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Tuesday, March 20, 2018

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Women who were physically fit in middle age were at a lower risk of developing dementia than women who were less fit. Fit women were also more likely to delay dementia than less fit women. Those are the results of a longitudinal observational study published online in the journal Neurology on March 14.

How Fitness Affects the Brain

Physical activity produces changes in areas of the brain also vulnerable to aging and Alzheimer's damage, such as the hippocampus, which plays an important role in learning, memory, and navigation.

Worldwide, 50 million people have dementia, and about 10 million are diagnosed each year, according to statistics from the World Health Organization. Physical activity has been linked in earlier studies to the slowing of cognitive decline and a decreased risk of dementia in old age, but few studies have examined the link between fitness in middle-age and dementia in very old age. Evidence on the long-term effects of fitness on brain structure and dementia risk is limited.

Mid-Life Fitness and Dementia Risk

To see if fitness levels in midlife affected dementia risk late life, researchers followed 191 Swedish women with an average age of 50, who were enrolled in the Prospective Population Study of Women (PPSW), for a total of 44 years.

The participants took a bicycle exercise test at the start of the study to measure their cardiovascular fitness. They also had their heart rate measured, blood pressure recorded, and perceived fatigue noted. They also underwent an electrocardiogram (ECG).

Six times through the course of the study, geriatric psychiatrists determined dementia based on information from neuropsychiatric examinations and interviews with patients. An official diagnosis was given if the participant had dementia according to both sources, or if it was evident from one source, and the other source spotted similar dementia symptoms.

Higher Fitness Equals Lower Dementia Risk

After the 44-year follow-up, women who had a high level of fitness at midlife, had a 5 percent risk of developing dementia compared to a 25 percent risk for women with medium fitness levels and a 23 percent risk for women with low fitness levels. Those who stopped exercising due to blood pressure, chest pain, or other cardiovascular problems, had a 45 percent higher risk of dementia. "This indicates that adverse cardiovascular processes might be going on in midlife that seem to increase the risk for dementia," according to the researchers.

Fitness Link

The association between high fitness levels and low dementia risk in this Swedish population suggests that improving fitness in midlife could be help delay or prevent dementia.

Further research is needed to determine if fitness can prevent dementia, and when specifically, during a person's lifetime, high cardiovascular fitness is essential. Fitness levels need to be measured more than once to take into account changes in fitness over time.

For more on exercise and the brain, read our story in The Waiting Room called The Exercise Effect.

Monday, March 19, 2018

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Medical cannabis therapy can reduce pain intensity, improve quality of life, and reduce the use of opioids in an elderly population, according to a prospective observational study published in the European Journal of Internal Medicine.

Managing Chronic Pain in the Elderly

Aging influences the biochemical and physiological effects of drugs on the body. For example, a slow metabolism, a normal part of aging, can increase the likelihood of experiencing side effects such as nausea, vomiting, constipation, and falls in seniors who take prescription medicines such as opioids for pain management, according to the National Safety Report.

Americans over the age of 65 make up 13 percent of the total population, but they account for the use of 34 percent all prescription drugs, and 30 percent of all over-the-counter (OTC) drugs, according to the National Council on Patient Information Education (NCPIE). The use of medical marijuana is also rising in the aging population for treating conditions such as cancer, Parkinson's disease, post-traumatic stress disorder, ulcerative colitis, Crohn's disease, and multiple sclerosis, according to a systematic review in Clinical Psychopharmacology and Neuroscience. Yet, current evidence on the efficacy and safety of the drug in the elderly is limited.

Studying Cannabis for Pain

To test the safety and efficacy of medical cannabis for treating pain in older adults, researchers in Israel identified 1,186 patients over the age of 65 who initiated treatment with medical cannabis from Israel's largest medical cannabis supplier, from January 2015 to October 2017. More than 60 percent of patients had been prescribed cannabis to treat pain, including pain related to cancer.

Patients received treatment either as an oil or by smoking or using vaporization. Before starting treatment, a nurse took each patient's medical history, including the reason for needing cannabis, medication-use habits, a detailed list of symptoms, a quality of life assessment, and demographic data. The nurse then recommended specific cannabis strains for each patient's condition.

