Brain Injury Law Blog : Head Injury : Coma : Personal Injury : Las Vegas Nevada Lawyer & Attorney Tim Titolo

The Lou Ruvo Las Vegas Medical Center, part of the Cleveland Clinic, will participate in a multi-center Alzheimer's Study.  

The study will be to advance early detection and treatment for Alzheimer's.  Dr. Kate Zhong, the senior director of clinical research and development at the Cleveland Clinic Lou Ruvo Center for Brain Health, will direct a clinical trial aimed at finding an inexpensive blood test to detect Alzheimer's disease.

 The Las Vegas Review Journal revealed:

 The first multi-site clinical trial in the United States aimed at trying to identify Alzheimer's disease through an inexpensive blood test will be directed by researchers at the Cleveland Clinic Lou Ruvo Center for Brain Health.

Currently the only definitive way to diagnose the disease is by direct examination of brain tissue after the patient dies.   This obviously does little to prevent the disease from advancing while the patient is alive.

Some experts have put the cost of a blood test at $200. Current sophisticated brain imaging costs $2,000 or more.

PAUL HARASIM reports

Last month, Robert Nagele, a professor at the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, said he developed a blood test that is more than 90 percent accurate at identifying antibodies in the blood specific to the disease.

Dementia is a loss of brain function that occurs with certain diseases. Alzheimer's disease (AD), is one form of dementia that gradually gets worse over time. It affects memory, thinking, and behavior.

Memory impairment, as well as problems with language, decision-making ability, judgment, and personality, are necessary features for the diagnosis.

 Las Vegas Nevada Receives Attention as Serious Medical Research and Treatment Center

Since establishing the Cleveland Clinic Lou Ruvo Brain Injury Center in Las Vegas, the city is a viable contender with other national brain specialty centers.  Cleveland Clinic's Lou Ruvo Center for Brain Health (CCLRCBH) provides state-of-the-art care for cognitive disorders and for the family members of those who suffer from them. The physicians and staff at the CCLRCBH are working towards:

• Early diagnosis
• Providing excellent care to patients
• Offering care for the caregivers
• Development of new, powerful treatment options

Another recent advance in brain health in Las Vegas is the union of Stanford University and St. Rose Hospital in the neurosurgery field.  This year , U.S. News & World Report named Stanford Hospital and Clinics one of the top 17 hospitals in America.

 Another Las Vegas Review Journal piece quotes Maureen Peckman's views on the new neurosurgery center:

Maureen Peckman, chief emerging business officer for the Cleveland Clinic, which oversees the operations and development of the Lou Ruvo Center for Brain Health, welcomed the partnership.

"I think that any time our community can attract top-level medical partners in the valley, it's a boon for patient care, boon for raising quality, a boon for everyone engaged in health care in the community," she said.

It is wonderful to see Las Vegas diversifying itself as the great recession continues to swell.  The addition of quality medical facility alliances may be the silver lining to the City's failed reliance on the one industry it historically relied on.  This may be especially true for brain health.

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Nevada Brain Injury Law 

We know that repeated traumatic brain injury can lead to Alzheimer's disease.  But did you know that even one traumatic brain injury can as well.  So whether multiple blast injuries, sports injuries or even just one car accident with traumatic brain injury, you could raise the chances of developing Alzheimer's in later years.

Over 1.7 million Americans suffer a traumatic brain injury each year, and beyond the immediate effects, growing evidence demonstrates that a single traumatic brain injury, or TBI, may initiate long term processes that further damage the brain. Boxers call this "punch-drunk" syndrome.

Douglas Smith, MD, professor of Neurosurgery and director of the Center for Brain Injury and Repair at Penn's Perelman School of Medicine states:

"A single traumatic brain injury is very serious, both initially, and as we're now learning, even later in life. Plaques and tangles are appearing abnormally early in life, apparently initiated or accelerated by a single TBI."

If you or someone you know has suffered a traumatic brain injury, be on the look out for symptoms of Alzheimer's later in life.  Even at a younger age than you would otherwise think.

The first symptoms of Alzheimer's disease you may notice are increasing forgetfulness and mild confusion.  Here are some others:

Memory

• Repeat statements and questions over and over
• Forget conversations, appointments or events, and not remember them later
• Routinely misplace possessions, often putting them in illogical locations
• Eventually forget the names of family members and everyday object

Disorientation and misinterpreting spatial relationships

 Speaking and writing
Those with Alzheimer's may have trouble finding the right words to identify objects, express thoughts or take part in conversations. Over time, the ability to read and write also declines.

Difficulty with Thinking and reasoning

Difficulty Making judgments and decisions

Difficulty Planning and performing familiar tasks

Changes in personality and behavior
Brain changes that occur in Alzheimer's disease can affect the way you act and how you feel. People with Alzheimer's may experience:

• Depression
• Anxiety
• Social withdrawal
• Mood swings
• Distrust in others
• Increased stubbornness
• Irritability and aggressiveness
• Changes in sleeping habits
• Wandering

 If you or someone you know has suffered traumatic brain injury, contact the Titolo Law Office today.

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 Cate Newton sent this great post. http://www.medical-assistant.net/alzheimers-resources concerning Alzheimer's.  She asked that I share it with my readers.  Here is part of it.

Quick Facts

• The human brain changes over time, but the abnormal occurrence of plaques and tangles is a sign of dementia-related disorders. While scientists do not know the exact connection between these abnormalities and Alzheimer’s, they do understand that nerve cells are being blocked, causing memory loss and other cognitive disabilities (Alzheimer’s Association).
• Alzheimer’s usually affects older victims, especially those over 60. The disease slowly progresses, affecting thought, memory, and language in subtle then more apparent ways (Medline Plus).
• More than 5 million Americans are currently affected by Alzheimer’s and are expected to reach 15 million by 2050. These numbers reach greater proportions internationally, with a current 26 million affected by the disease and a 106 million predicted by 2050 (Alzheimer’s Disease Research).
• Women are more likely to develop Alzheimer’s than men because women tend to have longer life expectancies and hence are more vulnerable to aging-related diseases (Women’s HealthCare Forum).
• Genetics is only one of the factors that contributes to Alzheimer’s. While researchers do not know what exactly causes Alzheimer’s, there has been scientific evidence linking four chromosomes to the disease: 1, 14, 18, and 21 (WebMD).

