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Thursday, January 29, 2015

BY REBECCA HISCOTT

 

Image via Robbie Grubbs on Flickr.

 

Kids who get concussions between the ages of 10 and 12 may at risk for more severe cognitive problems than kids who experience concussions as teenagers, according to a new study of former NFL football players published in the journal Neurology.

 

That’s because the brain undergoes a crucial period of development during those years that may be stalled by repeated blows to the head. The study results emphasize the need for more research into the effects of childhood head trauma, and offer important cautions for parents looking to keep their children safe.

 

The Role of Youth Football

In this study, researchers administered memory, intelligence, and reason and problem-solving tests to 42 former NFL players between the ages of 41 and 65. All had complained of problems with memory, thinking, and mood for at least six months. Half had played tackle football before the age of 12, while the other half started playing football as teenagers. Players in both groups had sustained a similar number of concussions over the years.

 

The results? Athletes who played tackle football before age 12 performed worse on the entire battery of cognitive tests. On a word-recall test, for instance, athletes exposed to tackle football earlier had a harder time remembering a list of words they had learned 15 minutes earlier. As a whole, the group did approximately 20 percent worse than the group of players who were exposed to tackle football after age 12.

 

But, the researchers added, all participants, even those who started playing football as teens, performed worse than average on these cognitive tests—confirming that a history of repeated hits to the head isn’t good for the brain at any age.

 

How Tackle Football Affects Young Brains

During the critical period of development that occurs in the brain between the ages of 10 and 12, key brain structures such as the amygdala and hippocampus, which help regulate thinking, memory, decision-making, and emotions, begin to reach their adult volume.  Extra synapses—structures that help brain cells communicate with each other—are pruned away during this time, allowing for more efficient information processing.

 

But repeated blows to the head from tackle football may interrupt this development, said study author Robert A. Stern, PhD, a professor of neurology, neurosurgery, and anatomy and neurobiology at Boston University School of Medicine, in a news release.

 

Think Twice About Pop Warner

The researchers warned that the study results don’t apply to all children who play sports, or even all children who play football. While it offers insight into when concussions may cause the most damage, the study tested athletes who had all played professional football and had experienced many more concussions in their lives than the average person.

 

That said, the results do underscore the importance of understanding the impact of concussion and getting the appropriate treatment, wrote Christopher M. Filley, MD, a behavioral neurologist at the University of Colorado School of Medicine in Aurora, CO, and Charles Bernick, MD, MPH, medical director of the Lou Ruvo Center for Brain Health at the Cleveland Clinic in Ohio, in an accompanying editorial. In fact, they said, repeated blows to the head have been associated with a form of degenerative dementia called chronic traumatic encephalopathy later in life.

 

Football has the highest injury rate of all team sports, and approximately 70 percent of football players in the US are under the age of 14. The study results should give parents and doctors pause before signing young children up for football practice, they said.

 

How to Recognize a Concussion

Difficulty with memory, attention, concentration, or thinking, headache or lightheadedness, blurred vision, fatigue, behavioral changes or mood swings, and altered sleep patterns are all symptoms of concussion.

 

If your child exhibits these symptoms following a blow to the head or other head injury, see your doctor immediately. The only treatment for a mild concussion—which makes up the majority of sports-related concussion—is rest. Monitor your child’s symptoms, and call a doctor if you notice them getting worse.

 

Staying educated and up-to-date on the signs, effects, and treatments for concussion is one of the best ways to keep children safe without kicking them off the field. The American Academy of Neurology offers a set of guidelines for recognizing and monitoring the symptoms of concussion. Being prepared is half the battle—after all, the best defense is a good offense.

 

To learn more about concussion and traumatic brain injury, see Traumatic Brain Injury: The Basics and browse our archives here.


Wednesday, January 28, 2015

BY REBECCA HISCOTT

 

 

Falls can be life-altering, even deadly, for seniors. In fact, it’s the most common cause of injury among adults 65 and older. As many as one-third of elderly adults fall each year and if you have a neurologic disorder (such as stroke, dementia, peripheral neuropathy, or Parkinson’s), your risk of falling triples. If that weren’t bad enough, a new survey published in the journal JAMA Internal Medicine reports that falls are on the rise, with more seniors experiencing falls than they were 12 years ago.

 

How the Falls Were Tracked

The University of Michigan Health and Retirement Study surveys more than 26,000 American adults over the age of 50 every two years in order to track shifting demographic patterns as people leave the work force and develop new health care needs. When researchers analyzed data from the survey, looking at self-reported falls every two years from 1998 through 2010 in a sample of adults aged 65 and older, they found that falls increased by 8 percent—from about 28 percent in 1998 to 36 percent in 2010. The increase did not, however, result in more injuries, meaning that the majority of these falls were minor.