Measuring Efficacy

Researchers followed up with patients after one month and again six months after treatment via telephone interview. At the six-month follow-up, the researchers assessed the occurrence and frequency of all side effects, including headache, dizziness, and nausea. They also assessed cannabis efficacy by measuring quality of life, pain intensity on a 0 to 10-point scale (0=no pain, 10=worst pain imaginable), patients' perception of the drug's effect on their condition, and treatment success. ​

Medical Cannabis Improved Pain

After six months, medical cannabis significantly improved pain and quality of life for older adults with minimal side effects. More than 93 percent of 901 participants reported their pain dropped from eight to four on the 10-point scale. Quality of life upgraded from "bad" or "very bad" to "good" or "very good" in approximately 60 percent of patients. More than 70 percent of patients reported experiencing moderate to significant improvement in their condition.

Dizziness (9.7 percent) and dry mouth (7.1 percent) were among the most common side effects. After six months, a total of 18.1 percent of patients stopped using opioid analgesics or reduced their dose.

The researchers say their findings suggest that medical cannabis is safe and effective with minimal to no side effects for patients age 65 and older. Cannabis may also decrease this aging population's dependence on prescription medications, including opioids.

Study Limitations

Researchers acknowledge that the observational nature of the study only allows them to determine a link between cannabinoids and pain relief not causality. In addition, most of the patients were using a mixture of cannabis strain, which meant researchers couldn't determine the exact dose of active drug each patient was getting.

They say additional study is needed, including double-blind, randomized-controlled trials.

An Expert Comments

The study is encouraging, says Brain J. Wainger, MD, PhD, assistant professor of neurology and anesthesiology at Harvard Medical School and an attending physician at Massachusetts General Hospital. But because it was observational, he's cautious about the results. With studies on pain, he says, researchers have to take into account the placebo effect—a response related to a person's expectation of benefit—when interpreting the results. "It's hard to interpret the magnitude of the benefit that's due to the cannabinoids, although I think it's encouraging, and warrants additional studies." Until then, he says the evidence supporting opioids for pain management is stronger than for cannabinoids.

Dr. Wainger says opioids are a second choice for treating pain, after over-the-counter painkillers such as nonsteroidal anti-inflammatory drugs and acetaminophen, because of concerns about safety and addiction. Cannabinoids would be considered a third choice, he says, because the data about efficacy are weaker.

For more about medical cannabis and chronic conditions, read Weedbackers.

Wednesday, February 14, 2018



A special exercise program that focuses on balance and eye movements improved balance-related symptoms of multiple sclerosis (MS) such as fatigue, dizziness, and vision problems, according to a study published online in Neurology on January 31.

Poor Balance Is Common for People with MS

Impaired balance, along with fatigue, dizziness, and vision problems, are common symptoms associated with MS and can lead to limited mobility and falls, as well as a reluctance to pursue social activities.

Integrating information from the eyes, ears, and proprioception (a sense of one's self in space) is what allows the body to maintain balance. For many people with MS, the ability to integrate that information is impaired and balance is affected. To date, rehabilitation programs aimed at improving balance and walking ability have focused on strength exercises that do not address the accompanying balance and fatigue problems many people with MS experience.

A Better Balance Program

To find out if a program called Balance and Eye Movement Exercises for Persons with Multiple Sclerosis (BEEMS) that allows patients to process a variety of sensory information while also performing balance and eye movement exercises could help improve balance and reduce dizziness and fatigue, researchers at the University of Colorado School of Medicine in Aurora recruited 88 MS patients to take part in the study. Eligible participants, who ranged in age from 18 to 60, had to be able to walk 100 meters with a cane or other assistive device on one side. They also were assessed for balance, fatigue, and dizziness

Half of the patients were then assigned to BEEMS training while the other half (the control group) were offered the intervention after the end of the 14-week study. The BEEMS group engaged in six weeks of supervised exercises twice a week and received instructions for at-home exercises, which they were expected to perform daily.

Exercises involved maintaining balance on difference surfaces and while walking, both with and without head movements and with the eyes open and closed. During the remaining eight weeks, patients completed one supervised exercise session each week, along with the daily home exercises.

Program Improved Balance

At the six-week mark, improved balance was seen in patients in the exercise program, compared to the control group, as measured on a balance test. People in the BEEMS group saw their test scores improve 10 points compared to three points for those in the control group. After 14 weeks, improvements among MS patients continued to remain significant.

