July 31, 2008, 11:17 am

Link between Heart Disease and Later Dementia

Some researchers believe they have found a link between heart disease and impaired cognition and later dementia. Judith Groch in Medpage today writes, “Coronary heart disease in midlife is associated with poorer results on cognitive tests, such as reasoning, vocabulary, and verbal fluency, with the effect particularly marked in men, a study found.”

Archana Singh-Manoux, Ph.D., of University College London and INSERM in Villejuif Cedex, France, and colleagues utilized data from the Whitehall II study which consisted of 10,308 civil servants working in Whitehall London, 33% of which were women, and began in 1985. “Coronary heart disease events were assessed up to the 2002 to 2004 phase of the study when 5,837 participants (28.4% women) took six cognitive tests: verbal and mathematical reasoning, vocabulary, phonemic and semantic fluency, memory, and the mini-mental-state-examination (MMSE).”

Among men the results showed that those having a history of coronary heart disease scored lower on reasoning, vocabulary and the MMSE. The study also found:

Among men, the trend within coronary heart disease cases suggested progressively
lower scores on reasoning, vocabulary and semantic fluency among those with a
longer duration of heart disease.

Men whose first coronary event occurred more than 10 years before had lower scores on reasoning (22.94, 95% CI 24.35 to 21.52), vocabulary (23.58, 95% CI 25.00 to 22.16), semantic fluency (22.10, 95% CI 23.54 to 20.64), and the MMSE (21.84, 95% CI 23.35 to 20.32). The test for trend and an examination of the effect for each five-year period among men suggests a trend for lower cognitive scores for verbal and mathematical reasoning and semantic fluency with increase in the time since a first cardiac event.

Among women, the association between time since the first event diagnosed 10 years earlier and cognitive performance showed a trend toward lower scores for semantic fluency. However, for this analysis, the numbers were small.

While the study suggests that there is a correlation between heart disease and dementia, it is uncertain exactly how the one affects the other. Grouch reports “At this point the researchers said they cannot explain the pathophysiological pathway for their findings. It is possible, they said, that shared risk factors drive this association or that impaired cognition or incipient dementia may in itself lead to coronary heart disease through poor health self-care.”

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July 25, 2008, 10:21 am

Cognitive Decline Measure via Hearing Test

According to John Gever in Medpage today researchers believe that central auditory testing may act as an early screen for cognitive decline in the elderly. George A. Gates, M.D. of the University of Washington and colleagues conducted a study of 313 patients at least 71 years old. They found that “several measures of central auditory processing were impaired in those diagnosed with Alzheimer’s disease and, to a lesser extent, those with memory impairment but not meeting criteria for Alzheimer’s.”

Dr Gates explains that “Hearing speech involves detection, recognition, and comprehension, the latter being clearly a cognitive task.” He suggests that central processing test should be performed in older patients experiencing hearing loss, and that a negative finding on the hearing test can help alleviate some anxiety for the individual and verify that a hearing aid may help.

According to Dr. Gates the central processing tests are easy to administer because standardized prerecorded materials are used, and that the test could be used as a screening tool for cognitive decline. “He said central processing defects can be treated. Training programs have been developed that help patients listen more carefully to improve their comprehension.”

Click here to read the full article

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July 22, 2008, 9:30 am

Leveling the Barriers

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July 21, 2008, 6:00 am

Bullying linked to Suicide Risk

According to the New York Times it’s not just the victims of bullying that are at risk. Apparently the bullies themselves are at risk for suicidal thoughts. The 13 country review of bullying research conducted by researchers from the Yale School of Medicine found that both parties have a high risk for suicidal thoughts. “The review analyzed 37 studies that looked at bullying and suicide among children and adolescents.” They found that almost all of the studies showed this link.

Bullying tormentors also are at risk. Compared to other kids, a child who bullies may be at two to nine times higher risk for suicide, according to the study. Girl bullies appear to be at highest risk. Some researchers have also found a “dose-response” relationship, showing that those who bully more frequently are at highest risk for suicide.

While the studies showed an association with bullying and suicide, it wasn’t clear whether the behavior actually increases risk for suicide or whether kids already at risk for suicide are more likely to become bullies or their victims. The researchers noted that most of the studies failed to take into account the influence of factors like gender, psychiatric problems and a history of suicide attempts.

According to international studies, bullying is common and affects anywhere from 9 percent to 54 percent of children.

