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Friday, May 29, 2015




Plagued by insomnia or fitful sleep? You may have a lower tolerance for pain than people who sleep soundly, according to a new study. And if you have both insomnia and chronic pain, two conditions that often occur together, you may be even more sensitive.


A team of European researchers looked at data from 10,412 people aged 30 to 87 who were enrolled in an ongoing health study in Norway. Between 2007 and 2008, the participants answered questionnaires about their sleep patterns, including sleep duration, the time it took to fall asleep each night, and how often they experienced bouts of insomnia. They also reported whether they had chronic pain (defined as persistent or frequently recurring pain that has lasted for three months or more), depression, or anxiety.


To measure pain sensitivity, researchers gave participants what is called a cold pressor test. Subjects placed their hands in a basin of extremely cold water and had to hold it there for as long as they could, for up to 106 seconds. At the same time, they periodically rated how much pain they were feeling on a scale of zero to 10, with 10 being the greatest pain imaginable. The researchers calculated subjects’ sensitivity to pain by observing whether and when they removed their hands from the water, combined with their pain intensity ratings.


Insomnia Is Linked to Pain Sensitivity

Overall, 68 percent of the participants were able to keep their hands in the cold water for the full 106 seconds; 42 percent of those with insomnia took their hands out early, while 31 percent of those without insomnia did the same.


The more frequent and severe a subject’s insomnia, the more sensitive to pain he or she was. People who reported having episodes of insomnia more than once a week had a 52 percent higher risk for pain sensitivity than people who reported no insomnia. Those who reported monthly bouts of insomnia had 24 percent higher pain sensitivity. Those with the most severe insomnia (based on self-reports of how much the condition affected their lives) had a 104 percent increased risk for pain sensitivity compared with people who reported no insomnia-related complaints.


Those who took longer to fall asleep at night were also more sensitive to pain. People who spent more than one hour in bed before falling asleep had a 53 percent higher risk compared with those who could fall asleep within 15 minutes. Total sleep time did not impact pain sensitivity, however.


Insomnia and Chronic Pain Are a Double Whammy

People who had both insomnia and chronic pain were more than twice as likely to be sensitive to pain as people with neither condition, the researchers found.


The results suggest that psychological factors may be involved in the link between sleep problems and pain, the researchers said. For example, people with chronic pain and insomnia may also have depression, which could exacerbate both conditions. There may also be a biological component, they said. The neurotransmitter dopamine, for instance, is known to help regulate the body’s sleeping and waking patterns, and pain has been shown to affect dopamine signaling, which can have an impact on sleep quality. More research is needed to understand the relationship between sleep, pain, and dopamine, the researchers said.


Treating Pain Helps Treat Sleep Problems, and Vice Versa

Whether you tackle your insomnia or your chronic pain first, treating one will help the other, the researchers said. For instance, cognitive-behavioral therapy—which helps people uncover negative thoughts and behaviors that might be making a condition worse, and replace them with positive thoughts and attitudes—has shown promise for treating both chronic pain and insomnia. But more research is needed to look for the best interventions that can treat both conditions, the researchers said.


In the meantime, if you’re experiencing frequent insomnia or persistent pain, see a doctor or neurologist specializing in sleep medicine or pain. He or she may be able to recommend the most appropriate treatments to help you get more rest and feel less pain.


For more coverage of sleep disorders, browse our archives here, and look through our past articles for more information about dealing with chronic pain.


Image via Alyssa L. Miller on Flickr.

Thursday, May 28, 2015




Nearly 90 percent of kids and teens who sustain a concussion and return to school before their symptoms fully resolve report academic troubles, according to a new study by researchers at Children’s National Health System and the George Washington University School of Medicine in Washington, DC.


Researchers surveyed students between the ages of 5 and 18 who had had a concussion less than four weeks earlier. They asked whether the kids were still experiencing concussion symptoms, including headaches, fatigue, dizziness, moodiness, and difficulty concentrating. If so, the researchers asked whether the students felt their academic performance had suffered as a result.


Post-concussion Symptoms Interfere with Learning

Among the 349 students, 240 said they were still experiencing concussion symptoms, and 88 percent of those said that their symptoms were interfering with their learning. Seventy-seven percent reported that academic skills such as note-taking, studying, or doing homework had suffered. The more severe a student’s symptoms were, the more likely he or she was to report academic problems.


Even kids who were considered to be recovering well registered some concerns: 38 percent reported that symptoms such as headaches or concentration problems had interfered with their learning, and 44 percent said their academic skills had suffered.


High school students were the most likely to express concerns about their academic performance or report a perceived decline in learning skills, probably because they had more challenging workloads and more extracurricular demands than elementary or middle school-aged students, the researchers said. Math class was often cited as the greatest challenge.


Study Caveats

The study has some limitations: The researchers did not obtain copies of the students’ grades before and after their concussion, and instead relied on reports from kids and parents about academic performance. Also, students and parents may have over-reported concussion symptoms, or may have reported academic problems that were unrelated to the symptoms, the researchers noted.