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 It may surprise you to know that older driver's actually see more than younger drivers.  And that is why they have difficulty driving.

It turns out that as the brain ages, the visual intake gets bigger.  Older brains attempt to take in the background of all motion in their field of vision.  This makes the brain's ability to focus on relevant movement, important when reacting to driving movements, more difficult.

In a healthy, young person, a brain region called the middle temporal visual area, or MT, actively suppresses often irrelevant background motion so that he or she can concentrate on t

he more important motions of smaller objects in the foreground.

But this above average motion perception is not something to look forward to as we age. Because the brain is spending its limited resources constantly paying attention to the unimportant motions of background objects, it has a harder time noticing the motions of smaller objects.

Fellow blogger, Dr. Virginia Campbell, recently posted an interview the authors of "Sleights of Mind: What the Neuroscience of Magic Reveals about Our Everyday Deceptions" by Stephen L. Macknik, Susana Martinez-Conde, Sandra Blakeslee.  This book is the result of the authors' yearlong, world-wide exploration of magic and how its principles apply to our behavior. Magic tricks fool us because humans have hardwired processes of attention and awareness that are hackable—a good magician uses your mind's own intrinsic properties against you in a form of mental jujitsu.

You can read about the findings in the Journal of Neuroscience.

 

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Is it Dementia or Heart Medication?

It may be time to consider guaging your forgetfulnes by the heart medication you take.  2010 generated interesting findings. 

Scientific American  reports Cholesterol-lowering statins such as Lipitor, Crestor and Zocor are the most widely prescribed medications in the world, and they are credited with saving the lives of many heart disease patients. But recently a small number of users have voiced concerns that the drugs cause unexpected cognitive side effects, such as memory loss, fuzzy thinking and learning difficulties.

While these side effects are reported in only a small number of cases, it is important to get proper diagnosis and care: especially if you have high cholesterol.

Is your Brain Fat?

Well...yes it is. Or at least it requires fat to operate well. Cholesterol is a waxy substance that, among other things, provides structure to the body’s cell membranes. It also clogs arteries and blood vessels.

Statins

Some studies report that statins improve memory in certain people by lowering the risk of dementia. But the fact that statins may be bad for others arises because of different biochemical pathways and genetic predispositions.

Statins may prevent the body from making cholesterol-based myelin which insulates axons and speeds neuron connections.

So if you are having difficulty making decisions, remembering things or being yourself, and you are taking statins, talk to your doctor. You can likely switch medicine and see improvement. Of course if you recently hit your head you should also tell your doctor as you may be suffering signs and symptoms of brain injury.

On the other hand, non-statin heart medication has been shown to promote brain health by reducing dementia.

In January 2010, Boston University scientists, reporting in the British Medical Journal, say a class of high blood pressure drugs called angiotensin receptor blockers is associated with a striking decrease in the risk of occurrence and progression of dementia.

The researchers, using information from a U.S. Department of Health System Veterans Affairs database of more than 5 million people, examined records of more than 800,000 predominantly male patients 65 or older.

The researchers compared the patients in groups that included those using an angiotensin receptor blocker (ARB); those using an ACE inhibitor called lisinopril (Prinivil, Zestril); and those using other blood pressure/heart disease medications (excluding statins). 

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According to the Society of Actuaries, the leading cause of U.S. long-term care claims is Alzheimer's, the brain disease that renders over 5 million Americans unable to handle all the acts of daily living unaided.

President Obama states in an article he wrote "What Health Care Reform Means for the Alzheimer's Community" -- that the recent health reform legislation, the Affordable Care Act, will assist Alzheimer's sufferers and their caretakers in several ways:

-- Require new health insurance plans to cover preventive services;

-- Reduce out-of-pocket prescription drug costs for Medicare beneficiaries;

-- Make Alzheimer's-related training available for long-term care employees; and

-- Offer a new long-term care insurance public option -- the CLASS Act.

Part of the Health Care Reform that becomes effective is the annual wellness visit for Medicare beneficiaries beginning January 2011. The care is part of the comprehensive health care reform legislation known as the Patient Protection and Affordable Care Act. 

New reforms under the Affordable Care Act  begin to bring to an end some of the worst abuses of the insurance industry. These reforms will give Americans new rights and benefits, including helping more children get health coverage, ending lifetime and most annual limits on care, and giving patients access to recommended preventive services  without cost-sharing. These reforms will apply to all new health plans, and to many existing health plans as they are renewed. Many other new benefits of the law have already taken effect, including rebate checks for seniors in the Medicare  donut hole and tax credits for small businesses. And more rights, protections and benefits for Americans are on the way now through 2014.

As the leading research, advocacy, and support organization for Alzheimer's disease, the Alzheimer's Association®  has been actively involved in efforts to increase early detection of Alzheimer's and other dementias. To provide better medical care and outcomes for individuals with Alzheimer's and other dementias, possible dementia must first be detected, followed by diagnosis and notation in a patient's medical record. To provide this foundation for better care to Medicare beneficiaries, the Alzheimer's Association® is pleased that cognitive impairment has been included in the Annual Wellness Visit for older Americans.

As baby-boomers move into the after-65 age group, they will benefit from the health care modifications and reforms. The Alzheimer's Association® has established the Medicare Cognitive Impairment Workgroup comprised of stakeholders and national thought leaders with expertise in the detection of cognitive impairment. The group will come together in January to build consensus around appropriate methods and processes that can be used in the primary care setting to detect possible cognitive impairment during the Medicare Annual Wellness Visit.

