24th November 2010 by Christian Elliott
A common theme I heard at the Society for Neuroscience conference last week was the easy availability of preventive steps that can be taken now to reduce the rate of new Alzheimer’s cases. Two of these preventive steps that have strong research evidence are lifestyle choices:
1. Moderate aerobic exercise (30 minutes) a few times a week sharply upregulates a protein called BDNF, which encourages new neuron growth, especially in the hippocampal and frontal cortex areas which are vital to learning and memory.
2. Antioxidents, from both food sources and Vitamin C tablets, have strong neuroprotective properties. (My personal favorite source of antioxidents is red wine.)
Another preventive measure is routine cognitive health screening in a doctor’s office or health clinic. Computer based memory screening tools are now sensitive enough to pick up early signs of memory impairment that older paper tests might miss.
As Americans dig into their turkey feast tomorrow, it would be a good idea to schedule preventive step # 1 above during the weekend!
15th November 2010 by Christian Elliott
The Society for Neuroscience is conveniently holding its annual conference here in my hometown of San Diego this week. Earlier this afternoon, US Representative Patrick Kennedy gave a very honest and personal speech on how brain illnesses have affected his family, including his father’s (Senator Ted Kennedy) death from brain cancer, his own struggles with Bipolar disorder, and family members who have succumbed to Alzheimer’s Disease.
Rep. Kennedy is also very passionate about the struggles many US military service members face with traumatic brain injuries (TBI). He accurately notes that there really isn’t a national organized effort on solving major brain disorders like Alzheimer’s and TBI, and that ‘political science’ and neuroscience need to work together on a national plan that has political backing.
It will be interesting to see how Patrick Kennedy’s new brain advocacy endeavor, www.moonshot.org, evolves over the next year.
5th November 2010 by Christian Elliott
(Author note: This article discusses cognitive screening for memory complaints and mild cognitive impairment (MCI) that can lead to Alzheimer’s and other forms of dementia.)
A final thought on the National Academy of Neuropsychology conference last month: health care reform and Medicare fee reductions are fundamentally changing the way cognitive testing and assessments will be performed in the future.
With the average Medicare reimbursement for a cognitive assessment now well below $100, the only practical solution is a set of well validated, standardized computer based tests that can be administered in a doctor’s office or other primary care setting. So what could a computerized cognitive test standard look like?
1. Total test time 30 minutes or less.
2. Administered on a computer with mouse and keyboard, or a touchscreen.
3. Tests on short term (episodic) memory, learning, working memory, visuospatial skills.
4. Tests are scored automatically with a consistent reporting format – this means changes or declines from previous test scores can be noted for medical followup.
Having previous cognitive test scores available (the fancy term is longitudinal cognitive health record) to compare against the most recent test is a critical point: changes in individual cognitive performance will be more informative and reliable than simply comparing a score against an average for a particular age group.
**New: Download the MyBrainTest Consumer Fact Sheet on cognitive screening tests.
**New: Medicare Annual Wellness Cognitive Exam packet now available for health care providers.
Then the question becomes: At what age should a baseline cognitive assessment, for at least episodic memory, be encouraged?
29th October 2010 by Christian Elliott
Douglas Watt from Harvard Medical School provided a useful update on Alzheimer’s research at the National Academy of Neuropsychology conference earlier this month. His key points:
1. Late diagnosis of memory loss and cognitive impairment contribute to underestimation of the problem – the current estimate of 5.5 million with Alzheimer’s in the US alone is probably low.
2. Many physicians and associated health care providers still rely on the Mini-Mental State (MMSE) paper exam, which isn’t very useful for early stage memory impairments – MMSE is good for measuring moderate to severe dementia, but that doesn’t help with the goal of catching early signs of cognitive impairment. This is a prime reason why computer based cognitive screening can be very effective in a primary care setting.
3. A combination of short term memory screening and biomarker tests is the best scenario for catching Alzheimer’s in the pre-clinical, or prodromal phase. Biomarker tests for Alzheimer’s are all over the map right now (including very high false positive results with some tests), so this will take a while to sort out.
4. Moderate daily exercise, foods with high antioxidant content, and positive social engagement reduce the chances of developing Alzheimer’s. Sedentary daily routines, obesity, Type II diabetes, and social isolation greatly increase chances for Alzheimer’s and other forms of dementia.
There was also an interesting discussion on the role of general inflammation in the brain as a cause of Alzheimer’s. There is increasing speculation that beta amyloid may not be the cause of Alzheimer’s, but more of a symptom. This has implications for future drug discovery efforts, with more of a focus on compounds that reduce CNS inflammation.
21st October 2010 by Christian Elliott
Interesting update on TBI rehabilitation methods at the National Academy of Neuropsychology conference last week. The recovery period for even a “mild” traumatic brain injury can last for several months, and more severe injuries usually require a much longer period. TBI symptoms can many times include emotional regulation problems (commonly part of PTSD), along with cognitive issues with attention, memory retention, and learning.
Christopher Bell and Margo Villarosa from Walton Rehabilitation Health in Augusta, GA provided a detailed overview on their brain injury rehabilitation program, which is based on the Rusk Institute of Rehabilitation brain injury protocol, or Rusk Protocol. The protocol has the following components:
• 20-24 weekly outpatient sessions, with a minimum of 2 hours for each group session
• Emotional self-regulation training
• Practical problem solving training– “Clear Thinking”
• Achieve the best competence and stability of daily living arrangements for each patient
• Patient:Staff ratio of approx 2:1
This is a fairly intensive outpatient model that requires a significant 6 month commitment from both patients and staff. It is also a realistic model that recognizes that both cognitive and emotional rehabilitation is necessary with many forms of TBI.
The Walton Rehabilitation staff that presented the protocol also mentioned that the nearby Eisenhower Medical Center at Ft. Gordon may use the Rusk protocol for service members with blast related TBI.
Readers can contact me if they would like a copy of this rehabilitation protocol.