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Wednesday, January 18, 2017

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BY SARAH OWENS

Occupational therapy may delay the progression of symptoms in people in the early stages of dementia, according to a new observational study published online on December 22 in the Journal of Alzheimer's Disease.

Applying Occupational Therapy

Researchers in France studied 421 patients with mild dementia from 16 community homes in Aquitaine, a region in southwest France, for six months between January 2014 and June 2016. All dementia patients had been referred to home-based occupational therapy, a type of therapy focused on improving performance in daily activities, by their primary care doctors or clinics.

During the first three months, an occupational therapist visited each home 12 to 15 times. At the first assessment, patients' behavioral problems and remaining abilities were assessed and their needs identified. At each following session, the therapist trained patients how to compensate for their shortcomings and how to navigate their environments better. For instance, patients were taught how to perform routine activities like cooking or brushing teeth more easily.

The therapists also taught caregivers how to supervise their patients so their loved ones didn't get lost or forget to take medication. The therapists also taught the caregivers how to improve their patients' problem-solving skills, as well as how to increase their patients' participation in social activities.

After three months, the therapists' visits ended, but the researchers continued to observe the patients to see how they fared following the end of the intervention.

Measuring Cognitive Health and Quality of Life

All patients were given a series of tests three times—at the beginning of the study, three months into the study, and at six months (the end of the study)—to measure a variety of aspects of cognitive health, including recall, attention, language, orientation, and following commands.

Meanwhile, caregivers took two tests: one asking them to assess changes in their loved one's quality of life (for instance, self-care skills, ability to move, and level of pain) and another one to determine whether their burden of care had changed. Finally, the researchers recorded whether the participants experienced neuropsychiatric problems, such as outbursts or delusions, during the study period.

Occupational Therapy Linked to Better Outcomes

When the researchers analyzed the test results at the conclusion of the study, they found that the patients' cognitive abilities remained stable over time, with no significant decline, indicating that occupational therapy may help keep patients' brains healthy.

They also found that instances of neuropsychiatric problems decreased during the study period. Patients' quality of life improved during the first three months (when a therapist was still visiting their home), but declined during the following three-month follow-up period, indicating that ongoing therapy may be required to sustain better quality of life. Finally, caregivers reported that the therapy reduced their own burden of care.

The results, the study authors concluded, suggest that home-based occupational therapy can benefit both patients with dementia and their caregivers. However, the trial was observational, not randomized, meaning that the researchers did not have a control group of people who did not undergo therapy to compare outcomes.

Read our story "Conversation Starter," on Maria Shriver's effort to raise awareness of Alzheimer's disease in honor of her late father: bit.ly/NN-ConversationStarter.


Tuesday, January 17, 2017

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​Credit: Stuart Miles​

BY FRAN KRITZ

If you're between the ages 40 and 75 and not currently taking a daily cholesterol-lowering statin, you may want to discuss it with your doctor, if he or she hasn't brought it up already. The US Preventive Services Task Force, a volunteer body authorized by Congress that regularly reviews the benefits and harms of preventive care and makes recommendations based on available research, recently updated its recommendation on who should be considered for a statin drug.

New Recommendation Based on 19 Clinical Trials

Drugs such as atorvastatin (Lipitor) and simvastatin (Zocor) lower cholesterol levels in the bloodstream and are associated with a reduced risk of cardiovascular disease, including strokes. The new guidelines, published in the November 2016 issue of JAMA, are based on summarized data from 19 trials involving a total of almost 72,000 patients. The results: Statin therapy is associated with a reduced risk of deaths for any reason as well as deaths from cardiovascular events such as strokes and heart attacks.

Earlier recommendations focused on who should have a blood test to check for high levels of cholesterol. Those with high levels were then advised to take statins. The new guidelines recommend that everyone 40 to 75 with even a single risk factor for a cardiovascular event—such as high cholesterol, high blood pressure, diabetes, or smoking—and a 10 percent or greater risk (determined by a risk calculator created by the American College of Cardiology and the American Heart Association) of having a heart attack or stroke in the next 10 years be prescribed a daily statin drug.

The new guidelines are similar to those released by the American College of Cardiology and American Heart Association in 2013, which advised physicians to think beyond just cholesterol levels to determine risk of a cardiovascular event. Obesity and high blood pressure, for example, contribute to the risk of a cardiovascular event.  "People with no signs, symptoms, or history of cardiovascular disease can still be at risk for having a heart attack or stroke. Fortunately, statins can be very effective in helping some people between 40 and 75 years old reduce this risk," says Task Force Chair Kirsten Bobbins-Domingo, MD, PhD, professor of medicine at the University of California, San Francisco School of Medicine.

Stroke Prevention

Statins are associated with a reduced risk of stroke independent of lowering cholesterol, says Osama Zaidat, MD, FAAN, professor of neurology, neurosurgery, and radiology, and director of the Neurointerventional Program at the Medical College of Wisconsin, Milwaukee. Statins appear to prevent some strokes by reducing inflammation and reducing plaque that can form in arteries and cause strokes, he says.