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Las Vegas Human Brain Injury Blog

We normally attribute smoking to lung cancer. A Recent Study now links smoking to later life dementia. My mother smoked more than a pack a day and finally succumbed to the disease. Her cancer originated in the lungs and metastasized to her brain. The 6 month ordeal was absolutely heartbreaking. And she quit smoking after getting the diagnosis which was obviously too late. She was my personal longitudinal study subject of the consequences of smoking. And she thought she was so clever with her moth balls to hide the odor and pretend she was not smoking. And I remember during the year prior to her diagnosis how her apartment, food she prepared, clothes she washed, and just about everything else smelled like moth balls. A far cry from theEast Coast Long Island Italian aromas of holiday cooking I cherished from my childhood.

Beginning January 1, 2011, the 79 million-member baby boom generation will begin - at a rate of 10,000 per day - reaching the age of 65. Growing older, while not the cause of Alzheimer's, is the single most significant factor in gauging a person's risk of the disease. The Alzheimer's Association estimates that the number of Americans with this devastating disease will balloon from just over 5 million today to 7.7 million by the year 2030 and could reach nearly 16 million by the middle of the century.

And now we have increased risk of dementia due to smoking.

“We found a two-fold increase in risk [of dementia] among those who smoked two packs per day, a 44 percent increase in those who smoked one to two packs, and 37 percent increase in those smoking one-half a pack per day in mid-life,” Dr. Whitmer told Neurology Today. I wonder if my mother began having dementia that ended up being masked by the cancer. She was forgetting things more.

The study, published in the October 2010 issue of Archives of Internal Medicine, sought to discover whether smoking, a know risk factor for several life-threatening diseases, had long-term association with dementia. This link is previously controversial. The study compiled data over many years. The results revealed a 100% increase in dementia. This does not leave a lot of room to think heavy smokers are immune from related dementia.

So what can you do besides not start or quit smoking? Take more Fish Oil? Not so fast.

Fish oil is oil derived from the tissues of oily fish. Fish oils contain the omega-3 fatty acids eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA), precursors to eicosanoids that

are known to reduce inflammation throughout the body, Studies published in 2004 and 2009 have suggested that fish oil may reduce the risk of depression and suicide. One such study reported that patients who were given the omega-3 fatty acid docosahexaenoic acid fared no better cognitively or functionally than those who took a placebo over 18 months. and are thought to have many health benefits.

So now you know. To decrease the risk factor for dementia – DO NOT SMOKE. If you think you’re decreasing the risk factor by taking Fish Oil, you may not be. As for me, I continue to not smoke and continue taking Fish Oil.

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Lou Ruvo Brain Center - Working Together to Fight Alzheimer’s

This month I continue covering the Cleveland Clinic Lou Ruvo Center for Brain Health. Recall last month a new Director was appointed. This month the Center is emphasizing its progress and plans for future progress.

Some perspective: There are 5.3 million Americans with Alzheimer’s disease (including 29,000 Nevadans). This number is estimated to reach 16 million by 2050. September 21 is World Alzheimer's Day – a day when the Alzheimer's Association joins with organizations and people around the globe to raise awareness about Alzheimer's and its impact on our families, communities and nations. Today, 35 million people worldwide are affected by Alzheimer's and related dementias, and this number is growing rapidly. World Alzheimer's Day is an opportunity to raise awareness about Alzheimer's disease and the need for more education, support and research.

The Lou Ruvo Center, located in downtown Las Vegas is consistently performing clinical studies and reaches out to all volunteers to help. Education is the goal, Jeffrey Cummings, a medical director at Lou Ruvo Center for Brain Health explains, “Patients must participate in trials if there is to be any progress in developing new treatments for Alzheimer’s disease. Trials are critically important partnerships among patients and families, doctors and scientists to advance new treatments for the Alzheimer’s disease.” Las Vegas Sun Sept. 19, 2010.

The Lou Ruvo Center for Brain Health has been in various stages of opening as construction was completed and is now fully operational. World Alzheimer’s day is September 21 and The Center announces it has great plans and hopes for finding a cure. And of course this gives Las Vegas some notoriety in the field of medicine – something most would agree is sorely needed.

First, While most previous drugs have failed, the drugs being tested today are based on years old science (it takes 7 to 10 years for a drug to be approved by the FDA) Since we now have a better understanding of which proteins damage the brain (build up of a toxic peptide called beta amyloid) we can be more focused. (See my post on July 15, 2009.)

Second, newer and better brain imaging technology and spinal fluid tests significantly affect drug development. This is revolutionizing the way we think about Alzheimer’s disease. These new imaging techniques give researchers a clearer picture of those likely to develop Alzheimer’s later in life at an earlier age.

Third, early diagnosis is a major goal. Since we are able to detect disease onset sooner, a patient may still make crucial decisions regarding care and more while their faculties are still more or less intact.   Participation in health care and other life decisions prior to intellectual decline is an important aspect of any patient’s care.

If you are interested in participating in clinical trials contact Cleveland Clinic’s Lou Ruvo Center for Brain Health by clicking here.

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PET Scans Affirmed

New research has identified the memory and brain scan tests that appear to predict best whether a person with cognitive problems might develop Alzheimer's disease. The research is published in the June 30, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology. (AAN)

Longevity tests are tests that examine data over time rather than at one moment in time.  The study looked at participants between the ages of 55 and 90 and were followed for an average of 1.9 years. During that time, 28 of the participants developed Alzheimer's disease.

People who showed abnormal results on both PET scans (positron emission tomography) and episodic memory tests were nearly 12 times more likely to develop Alzheimer's disease than those who scored normally on both measures.