Click here to read the full article

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July 18, 2008, 11:30 am

Obsessive-Compulsive Disorder Susceptibility Predicted by Brain Activity

MedPage Today Crystal Phend reports that researchers conducting a study at the University of Cambridge found that individuals with Obsessive-Compulsive Disorder (OCD), and their unaffected first-degree relatives, had different brain activity when compared to those without a family history of Obsessive-Compulsive Disorder.

The study involved 14 individual’s suffering from Obsessive-Compulsive Disorder, 12 of their relatives, and 15 people without a history of Obsessive-Compulsive Disorder. Their brains were monitored while working on “a task designed to make them learn a task one way and then, after negative feedback, to learn the reverse, which should have activated the neural region that facilitates behavioral flexibility.” Phend reports that Samuel R. Chamberlain, PhD and colleagues found:

…that while working out solutions to these tasks, patients with obsessive-compulsive disorder and their unaffected relatives had less activation than did controls bilaterally in regions including the lateral orbitofrontal cortex, the lateral prefrontal cortex, and the left parietal cortex.

While learning the reverse, the differences between obsessive- compulsive disorder patients and their relatives compared with controls became significant.

When grouped into clusters, the findings for obsessive-compulsive disorder patients and their relatives compared with controls, respectively, included:

• Underactivation in the left lateral orbitofrontal cortex and left lateral prefrontal cortex (P<0.001 for both)
• Reduced activity in the right lateral orbitofrontal cortex and right lateral prefrontal cortex (P<0.01 for patients and P<0.05 for relatives)
• Lower activation of the left parietal lobe (P<0.05 for both)
• Reduced activation in the right parietal lobe (P<0.01 for both)

Chamberlain SR, et al “Orbitofrontal dysfunction in patients with obsessive-compulsive disorder and their unaffected relatives” Science 2008; 321: 421-422.

Click here to read the full article in MedPage Today

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July 17, 2008, 1:35 pm

Gender differences in Concussion Mending

According to ScienceDaily the 2008 American Orthopaedic Society for Sports Medicine Annual Meeting at the JW Marriott Orlando Grande Lakes shows that females recover differently from males after sustaining a concussion, and even from others with a history of concussion.

The authors studied concussion recovery patterns in 234 soccer players (61 percent female, 39 percent male) ages 8 to 24. The individual’s were tested on attention, memory, processing speed and reaction time, following a concussion. The results were then analyzed to determine “group differences in performance between male and female participants and those with a previous history of concussion.”

According to the article the results found that females performed significantly worse than males on tests of reaction time and were more symptomatic. “Additionally, there was a trend, although not significant, towards females testing poorly regarding verbal memory and processing speed when compared to males.” Furthermore the individual’s who had a “history of concussion performed significantly worse on verbal memory testing after another concussion”. ScienceDaily reports:

“There’s a theory that males typically have a stronger neck and torso that can handle forces better,” said Dr. Colvin. “But when we accounted for Body Mass Index in this study, we still found a difference between males and females. Therefore, there are differences in recovery between genders that cannot simply be attributed to size difference. More studies are needed to determine the reason for differences in recovery between males and females.”

Click here to read the full article

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July 11, 2008, 7:34 am

Concussion Effects Last Longer for Female Athletes

Recovery from concussion may take longer for a female athlete than their male counterpart. In a study from the University of Pittsburgh by Alexis Chiang Colvin, M.D., reported at the American Orthopaedic Society meeting in Orlando, female soccer players were noted to have lower neurocognitive scores and reported more symptoms than male peers after a concussion.

This is important for players and coaches in responding to concussion injuries among female athletes. Players with prior concussion histories had more problems with overall memory, reaction time and visual processing speed. Coaches need to be vigilant in noting athletes with prior concussive injuries and acting conservatively to remove them from play. For players without a history of concussion it is important to rapidly identify a potential concussion and make the important decision to have the individual further evaluated. Returning athletes with potential concussion to play can result in additional injuries and greater risk for long term neurocognitive problems.

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July 10, 2008, 10:10 am

Guns and Health

The Supreme Court's decision which struck down a ban on handgun ownership in Washington, D.C. flies in face of epidemiological evidence that guns are associated with injury and death. The matter before the Court was decided in a 5-to-4 decision and the decision was related to a constitutional standard.Clearly some of the Supreme Court justices had concerns in this case, too. Lets look to the Centers for Disease Control and Prevention who have been examining gun related injuries and deaths for some time. In 2005 there were 30,000 deaths and 70,000 non fatal injuries. About 25% of the non fatal injuries and 10% of the deaths occurred in children and adolescents.It is a known fact that access to a gun increases the likelihood of completion of a suicidal act. We are not many months past the tragedy in Virginia were many individuals were killed and others seriously wounded by a mentally ill individual before he turned his weapon on himself. The  student in Virginia was able to acquire weapons even with a mental health history.
 