More Support at School Is Needed

Still, the researchers said, the study results underscore the importance of getting medical experts and school staff to create a targeted plan to support kids who return to school after a concussion. This could involve, for example, giving these kids and teens more time to complete homework or tests, or letting them take breaks from class or leave early to avoid the hallway crush.


“No one return-to-school plan is going to work for every kid,” said study author Danielle M. Ransom, PsyD, a post-doctoral fellow at Children’s National Health System in Washington, DC, in a recent interview. She said that in future research, she and her colleagues plan to “examine what evidence there is for various clinical approaches and what the best evidence-based recommendations might be to help kids returning to school.”


To learn more about concussion, see Traumatic Brain Injury: The Basics. For more coverage of how concussion is treated, browse our archives here.


Image via Phil Roeder on Flickr.

Wednesday, May 27, 2015




Here’s more sobering news about depression: People who are over 50 and depressed may be twice as likely to have a stroke as someone who isn’t depressed, according to a new study. And even people whose depressive symptoms subside have a higher risk than people who have never been depressed, at least in the short term, the researchers found.


Paola Gilsanz, ScD, Yerby Postdoctoral Research Fellow at the Harvard T.H. Chan School of Public Health, and Maria Glymour, ScD, MS, an associate professor of epidemiology and biostatistics at the University of California, San Francisco, and colleagues looked at data from 16,178 men and women aged 50 and older with no history of stroke enrolled in the Health and Retirement Study between 1998 and 2010. Every two years, researchers asked them about several health factors, including symptoms of depression and history of stroke. During the 12-year study period, participants reported 1,192 cases of stroke.


Study Reveals Depression-Stroke Connection

Gilsanz, Glymour, and colleagues found that people who reported at least three depressive symptoms—such as poor sleep, lack of appetite, and persistent feelings of loneliness or hopelessness—at two consecutive visits (meaning at least four years) had a 114 percent increased risk of experiencing a stroke within the next two years compared with people who reported no symptoms of depression.


The risk remained 66 percent higher for participants who reported that their depressive symptoms had subsided between interviews. Women who reported that their symptoms had abated still had an 86 percent higher stroke risk than non-depressed women. However, recent-onset depression—occurring between interviews—did not have an impact on stroke risk within the next two years.


Possible Links between Depression and Stroke

Researchers aren’t sure why depression increases a person’s risk for stroke, but they have some theories. First, depression may encourage people to adopt unhealthy behaviors, such as smoking or not exercising, that are known to increase stroke risk, the researchers wrote. But depression may also cause or contribute to long- or short-term changes in the brain and body that may, in turn, increase stroke risk, such as high blood pressure, atrial fibrillation (irregular heartbeat), atherosclerosis (buildup of fat and cholesterol that blocks the arteries), or inflammation.


“Our findings suggest that effects [of depression] occur over the longer term through accumulated damage,” since short-term increases or decreases in depressive symptoms did not appear to have an impact on stroke risk, the researchers wrote.


Treat Depression Early to Lower Stroke Risk

Since the findings have not been reported before, other research groups will need to replicate and confirm the results, the authors of the current study said. But “if replicated, these findings suggest that [doctors] should seek to identify and treat depressive symptoms as close to onset as possible, before harmful effects start to accumulate,” said Gilsanz in a news release.


For more coverage of the link between depression and stroke, browse our archives here. To learn more about depression and how to treat it, see the resources at the National Institute of Mental Health.


Image via IntelFreePress on Flickr.

Tuesday, May 26, 2015




Depression is more common in people with Parkinson’s disease (PD) than in the general population, and research suggests it may be a risk factor for the condition, or even an early feature of the disease. Now, a new study published in Neurology strengthens that link.


Gathering data from a national register of health records for the Swedish population, study author Peter Nordström PhD, a professor and chief physician in the Department of Community Medicine and Rehabilitation at Umeå University in Sweden, and his colleagues looked at a sample 140,688 people who were aged 50 or older at the end of 2005 who were diagnosed with depression between 1987 and 2012. They matched each person with depression with three “control” participants of the same age and sex who did not have depression; in total, the study population included 562,631 people. They then followed these patients for up to 26 years.


During that time, 1,485 people with depression (or 1.1 percent of the depressed group) and 1,775 people without depression (or 0.4 percent of the non-depressed group) developed PD. Compared with those without depression, people who were depressed were 3.2 times more likely to develop PD within the year after they were diagnosed—a more than 200 percent increased risk. And 15 to 25 years after the depression diagnosis, they were still 50 percent more likely to develop PD than non-depressed people.


More Severe Depression Increases PD Risk

Researchers found that people who had been hospitalized at least once for depression were 3.5 times more likely to be diagnosed with PD than people who received treatment for depression but were never hospitalized. And people who had been hospitalized for depression five or more times were 40 percent more likely to be diagnosed with PD than people who had been hospitalized for depression only once.


Looking for a Genetic Link

To see whether there might also be genetic or environmental factors contributing to the link between the two conditions, the researchers then looked at the incidence of depression and PD in 540,811 pairs of siblings. Although Parkinson’s was more common among people had a sibling with PD, depression in one sibling did not increase the risk of the other sibling developing PD.


