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Tuesday, June 27, 2017

 

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BY FRAN KRITZ

As people age, an accumulation of health problems—changes in muscle strength, coordination, vision, and hearing—contribute to an increased risk of falls, says Lisa Shulman, MD, FAAN, director of the University of Maryland Parkinson Disease and Movement Disorders Center in Baltimore. Many people also develop damage to their nerves, or neuropathy, which can cause numbness in the feet and can change how you perceive where your feet are in relation to the floor. If your hearing or vision is impaired, it's harder to anticipate obstacles. And if you stumble or are less flexible in your knees and hips, you're more likely to fall, says Dr. Shulman.

Cognitive Contribution

Physical limitations increase the risk of falls, but so do cognitive changes, notes Dr. Shulman. "We don't recognize that walking requires a combination of both mobility (motor function) and attention (cognitive function)," she says. "If you're walking from the parking lot to the store, you're not just walking. You're also avoiding moving cars, looking for the store entrance while you put away your car keys, and reaching for your shopping list. And you may be walking with a friend who is telling you her latest news. So walking is really a complex act of multitasking, where your attention is divided in many ways. Studies show that even doing just two things at once, such as walking while talking, increases the risk of falls."

Walking and Talking

Measuring the brain activity of healthy older adults while they're walking and talking can predict their risk of falling, according to a new study published in the December 7, 2016 issue of Neurology. Conducted by researchers at the Albert Einstein College of Medicine in New York City, the study involved 166 older adults with an average age of 75 who were already enrolled in an ongoing mobility study. The participants were asked to do three tasks: 1) walk at a normal pace, 2) recite alternate letters of the alphabet while standing, and 3) walk at a normal pace while simultaneously reciting alternating letters of the alphabet.

Multitasking Increases Risk

The researchers measured both walking and letter reciting speed and used noninvasive sensors on the participants' foreheads to measure changes in oxygen levels at the front of the brain. After the testing was completed, the researchers contacted participants every two to three months over the next four years to find out whether they had experienced a fall. Seventy-one participants reported a total of 116 falls, and 34 fell more than once. (Most falls were not serious, with only 5 percent of them resulting in fractures.)

Neither the speed at which the subjects walked nor their speed of reciting alphabet letters predicted who would be more likely to fall. Brain activity during those actions was also not a predictor. But when the researchers looked at brain activity measured when subjects were walking while talking, they found that elevated activity signaled an increased risk of falling in the future. Each incremental increase in brain activity was associated with a 32 percent increased risk of falls.

Looking for Clues

"Our findings suggest that changes in brain activity that influence walking may be present long before people exhibit any sign of walking difficulty. Now we need to find the underlying biological mechanisms or diseases that may be altering brain activity and, if possible, correct them to help prevent falls," says Joe Verghese, MBBS, director of the division of cognitive and motor aging at Einstein and director of the Montefiore Einstein Center for the Aging Brain and the lead study author.

Lower Your Risk

Neurologic conditions that affect gait and mobility such as stroke, Parkinson's disease, multiple sclerosis, neuropathy, and Alzheimer's disease increase the risk of falls, says Dr. Shulman. Talk to your doctor about what type of fall prevention program would be best for you, says Pinky Agarwal, MD, FAAN, a neurologist who specializes in movement disorders in Kirkland, WA. While many programs include strength training and balance exercises such as tai chi, others may be tailored specifically to people with conditions like Parkinson's disease or stroke. Many fall prevention programs are free, or covered by insurance or Medicare.


Monday, June 12, 2017

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BY ROBERT FIRPO-CAPPIELLO

 

In the June/July 2017 issue of Neurology Now, we interview Christine Ha, 2012 MasterChef winner who lost her vision due to neuroymelitis optica, a rare autoimmune disease. After relearning to cook, Ha started a blog called theblindcook.com, which caught the attention of the producers of MasterChef, who encouraged her to audition for a spot on the show. Not only did Ha make the cut; she went on to win, becoming the first blind contestant to appear on the show and to nab the title. We asked her for some of her favorite Mediterranean-style recipes to tie in with our feature on diets linked to a lower risk of cognitive decline (bit.ly/NN-Diets).

Bruschetta

This classic meat-free Italian appetizer gets a pleasant kick from red onion and garlic. These slices will satisfy four people as pre-dinner finger food, but portion sizes and ingredient amounts can vary depending on the size of the baguette and personal taste.

