Alzheimer's Disease and Abeta Protein

Amyloid beta (Abeta) that accumulates in Alzheimer's disease (AD) plaques resembles LL-37 , a peptide with anti-microbial properties, according to researchers at Harvard Medical School. Abeta has been suggested to be the "brain's protector" against infections, but also appears to be ramped up after traumatic brain injury or stroke in addition to chronic low-grade infections. Interestingly, Abeta is toxic to brain cells. But it is cleared quickly once produced . With too great a response or too many brain insults, Abeta may turns against the body. This suggests a new way of thinking about the pathology of AD in that it may be viewed as an auto-immune disease. Too little Abeta in our brains may lead to increased risk of infections ...too great an accumulation of Abeta carries with it an increased risk of AD. Soscia,SJ Kirby,JE Moir,RD PLoS One 2010 Mar 3;5(3):e9505

HELMINTHS NEEDED FOR BALANCED IMMUNITY ?

Diseases such as inflammatory bowel disease (IBD) were rare before the 1920's, when public health efforts began making strides in cleaning up our water supply,modernizing the treatment of sewage, and improving farming practices.These changes certainly benefited us by reducing or eliminating exposure to many disease-causing pathogens, they also had the unintended consequence of removing exposure to beneficial or even necessary organisms.

People lived closer to the soil in the past, without indoor plumbing and with direct exposure to animals. The result was near universal colonization with helminths, which are complex wormlike animals that inhabit the gastrointestinal tracts of mammals. Like the many bacteria also found in the gut, some helminths can cause disease in a host animal but many are relatively harmless and, in fact, are important regulators of the immune system.

According to Dr. J. Weinstock , a gastroenterologist at Tufts University, " helminths exert a powerful effect on immunity in the host, primarily by inducing the regulatory arm of the immune system, which is important in reigning in the effector ' fight and kill ' arm of the immune system." The regulatory arm hones and shapes the immune response to bacteria, viruses, and parasites, quelling the effects of the effector arm so as to prevent needless tissue damage by turning against the host.

Diseases such as IBD, asthma, rheumatoid arthritis, and multiple sclerosis remain uncommon in less-developed parts of the world where helminthic colonization is still widespread.

Interestingly, petrified human stool many thousands of years old has been found to contain helminth eggs, and autopsies of mummies have found traces of helminths. In fact, the frozen iceman Otzi, found in the northern Alps in 1991 where he had lain in a glacier since 3300 B.C., had T. trichiura in his gut.

Int. J. Parasitol. 2007;37:457-64

Gut 2005;54:87-90

Ann. Rheum. Dis. 2008;67:518-23

Mild Traumatic Brain Injury Detected

Mild Traumatic Brain Injury (mTBI) can be detected using diffusion tensor imaging (DTI) which is an application of MRI that is sensitive

to the direction of the movement of water molecules through tissue.In the intact brain, the primary direction of movement is parallel to axonal bundles, which is caled anisotropy.But when these axons are damaged, the movement becomes less aligned with the bundles.If there is a change in the direction of diffusion of water due to microscopic damage , it is reflected in a decrease in anisotropy.This finding may allow the diagnose of patients with mTBI in whom routine MRI scans are often normal.

Radiology 2009;252 (3) :816-824

BELL'S PALSY RECOVERY

BELL'S PALSY RECOVERY more likely with corticosteroids (higher doses of more than 450 mg ).Adding antiviral drugs (acyclovir is generic and therefore less expensive) may have additional benefit but this was of borderline statistical

significance. JAMA 2009;302(9):985-993

MIGRAINE IN MRS. LINCOLN?

Mary Todd Lincoln suffered from debilitating headaches ( possibly migraine ) throughout her adult life. "Abraham Lincoln Vampire Hunter" by Seth Grahame-Smith

NEW MIGRAINE DRUG CLASS

Telcagepant (MK-0974), the first orally bioavailable neuropeptide calcitonin gene-related peptide (CGRP) receptor antagonist, relieved pain and other migraine symptoms.

Merck is in phase III of the clinical development of this drug and is addressing dose dependent liver toxicity. Neurology2009;73:970-977

END-OF-LIFE ISSUES IN DEMENTIA

Ethical issues are discussed in the management of the demented patient at www.aan.com/go/about/position

The appropriate form of treatment for most patients with advanced dementia is palliative care in which measures that maintain comfort are emphasized and whose goal is to improve quality,not the quantity, of life