 

Unexpected Results

Although they expected to see an increase in falls simply because there are more 80- and 90-year-old adults than ever before, the researchers were surprised to see that the changing age demographic was not the cause, said lead author Christine Cigolle, MD, MPH, an assistant professor in the departments of Family Medicine and Internal Medicine at the University of Michigan and a research scientists at the VA Ann Arbor Healthcare System Geriatric Research, Education and Clinical Center, in a news release.

 

What they did not expect to see was an increase in falls across all age groups, with the biggest spike among the youngest study participants, those just over 65.

 

Cause of More Falls Remains a Mystery

Are older adults really falling more than they were before, or are they simply better at reporting their spills? That remains unclear.

 

“It’s possible that older adults may be more likely to report it now than before,” said Dr. Cigolle. “However, if the prevalence of falls is actually increasing as much as it seems to be, we need to do more work to identify possible factors and how we can address what we know to be a high risk among a vulnerable group.”

 

If the increase in falls is not a result of better reporting, it could be because of an increase in risk factors (for example, taking medications with side effects like dizziness and drowsiness), she said. More research is needed to determine the cause of the higher rate.

 

Stay Grounded

Whether you have a neurologic condition that causes balance problems or simply want to reduce your risk for falls, read these quick tips. And, don’t forget to check out the recent Neurology Now article on preventing falls for more expert advice.

 

·         Talk To Your Doc. If you’ve fallen more than once within a single year, or have sustained an injury as a result of a fall, check in with your physician. Your vision might be failing, your balance might be off, or your medications could be causing side effects that are affecting your balance. Whatever the cause, your physician can help you identify it and suggest ways to remedy it.

 

·         Get Your Vision Checked. Worsening eyesight is one of the main reasons seniors fall. If you think your vision might be changing or failing, visit an optometrist to make sure your prescription is up to date. Schedule regular checkups, just to be sure.

 

·         Try Tai Chi. Clinical studies show that tai chi helps improve balance and reduce falls in older adults. But staying active, in general, can help you maintain good balance and muscle strength. If you don’t know what activity to try, ask a physical therapist to help you customize a plan that’s safe and appropriate.

 

·         Manage Your Meds. Some medications, such as antipsychotics, certain painkillers, and sleeping pills, can cause side effects such as dizziness, drowsiness, and balance problems. Make sure your doctor, pharmacist, and other specialists have a list of all your prescription and over-the-counter medications, so they can make changes as needed. If you notice yourself feeling dizzy or drowsy more often, talk to your doc about switching drugs or changing your dose.

 

·         Fall-Proof Your Home. Clear the clutter from your floor and stairs and make sure your rugs are secured to the floor. Those are just some of the ways to make your home a fall-free zone. For other tips, consult this handy checklist. You may also want to talk to a physical or an occupational therapist during this process to ensure that your modifications keep you safe and standing on solid ground.

 

To learn more about how to prevent falls, look through our archives here.


Tuesday, January 27, 2015

BY REBECCA HISCOTT

 

As we age, many of us may become depressed, irritable, or anxious—and not just because we’re sad or mad about getting old. Researchers believe it may be a natural part of the aging process. Now, a new study published in the journal Neurology suggests that, in some cases, these mood changes may be early symptoms of Alzheimer’s disease and dementia.

 

 “While earlier studies have shown that an estimated 90 percent of people with Alzheimer’s experience behavioral or psychological symptoms such as depression, anxiety, and agitation, this study suggests that these changes begin before people even have diagnosable dementia,” study author Catherine M. Roe, PhD, a research assistant professor of neurology in the Knight Alzheimer's Disease Research Center at Washington University School of Medicine in St. Louis, said in a news release.

 

 

What the Researchers Found

Dr. Roe and her colleagues administered tests to look for psychiatric symptoms such as depression, delusions, agitation, anxiety, apathy, and irritability in 2,416 adults over the age of 50 who had visited one of 34 Alzheimer’s centers across the country to participate in the study. At their first visit, none of the subjects showed signs of Alzheimer’s disease or dementia.

 

After seven years of follow-up, more than half of the participants (1,218 in all) developed dementia. They also developed depression and other behavioral symptoms sooner than participants who did not progress to dementia. For instance, 30 percent of people who developed dementia had symptoms of depression after four years of follow up, compared with 15 percent of those who did not develop dementia.

 

Looking closer, the researchers noticed that the mood changes followed three distinct phases: irritability, depression, and changes in nighttime behavior; anxiety, apathy, agitation, and changes in appetite; elation, hallucinations, delusions, disinhibition, and motor disturbances.

 

While all of the participants were more likely to develop psychiatric symptoms as they aged, overall, the findings suggest that depression may be a “modest risk factor” for people with pre-clinical dementia, they wrote.