Ingredients

4 Roma tomatoes, diced & strained

½ red onion, diced

Fresh basil leaves, thinly sliced

Minced garlic

Extra virgin olive oil to taste

Balsamic vinegar to taste

Salt and pepper to taste

1 whole grain baguette, sliced into ¾-inch slices

1/8 cup grated parmesan cheese

Instructions

  1. In a medium bowl, combine tomatoes, onion, and basil. Add olive oil, balsamic vinegar, salt, and freshly ground black pepper to taste. Toss well and set aside.
  2. Meanwhile, bake baguette slices at approximately 350 degrees for 3 to 5 minutes or until bread is lightly toasted.
  3. Top with tomato onion mixture. Add parmesan cheese on top if desired.

Furikake-crusted Yellowfin Tuna with Wasabi Mayo

This recipe is designed for tuna steaks cut approximately 1-inch thick. If you've got thinner steaks, cook for less time. Furikake is a Japanese seasoning with dried seaweed, bonito flakes, and sesame seeds, available at specialty food stores. Serves four.

Ingredients

4 yellowfin tuna steaks, approximately 6 oz. each

Salt and pepper

Grapeseed oil, or your favorite cooking oil

4 tsp furikake

4 oz. cholesterol-free canola mayonnaise

4 tsp wasabi paste or to taste

A few dashes of yuzu, a Japanese citrus, or fresh lemon juice

Instructions

  1. Pat tuna steaks dry and season both sides lightly with salt and pepper. Sprinkle furikake on top, bottom, and sides of steaks. Set aside.
  2. In a small bowl, whisk together canola mayonnaise, wasabi paste, and yuzu or lemon juice. Adjust flavors to taste. Set aside to let flavors thoroughly combine while you cook the steaks.
  3. Heat a skillet over high heat. Add oil to lightly coat the pan. Sear tuna steaks on both sides until seared on the outside but rare on the inside, approximately 1 minute per side. Turn down the heat a little if the furikake starts to burn.
  4. Serve immediately with wasabi mayo on the side for dipping.

Quick & Easy Shrimp and Tomato Linguine

This simple but super-satisfying recipe is a good way to use up ripened tomatoes. It makes more than enough for four people, and tastes even better as a leftover after a day in the fridge.

Ingredients

4 tbsp. olive oil

3 cloves garlic, minced

½ medium onion, diced (optional)

4 cups tomatoes, diced

1 cup dry white wine

1 portobello mushroom cap, chopped (optional)

Salt and pepper

1 (16 oz.) package of linguine pasta

1 lb. medium shrimp, peeled and deveined

1 tsp. red chili pepper flakes

Instructions

  1. Heat 2 tbsp. olive oil in a large saucepan over medium heat. Stir in garlic and onion and cook until fragrant, about 2 minutes. Add tomatoes, mushroom, and wine. Simmer over low heat for 30 minutes, stirring frequently. Once tomatoes have simmered into a sauce, season with salt and pepper.
  2. While tomato mixture is simmering, cook linguine according to directions for al dente pasta.
  3. Season shrimp with red chili pepper flakes, salt, and pepper. Heat remaining 2 tbsp. olive oil in a large skillet over medium-high heat, and cook shrimp until pink on the outside and no longer translucent in the center, about 5 minutes. Add shrimp to sauce, and serve over linguine with grated Parmesan if desired.

To read our feature about Christine Ha, go to bit.ly/NN-Ha.


Wednesday, May 24, 2017

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BY MARY BOLSTER

In our June/July 2017 issue of Neurology Now, we feature the winners of the American Academy of Neurology's 2017 Neuro Film Festival, who each won $1,000. Bill Doorley won in the Why I Think Neuroscience Is… TM Essential category for his portrait of Dr. Deborah Warden and her life with primary lateral sclerosis (bit.ly/NFF-Essential). In this online exclusive, we share more information about the other winners.

Why I Think Neuroscience Is…TM Critical

Imagine running seven marathons in seven days on seven continents—with brain cancer. That seemingly impossible feat was accomplished by BethAnn Telford, 47, from January 23 through January 29, 2017. Following her every step of the way while lugging camera equipment was Meghan Tucker, whose 7-year-old niece, Gracie, was one of the 10 children with brain cancer to whom Telford dedicated her races in the World Marathon Challenge. Tucker's short video comprising highlights from Telford's seven races won the $1,000 Grand Prize in the Why I Think Neuroscience Is…TM Critical category.