The Supreme Court's decision puts us into an unfortunate and risky epidemiological experiment. Access to guns needs to be regulated. There are far too many individuals who will come to the attention of medical and mental health professionals as a result of poorly defined limits on guns. We see these individuals as far more than a statistic. They are family, friends, neighbors and people from our community.The issue is one of allowing cities and states to control access by restricting ownership. Think of what a 50% reduction in deaths and injuries would be.

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, 9:40 am

Mental Health Parity: The Struggle Continues

This Congressional session marks the first time that both houses of Congress have passed legislation regarding mental health parity. Last fall, the Senate adopted the Mental Health Parity Act and, in March the House passed the Paul Wellstone Mental Health and Addiction Equity Act. The two bills differ in language which has stalled the final passage of the legislation. The difference lies in the definition of mental illness. The Senate bill is silent on the matter which would allow for insurers to define the definition of mental illness. The House bill relies on the Diagnostic and Statistical Manual (DSM) to explicitly define mental health and substance abuse conditions.

The difference in the bills and the impediment to progress is all about money. Most health insurance plans do not formally define the conditions which they cover. They use the term "medically necessary" to define the scope of coverage. They do not use the ICD or DSM to define conditions. Coverage may be denied if, in the opinion of the insurer, a condition would not improve with treatment or if the treatment is not considered appropriate or effective or is experimental. The House bill which uses the DSM relies on that manual's definition of the 300 or so disorders which includes some that may not require intervention and may not effect functional abilities and capacities.

The battle about money between the two bills has some long range implications. Will insurers design benefits for mental health conditions control and balance costs and restrict access to care? They likely would if the legislation required treatment of the all inclusive DSM conditions. Insurance plans may be designed to discourage people with serious and chronic mental health conditions from enrolling by using prohibitive cost sharing techniques. If that was the case, then the Mental Health Parity Act would be an empty vessel. There would be people who remain uncovered by insurance simply because the required coverage would be of no benefit to them. The Federal Employee Health Benefits Program of 2002 established parity, but disallowed treatment for conditions which were not serious. The analysis of the claims conducted for this program showed that treatment was directed towards serious mental health conditions.

The House model based on the DSM criteria could backfire and force insurance companies into the stance of raising the bar to force disenrollment of individuals with serious and chronic mental health conditions. The solution will be found in brokering the House and Senate versions to prevent exclusion of entire categories of problems due to the high costs associated with those conditions and to use the concepts of "medically necessary care and treatment" to focus resources on the serious and chronic mental health and substance abuse conditions. For Mental Health Parity to exist as functional coverage we need to find a solution which allows insurance resources to be used for those mental health and substance abuse conditions which cause impairment, disability and suffering.

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July 8, 2008, 8:33 am

Risk by the Numbers

The type of recreational activities, age, gender and other factors are part of understanding how much risk we are exposed to. For example: snowboarding causes 20 injuries out of every 100,000 people while fishing causes only 4 injuries in 100,000. Men are involved in 68% of all injuries. 15-24 year old people  make up 33% of all injuries by age with children to age 14 being second at 25%. Injuries to the head and neck are 23% of all injuries from recreational activities.

Even being a couch potato has risks as the likelihood of health related deaths increases from inactivity. Certain "bad habits" increase our risks. A 55-year old man who smokes is as likely to die over the next ten years of his life as a 65-year old man who has never smoked. And, motor vehicle accidents remain a high risk factor. A 35-year old woman is as likely to die in an accident in the next 10 years of her life as she is to die from breast cancer.

As we are enjoying the summer months it is important to keep safety in mind to reduce those risk factors which we can affect. For example: wear a helmet when bicycling and motorcycling. Don't drink (or use other substances) and drive, or water-ski, or jet ski. Brain injuries are most common in males between 18 and 24, a group who are known to be "risk takers". Another group who recently have come to our attention are 50+ year old males who have brain injuries from motorcycle accidents.

There are many positive things you can do to not become a statistic. Most of them involve using your brain to identify and reduce risks. Think first!

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