With sophisticated brain imaging tests now making their way out of research labs or clinical trials, and into the doctor’s office, both patients and physicians will have to confront some important ethical and legal questions on how these tests are used. That’s the message from a seminar on amyloid imaging, hosted by the American Academy of Neurology annual conference in San Diego this month.

Most of the brain imaging focus is on detecting the presence of amyloid beta, a type of protein that is the hallmark of Alzheimer’s disease pathology in the brain. Amyloid beta is also present in the brains of persons with Mild Cognitive Impairment (MCI), a milder disease state that may lead to full blown Alzheimer’s later on. Surprisingly, a significant percentage of cognitively healthy older adults also have amyloid deposits in their brains. There is still debate on whether amyloid presence in the brains of cognitively healthy adults has any predictive value on the chances of developing Alzheimer’s disease later in life.

(Download a copy of the state of the market report on early detection tests for Alzheimer’s disease.)

This situation brings up a series of interesting questions:

Can life insurance and long term care insurance providers demand an amyloid imaging test, and potentially deny coverage based on those test results, even for people that are cognitively normal?

Can a person with MCI, and a positive amyloid imaging result, still drive a car? (Yes, most likely they can.) Should they still drive a car? (Some US states mandate physician reporting of “impaired drivers” to the DMV.)

Are most physicians prepared to educate patients on the results and implications of amyloid imaging tests? (Probably not.)

This last question gets to the heart of one looming ethical issue with brain imaging tests: A model for physician and patient education on what an amyloid imaging test result means doesn’t exist yet. This opens the door to much potential confusion and patient harm if the test results aren’t understood in a framework that physicians and patient advocacy groups agree on.

MyBrainTest will continue keep an eye on this issue as it percolates in the health care industry.
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Imagine stepping into a virtual reality environment that recreates in amazing detail the sights, sounds, and smells of a past experience, or a setting that triggers addictive behaviors, such as a bar scene with a favorite drink placed in front of a recovering alcoholic. And then into this virtual reality steps a helpful digital avatar that guides the user through difficult emotions, and into developing better coping skills.

That’s the goal of new cognitive technology systems in development that were demonstrated at the ESCoNS 2.0 conference, which marries entertainment software with practical cognitive neuroscience.

Much of the current virtual reality (VR) research is being funded by the Dept. of Defense, which has been trying for years to help military service members who suffer from brain injuries and PTSD symptoms as a result of the wars in Iraq and Afghanistan.

Dr. Skip Rizzo from USC’s Institute for Creative Technologies demonstrated a powerful VR environment, dubbed “exposure therapy”, that places the user in a Humvee during an IED attack. In addition to the visual and auditory stimulation, the VR system includes strong low frequency waves that approximate the blast wave of an IED detonation. The hope is that allowing service members to relive these experiences in a “safe” environment, the training will tune-down the overly active stress responses many have after returning home.

VR cognitive training for emotional resilience and good coping behaviors also show some promise. Typical addiction relapse rates are very high with traditional treatments, which has created something of a revolving door (and profitable business model) with the hundreds of addiction treatment centers in the US. Lower cost VR applications could open the door to better and more sustainable outcomes for many types of addiction.
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A recent study published in the medical journal Cephalalgia brings forward some new information on the relationship between migraine events and vascular health.

Several population based studies have already pointed to a connection between vascular risk factors such as smoking, diabetes, and high cholesterol levels and the increased incidence of migraines.

The new Cephalalgia study looked at a link between patients who have migraine with aura and the potential risk of ischemic stroke or heart attack, and concluded that migraine with aura can elevate the risk of these serious cardiovascular events. The “how & why” of increased stroke and heart attack risk in people who report migraine with aura isn’t well understood at this point.

On a related note, the American Academy of Neurology (AAN) has released new recommendations for testing and treatment of migraines and headaches. The new AAN guideline on medications for severe headaches and migraines strongly suggest that opioids and barbiturates should be avoided – frequent use of these medications can actually increase the severity of migraine events.

The second AAN guideline suggests that electroencephalography (EEG) tests are not useful for diagnosing headaches, and are an unnecessary expense. This second recommendation is part of the “Choosing Wisely” initiative, where many professional medical associations have recommended that many tests be stopped as they add little clinical value.
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A number of news articles and reports on elder financial abuse do a good job of highlighting the growing problem of older adults being targeted for financial theft and fraud. This study by MetLife lists the types of financial predation towards seniors that can and do happen.

What tends to be missing from these studies is a more in depth understanding on what has changed in the life of an older adult that may make him or her more vulnerable to financial exploitation. One of the main changes can be the onset of short term memory loss associated with the early stages of Alzheimer’s disease and other types of dementia.

Memory changes in loved ones to look for include new difficulties in calculating tips and change, and forgetting to pay bills. A key point here is that a sustained negative change in handling personal finances should be a cause for concern. A free Alzheimer’s – Dementia Symptom Checklist can be completed online here, and also downloaded for later reference.
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Habitually drinking several sodas on a daily basis can increase the risk of depression, according to a long term study sponsored by the National Institutes of Health. The NIH project surveyed over 260,000 people in 1995 and 1996, taking information on daily beverage consumption, including soda (both diet & regular), fruit drinks, and coffee.

The NIH study then followed up with participants a decade later to determine how many had received a diagnosis of depression since the original study years. It turns out that study participants who regularly consumed four or more cans of soda per day had a 30% greater chance of developing depression compared to participants who did not consume soda drinks.

A key point to highlight here is the almost quaint idea of having only a 12 ounce can of soda, which contains about 39 grams of sugar. Most fast food soda drinks now contain around 38 ounces (128 grams of sugar), and double Big Gulps contain a whopping 50 ounces (160 grams of sugar). In other words, super-sizing one soda drink is the same as drinking four regular size cans of soda. There is a direct link between high levels of sugar consumption, diabetes, and obesity. It follows that depression can be part of this spiral.

So what about drinking only diet sodas every day? The research evidence points to the possibility that using “fake” sugar like saccharin and aspartame alters the food consumption feedback loop between the body and brain. When your brain can’t tell the difference between real and fake sugar, it discounts the importance of any sweet food, which can encourage higher food consumption levels. Read more here.

As with most things, moderation is a virtue. Drinking a soda on an occasional basis is fine, drinking the equivalent of 4-5 cans of soda every day probably isn’t.

On the positive side, the NIH study indicates that drinking four cups of coffee each day may provide a modest defense against depression. Study participants who drank four cups of coffee daily had a 10% less chance of depression compared to non-coffee drinkers.

See also This is Your Brain of Fat and Sugar.
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