Thin people statistically face higher risks of dementia

Researchers at Milan University examined a total of 245 patients averaging 74 years old who had been suffering from mild cognitive impairment for approximately two-and-a-half years. The mental capabilities of about half the patients remained stable during that period. About two thirds of those whose condition had deteriorated developed Alzheimer's Disease. The remaining third developed another form of dementia. Those whose cognitive disturbance deteriorated had a significantly lower BMI (mean value of 23.81) than those whose condition had remained unchanged (BMI mean of 25.47). Especially significant was the elevated risk of deterioration among those patients with a BMI of 23 or under. 

Illustration of patient inside scanner
 

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New research supported in part by grants from the National Institute of Aging, part of the federal government's National Institutes of Health, and the U.S. Department of Defense, brings hope to the understanding and treatment of Alzheimer's Disease.

Reported in the Sept. 2 issue of the journal Nature,  the problem in Alzheimer's disease,  is beta-amyloid, a protein that accumulates in the brain and causes nerve cells to weaken and die.

Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear after age 60.

Alzheimer’s disease is the most common cause of dementia among older people. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—to such an extent that it interferes with a person’s daily life and activities. Estimates vary, but experts suggest that as many as 5.1 million Americans may have Alzheimer’s.

Drugs designed to eliminate plaques made of beta-amyloid have a fatal problem: they need to enter the brain and remove the plaques without attacking healthy brain cells.  Scientists have learned an enormous amount about how beta-amyloid plaques are formed and the toxic effects that these structures as well as the earlier forms of beta-amyloid have on neurons and synapses. These findings have opened up new avenues of investigation and new possibilities for therapeutic targets. New research from the laboratory of Nobel Prize winner Paul Greengard, however, suggests that treatments modeled on the blockbuster cancer drug Gleevec could be the solution. 

Gleevec has the unique ability to bind to a protein that triggers the production of beta-amyloid plaques. The new research from Greengard's lab shows that this protein, called gamma-secretase activating protein (GSAP), dramatically and selectively increases the production of beta-amyloid peptide, which makes up the senile plaques found in the brains of most people with Alzheimer's. 

We are still far from shouting "success" and "cure" but we are inching closer.  Scientists are conducting studies to learn more about plaques, and other features of Alzheimer’s disease. They can now visualize plaques by imaging the brains of living individuals. They are also exploring the very earliest steps in the disease process. Findings from these studies will help them understand the causes of Alzheimer’s.

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Read this article featured in Discover about Lou Gehrig and the disease that bears his name:

That may seem a strange question, akin to asking who’s buried in Grant’s tomb. But a new study proposes that some athletes diagnosed with Lou Gehrig’s disease may in fact have a different fatal disease that is set off by concussions.

Researchers have previously investigated the link between athletes and this neurodegenerative disease, more technically known as amyotrophic lateral sclerosis (ALS). A recent study examined what seemed to be a higher than usual incidence of Lou Gehrig’s disease among soccer players, and, of course, the disease bears the name of a New York Yankee who was famously undaunted by the hard knocks of his sport. Though it’s impossible to determine now whether Lou Gehrig suffered from ALS or a different condition (Gehrig was cremated), the study’s lead author speculates that Lou Gehrig’s disease might be a misnomer:

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Exercise is a form of anti-dementia.  A May 2010 online issue in the journal Annals of Neurology, the official journal of the American Neurological Association and the Child Neurology Society, reveal results of the study by Boston University School of Medicine.

In the new study, U.S. researchers confirmed the known link between obesity and lower total brain volume and also found that abdominal fat in otherwise healthy middle aged people is associated with lower total brain volume, suggesting a greater risk of dementia and Alzheimer's later on in life.

A clinical diagnosis of dementia is made when two or more brain functions are significantly impaired. The condition shows as short term and long term memory decline, and deterioration of language, problem solving and other cognitive abilities. It can result from irreversible causes such as Alzheimer's disease, vascular dementia, and Huntington's disease, or it can result from treatable causes such as brain tumor, reaction to drugs, or metabolic problems.

According to World Health Organization (WHO) figures released in 2005, there are about 24 million people in the world living with dementia, with 4.6 million new cases coming forward every year.

So the take away here is do not forget to stay slim, eat well, excercise and stay healthy or, later,  you might forget!

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Worried about whether your favorite desert will taste the same in years to come?  New research out of Milan, Italy reveals a possible link between flavor and abnormal eating behavior in patients with Alzheimer's Disease.  And words put to music assist those same patients memory of the words sung as opposed to spoken.  But not so for healthy adults.

Forget Flavor?

The Journal Cortex  published "Flavour processing in semantic dementia" by Katherine E. Piwnica-Worms, Rohani Omar, Julia C. Hailstone, and Jason D. Warren, and appears in Cortex, Volume 46, Issue 6 (June 2010).

The researchers tested patients' flavour processing using jelly beans: a convenient and widely available stimulus covering a broad spectrum of flavours. The abilities of patients to discriminate and identify flavours and to assess flavour combinations according to their appropriateness and pleasantness were compared with healthy people of the same age and cultural background. Patients were able to discriminate different flavours normally and to indicate whether they found certain combinations pleasant or not, but they had difficulty identifying individual flavours or assessing the appropriateness of particular flavour combinations (for example, vanilla and pickle).

These findings provide the first evidence that the meaning of flavours, like other things in the world, becomes affected in semantic dementia: this is a truly 'pan-modal' deficiency of knowledge. The research gives clues to the brain basis for the abnormal eating behaviours and the altered valuation of foods shown by many patients with dementia. More broadly, the results offer a perspective on how the brain organises and evaluates those commonplace flavours that enrich our daily lives.

So if you ever hear an elderly person announce, after trying frog legs, "tastes like chicken," consider these findings.

