Brain Evaluation

A Drug found to Temporarily Improve Social Behaviors in Frontotemporal Dementia

Oxytocin has been tried successfully with autism and recently was trialed with patients diagnosed with frontal temporal dementia, FTD.  Social behavior is a common consequence of FTD, individuals can become emotionally blunted and withdrawn.  Evidence in the use with autism is that it enhances “relatedness”.  The hormone is thought to enhance positive cues from the environment and to reduce negative ones leading to decreased sensitivity to feeling threatened by the environment.   Time and further research will provide confirmation of whether this drug could be of benefit to those diagnosed with FTD. Neurology Today 1-19-12.

Positive Effects of Nicotine for Neurodegenerative Disorders

Researchers are looking at the positive effect of nicotine on dyskinesias and impulsivity in Parkinson disease, cognitive deficits in ADHD and attention and memory for mild cognitive impairment.  Neurology Today (1-19-12) reports on a recent study published in Neurology involving 67 subjects who participated in a randomized study using the nicotine patch.  The results indicate significant improvement in attention, memory and psychomotor speed.  Nicotinic receptors are seen as regulating other receptor systems like a gain amplifier. 

 

Alzheimer Cascade Starts Two Decades Before Symptoms

Presentation at the neurology conference as interim analysis of data focusing on dominantly inherited Alzheimer disease shows that there is a pathophysiologic cascade leading to the disease that begins to appear 20 years prior to clinical symptoms being seen. Markers include declining left hippocampal volume, increasing presence of tau protein in the CSF and increasing third ventricle volume seen on MRI studies.  Neurology Today, October 20, 2011.  This suggests that small signs of memory changes are very important and not to wait to have neuropsychological testing, to see your primary care physician or neurologist and to strengthen the brain through brain training.

Mild Cognitive Impairment Affects 10 to 20 percent of Older Adults Leaving Them at Risk to Develop Dementia

The presence of mild cognitive impairment (MCI) ranges from 10 to 20 percent of older adults in the United States and Western Europe.  Eighty percent of those diagnosed with MCI are at risk for the diagnosis of dementia in ten years time. (Neurology Today, September 1, 2011)  These dramatic numbers suggest the importance of not waiting for memory issues to become worse and instead to address problems.  Addressing problems early offers the older population the benefit of graceful aging instead of the risk of dementia.  The point being is that there is the opportunity to address memory problems when they are first seen before excuses are made and mistakes due to forgetting are covered up.   Those at risk with MCI can protect their brain with early diagnosis by a neuropsychologist and then seeing their primary care physician or neurologist for medication to prevent further decline.  Brain training helps to bring back memory processes if they are affected and to build brain processes for further prevention.

Age Remains the Single Most Potent Risk Factor for late onset Alzheimer Disease

Age associated decline in health status is a risk factor for Alzheimer’s dementia, age related problems such as heart disease, hypertension, stroke and diabetes are recognized as AD risk factors. Other problems that are common in older people make things worse such as; high plasma cholesterol, morning cough, a sedentary lifestyle, pesticide exposure, dementia in a spouse, feeling tired, lonely and unwell shown to increase the risk of dementia. The idea that emotional and physical frailty are related to dementia.

White matter normal aging versus dementia, what is the difference?

The frontal processes reveal the normal affect of aging given the high level functioning of this brain area and consequently its vulnerability to decline.  Reduced processing speed, decreases of gait speed, reaction times, working memory, abstract reasoning, problem solving and memory retrieval naturally decline during the aging process.  Decreases in the regional posterior cingulated brain area are areas directly correlated with performance in attention, memory, visuospatial and language performance.  Alzheimer’s Dementia however affects the hippocampus area and temporal as well as parietal association cortex.  Neurology 2011, 77, 14-15

Cognitive Impairment is more common in the Southeastern US called the “Stroke Belt”

The stroke belt are the states; Alabama, Arkansas, Georgia, Louisiana,  Mississippi, North Carolina, South Carolina and Tennessee.  First reported in 1965 was the 50 percent higher stroke mortality rate in these southern states.  The current study reveals that the odds of having cognitive impairment was 18 percent higher among residents from these states after adjusting for factors of age, sex and educational level.   The study is seen as underscoring the health behavior of the individuals living in these regions. Neurology Today July 7 2011

Insulin Resistance Linked to Alzheimer’s Plaque 15 years later

This is the headline for the Neurology Today article of 9-2-2010 from a study finding that higher readings on diabetes-related factors including a two hour post load plasma glucose was related to an increased risk of having the characteristic neuritic plaques upon autopsy ten to fifteen years later.  We also know that insulin resistance syndrome and Type II diabetes is related to insomnia and poor sleep.  Thus, the suggestion that poor sleep and insomnia puts people at risk for dementia.

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.

 

 

Dementia has Already Affected the Brain Before Anyone Notices a Memory Problem

This concept was recently presented at a psychiatric conference in November of this year.  The idea being that the brain has already developed the plaque or tangles or the changed picture denoting impairment for approximately ten years prior to memory problems being seen sufficiently to suggest the need for evaluation.  In other words this means that we are ten years too late to make a difference by the time someone notices some memory or word retrieval difficulties.  Likely this is the problem behind the research studies that are not showing robust medication effects.  The medication is designed to prevent further brain impact and not to restore last functioning.  Thus at whatever point the medication is taken would theoretically stop further decline.  But what if the medication is taken at the moderately impaired dementia stage because that was the point that a memory problem became outwardly apparent?  The result would probably not be that favorable.  I think that this has resulted in a negativity towards the medication in combination with individuals not understanding that they will not notice a difference. People are used to taking a medication to fix something and that is simply not the case with the dementia medications.  The result seems to that the aged are not starting on medication when they see a problem and even when the problem has resulted in the need for a residential change. This is the reason why the combination of medication and cognitive brain training is successful.  I truly wonder what the research would look like if dementia was identified early and treated with both medication as well as brain training.  So while there is the hesitation on medication Rome seems to have been burning for some time.