Neurology News
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Tuesday, September 19, 2017

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BY SARAH OWENS

People who quit smoking after a stroke or a transient ischemic attack (TIA) significantly reduce their risk of a second stroke, heart attack, or death, according to a new study published online on September 8 in Neurology.

Tobacco's Dangers

Tobacco use is a major risk factor for stroke, accounting for as many as a third or more of all strokes in the United States. Smoking (and other forms of tobacco use) also raise the risk of dementia and Alzheimer's disease, as well as other health conditions like asthma, cancer, and coronary artery disease.

Another risk factor for stroke is already having had a stroke. That's why stroke survivors who smoke are especially at risk.

Assessing Tobacco Use

To measure the health benefit of quitting smoking among stroke survivors, researchers at several universities in the United States and the United Kingdom followed 3,876 participants in the Insulin Resistance Intervention after Stroke (IRIS) study. This international trial involving almost 180 hospitals in seven countries was designed to test the long-term effectiveness of a diabetes drug called pioglitazone. All participants had recently had a stroke or a TIA, and some were smokers. They did not have diabetes, but they were insulin resistant.

At the start of the five-year study and every year thereafter, the researchers gave the participants a questionnaire about their history of tobacco use. At the beginning of the study, 1,072 participants identified as smokers. By the time the participants were randomly assigned to receive pioglitazone or placebo in the IRIS study (the time varied among participants), 450 had quit smoking.

Over the five-year study period, the researchers reviewed the participants' health records to determine how many had had strokes, heart attacks, or died. Then they compared the tobacco use questionnaires to those health records to look for associations between smoking status and health events.​

Never Too Late to Quit

Among people who quit smoking, the five-year risk of stroke, heart attack, or death was 15.7 percent, significantly less than the 22.6 percent among patients who continued to smoke.

These findings show that it's never too late to quit smoking, the study authors say. Plus, they add, the fact that the difference in risk was so substantial within a relatively short time suggests that the risk might drop even more over a longer period of time.

Talk to your Doctor About Quitting

Plenty of resources are available to help you quit smoking. Talk with your doctor, who can direct you to resources, programs, and support groups to help you quit. You can also visit smokefree.gov, a website of the National Institutes of Health, to create a quit plan, learn tips and tricks, speak with experts, and more.


Monday, September 18, 2017

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BY SARAH OWENS

Women who are deficient in vitamin D may have an increased risk of developing multiple sclerosis (MS), according to a new study published online in Neurology on September 13.

A Key Vitamin for Brain Health

Vitamin D plays an important role in health, boosting bone growth and possibly helping to reduce the risk of various diseases. Our bodies make vitamin D when sunlight shines on our skin. It can also be ingested through fatty fish like salmon, egg yolks, foods that have been fortified with vitamin D such as milk and orange juice, and supplements.

For the past decade, researchers have studied the link between vitamin D and MS. Most studies have been small, enrolling fewer than 200 patients, and one did not enroll enough participants who were deficient in vitamin D to adequately assess the link.

Bigger Picture

To look more closely at the association between vitamin D deficiency and MS risk, researchers at Harvard T.H. Chan School of Public Health in Boston and at the University of Turku on Oulu, Finland, assessed data from the Finnish Maternity Cohort study, a large study of more than 800,000 mothers in Finland that has been underway since 1983. The study contains over 1.8 million stored blood serum samples.

The researchers used a special test to measure levels of vitamin D in participants' blood serum samples. Then they assessed participants' health records to identify 1,092 women who had been diagnosed with MS during the course of the study.

A Clear Connection

After comparing levels of vitamin D in the blood samples to MS diagnoses, the researchers found that women with deficient levels of vitamin D had a 43 percent higher risk of developing MS during the course of the study than women with sufficient levels of vitamin D. Additionally, MS risk decreased with increasing vitamin D.

The findings "directly support vitamin D deficiency as a risk factor for MS," the study authors say, and provide a "rationale for broad public health interventions to improve vitamin D levels."

Boost Your Vitamin D

For the sake of your brain as well as your bones, make sure you're getting enough vitamin D in your diet, from sunshine, or through supplements. Get your blood tested regularly to monitor for a deficiency; and, if you're found to be deficient, discuss ways to increase your vitamin D levels with your doctor.

For more on how vitamin D benefits brain health, read our story, "Vitamin D Download": bit.ly/NN-VitaminD.


Monday, September 11, 2017

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BY SARAH OWENS

Drawing a simple spiral with a pen designed to measure drawing speed and pen pressure may help doctors diagnose and measure the progression of Parkinson's disease. That's according to a study published online in the journal Frontiers in Neurology on September 4.

Wobbly Writing May Indicate PD

Parkinson's disease causes a range of movement symptoms, including tremors in the hands, arms, and legs; stiffness; impaired balance, and slow movement known as bradykinesia, which can impair writing and drawing.

Because Parkinson's is progressive, initial symptoms can be subtle and easy to miss. But early diagnosis is critical to slowing the progression. That's what caused researchers to investigate subtle changes in drawing as a possible test for detecting and measuring the disease.​

Putting Pen to Paper

Researchers at Dandenong Neurology Center in Melbourne, Australia, recruited 27 patients with severe Parkinson's disease and 28 healthy controls, for a total of 55 patients. All participants were right-handed, and were matched by age.

