in 
Alzheimer's
Alzheimer's Health Topics
Sunday
23Nov
Which are More Important In Alzheimer’s, Plaques or Tangles?
Sun, November 23, 2008 at 03:00AM The brains of Alzheimer’s patients are characterized by the presence of microscopic changes that are descriptively called plaques and tangles. They were described by Dr Alois Alzheimer in 1906 when he first reported the disease bearing his name. Recent approaches in drug development have focused on preventing the development of one or other of these pathological changes. Attention has been chiefly on anti-plaque formation mechanisms, but a new finding reported at the Society for Neuroscience meeting suggests scientists may have been barking up the wrong tree.
Dr Chanzig Guela, of Northwestern University in Chicago, described the results of brain pathology exams in older people (80-year-olds) who had high-quality mental functioning. The subjects had to have a cognitive performance test result equivalent to that of a 50-year-old, be fully involved in personal and social activities, and have a major accomplishment, such as writing a book, after age 80.
On autopsy, the brains of 5 such high-functioning elders had only 25% the amount of tangles as the brains of 6 elderly people who had shown cognitive decline (but no dementia). On the other hand, beta-amyloid plaques seemed to be more extensive in the 5 high-functioning 80-year-olds than in the 6 controls.
Obviously, the numbers in this study are extremely small – the differences were not enough to reach statistical significance, and certainly not enough to draw definite conclusions. However, they suggest that there is a possible roll for accumulation of tangles in the causation of cognitive impairment and dementia. This may be sufficient for pharmacological researchers to switch their research direction to give tangles more attention than they have in the past . . .
Saturday
22Nov
You Don’t Need Prescription Meds to Treat IBS
Sat, November 22, 2008 at 03:00AM Irritable bowel syndrome, or IBS, is a common, distressing disorder of the intestines producing one or more of the following: abdominal cramping pain, bloating, intestinal gas, and diarrhea or constipation (sometimes both). Effective prescription medications have been introduced recently – alosetron (Lotronex®) and Lubiprostone (Amitiza®) – but many patients can be treated successfully by simpler methods that address the principal symptoms. The effectiveness of three such approaches has been reported in the British Medical Journal, using meta-analysis of numerous published studies.
Twelve studies were identified that compared fiber intake with a placebo or no treatment at all. They included 590 patients, 20% to 90% of whom were women. The specific fiber used in 6 of the studies was ispaghula husk, or psyllium. In these, 64% of the placebo or no treatment patients had persistent symptoms during and after treatment. With the psyllium treatment, only 52% had continued symptoms, so that there was a 13% reduction in frequency of persistent symptoms. The number-needed-to-treat was 6. Bran showed no benefit over placebo.
Twenty-two studies examined the effectiveness of 12 different antispasmodic drugs, in 1775 patients. Overall, 56% of the placebo patients in these studies had persistent symptoms during and after treatment, compared with 39% given antispasmodics, representing a reduction of 32%, and a number-needed-to-treat of 5. The most effective antispasmodics were otilonium (not available in the USA) and hyoscine (Buscopan®).
Finally, 4 studies compared peppermint oil with placebo, in 390 patients. Of those taking the peppermint oil, 25% had persistent IBS symptoms, compared with 65% of the placebo patients. This shows a reduction in symptoms of 57%, on average, and a number-needed-to-treat of 2.5.
These meta-analyses showed clearly that all 3 selected treatments were effective in IBS, with peppermint oil as the best, antispasmodics as second best, and added fiber in third place. Remember that there are other approaches to management, without necessarily involving prescription medications – e.g. dietary modification (avoiding gas-producing foods, adding more fiber), and symptomatic treatment of diarrhea (loperamide or Imodium®) or constipation (laxatives). There are many excellent web sites about IBS, but be careful – not all treatments are well-tested, and most ‘cures’ are expensive and don’t work. One of the better sites is that of the IFFGD.
Friday
21Nov
Careful Where You Rest Your iPod Headphones
Fri, November 21, 2008 at 03:00AM People with a heart pacemaker or an implanted cardiac device should be careful where they leave the headphones of their MP3 player. According to a report at the American Heart Association meeting this year, the magnets in the headphones might throw off a pacemaker or defibrillator when placed within an inch of them.
