Wednesday, December 4, 2013

Decreased Alzheimer's Risk with Cancer/Chemotherapy

  Pancreatic,liver and lung cancer were found to decrease the risk of Alzheimer's disease by 10 to 51%.Conversely, melanoma and prostate CA were associated with an increased risk of AD.
  Further, cancer patients that received radiation or chemotherapy had an added reduced risk of AD of 17 to 23%.
Neurology 2013;81(4):322-328
BMJ 2012 Mar 12;344:e1442

Monday, October 28, 2013

Ultrasound Thalamotomy Treatment For Essential Tremor

  From the U of VirginiaCOM 15 study patients with essential tremor were treated with MRI-guided focused high-intensity ultrasound waves (sonification) to ablate the ventral us intermedius nucleus of the thalamus. Significant improvement was seen in all patients that were heretofore unresponsive to drug treatment (typically 50% of patients with ET which is inherited).
  The down side: this treatment, unlike deep brain stimulation, is irreversible and therefore adverse events are permanent including four patients in this study that suffered persistent paresthesias.
  The up side: US thalamotomy may be applicable to other disorders : brain tumors, other movement disorders, epilepsy and central pain disorders.
NEJM 2013;369:640-648
Lancet Neurology 2013;12(5):462-468

Monday, October 21, 2013

Copper - A Suggested Relationship to Alzheimer's Disease

  From researchers at the U of Rochester, when studying aging mice that were fed drinking water (with only low levels of copper) found a four fold increase in copper in brain capillaries and a two-fold decrease in in LRP1 (lipoprotein receptor-related protein 1). LRP1 facilitates the transport of amyloid beta across the blood-brain barrier and into the bloodstream for removal. If the level of LRP1 is reduced then Abeta transport is reduced and its accumulation results in the production of plaques and deposits seen in the brains of patients with AD.
  It might be that as we get older our brains may be more sensitive to to copper in our diet and water.
  Because copper is a vital nutrient to cell function altering it will be a complicated task. Currently there is a study in phase II trials employing PBT2 , a chaperone molecule to escort copper from the brain.
  The fact that copper prevents the pleating of amyloid-beta has been known for many years. But in the lab, at least, copper decelerates the deposition of amyloid- beta in plaques.
Proc Natl Acad Sci USA 2013;E-pub2013 aug 19

Sunday, October 6, 2013

Breastfeed and Reduced Risk of Alzheimer's Disease

  From the UK, women that breastfed had a lower risk of Alzheimer's disease than those that did not.
  Breastfeeding is an important modifier of cumulative endogenous hormone exposure for mothers.
Journal Of Alzheimer's Disease 2013 July 23

Cancer vs Alzheimer's Disease

  The risk of cancer in alzheimer's patients is reduced by 50%.
  The risk of Alzheimer's in patients with cancer is reduced by 35%.
Neurology 2013 July 10

Trisomy 21 Chromosome Inactivated in Cells of Human Down Syndrome and its AD Implications

  From researchers at U os Mass, the extra 21st chromosome in human cells of Down syndrome was made inactive.
  Clinical trials are now underway whose goal is to improve cognition in those with Down syndrome.
  Of importance is the fact that the gene that codes for amyloid-beta peptide (which accumulates in excess in the brains of patients with Alzheimer's disease) is located on the 21st chromosome. Those with Down syndrome produce 50 % more of this protein and are at great risk for developing Alzheimer's disease by their early 40's.
  Regarding technique, researchers employed the RNA gene that normally inactivates one of a female's X chromosomes called XIST. The team employed zinc finger nuclease technology (a method of editing the genome) to place it into one copy of the 21st chromosome. The receiving chromosome was in an induced pluripotent stem cell derived from fibroblast cells from a patient with Down syndrome.
Nature 2013;E-pub 2013 July 17

Monday, July 22, 2013

Low back pain ? Yoga and Amusement Parks !

  From researchers at Essen Germany , found strong evidence for short-term effectiveness and moderate evidence for long-term effectiveness of yoga for chronic low back pain.
Clin J Pain. 2013 May;29(5);450-60
 From the dept. of spinal surgery, Mie U. Japan, low back pain was significantly alleviated when test subjects were in an amusement park, though temporary, demonstrating that enjoyable activities lessen low back pain.
J Pain Res. 2012;5:409-13

Low back Pain ? Aerobic Walk

  From the department of Physiotherapy Tel-Aviv, a six week aerobic walk program was as effective as six weeks of specific strengthening exercise program for low back.
Clin Rehabil. 2013 Mar;27(3):207-14