Since her own diagnosis of brain cancer in 2005, Telford has been running for her life—literally. Every race she enters, she raises money for Accelerate Brain Cancer Cure (ABC2), a nonprofit organization for which she's an ambassador. The goal for 2017 is $1 million. The tally so far? $909,688. Make that $910,688: Tucker plans to donate her prize money from the Neuro Film Festival to the charity.

Tucker first met Telford in 2012 when she attended a Race for Hope 5K fundraiser for the brain cancer community in Washington, DC. "I was unprepared for the instant love and support my family received at the event," Tucker recalls. She has remained an integral part of Team BT, the group of friends, families, and other folks engaged in battling brain cancer that Telford formed to help in her fundraising efforts.

Days before Telford left for the World Marathon Challenge, she heard about the Neuro Film Festival and encouraged Tucker and two people from ABC2 to submit a short video (less than 5 minutes) from her weeklong adventure. "We agreed immediately that the film festival was perfect for getting the message out about advocacy and awareness of brain cancer research," says Tucker.

The video chronicles Telford's grueling itinerary: From the snowy plains of Union Glacier, Antarctica, on Day 1 to the rainy metropolis of Punta Arenas, Chile, on Day 2. On Day 3, Telford ran her third marathon in tropical Miami. After a transatlantic flight to Madrid, Spain, she finished her fourth marathon followed by a fifth in Marrakesh, Morocco, on Day 5. After a 10-hour flight from Marrakesh, Telford touched down in Dubai, United Arab Emirates, where she endured sweltering temperatures to complete her sixth marathon. Hours later, Telford hopped on a 15-hour flight to Sydney, Australia, where she started her last marathon well before dawn. Her times ranged from six hours and 11 minutes in Antarctica to four hours and 16 minutes in Spain.

Since completing the World Marathon Challenge, Telford has run the Boston Marathon in April and the 5K Race for Hope in May. She continues to meet with her doctors weekly and is preparing for bladder surgery in June due to a complication from her brain cancer, says Tucker. More running is definitely in Telford's future. "I can tell you she will never stop advocating on behalf of the kids who fight this disease," says Tucker. To get involved or donate, visit abc2.org or btwmc.org. To view the video, go to bit.ly/NFF-Critical.

Why I Think Neuroscience Is…TM Rewarding

Neurology resident Gianluca di Maria has always been fascinated by the intersection between the neuroscientist in the lab and the neurologist in the office. "Investing in neuroscience has a direct effect on the patient," he says. To illustrate that, he and his friends shot a video showing the connections and interactions between the scientist's work and the neurologist's engagement with the patient. "I've always enjoyed making movies," says Di Maria, who wrote the script, directed the video, and played the neuroscientist. He plans to use the prize money to buy a new camera. In the meantime, he will continue to work in a neuroscience lab, experimenting and looking for evidence-based results that will benefit patients. To watch the video, go to bit.ly/NFF-Rewarding.

Why I Think Neuroscience Is…TM Cool

Nancy Khuc's grandfather, a former teacher in Vietnam, was diagnosed with Alzheimer's disease in 2013 at age 86. Over time, he has forgotten the names and faces of his children, grandchildren, and great grandchildren. In her loving homage to him, Nancy, 16, reveals what he can still remember: Vietnamese poetry and proverbs. "My grandpa would typically recite the same two to three proverbs, but during the filming of the video, I learned that he knew at least 12," says Nancy. Intrigued by his selective memory, Nancy did some research on how Alzheimer's disease affects memory. "I learned that anything that contains some sort of rhythm or has been rehearsed many times does not require a lot of mental processing. This makes sense as my grandfather taught these proverbs to his students for 40 years."

Nancy has always been interested in film. In searching for opportunities for high school students, she discovered the Neuro Film Festival. "I instantly knew it would be a great platform to share my experiences of living with my grandfather," she says. The sophomore at Mount Ranier High School in Seattle hopes to make a documentary about her grandfather's experience, after she's studied more about Alzheimer's disease. "Filming my grandfather has made me far more interested in Alzheimer's and the brain than I thought I'd ever be." As for her prize money? She plans to give it to her parents for safekeeping until she decides how to use it. To view the video, go to bit.ly/NFF-Cool.


Tuesday, May 16, 2017

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BY ALLAN WU, MD

 

In the June/July 2017 issue of Neurology Now, we share Ted Chris Horn's story about how deep brain stimulation (DBS) helped eliminate his Parkinson's diseaserelated tremors. In this web-only exclusive, Allan D. Wu, MD, associate professor of neurology and a member of the Brain Research Institute and the Movement Disorders Program at the David Geffen School of Medicine at UCLA and a Neurology Now editorial board member, explains how DBS works and the types of patients who are candidates for the procedure.

