Neurology News

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Wednesday, November 15, 2017

BY SARAH OWENS

Inflammation in the body, which can be caused by such diseases as diabetes, high cholesterol, and high blood pressure, in middle age may cause brain shrinkage, or reduced brain volume, in late life. That's according to a study published online on November 1 in Neurology.

The Inflammation-Alzheimer's Connection

Previous research has shown that people with Alzheimer's disease have more inflammation in their bodies compared to healthy controls. But researchers didn't know if the inflammation resulted from the disease, or if the inflammation caused or exacerbated the disease. That's why researchers decided to follow cognitively healthy people who had increased brain inflammation in midlife over a long period of time to see if their brain volume – an important marker of brain health – changed as a result.

Measuring Brain Changes over Time

Researchers at universities throughout the United States analyzed data on 1,633 people who were participating in the Atherosclerosis Risk in Communities (ARIC) study, a long-running study designed to observe cardiovascular health in a large population. The participants were between 45 and 65 years old at the beginning of the study.

On a baseline test in 1987-1989, researchers took samples of the participants' blood plasma and analyzed it to determine levels of five inflammatory markers: fibrinogen, albumin, white blood cell count, von Willebrand factor, and Factor VIII. The participants completed a follow-up visit every three years until 1996-1998 to assess their cardiovascular health, then completed final follow-up visits in 2011-2013.

At the final follow-up visit–24 years after baseline–the researchers took brain MRI scans of the participants to determine any changes in their brain volume and integrity. They also assessed changes in memory by giving participants a delayed word recall test that asked them to memorize and then recall a list of 10 words following a delayed period..

More Inflammation, Less Brain Volume and Worse Memory

Participants who had elevations in at least three markers had a 5 percent average reduction in the volume of the hippocampus, an area of the brain linked with Alzheimer's disease. Increases in inflammation were also associated with worse scores on delayed word recall tests.

The findings suggest that systemic inflammation may contribute to neurodegeneration and cognitive aging, the study authors wrote. However, they noted that they only measured inflammation at one point in time, and further studies should analyze the effects of changes in inflammation over time.​


Wednesday, November 8, 2017

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BY SARAH OWENS

 

What's the secret to the so-called "super agers"—people who maintain sharp brain health into their 80s and 90s? Part of the answer may be that they have close, trusting relationships, whether with a spouse, family, or friends, according to a study published online in the journal PLOS One on November 1.

The Secret to Aging Successfully

It's normal for older adults to experience some degree of cognitive decline as the years go by. But super agers, who retain sharp cognition into their 80s and beyond, are exceptions.

Previous research has shown that their brains have different structures compared to adults who experience normal age-related cognitive decline. For example, their cortices—the part of the brain responsible for memory, attention, and decision-making—tend to be thicker, and they experience less whole-brain atrophy over time.

Measuring Well-Being

In order to determine whether lifestyle factors, such as diet, physical activity, and social relationships, keep super agers' brains healthy, researchers at the Northwestern University SuperAgers program in Chicago enrolled 31 older adults who fulfilled the criteria of super agers: adults over age 80 who perform at the level of 50- to 65-year-olds on a variety of validated cognitive tests, and who maintain that level over an 18-month period. They also enrolled 19 adults of the same age who were cognitively average—that is, they experienced a normal amount of cognitive decline expected with aging, but did not have dementia or mild cognitive impairment.

Participants completed a 42-question test about their well-being in six domains:

  • Environmental mastery, or the ability to maintain one's life without becoming overwhelmed.
  • Personal growth, or feelings of continued development and being open to new experiences.
  • Positive relations with others, which measures "satisfying, warm, trusting, high-quality relationships."
  • Self-acceptance, or positive feelings about oneself.
  • Autonomy, or the ability to be independent and resist societal pressures.
  • Purpose in life, or feeling that one's life is meaningful.

Better Relationships, Better Brain Health

When they compared the results on the questionnaire between the super agers and the cognitively average adults, the researchers found that both had generally high levels of psychological well-being. However, the super agers had significantly higher scores on the domain of positive relationships with others. This, the study authors suggest, means that "perceived high-quality social relationships may be an important factor in aging successfully."​

Why do relationships play such an important role in healthy aging? It will take further research to know for sure, the researchers say. But it may be because super agers have been reported to have a higher density of von Economo neurons, a specialized type of brain cell that is involved in "higher order social cognition and behaviors, such as social bonding, social intuition, and emotional regulation."

Whatever the reason may be, it's clear that maintaining positive relationships into old age is healthy—not just for your soul, but also for your brain.


Friday, November 3, 2017


BY SARAH OWENS

Certain positions and longer careers make football players more vulnerable to the brain damage associated with recurrent head impacts, according to a study published online in Radiology on October 31.

Risks of Hits to the Body and Head

Sports concussion is associated with cognitive decline and chronic traumatic encephalopathy (CTE). Additional research has suggested that even hits that do not cause an actual concussion, contribute to brain disease and cognitive decline. And brain damage is worse with recurrent hits, which are common in contact sports like football and ice hockey.

However, most players whose brains have been examined for damage caused by concussion and non-concussive head impacts were deceased or already showed signs of cognitive decline. Not much research exists on brain damage in living players who are seemingly cognitively healthy. Researchers wanted to explore the effects of concussion on brain health in such players, and to see if these effects were related to their career length and/or playing position.