Friday, July 19, 2013

New Form of Nimodipine to Treat SAH : Nymalize

  Nymalize, an oral solution for nimodipine , has been approved to reduce the adverse affects of vasospasm in patients with subarachnoid hemorrhage. The drug was previously available in a gel cap and had to be extracted by syringe resulting in accidental IV administrations of the drug rather than the intended installation into a nasogastric tube.
Arbor Pharm

Eat Your Nicotine Containing Veggies and Decrease Parkinson's Risk

  In a population based study of 490 newly diagnosed patients with Parkinson's disease and 644 healthy controls, patients that consumed fruits and vegetables that contain nicotine ie. from the same botanical family as tobacco, Solanaceae, including peppers (especially peppers), tomatoes and potatoes.
Annals of Neurology May 9, 2013

Non-melanoma Skin Cancer Decreases Risk of Alzheimer's

  Those older than 70 years that develop non-melanoma skin cancer have a dramatically decreased risk of Alzheimer's disease in a study of 1,102 patients.
Neurology May 15, 2013
  Conversely, it is known that patients with Parkinson's disease have a higher-than-expected frequency of melanoma and patients with melanoma are more likely to develop PD.
Int J Cancer. 2011 May 15; 128(10):2251-60

New Treatment for Pseudotumor Cerebri

  A team of neuro-radiologists and neurosurgeons at Johns Hopkins treated 12 patients with pseudotumor cerebri that failed drug treatment, weight loss and dieting by placing a stent via angiography into the transverse sinus of the brains of these individuals. The team employed the novel use of intravascular ultrasound imaging to place the 2 inch long stent thereby freeing the narrowing of the transverse sinus in these individuals and facilitating spinal fluid drainage, the accumulation of which causes increased pressure in the head and upon optic nerves inducing blindness. 10 of the 12 patients had a complete and lasting recovery.
  The condition is tied to obesity which is a growing epidemic in this country.
  The study will require verification and further research as to what causes the transverse sinus to narrow.
  One wonders if this treatment approach can be applied to other forms of intracranial hypertension.
Jrnl Of Neuro-Opthamology online March 14,2013

Sunday, July 14, 2013

Barber Motorsports Park

NASCAR Grand Am race in Alabama. Before an autograph session with Dr.Chris Prusinski on the left with co-driver Chris Hall of Great Britain. A capacity crowd was on hand welcoming the stars of Grand am as well as Indycar on a beautiful weekend north of Birmingham.

Cell Phones Change Brain Metabolism

Cell phone use increases brain glucose metabolism in the region closest to the antennae as per a JAMA article of February 23rd.
Whether these changes are due to heat generated by the phone or RF-EMF exposure is unclear.
The significance of this finding is also unclear. Researchers are divided about the risk of brain cancer and cell phone use.

Some researchers have also suggested a neuro-protective effect that exposure to electromagnetic waves in mice decreases the accumulation of amyloid in mice (the protein found in excess in the brains of those with Alzheimer's)
J Alzheimer's Dis 2010;19(1):191-210

Set Bedtime Good For Children's Brain

  Girls ...but not boys...that did not have a set regular bedtime at age 7 had significantly lower scores for reading, math, and spatial skills on standardized tests from UC London researchers.
  Non-regular bedtimes at age 3 were independently associated with lower cognitive skills at age 7 in BOTH girls and boys.
  The study suggests that when sleep is restricted or disrupted symptoms symptoms that reflect a reduced capacity for plastic change in the brain.
  The implication is that reduced or disrupted sleep , particularly if it occurs at key times in development, could have important impacts on health throughout life.
Y. Kelly,PhD Jrnl of Epidemiology and Community Health July 2013

Autism : One in Four Mothers of Autistic Children Have Antibodies That Target Fetal Brains

  University of California, Davis researchers have found maternal antibodies to seven fetal brain antigens in nearly one quarter of mothers with autistic children. This finding could lead to a maternal blood test to identify children at risk for autism spectrum disorder long before symptoms manifest. This finding may herald a potential treatment option to prevent autism by blocking exposure to these antibodies in children born to affected mothers.
  One in 88 children in the US have autism (CDC).
Translational Psychiatry
  In a second study, also from UC Davis, IgG from mothers of children with autism was given to pregnant rhesus monkeys the offspring of which displayed inappropriate social interactions.