Remember Music

The National Institute on Aging supports Research from Boston University School of Medicine. That research shows that patients with Alzheimer's disease (AD) are better able to remember new verbal information when it is provided in the context of music even when compared to healthy, older adults. The findings, which currently appear on-line in Neuropsychologia, offer possible applications in treating and caring for patients with AD.

Watching Grandma kick it to her genre of music explains these findings, or the other way around. So in the end, the last things I may remember are the lyrics to some old Led Zeppelin or Jethro Tull songs.  "Whole Lotta...Aqualung!"

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Alcohol abuse by teenagers is similar to drug abuse on brain development.  There are two major periods of mental development: The first three years of life and adolescence.  Hopefully by the early 20s the brain is fully developed.

During adolescence the brain has difficulty handling emotions, seeks high excitement/low effort activities, and has poor planning and judgment skills. You can either think back to your own teenage angst or look at your kids or grandkids.  That combination leads to a cycle in which impulsive decisions to consume reduce inhibitions more and lead to increased impulsiveness and risk taking.

It’s also attractive to teens because consumption begins a short period of feeling good with no effort expended.  Unfortunately this many times sets the stage for adult behavior as well.

The AMA reports, additionly, adolescent females who drink alcohol have a greater risk of benign breast disease than do their non-drinking counterparts, according to new research.

The 2010 statement indicates that the brain's frontal lobes, essential for functions such as emotional regulation, planning and organization, continue to develop through adolescence and young adulthood. At this stage, the brain is more vulnerable to the toxic and addictive actions of alcohol and other drugs.  The developmental interruption is the concern.

Alcohol is the most commonly used and abused drug among youth in the U.S., according to the Centers for Disease Control and Prevention.

Nearly three-quarters of students (72%) consumed alcohol by the end of high school, according to the 2008 Monitoring the Future study, which is funded by the National Institute on Drug Abuse. Each year, the study surveys a total of about 50,000 students in eighth, 10th, and 12th grades. In 2008, 55% of 12th graders and 18% of eighth-graders reported having been drunk at least once.

 The American Academy of Pediatrics has published an updated policy statement on alcohol use by youth and adolescents. The AAP recommends that physicians take the following steps to help prevent and reduce underage drinking:

• Become knowledgeable about adolescent alcohol, tobacco and other substance use through training programs or continuing medical education.
• Obtain a complete family medical and social history at prenatal and child wellness visits to explore potential genetic and family influences regarding alcohol and other substance use.
• Recognize risk factors for adolescent alcohol use and be aware of mental health problems that might occur in this age group.
• Use validated methods to screen regularly for alcohol and other drug use.
• Assess patients whose screening results are positive for alcohol use to determine the appropriate level of intervention.
• Use brief intervention and motivational interviewing techniques to work with patients who use alcohol but do not meet criteria for immediate referral.
• Discuss the hazards of alcohol and other substance use with patients.
• Strongly advise teen patients against the use of alcohol, tobacco and other illicit drugs.
• Encourage parents to be good role models for healthy life choices.
• Be familiar with local resources to which young patients can be referred for treatment.
• Support continuation of 21 as the minimum legal drinking age.
• Support further research into prevention, evidence-based screening and identification, brief intervention, and management and treatment of alcohol and other substance use by adolescents.

Source: American Academy of Pediatrics, "Policy Statement Alcohol Use by Youth and Adolescents: A Pediatric Concern," Pediatrics, published online April 12 .

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New Evidence that prevention will not cure Alzheimer's.  Here is some news that will turn your head around.  Just when you thought you might be doing everything right, you find out you might be wrong.  This reminds me of how much cigarette smoking is condoned Europe.  If you have ever been on an elevator in Italy or France you can not help but notice (and ingest) second hand smoke from the habitual smokers.  Now why is that?  Did Woody Allen's prediction in Sleeper come true?  Are cigarettes really good for you!?  And now the following.

An independent panel of experts meeting in the US concluded there is no evidence that you can prevent or slow down Alzheimer's, a progressive and fatal brain disease, even if you keep yourself active with exercise, social interaction, brain puzzles, or take fish oil, other supplements, or medication.  That is exactly the opposite of what we have been told.

The National Institutes of Health determined that the value of these strategies for delaying the onset and/or reducing the severity of decline or disease hasn't been demonstrated in rigorous studies.  Interestingly, the panel's assessment of the available evidence revealed that progress to understand how the onset of these conditions might be delayed or prevented is limited by inconsistent definitions of what constitutes Alzheimer's disease and cognitive decline. Other factors include incomplete understanding of the natural history of the disease and limited understanding of the aging process in general. The panel recommended that the research community and clinicians collaborate to develop, test, and uniformly adopt objective measures of baseline cognitive function and changes over time.
 

Alzheimer's Disease and Cognitive Decline, Structured Abstract. April 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/alzcogtp.htm actually concludes:

The current research on the list of putative risk or protective factors is largely inadequate to confidently assess their association with AD or cognitive decline. Further research that addresses the limitations of existing studies is needed prior to be able to make recommendations on interventions.

 But the initial ramifications may make us all rethink taking up smoking!  If you have not seen it, watch Woody Allen explain it in this short video.

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When my grandmother got old enough to officially be considered "blind" we decided it was time to take away her car and driving ability.  First off, I bought her the car a few years ago and so she spent her last years driving a new sporty car as opposed to the 20 year old Toyota her late husband left her.  And second, I moved her in with me to help make up for the transportation burden.  We drive her wherever she needs to go.  But a responsible decision needed to be made to get her less than safe driving skills off the road.  For her sake, our sake, and most importantly, for the sake of other drivers and passengers including little babies.

But taking away an elder's ability, or right, to drive is a dire move.  It supports the reality that as we age, more and more is taken away from us.

Dementia from normal aging also requires difficult decisions regarding driving.  Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.And since, statistically, those who suffer brain injury are more likely than not to develop dementia, driving may be an issue for those with mild and moderate brain injury.