The researchers, who came from Beth Israel Deaconess Medical Center in Boston, studied the effects of two iPod brands (Nano and Shuffle) on 60 patients with implanted pacemakers or defibrillators. While the iPods had no effect, their headphones produced interference in 23% of the subjects – inappropriate pacing in 4 out of 27 pacemaker patients, and inhibition of defibrillator action in 10 of 33 patients.
The magnetic field strength varies considerably with different brands of headphones, but, more important, the magnetic field strength falls off very rapidly with distance. However, it should be remembered that the magnetic field is always “on”, whether or not the iPod is switched on.
So, all you cardiac patients with implanted devices, who also like to listen to music on the move, please ensure you keep the headphones in your pants pocket rather than in your shirt breast pocket; and make sure your spouse or child removes any headphones before laying their head on your chest.
Thursday
20Nov
A Hidden Benefit from a Flu Shot
Thu, November 20, 2008 at 03:00AM Now’s the time of year to get your flu shot (if you haven’t had one already). And it’s just been reported that the shot can protect you from another risk – having a venous thrombotic embolism. This news emerged at the American Heart Association meeting in New Orleans. Dr Joseph Emmerich of the University of Paris described his study of the possible link between a flu shot and venous thrombosis.
Over 700 patients who were hospitalized with for a first episode of deep venous thrombosis or a pulmonary embolism were asked if they had had a flu shot in the last year. They were compared with an equal number of control subjects, matched for gender and age, who were also hospitalized but without thrombotic disease.
After factors such as body weight, oral contraceptive use, and varicose veins had been controlled for, having a flu shot was linked with a 26% reduction in the subsequent risk of having a venous thrombosis episode. The reduction was actually 48% in those patients younger than 52, which was the average age of the persons in the study.
The researchers hadn’t designed the study to find out why (or how) flu vaccination reduces the risk of venous thrombosis. One theory mentioned was that ‘protected’ patients might spend fewer days ill in bed (a known cause of thrombosis). Or perhaps an infection like influenza has a direct pro-thrombotic influence. Either way, it’s a positive finding that should encourage those doubters to go to the flu-shot clinic, straight away.
Wednesday
19Nov
Don’t Neglect Your Triglyceride Level
Wed, November 19, 2008 at 03:00AM Once you’ve got your total cholesterol and the ‘bad’ cholesterol (LDL-C) under control, it’s easy to think everything is fine. It may not be, though. A Danish study reported in the Journal of the American Medical Association shows a clear parallel between raised triglyceride levels and the likelihood of an ischemic stroke (the commonest type of stroke).
This study measured non-fasting triglycerides; this may not be the usual type of sample, as triglycerides are usually determined on fasting blood samples. Elevated non-fasting triglycerides have been implicated in coronary artery disease, so it seemed pertinent for the researchers to look at a relationship with ischemic stroke. Thirty-year data from almost 14,000 men and women between 20 and 93 were analyzed.
The subjects were classified according to their non-fasting triglyceride levels above 89 mg/dL. Those with a level between 89 and 176 mg/dL had a 30% higher risk of ischemic stroke; between 177 and 265 mg/dL a 60% increase (men) or 100% increase (women); between 266 and 353 mg/dL a 50% (men) or 40% increase (women); and between 354 and 442 a 120% (men) or 150% increase (women).
Clearly, raised triglyceride levels must be added to the list of risk factors for stroke. Both men and women stroke victims averaged non-fasting levels about 40 mg/dL higher than people without stroke. There are effective ways to lower a raised triglyceride level, so don’t ignore the problem; ask your doctor for advice and, if necessary, the appropriate medication.
Tuesday
18Nov
Music - “The Food of Love” for the Heart
Tue, November 18, 2008 at 03:00AM This is not the first report of the benefits of music to heart health; it’s also been reported to benefit the treatment of stroke. But now a study described at the American Heart Association Meeting has shown effects of music on endothelial function. (The endothelium is the layer of cells lining the insides of the blood vessels.)