Monday, June 3, 2013

Prevent or Delay ALS

  High dietary intakes of foods high in carotenoids (beta-carotene and lutein) may help prevent or delay the onset of amyotrophic lateral sclerosis.
Annuals of Neurology Jan. 29 2013

Sunday, June 2, 2013

PLIE Helps Patients with Alzheimer's

  PLIE (Preventing Loss of Independence Through Exercise) is a new program that combines elements of Eastern and Western traditional exercises and emphasizes focus on performing basic functional movements,encouraging social engagement and increasing bodily awareness. In the small group studied, patients would arrive at the exercise facility not remembering that they had been there but would start going through the movements of the routine. This fits with what we know about Alzheimer's : memory for events is impaired but procedural memory holds out and resists declination.
65th Annual AAN meeting San Diego March 2013
  In a related study, daily walking has been shown to stabilize Alzheimer's disease across one year.
Arch Gerontol Geriatr. 2013;56(1):96-103

Colicky Infants at Risk for Childhood Migraine

  Children that presented to the ER with migraine were 6x more likely to have a history of colic during infancy.
  It is theorized that colic may represent sensitization of the perivascular nerve terminals in the gut.
   Sadly, the brain-gut relation remains one of the least understood and least researched areas of medicine.
JAMA 2013;309(15):1607-1612

Gene Mutation Increases Risk of Alzheimer's

  ABCA7 genetic mutation in African Americans nearly doubles the risk of Alzheimer's disease. It is not associated with the disease in Europeans.
JAMA April 10, 2013

Saturday, April 27, 2013

New Treatment Guideline in Acute Spinal Cord Injury: NO STEROIDS

   The first new spinal cord injury treatment in a decade cites strong evidence that high-dose steroids are associated with harmful side effects, including death, in acute spinal cord injury.
Joint Section on Disorders of the Spine and Peripheral Nerves of the Congress of Neurological Surgeons and the American Association of Neurological Surgeons

Coffee, Tea or Fiber ? To Decrease Stroke Risk

   Greater dietary fiber intake is decidedly associated with lower risk of first stroke. 
STROKE March 28,2013
   Higher consumption of green tea and coffee may decrease the risk of cardiovascular disease and stroke. 
STROKE March,14 2013

Friday, April 26, 2013

Obstructive Sleep Apnea Increases Risk of Dementia

   From WashUCOM St. Louis, more than half the study participants with obstructive sleep apnea (OSA) developed dementia. 
   It is uncertain as to the pathological mechanism which may be involved :repeated drops in oxygen? the paucity of deep (reparative) sleep? or some other mechanism.
JAMA 2011;306(6):613-619

Monday, April 22, 2013

Travel to Mars but Loose Your Marbles ?

   Researchers from URMC in cooperation with the NASA Space Radiation Lab at Brookhaven exposed double transgenic mice ( with APP and Presenilin mutations), that were destined to develop Alzheimer's pathological changes anyway, to Iron-56. Six months after 10 and 100 cGy radiation at 1GeV/u the mice displayed impairment on behavioral studies. After sacrifice, there was evidence of accelerated beta amyloid deposition.
   This is the first study to demonstrate that HZE particle radiation can increase beta amyloid plaque pathology.
  Studies are underway with normal mice to see if the effects can be duplicated.
PLoS One 2012;7(12):e53275. E-pub 2012 Dec 31

Monday, April 1, 2013

Immuno-therapy For Parkinson's Disease ?

   From the labs of the University of Pennsylvania comes an important supportive paper to the growing body of evidence that alpha-synuclein (AS) travels through the brain in a prion-like manner effecting anatomically connected regions, inducing Lewy body formation and causing the cell death of dopaminergic neurons.
   This study suggests that "templated recruitment and transmission" is the mechanism of disease. 
   The results also suggest that delivering antibodies to the brain of affected animals to bind to extracellular AS would be a way of interrupting the spreading process and theoretically halting the disease.
Science 2012;338(6109):949-953

Chronic Traumatic Encephalopathy

   Chronic Traumatic Encephalopathy is characterized by the accumulation of tau protein deposits in the form of neurofibrillary tangles (NFTs), glial tangles, and neuropil threads in the brain....which cause brain cell death and in the later stages brain atrophy. The regional brain distribution of these protein deposits is unique to CTE.
  The above findings were the result of a blinded review of three tissue samples from unidentified brains including NFL player Junior Seau.
   Little is known about the cause of this disease which results in signs of cognitive impairment and personality changes especially depression.
   Recall from my earlier reviews that tau NFTs are also seen in the brains of Alzheimer's and Parkinson's disease...although different in pattern of distribution.
Brain 2012;E-pub 2012 Dec. 2

