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Tuesday, June 21, 2016

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BY SARAH OWENS

If you're always on the go from one activity to the next, even staying up late to check off the last item on your to-do list, you may be doing your brain a favor. That's according to researchers at the Center for Vital Longevity at the University of Texas at Dallas, who found that older adults who have packed to-do lists scored better on tests of memory, reasoning, and other measures of cognition.

Testing Cognition

Studies demonstrate that consistently engaging in mentally stimulating activities enhances memory in older adults. To find out if simple busyness—whether mentally stimulating or routine—also improves cognition, the UT researchers looked at a subgroup of 330 adults from the Dallas Lifespan Brain Study, a comprehensive look at the aging brain. The adults, who ranged in age from 50 to 89, completed a questionnaire to assess their level of busyness, including answering questions such as How busy are you during an average day? and How often do you have too many things to do each day to actually get them all done? On a scale of 1 to 5 with 1 being "Never" or "Not busy at all" and 5 being "Very often" or "Extremely busy," participants reported their level of busyness. The higher their score, the busier their schedules.

Participants in the study were then given a series of tests that measured five aspects of cognition: processing speed, or how quickly new information is processed; working memory, the ability to store information temporarily to complete a task; episodic memory, the ability to recall past experiences and people; reasoning; and crystallized knowledge, or tackling problems using learned experience.

In completing the tests, participants had to recall names, solve puzzles, remember the locations of objects, and recognize patterns, among other tasks.

Busyness Benefits

Researchers found that study participants who indicated higher levels of busyness on their questionnaires had better cognition in all five domains of cognitive function. Of all domains, episodic memory was most strongly associated with busyness, although the benefit on the other cognitive domains was "significant," too. Additionally, researchers found that busyness "was similarly influential in adults aged 50-89," suggesting that all participants had better cognition if they were busier, regardless of their age.

Correlation or Causation?

The study authors pointed out a potential conflict between correlation and causation: people with better cognitive abilities may already have a greater ability to load up their schedules and to multitask, rather than the other way around. Still, they pointed out that their findings agree with other studies showing that "sustained engagement in mentally challenging activities" helps improve memory in older adults.

Byproducts of Busyness

The researchers suspect that busy people tend to benefit in other ways.

  • Full engagement. Whether you're socializing, volunteering, exercising, or even just doing chores, staying engaged in tasks can help keep your brain alert.
  • Always learning. Researchers hypothesize that busyness may just be a term for "constantly learning," since busy people are more likely to be exposed to new information and new situations on a daily basis.
  • Lifelong pattern. Since researchers found that the effect of busyness was consistent across age groups, there is a benefit to staying active and busy through middle and late adulthood.

Wednesday, June 15, 2016

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BY SARAH OWENS

Dementia affects more than just memory–it affects behavior, too. In fact, behavioral problems, including agitation, restlessness, and irritability, are sometimes more difficult to manage. And staff at many nursing homes dedicated to caring for people with dementia often lack the expertise required to provide specialized treatment for these symptoms. As a result, employees may use less-than-ideal tactics to care for these patients, including physical restraints and antipsychotic medications. But is there a better alternative?

Videoconferencing sessions with off-site geriatric experts may be the answer, according to results of a pilot study published in Journal of the American Medical Directors Association. These sessions, which involve nursing home staff meeting with geriatric experts via online video, may bridge the gap in expertise and reduce the use of physical restraints and antipsychotic medications for residents with behavioral symptoms of dementia.

Project Videoconference

The videoconference program, called Project ECHO-AGE, connected nursing home staff members at 11 community-based facilities in Massachusetts and Maine with experts in geriatric care at an academic medical center.

From July 2012 to December 2013, one or more members of the nursing home staff—a nurse, a nurse assistant, or an activities director—met twice a week for two hours with a group of clinical experts, including a geriatrician facilitator, a geropsychiatrist specializing in psychoactive medications, a behavioral neurologist, and a part-time social worker. During each session, the nursing home staff presented three or four "challenging" long-term residents, whose identities remained anonymous. The experts then discussed each case and made recommendations for proper care. At the end of the project, researchers compared the use of physical restraints and antipsychotic medications for residents at participating nursing homes with their use for residents at control facilities.

Expertise Leads to Better Care

Researchers found that residents in participating nursing facilities were 75 percent less likely to be physically restrained than residents at control facilities. In addition, they were 17 percent less likely to be prescribed antipsychotic medication than their counterparts in control facilities.

Decreases in the use of physical restraints and antipsychotic drugs were most pronounced during the first three months with a 67.3 percent and 12.5 percent decrease in the use of physical restraints and antipsychotic drugs, respectively, at participating centers. At control facilities, the use of physical restraints and antipsychotic drugs increased 11.5 percent and 12.5 percent, respectively. 