 

Which Comes First

Is depression a result of Alzheimer’s disease or a cause? That’s the million dollar question that Dr. Roe and colleagues were unable to answer. The researchers could not determine whether these psychiatric symptoms were a result of the same brain changes that cause Alzheimer’s and dementia, or whether they were in fact the first manifestation of the disease.  

 

“We still don’t know whether depression is a response to the psychological process of Alzheimer’s disease or a result of the same underlying changes in the brain,” Dr. Roe said. She added that more research is needed to identify the relationship between these two conditions.

 

Protect Your Brain

Alzheimer’s disease can’t be cured, but there are a few ways to reduce your risk. First thing to do is get your health under control: heart disease and stroke, as well as high blood pressure, high cholesterol, and diabetes, can dramatically increase your risk for Alzheimer’s. Adopt these heart-healthy measures to protect your head:

 

·         Revamp Your Diet. Purge your pantry of processed foods. Read labels and avoid foods loaded with sodium and added sugar. Stock your kitchen with more fruits, vegetables, and whole grains, and moderate your alcohol intake.

 

·         Move Your Body. Aerobic exercise such as walking, cycling, or swimming for 30 minutes five times a week helps lower your blood pressure and blood sugar levels and raises high-density lipoprotein, the “good” kind of cholesterol.

 

·         Kick Butts. If you haven’t yet, now’s the time to quit. Smokers are at a higher risk for almost every health problem, including stroke, which can cause brain damage that makes you more vulnerable to Alzheimer’s disease and dementia. Need help quitting? Check out smokefree.gov for some handy resources.

 

·         Catch Enough Zzzz’s. Studies in mice and humans suggest that getting seven to eight hours of sleep every night may give the brain time to clear away potentially harmful toxins, including amyloid-beta, a protein believed to be involved in Alzheimer’s disease.

 

·         Keep Your Friends Close. Recent research suggests that staying connected to friends and family can help protect against cognitive decline. Consider joining a community center to participate in weekly activities, or schedule regular get-togethers with friends and family. Staying social can also protect against depression!

 

·         Don’t Ignore Health Problems. If you have untreated high blood pressure, high cholesterol, or diabetes, talk to your doctor about medications and lifestyle modifications that can help you manage them.

 

To learn more about Alzheimer’s disease, see Alzheimer’s: The Basics. For more coverage of the link between depression and dementia, browse our archives here.


Monday, January 26, 2015

BY REBECCA HISCOTT

 

If you have epilepsy and you sleep on your stomach, you may be at a higher risk for sudden unexpected death than those who sleep in other positions, according to a new study published in Neurology. This is particularly true for those who experience generalized tonic-clonic seizures.

 

For those whose seizures are not adequately controlled with medication, a phenomenon known as sudden unexpected death in epilepsy (SUDEP) is the leading cause of death. It usually happens unwitnessed during sleep, said study author James X. Tao, MD, PhD, an associate professor of neurology and director of the Electroencephalography (EEG) Laboratory at the University of Chicago, in a news release. It occurs in approximately 1 out of 1,000 people with epilepsy each year and its biological causes are largely unknown.

 

What the Researchers Found

After reviewing data from 25 studies that looked at 253 cases of SUDEP in which the patient’s body position had been recorded, Dr. Tao and colleagues found that 73 percent of the subjects died sleeping on their stomachs versus 27 percent who died in other sleep positions.

 

In a subgroup of 88 SUDEP cases, younger epilepsy patients were nearly four times as likely to be found on their stomach (also known as the “prone” position) compared with older subjects; 86 percent of people under 40 who died from SUDEP were sleeping on their stomach, compared with 60 percent of those over 40.

 

“We’re not sure why this was more common in younger people. It may be that they are more likely to be single and not have anyone with them during a seizure while sleeping,” Dr. Tao said.

 

In addition, 11 SUDEP cases occurred while patients were being monitored with video EEG. All 11 of them died while sleeping in the prone position and most had been on their stomachs before the seizure occurred. The patients also all had generalized tonic-clonic seizures and postictal generalized EEG suppression, a specific pattern of post-seizure electrical activity in the brain that can be detected by EEG. This pattern almost exclusively appears in the brains of people with generalized tonic-clonic seizures.

 

Who Is At Risk?

If you have generalized tonic-clonic seizures (which involve muscle stiffening and convulsions), postictal generalized EEG suppression, and you sleep on your stomach, you are at higher risk for SUDEP, the researchers said. Other known risk factors include early onset of epilepsy, chronic resistance to medication, and nocturnal seizures.

 

“Adults often have an impaired ability to wake up after a seizure,” which may hinder their ability to move their head when the airway becomes obstructed by soft bedding, thereby leading to SUDEP, Dr. Tao said.