Categorizing Players

In a study funded by the National Football League (NFL) Charities and the NFL Players Association, researchers at the University of North Carolina at Chapel Hill, Queen's University in Kingston, Ontario, Canada, and the Biomedical Imaging Research Institute at Cedars-Sinai Medical Center in Los Angeles enrolled 61 former collegiate and professional football players between 2011 and 2013. The players ranged in age from 52 to 65 years. They sorted the players according to their career duration (retired after college football or played pro for at least five years after college), concussion history (low frequency: zero to one concussions; high frequency: three or more), and field position (linemen vs running backs, wide receivers, and other running positions).

Participants underwent two types of imaging: diffusion tensor imaging (DTI), which measures the integrity of white matter in the brain; and functional magnetic resonance imaging (fMRI), which measures healthy brain function while participants perform a task.

Length of Career and Position Matter

Both career length and position, as well as concussion history, were significantly related to the players' brain health. Compared to running backs and wide receivers, linemen had more white matter damage and worse brain function scores while performing a task. Similarly, compared to players who retired after college, those who went on to play professionally for at least five years had worse white matter damage, although there was not a significant difference in brain function while performing a task.

Players who sustained three or more concussions had both worse white matter damage and worse brain function compared to those with fewer than three concussions.

The authors conclude that the results—that linemen who played professionally and sustained many concussions have an increased risk of brain injury and possibly brain disease—may help inform and improve future game alterations designed to protect players.


Wednesday, November 1, 2017

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Credit: Sira Anamwong

BY SARAH OWENS

People with Parkinson's disease and parkinsonism, a related movement disorder, had more weight loss following their diagnosis compared to controls. And rapid weight loss was associated with an increased risk of becoming dependent on caregivers, of developing dementia, and dying, according to a study published online in Neurology on October 27.

A Common Side Effect

Weight loss is a known side effect of Parkinson's disease (PD) partly because people with the disease may eat less and expend more energy when moving. But those reasons don't fully explain the association, researchers say. Previous research has also hinted that weight loss may be associated with worse outcomes.

Looking for Tips in the Scale

To investigate the weight loss link in a larger cohort of patients over a longer period of time, researchers at the Institute of Applied Health Sciences at the University of Aberdeen in Scotland analyzed data on 515 people who participated in the Parkinsonism Incidence in North-East Scotland (PINE) study, a long-term study of people with PD and parkinsonism as well as a control group matched by sex and age. Of these participants, 187 had Parkinson's disease, 88 had parkinsonism, and 240 served as controls.

The researchers analyzed both the volume and timing of participants' weight loss during the study. They defined "significant" weight loss as a loss of more than 5 percent body mass, and early weight loss as loss that occurred within the first year of diagnosis. Then they used the participants' health records to see who developed dementia, who became dependent on their caregivers, or who died during the study's follow-up period. They compared the participants' timing and magnitude of weight loss with their outcomes to see if there was an association between weight and health.

More Weight Loss Linked to More Health Problems

People with PD and Parkinsonism experienced more weight loss early on compared to controls.

And early weight loss was associated with an increased risk of all three adverse outcomes analyzed: becoming dependent, developing dementia, and dying.​​

Weight loss may be a sign of a worse disease course in Parkinson's, the study authors conclude. They note that "targeted interventions to prevent or reverse weight loss in parkinsonism and PD may improve outcomes." But first, the findings should be replicated in other, large-scale, randomized studies, the authors say.


Friday, October 27, 2017

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BY SARAH OWENS

Doctors treating migraine in the emergency department (ED) should not prescribe hydromorphone, a powerful opioid. Instead, they should prescribe prochlorperazine (Compro), an alternate treatment that's more effective and may be less risky, according to a study published online on October 18 in Neurology.

Commonly Prescribed Opioid

Migraine is a common reason for visits to the ED, accounting for about 1.8 million visits per year. Opioid painkillers are prescribed in about half of those cases, and hydromorphone (Exalgo ER) is one of the most commonly prescribed.

But not much evidence from clinical trials exists to support the use of it, and some research suggests opioids may have negative consequences. For example, they may actually increase the frequency of migraines, or eventually make patients resistant to other, non-opioid treatments. To determine the effectiveness of hydromorphone, researchers conducted a head-to-head study comparing it with prochlorperazine (Compro), a common non-opioid migraine treatment.

Comparing Drugs

Researchers at several institutions in New York and California enrolled 127 patients who visited two EDs in New York City for migraine. They randomly assigned the patients to receive 1 mg of hydromorphone intravenously or 10 mg of prochlorperazine. Patients who received prochlorperazine were also given 25 mg of diphenhydramine, a drug designed to prevent restless movement that can be a side effect of prochlorperazine.

Two hours after treatment, the researchers followed up with the patients by telephone to determine how many experienced sustained headache relief, defined as a headache level of "mild" or "none." Forty eight hours after treatment, they called the patients again to determine if they still experienced headache relief, whether they would take the medication again for another migraine, and to report any adverse side effects, such as drowsiness or restlessness.

A Clear Winner

Sixty percent of participants who received prochlorperazine experienced sustained headache relief, compared to 31 percent of those who received hydromorphone. In addition, almost three-fourths of patients who took prochlorperazine said they would take the same medication again, compared to two-thirds of patients who took hydromorphone. Finally, the researchers found that the occurrence of side effects—drowsiness and restlessness—was about the same between the two groups.​

Forgo Hydromorphone in ED

The findings, the study authors say, show that "hydromorphone is substantially less effective than prochlorperazine for the treatment of acute migraine in the ED." As a result, they conclude, hydromorphone should be considered only after other options have failed.