Additionally, residents at participating nursing homes were less likely to experience at least one fall with a major injury and were less likely to develop a urinary tract infection compared to residents in control facilities.

A Model of Care

The researchers acknowledged the small number of facilities involved, but they are hopeful the program can be replicated in other facilities. Decreased use of antipsychotics may help prevent "costly adverse effects such as falls, hip fractures, and hospitalizations." Antipsychotics have also been associated with increased mortality and physical restraints "significantly compromise safety, dignity, and autonomy, and may actually increase overall risk of falls and fracture as well as mortality."

Overall, the researchers noted, using fewer antipsychotics and physical restraints is likely to benefit "the health, safety, and dignity of long-term residents." They hope videoconferencing may eventually "improve the management of other geriatric conditions and ultimately reduce health care costs." 


Tuesday, June 7, 2016

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BY SARAH OWENS

 

Athletes who sustain a concussion on the playing field are usually instructed to refrain from returning to practice or game play until all symptoms have resolved. Should the same protocol apply to the classroom as well? A new study in the American Journal of Public Health may help answer that question. Published online last month, the study found that the majority of high school and college students who sustain a concussion return to school less than one week later but continue to report difficulties in the classroom, suggesting that schools should offer special services and make extra adjustments for these students.

Tracking Academic Difficulties

Noting that concussion accounts for 13 percent of all injuries sustained among high school athletes in the United States, researchers at the University of Rochester in New York set out to determine whether these students had more academic difficulties when they returned to school than students who had other types of injuries. The researchers, led by Erin Wasserman, PhD, followed two groups of students—70 who had been diagnosed with a concussion and 108 who had sustained "musculoskeletal extremity injuries," all of whom had visited an emergency department—for one month post-injury.

Researchers recorded at what point students in each group returned to school. Additionally, one week and one month after the injury, researchers conducted telephone interviews, asking the injured students to rate their academic performance on a scale of 0 (not true at all) to 6 (very true). The students commented on statements such as "I have difficulty doing well on tests or quizzes," "I cannot stay on task," and "I get headaches or dizzy when I have to concentrate."

Study Results

Students who sustained a concussion returned to school two days later, on average, than students who sustained an extremity injury, such as to an arm or leg, according to the study. One week after their injury, post-concussion students scored worse on the telephone interview after adjusting for pre-injury grade point average, self-reported history of ADD/ADHD, and prior concussions than students with extremity injuries. One month post-injury, there was no difference between the two groups.

Digging into the Data

Within the group of students with concussion, the researchers found more disparities, including that female students and those with a higher number of concussions reported more classroom difficulties than male students and those with fewer concussions.

Caring for Concussed Students

The results, said the study authors, suggest that students who sustain a concussion are more likely to experience problems in the classroom than students who sustain other types of injuries in the first week after they return to school. The fact that there was no difference between the two groups after one month suggests that students had fully recovered from concussion by that time, although it's impossible "to determine exactly when concussed students [recovered]," the study authors added.

"Most students who play sports are not going to become professional athletes but they will need to continue with school and prepare for a career," said Dr. Wasserman, in a news release accompanying the study. "Just as they need guidance for when they can play again, they need guidance and protection for when it's appropriate to return to class and what to expect."

How Schools Can Help

The authors of the study make the following recommendations for post-concussion students.

  • Offer special services. Students who sustain a concussion should receive special attention during the first one to three weeks following their injury, including modifications to the curriculum, said the study authors. The study results "reinforce the need for [schools to establish] return-to-learn guidelines," the authors added.
  • Adjust academic standards. Teachers and school administrators should make adjustments for post-concussion students, including shorter school days, tutoring, reductions in academic workloads, and more time for completing assignments and tests.
  • Tailor adjustments for female students and those with multiple concussions. Since the study showed female athletes and athletes who had multiple concussions scored lower on the academic performance self-assessment, these athletes may need more time to return to the classroom.

Friday, June 3, 2016

Credit: atibodyphoto/FreeDigitalPhotos.net​

BY SARAH OWENS


A healthy heart is essential for avoiding stroke and heart disease. Now, a new study published in the Journal of the American Heart Association suggests that a healthy heart is also good for the brain. Habits such as not smoking, maintaining a healthy weight, engaging in moderate weekly physical activity, and following a healthy diet are associated with several indicators of good cognitive aging.

The Heart-Brain Connection

To assess the link between cardiovascular health and cognitive aging, researchers at Columbia University and the University of Miami analyzed a diverse subsample of 1,033 people from the population-based Northern Manhattan study, which looks at stroke and various risk factors in a multiethnic New York community.

At the beginning of the study, participants completed a cardiovascular examination based on the American Heart Association's (AHA) list of seven ideal health factors, including not smoking; having a body mass index (BMI) of less than 25; being physically active (at least 150 minutes a week); following a healthful diet; and having healthy cholesterol, blood pressure, and fasting glucose levels without medication. The majority of participants reported at least two or three ideal health factors.

