Brain Evaluation

Home Based Behavioral Support Showed Significant Improvement in Daily Living for Dementia Patient and Their Caregivers

Home based support made a difference in the lives of dementia patients and their caregivers seen in recent study in JAMA (September 1) at four months.  The home based program provided occupational therapy and nursing support to offer interventions and concrete strategies to address communication, everyday tasks and home safety and care coordination. When the program was over after ten sessions over a four month period, gains made did not persist when re-evaluated at nine months revealing the need for continuous intervention to address problems of shopping, meal preparation, and managing finances.  Significant improvements did not occur with bathing, grooming and getting out of bed which would make sense in terms of the help provided.  It appears that changes in the home setting have to be maintained on a continual basis requiring continued professional support.

 

 

Presence of Sepsis Can Cause Cognitive Impairment

Older people who develop septis, a rather common non-cardiac critical illness are 3.3 times more likely to have moderate to severe cognitive impairment as well as new physical limitations according to a study cited in JAMA (10-27-2010).  This suggests that sepsis is a major event in the life of an elderly person and can initiate cognitive/thinking or functional declines with lasting impact upon independence.  Statistics were presented that if able to survive sepsis that there is a ten percent chance of dementia and further physical disability and 50 percent are at risk for more subtle changes. The idea being that sepsis produces neurological problems and may be the pivotal issue leading to a downward decline of overall functioning in the community independently.      

Heavier Smoking during the 50’s may Double the Risk of Dementia in Later Years

Neurology Today (11-18-2010) cited a study that found heavier smoking in mid-life increased the risk of Alzheimer’s and vascular dementia in later life by as much as 100 percent. This is a long term study, the first long term comprehensive analysis of the potential influence of smoking.  The study was large scale involving 5,367 people diagnosed with dementia over the 23 year follow-up.  A two fold increase in dementia risk was found among those who smoked two packs per day, 44 percent increased risk in those who smoked one to two packs and 37 percent increase in those smoking one-half pack per day in mid-life years. 

 

Early Identification of Autism Spectrum Disorders

Differences in feeding were found in infancy between children in whom Autism spectrum was later diagnosed.  Infants were described as slow feeders and having a later acceptance of solid food which was still present at 15 months. Those children with autism spectrum were significantly more difficult to feed and more selective in their food choices than the control group. After 15 months the diet for the autistic group had significantly less variability and was more restricted. By 24 months the diet restriction was so great that these children were likely to be eating different foods from the rest of the family. By 54 months the children had a special diet due to allergies.  Higher rates of pica (eating non-edible substances) was greater in the autism children between 8 and 54 months.  Children with Autism Spectrum consumed fewer salads, vegetables, fresh fruit, sweets and carbonated drinks than the controls.  There were no weight differences among the children.  This study was documented in the Psychiatric Times (November 2010).  This study illustrates the feeding problems typically documented by parents of children diagnosed with Autism Spectrum Disorder.

 

Omega-3 Helpful for Depression without Co-Morbid Anxiety

A recent study (Clinical Psychiatry, 2010) found that those patients diagnosed with depression without anxiety as a co-morbid factor benefited in terms of reduced depressive symptoms following use of Omega-3  in the largest study yet (423 subjects) to evaluate its effects.  Some of the patients receiving benefit were those who had not shown relief from medication. A portion of the patients had chronic depression and still received benefit over placebo from the Omega-3 supplement. 

Stroke Risk Rises for On Hour Following Cup of Coffee but Only For Infrequent Coffee Drinkers

Neurology Today (11-4-2010) cited study finding that the jolt from a cup of coffee raises the risk of ischemic stroke for one hour but only in those individuals who drink it the least, no more than one cup per day.  This is against the growing body of research showing that regular coffee drinking is associated with a reduced risk of stroke.  This new study focuses upon acute affects as opposed to a longer term protective effect based upon the report of 78 percent of subjects (304 subjects).  232 subjects reported drinking within 24 hours and 35 within one hour of stroke onset.  For those who reported that they typically dank a cup or les per day, had a relative risk of having a stroke in the hour following the one cup was more than tripled suggesting a six fold temporary increase in the risk of stroke.

Alzheimer’s Disease and Diabetes May Share a Common Gene

Neurology Today (11-4-2010) documented a recent study suggesting that Alzheimer’s and Type II Diabetes are complex diseases, sharing risks of high cholesterol, obesity and vasculopathy.  Insulin receptors have been found in the brain used to help glucose get into the cells and play a role in learning and memory.  The gene association was only seen in female animals suggesting that for women diabetes may be a strong risk factor for Alzheimer’s. 

Treatment with Nemanda Found to Improve Function and Behavioral Symptoms in Lewy Body Dementia

A recent large study was reported in the Brown University Geriatric Psychopharmacology Update (November 2010).  Improvement was noted for Lewy body as opposed to Parksonian dementia when the study was completed at 24 weeks in terms of behavior but not thinking ability. At 12 weeks there was improvement seen in patients with Parksonian dementia but not the Lewy body group showed significant improvement on this medication.  However at 24 weeks only those treated who had Lewy body dementia revealed significant improvement.  Scores improved with regard to symptoms of delusions, hallucinations, sleep or nighttime behavior and appetite or eating disorder.  No different seen on scores testing cognition or activities of daily living.   This does suggest the benefit of this medication for dementia for behavioral issues, again illustrating that typically with this medication there are no changes outwardly with cognition, hence the need for brain or cognitive training.  The hypothesis being that the medication acts to prevent further decline but cannot restore what was lost.

Self-Efficacy is Helping Children Believe They Can Succeed

When a child sees their success as a result of their own actions they begin to develop internalized self-esteem and good feelings about themselves.  As these experiences occur more often and begin to build upon one another, self-esteem forms and the belief that they can accomplish any task and that no task is too difficult to achieve.  This is directly the opposite from children who struggle in school and have had too much failure in their lives resulting in the tendency to see everything as easy or difficult which really pertains to their thoughts about their ability to perform well at the task.  Mastery experiences in this regard are the building blocks to form good self-efficacy and belief that one can accomplish anything they set their mind to do.  In this regard it is important to recognize any accomplishment and to teach children to be proud of any task they complete regardless of how easy or how small the task was to accomplish.  Recognize the specific things your child does and praise them on that, name the strength they showed to accomplish the task, teach them to be proud of themselves deterring negative thoughts that might diminish their success.

 

Separating Alzheimer’s from Lewy Body Dementia

The two dementias have an overlap between one another as Lewy Body Dementia is accompanied by Alzheimer’s dementia 80 percent of the time and clinically diagnosed Alzheimer patients were found to have brain pathology associated with Lewy Body dementia at the time of autopsy 35 percent of the time.  Lewy body dementia is estimated to be present in 1.3 million people in the US however because symptoms are associated with other more well known dementias, it is often misdiagnosed and unrecognized.  Neurology Today (10-7-2010)

It can take several years for symptoms to surface clinically to make a diagnosis. However neuropsychological evaluation has a clear method to separate out symptoms of Alzheimer’s dementia from Lewy Body early in the disease process but not late in the disease process.  Symptoms overlap is far more likely to emerge during later stages of the disease process as more of the brain becomes compromised.