If your risk of a heart attack or stroke is between 7.5 percent and 10 percent, the decision to take a statin should be made with your doctor, according to the Task Force because the benefit for that group is not quite as clear. "Regardless of the risk for heart disease, everyone can benefit from not smoking, eating healthy, exercising, and limiting alcohol use. Statins aren't always the answer. Talk to your doctor about whether taking a statin is right for you," says Douglas K. Owens, MD, coauthor of the recommendation and  director of the Center for Primary Care and Outcomes Research at Stanford University in California. Statins are generally safe but do come with some side effects, including a very rare, but significant, risk of kidney failure—another reason to follow your doctor's orders for regular blood tests if a statin is prescribed.

Relieving Muscle Pain

Statins can also cause muscle pain when first prescribed. Although annoying it's not dangerous, says Dr. Zaidat, and can often be relieved by reducing the dose or by switching to another statin drug. Or, take coenzyme Q10 (CoQ10), a supplement that often can safely relieve muscle pain, says Ralph Sacco, MD, FAAN, president-elect of the American Academy of Neurology and chair of neurology at the Miller School of Medicine at the University of Miami. 


Thursday, January 12, 2017

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BY FRAN KRITZ

When the 2017 International Brain Bee, the international neuroscience competition for high school students, takes place in Washington, DC, this spring, the competition's founder, Norbert Myslinski, PhD, will have a new distinction—winner of the 2016 Society for Neuroscience outstanding educator award. Dr. Myslinski, who founded the Brain Bee in 1998 and is a professor of neuroscience at the University of Maryland School of Dentistry, won the award for his contributions to public education and awareness of the field of neuroscience.

Motivated by Family History

"Brain disorders in my family made me determined to find cures," says Dr. Myslinski, whose wife died of a brain tumor. His father, who was diagnosed with Guillain–Barré syndrome, died of a stroke. One of his brothers has a spinal cord injury, his mother has Alzheimer's disease, and many cousins manage multiple sclerosis, epilepsy, autism, and drug addiction. "Early in my career I realized that finding cures for these disorders needed not only funds, but also a steady stream of young dedicated scientists. In the last century, neuroscience was not a priority in our schools and society, so I made it my priority."

Inspiration for the Brain Bee

When the Dana Alliance for Brain Initiatives initiated Brain Awareness Week (BAW) in 1995 (this year Brain Awareness Week is March 13 to March 19), Dr. Myslinski formed the idea for the Brain Bee as a way to motivate young adults to pursue careers in neuroscience. The first competition was held at the University of Maryland in 1998. The next year, Dr. Myslinski contacted 12 other directors of BAW activities in the United States and Canada and created a network of Brain Bees and the international championship. "It has been satisfying to watch my students become leaders in neuroscience, neurology, and psychology around the world," Dr. Myslinski says. Marvin Chum, PhD, the 2002 international winner, for example, is now a professor of psychology and neuroscience at the Yale School of Medicine.

Peace Byproduct

Dr. Myslinski says a benefit he never anticipated is that the competition can be an instrument of peace around the world. "When I see a young girl working at a desk with an Israeli flag in front of her and next to her is a young boy with an Iranian flag in front of him, I realize we could be laying the framework for peace and cooperation in the future." The young adults compete against each other but in the end they cheer on the winners together. "When I see those young men and women from 25 countries, I realize that our future is in good hands."

Continuing the Brain Bee Buzz

The Brain Bee organization created a Brain Bee Alumni Club to unite winners pursuing science education and careers. Recently, it also created the International Youth Neuroscience Association (IYNA), a network of high school neuroscience clubs, which publishes a monthly neuroscience journal by and for teens.

There's little doubt that Dr. Myslinski's mission will having last benefits. A survey of past Brain Bee participants found that a large percentage was now studying or had become neurologists, neuroscientists, or neuro engineers. "Ninety five percent said they found the Bee to be a valuable experience," says Dr. Myslinski. "And 75 percent said it influenced their course of study."

For more information about the Brain Bee and past winners, go to bit.ly/NN-BrainBee.


Tuesday, January 10, 2017

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BY FRAN KRITZ

Caring for someone with dementia requires equal parts love and fortitude. It's a huge task, says Zaldy Tan, MD, director of the UCLA Alzheimer's and Dementia Care Program in Los Angeles,, who has witnessed firsthand the struggles and joys of his patients' caregivers. That prompted him to establish a caregiver "boot camp" where participants learn caregiving strategies and skills as well as how to care for themselves.

The camp is held four Saturdays a year in the Los Angeles area and includes onsite respite care for patients with dementia if there is no one to care for them at home. Workshops cover home safety, recreation therapy, handling problematic behaviors, and stress-relieving activities such as yoga. The day ends with caregivers interacting with trained actors to practice their newly learned skills.