What it is: Deep brain stimulation is a like a pacemaker for the brain. It consists of a stimulation electrode, a battery pack called an implantable pulse generator (IPG), and a thin, insulated wire that connects the IPG with the electrode. In a surgical procedure, the electrode is inserted through a small hole in the skull and implanted deep in the brain—hence the name DBS—with its end targeting areas of the brain related to Parkinson's disease symptoms. The wire extension snakes under the skin of the head, neck, and shoulder to connect the electrode with the IPG, which is positioned under the skin near the collarbone.

How it works: Once all parts are positioned correctly, electrical impulses are sent from the IPG through the wire extension and into the electrode in the brain where they block abnormal electrical signals and eliminate or improve motor symptoms of Parkinson's disease such as tremor and stiffness. After surgery, your neurologist will program the device by adjusting the amount of stimulation needed to control tremors and other motor symptoms. He or she will also periodically check the device and make any necessary adjustments.

Who qualifies: DBS isn't for everyone. It should be recommended by an experienced neurologist after careful consideration of the patient's particular pattern of symptoms and response to medications. Patients whose symptoms are well-controlled by medication, for instance, would not be encouraged to undergo DBS. Those like Ted Chris Horn whose symptoms responded to medications but were not adequately controlled (for example, they had excessive motor fluctuations) are more likely to be considered candidates.

What it controls: DBS works best on motor symptoms such as tremor, slowness, and rigidity. Other symptoms such as balance, memory problems, cognitive loss, and depression are not improved by DBS and in some cases, it may make them worse. For example, the procedure would not be recommended for patients with symptoms of dementia.

What to expect: As Horn experienced, the benefits of DBS can be dramatic. Many patients may reduce the dose or frequency of their medication or even stop taking drugs altogether, but DBS is not a cure, and symptoms will continue to progress.

How to prepare: If you're considering DBS or your neurologist has suggested it, be sure to do your homework and ask questions about the procedure, its effectiveness, your post-surgery recovery, any side effects such as bleeding or infection, and how long it may last. A positive attitude and realistic expectations both contribute to better outcomes.

 


Monday, May 15, 2017

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In the June/July 2017 issue of Neurology Now, we feature letters in response to our cover story on actress Marcia Gay Harden called "Role of a Lifetime" about her experience with her mother's Alzheimer's disease, in the April/May 2017 issue. Here, we include other letters we didn't have room to print.

Crowdsourced Data

I have a neurologic disorder and a background in science and technology. Are there any opportunities for those like me, who would like to have a more active role in finding a treatment or cure for my disorder (or other neurologic disorders)? Are there any opportunities for citizen-science or "crowdsourced" research?

—Albert C.

Tyler, TX

THE EDITOR RESPONDS: Thank you for your letter about crowdsourcing research. There are several efforts underway to crowdsource data, including one mentioned in a story in the June/July issue, "Making it Personal," on page 46. Called the All of Us Research Program and sponsored by the National Institutes of Health, it aims to recruit a million people to share data with researchers and each other. For more information, go to bit.ly/NIH-AllofUs. You can also support a specific research project through the American Brain Foundation's campaign to Outsmart Brain Disease at americanbrainfoundation.org.

Managing Medication

I don't think the term "noncompliance," which was used in the story about paying for medication, is appropriate ("Medication Management," February/March 2017, bit.ly/NN-MedicationManagement). The term implies that the physician or health care provider knows the best way for the patient to get well. A better term would be "self-directed care." This implies that the person is active in his or her care.

—Virginia M. Wepfer

Lake Milton, OH

Those of us who have multiple sclerosis (MS) or other conditions need help with copays for medication from time to time. Finding the steps to financial assistance can be a stressful path. Personally, I have found that it helps to call patient organizations such as the MS society. They can help reduce the stress of getting and paying for medication.

—Roxie Carter

Manning, SC

Migraine Mystery

I read the story of actress Bellamy Young's experience with migraines ("Relief at Last," December 2016/January 2017, bit.ly/NN-ReliefAtLast). Migraines started for me when I was about 25.  At first I had one or two a month, but they increased to up to 25 or so a month. Then I experienced a stroke that left me with minimal side effects, but no more migraines!

—Kathleen Best

Lakebay, WA