The BEEMS participants also experienced improvements in dizziness and fatigue by doing exercises that focused on controlling eye movement and head movements while standing and walking.

Integrative Exercise Makes a Difference

The study suggests an exercise program that incorporates processing multiple sensory information while doing balance and eye movement exercises should be included in physical interventions for MS patients. The BEEMS program paired with a functional training program could potentially lead to further improvements in gait, which could help patients safely do daily activities.

Still, further research is warranted to determine how long improvements can last beyond the 14-week mark with interventions such as physical therapy exercises that involve eye/head/limb coordination under the supervision of a health care professional.

For more about balance, read our story in Healthy Brain called Balancing Act.

Tuesday, January 16, 2018


In every issue of Neurology Now, we offer a mix of inspiring stories and practical advice for those living with neurologic conditions and their caregivers.  

From tips for navigating the often-daunting costs of caregiving ("Care Costs") and readjusting to life after the death of a loved one ("Begin Again") to stories about people who box to manage symptoms of Parkinson's disease ("Parkinson's on the Ropes") and artists who live with neurologic conditions ("The Art of Illness"), our most-read stories touch on the challenges and triumphs of living with neurologic conditions.


1. Protect Your Brain for Life: Follow these expert strategies to guard against injury and cognitive decline throughout your life.


2. Stay Steady on Your Feet: Falls are the number one cause of injury and death among older Americans, especially those with neurologic conditions. Protect yourself with these tips.


3. Care Costs: Caring for someone with a progressive neurologic disease can be financially challenging. This expert advice can help protect you and your loved one.


4. Parkinson's on the Ropes: Exercise programs incorporating boxing skills may help manage symptoms of Parkinson's disease. Find out how you can join a program near you.


5. Backup Plans: Sometimes family caregivers die before their patients. Here's how to prepare for the worst-case scenario.


6. The Art of Illness: Four artists talk about how their neurologic conditions affect their art.


7. Begin Again: Reclaiming life after years of caregiving is a gradual, up-and-down process. We asked those who've been there how to ease the transition.


8. 6 Ways to Help Pay for Adult Day Care Services


9. Weight Watch: Some disorders or medications can cause weight loss while others pile on the pounds. Learn how to chart a middle course or adapt to the new you.


10. Brain Storm: After brain surgery to remove a benign tumor, TV host and journalist Maria Menounos makes her health a priority.

Wednesday, January 10, 2018



People with early-stage Parkinson's disease had low levels of caffeine and caffeine metabolites in their blood compared to healthy controls, suggesting that caffeine levels may be used to diagnose people with Parkinson's, according to a new study published online on January 3 in Neurology.

The Caffeine-Parkinson's Link

Previous research suggests that caffeine may protect the brain against Parkinson's disease. People who consumed more caffeine daily appeared to have a decreased risk of developing the disease, and vice versa. In addition, preliminary animal studies suggest that caffeine may protect against degeneration in the substantia nigra, an area of the brain implicated in Parkinson's.

Checking Caffeine Levels

To investigate the association between how caffeine is metabolized in the body and Parkinson's symptoms, researchers in the department of neurology, the Research Institute for Diseases of Old Age, and the Laboratory of Proteomics and Biomolecular Science at Juntendo University School of Medicine in Tokyo, Japan enrolled 108 patients with early-stage Parkinson's and 31 age-matched healthy controls.

After collecting blood serum samples from all participants, researchers used a lab technique to analyze levels of caffeine and 11 caffeine metabolites, chemicals left behind when caffeine is used for energy by the body. They also asked the participants to report how many cups of caffeinated beverages they consumed per day.

Finally, the researchers compared the results on the blood serum analyses with the participants' disease status (Parkinson's or healthy) and the severity of their Parkinson's symptoms, as measured by two scales that rate stage and severity of the disease.

A Potential Diagnostic Tool

The researchers found that caffeine levels in the blood samples, and levels of 9 of the 11 caffeine metabolites measured, were elevated in patients with Parkinson's disease compared to the healthy controls. The associations remained significant regardless of the participants' total daily caffeine intake, the severity of their symptoms, their sex, and whether or not they carried genes that predisposed them to Parkinson's.

The authors concluded that their findings "indicate a neuroprotective effect of caffeine" and suggest that caffeine levels, as measured through blood serum tests, may be a reliable way to help diagnose Parkinson's disease.