In 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.

" 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.

"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.

"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.
Dr. Lipton also noted that cortical thickness could be a lifelong marker of brain reserve, a factor that protects against AD.

"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."

Cell 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.

A new study reported in this week’s Journal of the American Medical Association (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.

An interesting study was published this week in the British Medical Journal. 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.

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).

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.

I’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.

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."

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.

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."

Many 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).

"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.
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."

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.
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.
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."

A 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.

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.

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.

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.

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.

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.

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.

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.

A 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.

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.

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?

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.

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.