About seven years into the study, all participants completed a neuropsychological test, which measured cognitive health in four domains—episodic memory (the ability to remember events), processing speed (understanding and responding to new information), semantic memory (recalling facts and concepts unrelated to personal experience), and executive function (the ability to plan and focus). Another six years later, 722 participants took a second neuropsychological test.

Weight, Tobacco Use, Blood Sugar Affect Brain Health

The study results showed that a higher number of ideal cardiovascular health factors was positively associated with cognitive health, particularly in processing speed and "to a lesser extent, executive function and episodic memory." The risk factors that were most strongly associated with processing speed were ideal BMI, not smoking, and ideal fasting glucose levels.

Promoting Cognitive Health

The results suggest that cognitive decline may be preventable by maintaining good cardiovascular health. And people don't need to improve in all seven areas to protect their brains. Even those participants who had "only two or three ideal cardiovascular health factors had less decline over time across multiple [cognitive] domains," the study authors said.

Reduce Your Risk

  • ​Pile on the Produce. The authors of the study said an "ideal" diet, defined by AHA standards, includes at least four and half cups of fruits and vegetables a day, two or more 3.5-oz. servings of fish per week, three or more 1-oz. servings of fiber-rich whole grains per day, less than 1,500 mg of sodium per day, and no more than 450 calories of sugar-sweetened beverages per week.
  • ​Move more. The AHA defines "ideal" physical activity as a minimum of 150 minutes of "moderate intensity" activity per week.
  • Kick butts. Don't start smoking if you haven't already, and quit if you do.
  • Know your health numbers. Maintain healthy blood pressure, cholesterol, and fasting glucose levels.​

For more on reducing your stroke risk, read The Basics and browse our archive of articles on stroke. 


Tuesday, May 31, 2016

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BY FRAN KRITZ

Pimavanserin (Nuplazid), the first medication approved by the US Food and Drug Administration to treat Parkinson's disease-related hallucinations and delusions, is now available by prescription in pharmacies. A 30-day supply is $1,950 compared to $60 for clozapine (Clozaril) and $10 for quetiapine fumurate (Seroquel), both atypical antipsychotics. Pimavanserin will be covered by Medicare Part D plans, according to Acadia, the company that manufactures the drug.

To ensure that all patients have access to the new drug, the company will provide direct financial support to uninsured patients and guide Medicare patients, who have to pay a copay, to foundations for financial assistance, if qualified.

A Different Pathway

Atypical antipsychotic drugs such as clozapine and quetiapine fumurate target dopamine levels, which can lessen hallucinations but worsen motor symptoms of Parkinson's disease such as shaking and tremor, says Rachel Dolhun, MD, a neurologist who specializes in movement disorders and vice president of medical communications at the Michael J. Fox Foundation in New York City. Pimavanserin, conversely, targets the serotonin receptor. The hope, Dr. Dolhun says, is that the new drug will treat psychosis without worsening motor symptoms. Like other drugs in its class, pimavanserin carries a boxed warning about an increased risk of death among elderly people with dementia-related psychosis.

Talk to Your Doctor

People who are experiencing Parkinson's-related psychosis and their families and caregivers should talk to their physician about whether pimavanserin is appropriate. "Just because there is a new medication on the market, does not mean it's for everybody," says Dr. Dolhun. "It's a chance for families and doctors to take stock and review the current medication and symptoms. If psychosis is present and controlled but causing other symptoms and side effects, pimavanserin might be an option."

Raising Awareness

A new drug on the market may generate conversations about Parkinson's-related psychosis, says Dr. Dolhun. "A lot of people don't know that psychosis is a possible symptom of the disease or of the medications used to treat it," she says. "Or, people may not want to bring up the subject, fearing they're losing their minds. In reality, the psychosis may be a side effect of the disease or the drugs they're taking and there are things that can be done about it." 

Another option is important, says Melissa Armstrong, MD, FAAN, director of the Mangurian Clinical-Research Center for Lewy Body and Parkinson's Disease Dementia and assistant professor of neurology at the University of Florida Center for Movement Disorders and Neurorestoration in Gainsville. Hallucinations greatly impact the quality of life of people with Parkinson's disease and they are challenging for caregivers. In fact, uncontrolled hallucinations are one of the main reasons people are placed in nursing homes, says Dr. Armstrong. "Having a new medication that can help target these symptoms is a big step," she says. "At the same time, physicians need to be cautious in counseling patients and families about what to expect. Not all patients responded to the drug in the study and observed benefits were usually modest. Serious adverse events were more common in patients taking the drug than those taking placebo, so it is important to weigh the benefits and risks."
 

For more about pimavanserin, go to bit.ly/NN-NuplazidApproval. For more about Parkinson's disease-related psychosis, go to bit.ly/HelpforHallucinations.