disease that impairs memory, destabilizes emotions, and may progress to dementia.<br />
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CTE is the focus of the Center for the Study of Traumatic Encephalopathy. In the study, researchers analyzed the donated brains and spinal cords of 12 former football players, boxers, and professional hockey players. All 12 evidenced the build-up of abnormal tau protein found in CTE. However, the spinal cords of the 3 athletes thought to have ALS also contained the abnormal protein, a finding not characteristic of sporadic ALS. <br />
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The study authors concur that more research is needed. They recommend looking at how repetitive head injury may use other biological mechanisms such as inflammation to trigger neurodegenerative diseases, the role played by genetics, and the potential for therapeutic intervention. The long period of latency between traumatic brain injury and the onset of CTE and MND could become a window for treatment that would either dampen or block the "neurodegenerative cascade" that follows such brain trauma. <br />
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Increased awareness of the cumulative effects of concussion has resulted in improved football helmet design as well as how coaches manage players.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-17706669135260152822010-08-20T07:59:00.000-07:002010-08-20T07:59:05.121-07:00When trying to sleep, have you ever experienced strange feelings in legs that compel you to move them? If so, you may have experienced Restless legs syndrome (RLS). It most commonly affects the legs, but can also affect the arms or torso. Moving the affected body part provides relief for a brief period, but then the sensation returns. <br />
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RLS may start at any age, including early childhood. For some people it is a progressive disease. For others, it happens only under certain conditions, such as extreme fatigue, and then disappears. The sensations are unusual and unlike other common sensations. People who suffer from RLS have a hard time describing them but use words such as: uncomfortable, “antsy”, electrical, creeping and many others. While it may be impossible to describe the sensation to someone without RLS, other RLS sufferers can easily relate to the peculiar sensation. Some people have little or no sensation, yet still have a strong urge to move.<br />
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A National Institutes of Health (NIH) consensus panel established the following criteria for the diagnosis: 1) an urge to move the limbs with or without sensations, 2) improvement with activity, 2) worsening at rest, 3) worsening in the evening or night.<br />
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The diagnosis of RLS is made on a good medical history and physical examination. Other than preventing an underlying cause, such as anemia, no method of preventing restless legs has been established or studied. Treatment of restless legs syndrome involves identifying the cause of symptoms when possible. Stretching the muscles in the legs can bring instant and permanent relief, lasting several days or longer. This does not work for everyone: sometimes relief is temporary, and discomfort can return within seconds.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0tag:blogger.com,1999:blog-6793789911940846656.post-80171200664652234702010-08-16T15:36:00.000-07:002010-08-16T15:36:16.596-07:00Benign paroxysmal positional vertigo (BPPV) is a common clinical disorder characterized by brief recurrent spells of vertigo (dizziness) often brought about by certain head position changes, such as looking up, turning over in bed, or straightening up after bending over. BPPV is an important cause of vertigo with a prevalence of 11 to 64 per 100,000. In one study, 9% of elderly patients that underwent a comprehensive evaluation for nonbalance-related problems were found to have previously unrecognized BPPV. Delays in the proper diagnosis and treatment of this condition are still common, and can lead to unnecessary costs and limitations of function. The importance of recognizing this condition is underscored by the ease and effectiveness of treatment techniques that eliminate symptoms and the need for expensive testing. <br />
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BPPV is caused when small calcium carbonate particles that form in part of the middle ear move into one of the semicircular canals. When the calcium carbonate crystals move within the semicircular canal they cause vertigo. When this happens the eyes develop jerky movements (called nystagmus). The presence of nystagmus during the exam help make the diagnosis.<br />
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The reason for these calcium crystals are formed is not well understood. The calcium debris may break off following trauma or viral infections, but in many instances it seems to occur without identifiable illness or trauma. It may have to do with age-related changes in the protein. Patients with BPPV have recently been found to have more osteopenia and osteoporosis than matched controls, and those with recurrent BPPV tended to have the lowest bone density scores.<br />
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Treatment is to move a patient’s head in the correct direction to move the calcium crystals into a region of the middle ear where they will be normally adsorbed. Once gone, the symptoms resolve. If properly done, the repositioning maneuver eliminates BPPV immediately in greater than 85% of patients..<br />
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At present, the generally accepted recurrence rate of BPPV after successful treatment is 40 to 50% at 5 years of average follow up. There does appear to be a subset of individuals prone to multiple recurrences.Allen Wylerhttp://www.blogger.com/profile/10295516674242503530noreply@blogger.com0