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.