Saturday, March 30, 2013

Amyloid PET Scans Not Deemed to Improve Alzheimer Outcomes

  Members of a Medicare advisory panel (MEDCAC) concluded that there is insufficient evidence that PET scans completed using a new radioimaging contrast agent that identifies amyloid-beta burden in patients (amyvid, that received FDA approval last spring, as previously reported) improves health outcomes in suspected cases of early AD.
  This reaffirms the previously stated conundrum of neurologists that ask "Ok, so my patient has a significant amyloid-beta burden on PET scan, now what ?" as there are no universally accepted methods of treatment for such AND no clear evidence in humans that doing so affects the course of the disease. In addition, there is evidence in animal models of AD that amyloid-beta like proteins have an anti-microbial effect (neuro-protective at levels that are not neuro-toxic)
MEDCAC Jan 30,2013

Early Menopause Associated With Faster Decline In Memory

  A new study replicates the 2007 findings from a Mayo Clinic paper that indicates that an earlier age at surgical menopause  (oophorectomy) may be associated with faster decline in memory and global cognition.
  In a related report, hormone therapy may reduce the risk of Alzheimer's disease for women that receive treatment within five years of the time of menopause. These women had a 30% less risk of developing Alzheimer's. This effect was lost if treatment was received five years or more after menopause.
Neurology Oct 30, 2012

Beta Blockers Neuroprotective For Dementia ?

  From the American Academy of Neurology annual meeting in San Diego last week, autopsied brains from the Honolulu-Asia Aging Study revealed that people that had been treated with beta blockers alone (an older method of treating hypertension) showed fewer microinfarcts, less brain atrophy and fewer lesions of the type seen in Alzheimer's disease.
   Researchers concluded that Beta-blocker use is associated with a lower risk of developing cognitive impairment and decline in elderly Japanese American men.
  As previously reported, elevated blood pressure is a known risk factor for Alzheimer's disease and cognitive impairment.
  The surprising results of this study will be important for "hypothesis generation" about how beta blockers might influence Alzheimer's neuropathology and cognition later in life.

Sunday, March 24, 2013

New Imaging Method for Early Detection of Traumatic Brain Injury

  Five retired profesional football players age 45 and older with a history of concussions underwent PET scanning after IV injections of FDNNP, a chemical marker which binds to amyloid beta and tau .
  Compared with healthy males, the former pro athletes had elevated levels of FDNNP in the amygdala and subcortical regions of their brains.
  Additionally, higher levels of FDNNP correlated with a higher number of reported concussions.
American Journal of Geriatric Psychiatry online Jan 22, 2013

Battery Powered Patch for Migraine

  Zecuity ( sumatriptan iontophoretic transdermal system ) has been FDA approved for treatment of migraine.
  53% of patients treated were headache free and 84% nausea free at two hours.
  Zecuity is manufactured in Conshohocken,PA by NU Pathe

Hearing Loss is Associated With Accelerated Cognitive Decline

  Cognitive testing was performed on 1,984 older adults at five, eight, ten and eleven years. A total of 1,162 individuals with baseline hearing loss had 41% and 32% greater scores on 3MS and Digit Symbol substitution Tests respectively compared to those with normal hearing.
  The conclusion, those with hearing loss had a 24% increased risk for cognitive impairment.
JAMA online Jan 21, 2013

Lightning Triggers Migraine

  In this study, ninety patients with headache underwent a review of their headache diaries over a 3 to 6 month period. The results indicated that there was an increased likelihood of having a headache on days with  lightning after other variables associated with thunderstorms were added as covariates. 
  The mechanism resulting in this phenomena is unknown.
Cephalgia Jan 24,2013

Alzheimer's Disease Short Course Treatment

  This is a follow-up to a previous blog entry related to IVIG treatment of patients with Alzheimer's disease from the Mayo Clinic, Rochester,MN.
 Patients with early Alzheimer's disease receiving five doses of intravenous immunoglobulin (IVIG) over an eight week period  showed significantly less brain atrophy after 1 year than a placebo group.
  The problem is that IVIG is derived from human donor plasma and is extremely scarce supply. It's primary neurologic application to date has been in the treatment of patients with Guillain-BarĂ© syndrome. Production capabilities for all current suppliers could not begin to provide enough for all patients with mild to moderate Alzheimer's disease, let alone the even larger population with mild cognitive impairment.
  Therefore, if a short-term dosing regimen is as effective as continuing therapy, it would extend current supplies that may be provided to a larger number of patients.

Kile S, et al "Initial findings of a randomized double-blinded placebo-controlled study of intravenous immunoglobulin in mild cognitive impairment due to Alzheimer disease" AAN 2013; Abstract P01.013.