The University of Maryland researchers carried out a randomized cross-over study in 10 healthy adults; they were non-smokers, and averaged 36 years of age. An important feature was that the music should be enjoyable to the subject, and be compared with other stimuli – anxiety-provoking music, watching a humorous video, and listening to a relaxation tape. First, the volunteers selected 30 minutes of music they enjoyed. Then, they were asked to avoid listening to this particular music for 2 weeks before the study began. They were also asked to identify music that made them feel anxious (the sound-track to “Psycho” or "Jaws", maybe?).
To measure endothelial function, flow-mediated dilatation in the upper arm artery (brachial artery) was determined before and after 30 minutes of each test stimulus. The four stimuli were given on separate occasions, one week apart, for 30 minutes. The results showed that, compared with baseline, flow-mediated dilatation;
Increased 26% after enjoyable music
Decreased 6% after anxiety-provoking music
Increased 19% after watching a funny video
Increased 11% after hearing a relaxation tape
The size of increased flow-mediated dilatation – 26% - was roughly equal to that produced by aerobic physical activity or statin medication.
Previous reports have also shown that laughter – your own – can improve your cardiovascular health. This explains the good result from the humorous video in this study. Anyhow, if you’re stuck with your iPod rather than a DVD, you’ll do better – provided the music is something joyful!
Monday
17Nov
Testosterone Helps Improve Sex for Some Women
Mon, November 17, 2008 at 03:00AM Hormone treatment for postmenopausal women is now re-emerging, cautiously, because of the side effects reported with high-dose, long-term use. A study reported in New England Journal of Medicine has provided evidence that postmenopausal women with a low sexual drive can be helped by the use of a testosterone skin patch.
Over 800 women who had low sexual desire were allocated at random to apply one of three sorts of skin patches: testosterone 150 microgram, testosterone 300 microgram, or placebo. Treatment lasted one year. The women reported the weekly number of satisfying sexual episodes.
After 6 months treatment, the women using the higher testosterone dose patch reported a significant increase in the number of satisfying sexual episodes over the final 4-week period compared with baseline values; the increase averaged an additional two episodes per month. Those using the 150 microgram patch had an average of an additional 1.2 episodes per month, and placebo recipients had a smaller increase (0.7 episodes/month). Both testosterone doses levels increased sexual desire scores and reduced personal distress, compared with placebo.
Averse effects of the treatment included unwanted hair growth with the 300 microgram testosterone level; it was reported in 30% of the patients at that level compared with 23% of those on placebo.
Although the women were followed for a total of 18 months, the study wasn’t adequate to define the possible side effects of this form of hormone treatment. For instance, 4 of the testosterone-treated subjects developed breast cancer, although in one it was subsequently found to be present before the study started, and the other three all occurred in the first 4 months of the study. None of the placebo subjects developed cancer. The investigators of the study say the improvement in sexual desire was “modest but meaningful", but they think further studies are needed to clarify the safety profile of longer-term use of the patch.
Sunday
16Nov
Carefully Applied Electric Shocks to the Brain for Stroke?
Sun, November 16, 2008 at 03:00AM Electroconvulsive therapy (ECT) has fallen out of use in recent decades. It seems rather awful to apply an electric shock to the brain, and the results, when used in treating depression or schizophrenia, weren’t very good. Remember “One Flew over the Cuckoo’s Nest”? Now it’s been found that a short jolt of electricity to the scalp can improve dexterity in people who have had a stroke.
The relevant findings are posted in BioMedCentral Neuroscience. A weak current is applied by electrodes to the scalp. The effect is to stimulate or depress the underlying brain neurons, depending on the polarity of the current. Application of a depressive current over the non-dominant motor cortex (usually that on the left side) and a stimulating current over the dominant side was found to improve volunteers to improve their scores on key-board numbers input by 16%.
These findings, obtained in healthy volunteers, suggest strongly that a similar approach could be used in stroke victims to improve controlled movement in a non-dominant hand. Maybe there is a role for the application of electrodes to the skulls of some patients, after all!