Health & age-related problems

Childhood cancer survivors show sustained benefit from common ADHD medication

October, 2010

Ritalin helps some survivors of childhood cancer with attention problems.

Many survivors of childhood cancer experience cognitive problems as a result of their treatment. The drug methylphenidate (marketed under several names, the best known of which is Ritalin) has previously been shown to help attention problems in such survivors in the short term. Now a new study demonstrates that it can also be of benefit in the long term.

The study tested attention, social skills and behavior in survivors who had been on the drug for a year, comparing them to a similar group of unmedicated survivors. Although the drug did not lead to a significant gain in measured academic skills in math, reading and spelling, many did show improvements to attention that put them back in the normal range.

Nevertheless, the results also emphasize the need for other approaches, given that many did not benefit from the drug, and some may not be good candidates for medical or other reasons. The treatment group included 35 survivors of brain tumors and 33 of acute lymphoblastic leukemia (ALL). Any who suffered from ADHD before their cancer were excluded from the study.

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Alcohol dependence damages both episodic memory and awareness of memory

September, 2010

Adding to the evidence that chronic alcohol abuse produces various cognitive deficits, a new study reveals that it’s also linked to poor metamemory.

Metamemory (understanding your own memory capabilities) is important for learning. Now a study involving 28 alcoholics has found that, compared to controls, they not only performed more poorly on a test of episodic memory, but they were less accurate in their assessments of how good their memory was. The episodic memory task involved learning 20 pairs of items, followed by a recall and a recognition test 20 minutes later. Before the recognition test, participants rated their ability to recognize each nonrecalled word among 4 items. The alcoholics were relatively unaware of their memory deficits and believed that their memory was much better than it was. On a questionnaire of their general memory capacities, they also tended to report themselves as much more capable than they were. Their over-estimation was related to their low performance on tests of executive function.

The finding has implications for any recovery program, since alcoholics will tend to believe that they have mastered any learning long before they have.

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Adolescents with type 2 diabetes have diminished cognitive performance and brain abnormalities

September, 2010

Another study adds to growing evidence that diabetes, or poor glycaemic control, has serious implications for brain function.

A small study comparing 18 obese adolescents with type 2 diabetes and equally obese adolescents without diabetes or pre-diabetes has found that those with diabetes had significantly impaired cognitive performance, as well as clear abnormalities in the integrity of their white matter (specifically, reduced white matter volume, especially in the frontal lobe, as well as impaired integrity in both white and grey matter). Similar abnormalities have previously been found in adults with type 2 diabetes, but the subjects were elderly and, after many years of diabetes, generally had significant vascular disease. One study involving middle-aged diabetics found a reduction in the volume of the hippocampus, which was directly associated with poor glycaemic control.

It remains to be seen whether such changes can be reversed by exercise and diet interventions. While those with diabetes performed worse in all cognitive tasks tested, the differences were only significant for intellectual functioning, verbal memory and psychomotor efficiency.

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HIV infection prematurely ages the brain

January, 2010

New evidence suggests that for that those with HIV, the disease, medications, or both, are accelerating what is a normal age-related process.

Although HIV doesn't directly infect neurons, it appears that once it has crossed the blood-brain barrier, it affects supporting cells that can release immune factors that harm neurons. New techniques used on 26 subjects with HIV and 25 matched controls have now found that those with HIV showed decreased brain blood flow to levels roughly equivalent to readings seen for uninfected individuals 15 to 20 years older. It is suggested that HIV, medications, or both, are accelerating what is a normal age-related process. It’s estimated that 14-18% of AIDS patients in the U.S. are more than 50 years old, and this proportion is rapidly growing.

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Stress raises risk of mental decline in older diabetics

February, 2010

A large study of older adults with type-2 diabetes has found those with higher levels of the stress hormone cortisol are more likely to have experienced cognitive decline.