Participants were given a tablet computer with weighted paper placed on top and a special pen that can sense the pressure between the pen tip and the paper and the location of the pen's contact with paper, in order to measure the speed of drawing. They were then instructed to draw a simple spiral at their own pace while bright lights shined on the paper to create dots that guided the drawers.

The researchers took each participants' pen pressure and drawing speed and used them to create a composite score. When comparing scores between patients with Parkinson's and controls, the researchers found that people with Parkinson's drew more slowly and with less pressure.

Additionally, when they examined results within the Parkinson's group, the researchers found that those with more advanced disease had poorer composite scores than those with less-advanced disease. This, the researchers say, may indicate that writing skill diminishes as the disease progresses.

Based on their findings, the researchers conclude, tests similar to the spiral-drawing one may be used for "monitoring [Parkinson's] patients and assessing the severity of their disease."


Thursday, September 7, 2017

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BY SARAH OWENS

Low levels of serotonin in the brain may be a risk factor for mild cognitive impairment, according to a study published online on August 14 in the journal Neurobiology of Disease.

An Important Brain Chemical

Serotonin, a neurotransmitter found in the brain, the digestive tract, and the blood, relays messages between nerves to help regulate mood, memory, learning, appetite, and sexual desire.

But imbalances in serotonin can negatively affect these aspects of health. For instance, too much serotonin can lead to serotonin syndrome, a condition that can make a person act drunk or delirious and can even be fatal. There's also some evidence that too little serotonin can negatively affect cognition and may lead to dementia.

Scanning for Serotonin

Researchers at Johns Hopkins University enrolled 28 older adults (average age of 66) who had been diagnosed with mild cognitive impairment (MCI), a condition that involves impaired thinking and memory that may be a precursor to dementia. They also enrolled 28 healthy adults of the same ages who were cognitively normal as controls.

All participants underwent MRI scans to measure the volume of their gray matter, as well as positron emission tomography (PET) scans to measure the flow of blood and serotonin through the brain. After the scans, the participants took a variety of tests that measured their thinking ability, attention, decision-making, and ability to remember things they saw. The researchers hypothesized that participants with MCI would have lower serotonin levels in a widespread pattern throughout the brain compared to the controls.

Low Levels Associated with MCI

As hypothesized, the participants with MCI did have lower serotonin levels than the controls. On average, depending on the brain region, those with MCI had 10 to almost 40 percent more decline in serotonin levels compared to the control group.

Additionally, the changes in serotonin levels were greater than changes in gray matter volumes, suggesting that serotonin levels may be even more accurate markers of cognitive decline than gray matter atrophy.

Treatment Options

Antidepressants and antipsychotic medications can help boost and regulate serotonin in the brain. Some patients with MCI may even already take these medications, since depression can be a symptom of MCI and dementia. Therefore, the researchers say, if the serotonin-MCI link is confirmed in larger studies, low serotonin may be treatable: "Serotonergic agents could be used, potentially, to prevent cognitive decline and the emergence of neuropsychiatric symptoms."

To learn more about serotonin and its role in a variety of neurologic disorders, read our "Ask the Experts" Q&A on serotonin: bit.ly/NN-serotonin.


Tuesday, September 5, 2017

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BY SARAH OWENS

Dance may be an especially good form of exercise for brain health, according to a small study published on June 15 in Frontiers in Human Neuroscience.

Hip Hop and the Hippocampus

Any aerobic exercise such as dancing enhances heart health. But dancing also helps fine-tune motor skills. It also strengthens the vestibular system, which relates to balance, and improves visuospatial skills and the ability to sense where your limbs are in space.

As it turns out, many of these skills are associated with the hippocampus, a part of the brain that helps govern memory and emotion. And larger hippocampal volume indicates better brain health.

Measuring the Effects of Dance

To see if dance affects hippocampal volume, researchers at the University of Magdeburg in Magdeburg, Germany, enrolled 52 healthy older adults between the ages of 63 and 80. At the beginning of the study, all participants underwent MRI brains scans. Then they were randomly assigned to participate either in a six-month program of experimental, choreographed dance or fitness classes that did not include dance.

Classes met for 90 minutes, twice a week, for six months. In the dance class, participants had to memorize different moves that included body turns, head spins, arm moves, skips and hops as well as particular dances such as the chassée, mambo, cha cha, grapevine, and jazz square.

In the fitness class, participants engaged in exercises designed to build endurance, strength, and flexibility, including bicycle riding and walking on a treadmill. They did no coordinated arm and leg exercises.

Dance Boosts Hippocampal Volume

At the end of the six months, participants underwent another MRI scan to assess their hippocampal volumes. They also took two tests, the Somatosensory Organization Test (SOT), which measures improvement in somatosensory ability, and the Balance Master System test, which measures visual and balance skills.

Both groups showed increases in hippocampal volume, but the dance group had a significantly greater increase in the right hippocampus. Both groups also improved their somatosensory and balance skills, but only the dancers improved their visual skills.

The findings, the study authors say, suggest that dancing increases hippocampal volume more than normal exercise, and that increase in volume is associated with improvements in balance, somatosensory skills, and visual skills.

So if you're looking to take up a new form of exercise to improve your brain health, consider a dance class.​

For more on how exercise benefits different neurologic conditions, read our collection of stories on the topic at bit.ly/NN-Exercise.