3 Caregiving Tools

A list of strategies can't replace an intensive day of training but it's a start, says Dr. Tan. "No one has all the skills to care for someone with dementia, especially after it progresses," he says. "That's especially true for highly educated people, who think they can figure it out." Taking care of someone with dementia requires legal, financial, and medical care management. It also involves the ability to negotiate relationships with siblings or children and to find appropriate activities for the person with dementia as the disease progresses.

1. Seek out information. The better informed you are, the more confident you'll feel. Start with a call to the Alzheimer's Association, which has a 24-hour hotline at 866-232-8484. The Association's website (alz.org​) also offers strategies for caregivers. The Family Caregiver Alliance also has useful strategies at caregiver.org.

2. Don't avoid hard conversations. In the early stages of the disease, you have time to talk to your loved one about finances, goals of care, and end-of-life advance directives. "Those talks become very challenging, if not impossible, at moderate to severe stages of disease," says Dr. Tan. "The window to talk won't stay open forever, and once it closes the person won't be able to participate meaningfully in the discussion." Not every patient wants to have the conversation or is able to, but without it, the family or caregiver is left to make those decisions. "Getting to know your relative's values and preferences and what is acceptable and unacceptable really needs to happen as early as possible."

3. Take care of yourself. Dementia is a marathon, not a sprint, says Dr. Tan. "You need to train for it and get ready for the long journey." That means you need to maintain relationships independent of the person you're caring for so you have an outlet to decompress and relieve stress, he says. You also need to protect your health. That starts with telling your primary care physician that you're caring for someone with dementia. You also need to guard against depression, heart disease, and even dementia—health problems caregivers of people with dementia are at higher risk for, according to studies.

For example, a six-week study of 100 caregivers for people with dementia used blood tests to measure two biomarkers for cardiovascular health and assessments for symptoms of depression both before and after the trial. During the six weeks, half of the group was visited by a behavioral health professional to help them focus on enjoyable activities. The other half had no intervention. At the end of the trial, , the biomarkers and depression symptoms were lower in the group that focused on enjoyable activities than in the no-intervention group, according to findings published in the October 2013 issue of Behavior Research and Therapy. It's a finding 70-year-old Mallie Odle has taken to heart. Last year, Odle whose husband was diagnosed with Alzheimer's disease four years ago, participated in a clinical trial that included visits from a mental health professional focused on Odle's health. As a result of the visits, Odle increased the number of days her husband attends adult day care programs and returned to an activity she loves, volunteering in her church's office. "Through the caregiver program," she says, "I was able to see that it's okay for me to make plans for myself and not feel guilty." 


Monday, January 9, 2017

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BY SARAH OWENS

Doctors and coaches may have a new tool to diagnose concussions among children, and it may be so quick, reliable, and accessible that it can be used moments after a child takes a hit during sports practice or playtime. A new study published on December 22 in Scientific Reports found that a hearing test was able to accurately detect concussion in 90 percent of children.

The Difficulty of Diagnosis

Concussion, or a brain injury caused by a blow to the head, is a major problem among people who play sports, including children. It's estimated that between 1.6 and 3.8 million people sustain a sports-related concussion in the United States every year. But without a validated test, diagnosing concussion can be tricky and based on several factors, including interviews, neurological tests and imaging tests like CT scans and MRI, according to the Weill Cornell Brain and Spine Center.

Since a concussion can affect hearing, researchers at Northwestern University thought hearing could be a possible marker of concussion. They hypothesized that if they could find a way to reliably detect changes in hearing unique to concussion, they might be able to develop a simple diagnostic test.

Testing Hearing Response

The researchers recruited 20 children who had been diagnosed with concussion at the Institute of Sports Medicine at Ann and Robert H. Lurie Children's Hospital of Chicago, a specialty clinic for head injuries. They also enrolled 20 children without concussion as a control group.

First, they developed a hearing test to detect subtle changes in a hearing response mechanism called the frequency-following response (FFR), which can slow speech and decrease the ability to understand speech. Then they administered the test to all 40 children, using a device that emits sounds then measures FFR in the children's brains.

From the Lab to the Sports Field—and Beyond

The hearing test accurately identified 18 out of 20 (90 percent) of concussions. It also accurately identified 19 out of 20 (95 percent) of non-concussions.

The results, the study authors wrote, confirm that concussions do affect sound perception in subtle but identifiable ways. Since their test is objective, unlike subjective tests such as interviews, the results should be reliable. Since hearing ability varies among kids, the researchers suggest administering the test to children when they are still healthy to establish a baseline against which future tests can be compared. Children can be prevented from returning to play until their test returns to baseline.

The researchers believe this kind a test could be used to diagnose all types of concussions, not just those following a sports injury. Since fast diagnosis often means faster treatment, they hope that such a tool will help improve the health of active kids everywhere.​

Read our recent blog post about how concussion rates in kids have spiked over the past five years: bit.ly/NN-ConcussionSpike