 

Take These Precautions

To reduce your risk of SUDEP, practice these good habits:

  • Get Your Seizures Under Control. The most important way to reduce your risk for SUDEP? Take anti-epileptic drugs to control your seizures. If you’re already on medication and still have uncontrolled seizures, talk to your doctor about switching to a different drug or drug combination or upping your dose.
  • Stay Healthy. Avoid excess alcohol and illicit drugs, get enough sleep, follow a healthy diet, and stick to an exercise routine. These lifestyle changes can all help reduce seizures.
  • Sleep on Your Side or Back. The researchers can’t stress it enough: don’t sleep on your stomach if you have generalized tonic-clonic seizures or seizures at night.
  • Use Technology. Check out a seizure-tracking smart watch or similar device that can detect a seizure and wake you up. “Wrist watches and bed alarms designed to detect seizures during sleep may help prevent these deaths,” Dr. Tao said.
  • Inform Your Sleeping Partner. Ask your sleeping partner to push you onto your back if you have a generalized tonic-clonic seizure during the night, Dr. Tao suggested.

To learn more about SUDEP, visit sudepaware.org and browse our archives here.


Tuesday, January 20, 2015

BY REBECCA HISCOTT

 

A young child with autism. Behavior, not obvious physical features, distinguishes children with autism from other children. Here, as a familiar adult approaches this little boy to play, he prefers gazing at an object for an unusual length of time.

 

The sooner autism is diagnosed, the sooner parents can consult with experts to figure out which therapeutic options are appropriate for their child. Research has shown that early therapy can help correct or lessen some of the social and behavioral deficits of the disorder. But that diagnosis may not be happening in a typical visit to the pediatrician, according to a new study.

 

The decision to refer a child to a specialist for the more rigorous testing required for a diagnosis of autism is often made during a routine visit to the pediatrician. And if that decision is made based on brief observations alone, there’s a risk that even experts will miss a large percentage of children who need a referral, said lead study author Terisa Gabrielsen, PhD, NCSP, an assistant professor in the department of counseling, psychology and special education at Brigham Young University, in a recent interview.

 

That’s because even children with autism display mostly “typical” behaviors during these 10- to 20-minute visits, which may mask hallmark signs such as difficulty communicating, repetitive movements and behaviors, and a lack of certain social skills.

 

“We think our findings are an important clue as to why many children with autism are not identified until they are 4 to 5 years old or older,” she said. Typically, children with autism begin showing signs by age 1 or 2.

 

Study Design

The study, which was published in the journal Pediatrics, included 42 children between the ages of 15 and 33 months: 14 had been diagnosed with early signs of an autism spectrum disorder, 14 did not have autism but had suspected language delays, and 14 were developing normally. Researchers administered three tests that assessed the child’s risk for autism, including the Autism Diagnostic Observation Schedule (ADOS), which looks at whether a child displays abnormal behaviors in areas such as speech, making eye contact, showing or reading emotions, and movement.  

 

The researchers videotaped these evaluations in two 10-minute segments, so that there were two 10-minute videos for each child. They then showed the videos to two psychologists who specialized in autism spectrum disorders. The experts rated the children’s behaviors as either “typical” or “atypical” and indicated whether they would refer each child for a full autism evaluation, based on the behaviors observed in that video.

 

What the Experts Missed

Surprisingly, even though the children with autism displayed more “atypical” behaviors such as repetitive movements, avoiding eye contact, and not responding to their name, most of their behavior still looked like that of a typically developing child. The psychologists classified only 11 percent of the autistic children’s behaviors as “atypical,” compared with 2 percent among normally developing children.

 

When asked which of the children should be sent for an autism assessment, the psychologists were incorrect 39 percent of the time. The two experts agreed on what constituted an “atypical” behavior only 35 percent of the time—showing just how difficult it is to pick out atypical behavior in a short observation period, the study authors said.

 

Making a Diagnosis

A proper diagnosis of autism requires more than just a behavioral observation. It requires “autism screening tools, parent observations, developmental testing, and a detailed [medical and behavioral] history,” the authors wrote.

 

It also takes a full team both to diagnose and treat a child with autism, Dr. Gabrielsen added, involving input from “psychologists, speech and language pathologists, occupational therapists, developmental pediatricians, other health care professionals, and sometimes physical therapists”  in cases of physical disability or impairment.

 

The American Academy of Pediatrics now recommends that all children be evaluated for autism using tests such as the ADOS at 18 and 24 months. If you suspect your child may have autism or another developmental disorder, talk to your doctor about a referral for screening. You can also consult the Modified Checklist for Autism in Toddlers online.

 

To learn more about the signs of autism, visit the CDC’s resources on autism spectrum disorders and browse our archives here.