Caregiver.org blogs "As a general rule, individuals with early stage or mild dementia who wish to continue driving should have their driving skills evaluated immediately (see “Arrange for an Independent Driving Evaluation” below). Individuals with moderate or severe dementia should not drive."

Insurance Company studies state Yes, there is enough small-scale research to tell us that over time, driving and dementia don't mix. The harder question is exactly when driving skills deteriorate? This question is harder to answer and the research is not clear enough to give a simple answer. That is why we recommend an approach that includes observation of driving skills right from the point of diagnosis and planning ahead for the time when the person must stop driving.

The American Academy of Neurology has issued a new guideline to help determine when people with Alzheimer's disease or another type of dementia should stop driving. The guideline is published in the April 12, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Dementia reveals itself in many ways.  For example Dementia symptoms include difficulty with many areas of mental function, including:

Language
Memory
Perception
Emotional behavior or personality
Cognitive skills (such as calculation, abstract thinking, or judgment)

 The guidelines also found that caregivers should trust their instincts. A study found that caregivers who rate a patient's driving as "marginal" or "unsafe" were often proven correct when the patient took an on-road driving test. On the other hand, patients who deemed their own driving as "safe" were not necessarily accurate in their own assessments.

Caregivers and family members play a role in identifying warning signs from unsafe drivers with dementia. These include:

Decreased miles being driven

Collisions

Moving violations

Avoiding certain driving situations, such as driving at night or in the rain

Aggressive or impulsive personality traits.

Read the full report and guidelines at www.neurology.org/cgi/rapidpdf/WNL.0b013e3181da3b0fv1.pdf.

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All to often people who suffer from disease are unable to get care due to insurance company limitations and policies, lack of insurance or finances to cover expenses.  Sometimes folks are left with Social Security Benefit applications for their care.

In its effort to improve and expedite the disability determination process, the Social Security Administration (SSA) has announced that it will add early-onset Alzheimer's disease to its Compassionate Allowances Initiative. The initiative identifies debilitating diseases and medical conditions that meet the SSA's disability standards for Social Security Disability Income (SSDI) or Supplemental Security Income (SSI). 

Social Security is launching this expedited decision process with a total of 50 conditions.  Over time, more diseases and conditions will be added.  A list of the first 50 impairments -- 25 rare diseases and 25 cancers -- can be found at www.socialsecurity.gov/compassionateallowances.

This recent development will lead to increased care more quickly for those who could not otherwise afford it.

Since 2003, the Alzheimer's Association has been advocating on behalf of individuals with early-onset Alzheimer's as they navigate the Social Security disability determinations process and welcomes the SSA's decision. Until now, individuals with early-onset Alzheimer's disease have faced a myriad of challenges when applying for SSDI or SSI, including a long decision process, initial denials, and multiple appeals.

Today's decision will simplify and streamline the SSDI/SSI application process and decrease the wait time for benefits, which for some has lasted as long as three years. There are currently an estimated 5.3 million Americans with Alzheimer's disease. Although the majority of Alzheimer cases are individuals age 65 and older, a significant number of people under age 65 are also affected by this fatal disease and have few financial options other than the Social Security disability program. 

This good news comes at a time when politics has brought the issue of universal health care to a stand still.  It always intrigues me that certain folks think the "right" to choose a doctor, hence stumping public/social or universal health care, exists.  While, at the same time, those folks shun the idea that anyone has a "right" to not be subject to Rendition based on suspicion, or the "right" of due process.

What ever your reflection on the matter, the recent Compassionate Allowances Initiative moves us in the right direction.
 

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Most interesting news pegging the tobacco-industry.

A UCSF analysis of published studies on the relationship between Alzheimer's disease and smoking indicates that smoking cigarettes is a significant risk factor for the disease. After controlling for study design, quality of the journals, time of publication, and tobacco industry affiliation of the authors, the UCSF research team also found an association between tobacco industry affiliation and the conclusions of individual studies. Industry-affiliated studies indicated that smoking protects against the development of Alzheimer's Disease, while independent studies showed that smoking increased the risk of developing the disease.

Study findings were published online in the January issue (19:2) of the Journal of Alzheimer's Disease.  

Alcohol Use Found in Cognitive Decline

Studies of alcohol use and cognition among the elderly are rare and have mixed results. A study of drinking among the elderly in Brazil has found that heavy alcohol use is associated with more memory and cognitive problems than mild-to-moderate alcohol use, especially among women.

Results will be published in the April 2010 issue of Alcoholism: Clinical & Experimental Research .
 

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Since I recently posted on the topic linking high blood pressure to dementia, I came across my doctor's newsletter on Blood Pressure.  I reprint it here for those interested.

The leading cause of death and disability in the United States is from cardiovascular diseases, and the most common disease is high blood pressure.  High blood pressure, also known as
hypertension, usually does not have any symptoms – hence, the nickname “silent killer.”

Unfortunately, one-third of those who have high blood pressure do not realize it and are not aware of their risk for heart disease. Therefore, many people live years without treatment, possibly damaging their heart, blood vessels, and kidneys.

Lifestyle choices (e.g., weight control, tobacco use, proper nutrition, regular exercise) can help
prevent and/or control high blood pressure. The following are common questions and answers about blood pressure.

What is blood pressure?

It is the force of blood against the walls of arteries. Systolic pressure (the top number) is the force as the heart beats. Diastolic pressure (the bottom number) is the force as the heart relaxes.

A blood pressure reading of 120/80 mmHg is articulated as “120 over 80.”

What is the meaning of the numbers?

A systolic pressure of 120 or less is considered normal. Diastolic pressure of 80 or less is considered normal. Therefore, 120/80 or less is a normal blood pressure. The chart below shows normal blood pressure levels, as well as the levels of high blood pressure.