A study involving over 1000 older men and women (60-75) with type-2 diabetes has found that those with higher levels of the stress hormone cortisol in their blood are more likely to have experienced cognitive decline. Higher fasting cortisol levels were associated with greater estimated cognitive decline in general intelligence, working memory and processing speed. This was independent of mood, education, metabolic variables and cardiovascular disease. Strategies aimed at lowering stress levels may be helpful for older diabetics.

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Cognitive test distinguishes those at greater risk of stroke

February, 2010

A large long-running study has found that Swedish men in their 70s among the bottom 25% on the Trail Making Test B were three times more likely to have a stroke or a brain infarction compared to those in the top 25%.

A long-running study involving 930 70-year-old Swedish men has found that those who were among the bottom 25% on the Trail Making Test B were three times more likely to have a stroke or a brain infarction compared to those in the top 25%. Performance on the Trail Making Test A and the MMSE did not predict brain infarction or stroke. Test B measures the ability to execute and modify a plan, while Test A measures attention and visual-motor abilities, and the MMSE is a standard test of general cognitive decline.

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Depression not necessarily associated with lack of concentration

February, 2010

A review of 35 studies has found that depression does not always lead to cognitive impairment, and that processing speed is the cognitive function most consistently affected by depression.

A review of 35 studies published between 1991 and 2007 has found that depression does not always lead to cognitive impairment. Part of the variability in findings may be due to inconsistent measurement and diagnosis of depression. Processing speed was found to be the cognitive function most consistently affected by depression. Processing speed deficits can be helped by decreasing the amount of information to process at one time.

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Mental activity may protect against memory problems in MS

July, 2010

A new study points to the importance of cognitive reserve to protect sufferers of multiple sclerosis for cognitive impairment.

Memory and learning problems often occur in multiple sclerosis, but bewilderingly, are only weakly associated with the severity of the disease. A study involving 44 people around the age of 45 who had MS for an average of 11 years has found that those with a mentally active lifestyle had good scores on the tests of learning and memory even if they had higher amounts of brain damage. The findings suggest that, as with Alzheimer’s disease, 'cognitive reserve' protects against cognitive impairment. Differences in cognitive reserve may explain why some people have memory problems early in the disease, while others do not develop memory problems until much later, if at all.

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Test of implantable cardioverter defibrillator linked to cognitive problems

March, 2010

A study involving patients given on implantable cardioverter defibrillator (ICD) reveals that more than a third of participants had significant cognitive problems six weeks and six and 12 months after ICD surgery. Although most regained their normal abilities within 12 months, a few (10%) first developed difficulties at that point.

An implantable cardioverter defibrillator (ICD) is a small electronic device that monitors and regulates heartbeat, and many have been implanted in patients — an estimated 114,000 in the U.S. in 2006. Part of the implantation process involves ventricular defibrillation testing, which temporarily disrupts brain activity by causing a drop in blood pressure and blood flow to the brain. In a study involving 52 patients having cognitive tests several days before ICD surgery and again six weeks and six and 12 months afterwards, more than a third of participants had significant cognitive problems six weeks and six and 12 months after ICD surgery. Attention, short-term memory of visual words and objects, and auditory (spoken) words were most commonly affected. Although most patients regained their normal abilities by 12 months after surgery, a few (10%) first developed difficulties at that point. The results were unrelated to measurements of anxiety, depression and quality of life.

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Stroke patients regain the power of speech by singing

March, 2010

People deprived of speech following a stroke were taught to sing words instead of speaking them in a technique known as 'melodic intonation therapy'.

And in another pilot study, people deprived of speech following a stroke were taught to sing words instead of speaking them in a technique known as 'melodic intonation therapy'. Brain scans also showed functional and structural changes in the undamaged hemisphere after they had received the therapy. Doctors are now testing the therapy in 30 stroke patients to assess how many people who lose their speech after a stroke would benefit.

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The findings were reported at the American Association for the Advancement of Science meeting in San Diego.

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