This finding suggests that PD and depression are linked because “if the diseases were independent of each other but caused by the same genetic or early environmental factors, then we would expect to see the two diseases group together in siblings, but that didn’t happen,” Dr. Nordström said in a news release.


Is Depression a Risk Factor or a Symptom?

Dr. Nordström and his colleagues put forward three theories that might explain the link between Parkinson’s and depression. First, they said, depression and/or drugs used to treat depression could increase the risk for PD. Second, depression may be an early symptom of Parkinson’s disease, appearing well before motor symptoms and other manifestations of the disease occur.


Lastly, they said, it’s possible that genetic or environmental factors that cause depression may also cause PD—although the results of their study in siblings make this theory less likely.


Treating Depression Can Help

Even if depression turns out to be an early symptom of Parkinson’s, and therefore a result of neurodegeneration, treating the condition with antidepressant medication and therapy can be beneficial, experts say. 


“How people think about their illness—the coping skills they use, how they respond to symptoms, and how they perceive themselves—can have a big impact,” Roseanne D. Dobkin, PhD, a clinical psychologist at the Robert Wood Johnson Medical School in Piscataway, NJ, told Neurology Now in 2013. “Addressing negative thoughts and maladaptive behavior patterns can relieve some of the depression and related non-motor symptoms of PD, including sleep problems and anxiety.”


For more stories about the link between depression and Parkinson’s, browse our archives here. To learn more about depression and how to treat it, see the resources at the National Institute of Mental Health.


Image via Lloyd Morgan on Flickr.

Friday, May 22, 2015




The nationwide scrutiny of the NFL and sports concussions is unlikely to disappear any time soon. In the latest study of former NFL players, researchers found that those who experienced at least one concussion that caused a loss of consciousness are at a higher risk of brain atrophy, memory problems, and mild cognitive impairment (MCI) later in life.


For the small study, published in JAMA Neurology, researchers at the University of Texas Southwestern Medical Center administered memory tests and magnetic resonance imaging (MRI) scans to 28 former NFL players, 17 of whom reported they had experienced a grade 3 (G3) concussion causing a loss of consciousness, and eight of whom had been diagnosed with mild cognitive impairment and reported a history of concussion, as well as 21 cognitively normal people with no history of concussion and six people with MCI but no history of concussion. The former players’ ages ranged from 36 to 79.

Severe Concussion Linked to Brain Changes

The researchers found that the players with a reported history of concussion but without MCI had lower scores on verbal memory tests than the cognitively normal participants, although their scores still fell within what is considered the “normal” range for verbal memory. Former players with MCI performed worse on these tests than both the retired players without MCI and the healthy control group. The retired players with MCI and the six control subjects with MCI performed about the same on the memory tests.


MRI scans showed that the footballers who had not experienced a G3 concussion had a similar size hippocampus—a brain region linked to memory formation, which is one of the first to be damaged in Alzheimer’s disease—to the healthy controls. The hippocampus is expected to shrink a little over the course of normal aging, but too much shrinkage, or atrophy, could indicate brain disease or memory problems, the researchers explained. The athletes who had experienced at least one G3 concussion had a smaller hippocampus than the control subjects, and a smaller right-side hippocampus than the athletes who had not had a G3 concussion. And those with both MCI and a history of G3 concussion had a smaller left-side hippocampus than the control subjects with MCI.


Taken together, the researchers said, these results suggest that a history of severe concussion (those involving a loss of consciousness) increases the risk of hippocampal atrophy later in life.


Concussion May Be Risk Factor for MCI

As people age, they are more at risk of developing MCI, which may or may not progress into Alzheimer’s disease. But a history of concussion may also be a risk factor for developing MCI, the researchers said.


In this study, seven of the eight retired football players with MCI were over the age of 63, and all seven of those athletes had had a G3 concussion during their playing days. Only one of the former NFL players with no history of G3 concussion had MCI. This suggested to the researchers that after a certain age, having a history of G3 concussion increases the risk of developing MCI. The link between age and concussion history and developing MCI should be explored in future studies, they said.


More Study Needed on Concussion and Cognition

The results of this study should be interpreted with caution. Because the researchers asked this group of former NFL players to report on their concussion history years or even decades after the fact, their responses are subject to what researchers call “recall bias.” The players may not be remembering their experiences with concussion accurately, which could lead to under- or over-reporting of the number and type of head impacts they experienced during their playing days. In addition, they may have had other health problems that would affect their memory, which the researchers did not account for when collecting their data.


Still, the findings do emphasize the need for more research, recognition, and treatment of concussion, not just in professional sports. And future studies can hopefully be designed that take a more rigorous approach with a larger number of patients. “This is a preliminary study, and there is much more to be learned in the area of concussion and cognitive aging,” said study author Munro Cullum, PhD, a professor of psychiatry and neurology and neurotherapeutics at UT Southwestern, in a news release.


The silver lining, Dr. Cullum said, is that these findings apply only to concussions that cause a loss of consciousness, which are fortunately still fairly rare.


For more coverage of the latest sports concussion research, browse our archives here. To learn more about concussion, see Traumatic Brain Injury: The Basics.


Image via COD Newsroom on Flickr.