What are the dangers of high blood pressure?

High blood pressure places an additional strain on the circulatory system (i.e., heart and blood vessels).  This strain results in arteries becoming thicker, narrower, and weaker, sometimes causing an obstruction.  A completely obstructed artery often leads to heart attacks, strokes, kidney disease, and dementia.

Is low blood pressure a health problem?

The training effect of regular exercise, especially when working out rigorously, is a lower blood pressure. At times, an individual who does not exercise may experience regular low blood pressure. If symptoms do not accompany the low pressure, it usually is not serious. However, if
blood pressure suddenly drops, it may indicate an underlying problem causing inadequate blood flow to the heart, brain, and other vital organs. Symptoms may include dizziness or lightheadedness.

What are some tips to prevent/control high blood pressure?

Healthy living is at the heart of preventing and controlling high blood pressure. Are you:
 Maintaining a healthy weight?
 Engaging in regular physical activity (fi ve 30-minute sessions of aerobic exercise and two
30-minute strength training sessions per week)?
 Eating a low-fat, high-nutrient diet (fruits, vegetables, low-fat dairy foods, low sodium)?
 Limiting alcohol consumption?

References:
1. NIH – National Heart, Lung, Blood
Institute, www.nhlbi.nih.gov
2. American Heart Association,
www.heart.org
3. Blood Pressure Association (United
Kingdom), www.bpassoc.org.uk
Exceptional Doctors. Exceptional Care. Exceptional Results.
LivingWell
The Link Between Heart Health and Blood Pressure
February 2010
 

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 Another study has found that hypertension may contribute to increased risk of dementia, this time with evidence of actual brain abnormalities. I previously wrote about the link between Hypertension and Alzheimer's disease.

This is especially relevant to those who are not controlling their blood pressure. Blood pressure is not something one feels is high or low. Specific medical evaluation, blood pressure test, is necessary. 

Data from an offshoot of the Women's Health Initiative found that participants' baseline blood pressure was strongly correlated with volume of lesions in their brains' white matter, according to Lewis Kuller, MD, DrPH, of the University of Pittsburgh, and colleagues.

Along with earlier studies linking blood pressure to clinical dementia, the evidence "supports tight control of blood pressure levels, especially beginning at younger and middle age as a possible and perhaps only way to prevent dementia," Kuller and colleagues concluded online in the Journal of Clinical Hypertension.

Treating hypertension in the elderly appears to protect against dementia and cognitive decline.  Uncontrolled hypertension in older patients increases the risk of cognitive impairment. Hypertensive patients had a 70% greater risk of non-amnestic mild cognitive impairment compared with nonhypertensive patients according to Christiane Reitz, M.D., Ph.D., of Columbia University in New York. (C Reitz et al. "Hypertension and the risk of mild cognitive impairment." International Society of Vascular Behavioral and Cognitive Disorders meeting, July 11-14, San Antonio. Final program and abstract book. Abstract O-6)

For each year an individual took medication to lower blood pressure, the risk of dementia decreased by about 3%, found Rita Peila, Ph.D., an epidemiologist at the National Institute on Aging and a scientist at the Pacific Health Research Institute in Honolulu.

My question is whether a person who controls their blood pressure and hypertension with medicine can decrease their risk of dementia to that of someone without hypertension.  I predict that other risk factors would need to be accounted for but, other things being equal, can a person with controlled high blood pressure eliminate the risk of dementia?

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Now the million of cell phone users have good reason to keep on talking.  It baffles my mind to learn of something typically regarded as negative being cast into a positive light.  Reminds me of Woody Allen's Sleeper where future scientists discover cigarette smoking and eating fat is healthy.

An international team of researchers studying the long term effects of electromagnetic waves like those emitted by cell phones on mice were surprised to find they protected their brains against Alzheimer's and even reversed the memory damage caused by the disease.

The neuroscientists, electrical engineers, and neurologists published the study and findings in the Journal of Alzheimer's Disease. 

The research results are exciting.  But since they occur in mice, the ultimate human affects are still not known.  Dr. Susan Sorenson, Alzheimer's Society Head of Research, comments, 'This study could open new doors in Alzheimer's research but it also poses some interesting questions that need answers. However, dementia research is dramatically underfunded. The government currently spends eight times less on dementia research than cancer research. In order to make further scientific advances dementia needs to be given higher priority.' 

"Electromagnetic Field Treatment Protects Against and Reverses Cognitive Impairment in Alzheimer's Disease Mice."
Gary W. Arendash, Juan Sanchez-Ramos, Takashi Mori, Malgorzata Mamcarz, Xiaoyang Lin, Melissa Runfeldt, Li Want, Guixin Zhang, Vasyl Sava, Juan Tan and Chuanhai Cao.
Journal of Alzheimer's Disease, Volume 19:1 (January 2010).
 

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The American Medical Association (AMA) reports that PET (postron emission tomography) is able to detect the progression of Alzheimer's in patients with dementia.  Preclinical Alzheimer's disease can be detected by screening an individual's cerebrospinal fluid for biomarkers of the condition. In addition, imaging with positron emission tomography (PET) can detect deposits of the substance linked to dementia in living patients.

159 older adults (average age 71.5) who had undergone PET scans and did not have symptoms of dementia were assessed. These patients were followed for between 0.8 and 5.5 years after having the scan and underwent between two and six assessments for dementia during that timeframe.

A total of 23 participants progressed to clinically detectable dementia during follow-up, and nine were diagnosed with dementia of the Alzheimer type. These diagnoses were made by specialist clinicians who diagnosed the condition at an earlier stage than typically occurs and corroborated the diagnosis by declines in multiple cognitive domains as well as a loss of volume in certain areas of the brain.
 

If this new discovery can assist clinicians in detecting dementia and Alzheimer's symptoms earlier, treatment can be more effective.

This study provides support for the premise that preclinical Alzheimer's disease, detected by the cerebrospinal fluid signature for Alzheimer's disease predicts symptomatic Alzheimer's disease.  The study is published at Arch Neurol. 2009;66[12]:1469-1475.
 

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Have you ever seen a 65 year old man with graying head driving with the top down in his brand new red Corvette?  Or how about the 80 year old great grandmother who thinks her jet black hair is fooling anybody?  Well these otherwise refusing-to-act-their age folks might just be on to something.

God bless my grandmother, Mary, 86 years young.  She lives with me and my family and we just got back from a Christmas Holiday cruise.  And that was her second cruise in 6 months!  We call her the energizer bunny for obvious reasons.

Therapies that can keep us younger longer might also push back the clock on Alzheimer's disease, suggests a new study of mice in the December 11th issue of the journal Cell, a Cell Press publication.

Reduction of insulin signaling is known to extend life span, but now Dillin and colleagues report that this strategy can also work to mitigate and forestall the affects of Alzheimer's disease in a mouse model.

Most cases of Alzheimer's disease (AD) exhibit sporadic onset during the seventh decade of life or later, whereas the fewer mutation-linked, familial cases typically manifest during the fifth decade. These temporal features, common to numerous neurodegenerative diseases, define aging as the major risk factor for the development of these maladies (Amaducci and Tesco, 1994).

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According to Medilexicon's medical dictionary:

Cluster headache is "possibly due to a hypersensitivity to histamine; characterized by recurrent, severe, unilateral orbitotemporal headaches associated with ipsilateral photophobia, lacrimation, and nasal congestion."

Cluster headaches (also used in singular: headache), also nicknamed suicide headaches, occur several times a day, they come on unexpectedly, do not last long, and are generally very painful. The pain is usually intense, and sometimes only on one side of the head. Frequently, the sufferer also feels pain around the eye.

A cluster-headache sufferer can wake up during the night because of the pain. Often, this occurs at the same time each night. The eye on the painful side of the head may be reddened and watery. The individual's nose may be runny or blocked on the side of the nose where the pain is.

Read more here.

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A new study published in the Scientific Journal Neurology reveals that women who store fat on their waist in middle age are more than twice as likely to develop dementia when they get older.

The most common symptoms of dementia are forgetfulness, impaired speech and problems with recognition and orientation. It is a condition that can affect all our mental faculties and which is more common as we get older. Around seven per cent of the population over the age of 65 and just over 20 per cent of the over-80s have severe dementia.

Dementia isn't a specific disease. Instead, it describes a group of symptoms affecting intellectual and social abilities severely enough to interfere with daily functioning. It's caused by conditions or changes in the brain. Different types of dementia exist, depending on the cause. Alzheimer's disease is the most common type.

Memory loss generally occurs in dementia, but memory loss alone doesn't mean you have dementia. Dementia indicates problems with at least two brain functions, such as memory loss along with impaired judgment or language. Dementia can make you confused and unable to remember people and names. You may also experience changes in personality and social behavior. However, some causes of dementia are treatable and even reversible.

Dementia symptoms vary depending on the cause, but common signs and symptoms include:

Memory loss
Difficulty communicating
Inability to learn or remember new information
Difficulty with planning and organizing
Difficulty with coordination and motor functions
Personality changes
Inability to reason
Inappropriate behavior
Paranoia
Agitation
Hallucinations
 

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A new study published in Proceedings of the National Academy of Sciences (PNAS) promises to improve diagnosis and monitoring of Alzheimer's disease.  Scientists at the University of California, San Diego have developed a fast and accurate method for quantifying subtle, sub-regional brain volume loss using magnetic resonance imaging (MRI). 

The general pattern of brain atrophy resulting from Alzheimer's disease has long been known through autopsy studies, but exploiting this knowledge toward accurate diagnosis and monitoring of the disease has only recently been made possible by improvements in computational algorithms that automate identification of brain structures with MRI. The new methods described in the study provide rapid identification of brain sub-regions combined with measures of change in these regions across time. The methods require at least two brain scans to be performed on the same MRI scanner over a period of several months. The new research shows that changes in the brain's memory regions, in particular a region of the temporal lobe called the entorhinal cortex, offer sensitive measures of the early stages of the disease.
 

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Researchers in the USA have discovered a potential new function for anti-epileptic drugs in treating neurodegenerative disorders such as Alzheimer's and Parkinson's disease. The study, published in BioMed Central's open access journal Molecular Neurodegeneration, found that neurons in the brain were protected after treatment with T-type calcium-channel blockers, which are commonly used to treat epilepsy.

Read more here.

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A new study from a center for Alzheimer's research in the US suggests that cognitive skills other than memory, for example visuospatial skills that help us work out how objects relate to each other in three dimensions as we look at them, start to decline years before patients receive a clinical diagnosis for Alzheimer's.
 

In an article found at "Longitudinal Study of the Transition From Healthy Aging to Alzheimer Disease."
David K. Johnson; Martha Storandt; John C. Morris; James E. Galvin.
Arch Neurol, Oct 2009; 66: 1254 - 1259, conclusions were that pre-diagnosis events occur that currently do not fit into criteria for Alheimer's diagnosis.  Therefore what was formerly thought to be normal aging may actually be signs of Alzheimer's disease. 
 

The studies were funded by grants from the National Institute of Health.

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A recent study by Mount Sinai faculty suggests that a gene associated with onset of type-2 diabetes also decreases in Alzheimer's disease dementia cases. The research, led by Dr. Giulio Maria Pasinetti, MD, Ph.D., The Aidekman Family Professor in Neurology, and Professor of Psychiatry and Geriatrics and Adult Development at Mount Sinai School of Medicine, was published this week in the scientific journal, Archives of Neurology.

Read the full article by clicking here.
 

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