Alzheimer’s Doesn’t Stop Basketball Coach

Marc Gordon, MD

Tennessee Women's Basketball Coach Pat Summitt, 59, has announced her diagnosis of early-onset Alzheimer’s disease. She plans to continue coaching for as long as possible.

Early-onset Alzheimer’s disease (sometimes called younger-onset Alzheimer’s), is characterized by symptoms manifesting before age 65. Up to 5 percent of Alzheimer’s patients have the early-onset form—roughly 200,000 in the United States alone, according to the Alzheimer’s Association.

It’s impressive that Ms. Summitt decided to go public because a lot of people would have a tendency to feel like they would retire for personal reasons and not be open. But meaningful engagement in life is still possible with an Alzheimer’s diagnosis.

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Innovative Study Looks at How the Brain Communicates with Itself

Ashesh Mehta, MD

In today’s world, networks operate in diverse situations, from communication networks that permit a cell phone conversation to social networks that link friends on Facebook. These networks have properties (e.g., each computer in your home with a wireless network) and hubs, where multiple separate sub-networks come together (e.g., a person who bridges multiple social networks). 

It is increasingly being recognized that these properties operate in our brain too – in both normal functioning and as a mechanism for disorders of the nervous system, like the spread of seizures across the brain. Functional magnetic resonance imaging (fMRI) is a non-invasive method that can be used to measure the tiny metabolic changes that take place in an active part of the brain. To date, fMRI has been typically used to study what parts of the brain become active when subjects respond to stimuli (e.g., being shown pictures) or perform tasks (e.g., rotating objects in their mind’s eye). Recently, there has been interest in looking at how the brain works at rest, by measuring the fMRI signals in different brain regions and seeing how they activate and deactivate together. By measuring the relationship of activity between different brain areas, it is possible to describe an individual’s brain network, including sub-networks where brain areas with higher correlation are more closely connected (much like friends in a social network). While this has been studied extensively with fMRI, results have been difficult to interpret, because of the unclear relationship between fMRI signals and brain electrical activity. 
Validation of this fMRI methodology has recently taken a major step forward, with the findings published in a recent issue of Full Post - to Detail View

MS Drugs: Balancing High Cost with High Need

Karen Blitz-Shabbir, MD

The journal Neurology just published a population-based study to evaluate the cost-effectiveness of disease-modifying therapies (DMTs, or drugs that change the course or progression of the disease) in the United States compared to basic supportive therapy without DMT for patients with relapsing multiple sclerosis. The study concluded that the use of disease-modifying therapies in multiple sclerosis “results in health gains that come at a very high cost.”

Drugs for multiple sclerosis (which have been available since 1993) have dramatically changed the course of this often devastating disease. The arsenal of medications has been shown to slow progression of disability, prevent exacerbations and improve quality of life.

But pharmaceutical costs have gone up at unprecedented rates. Cost-effectiveness studies have shown that hospitalization rates dramatically decrease decrease with the use of drugs for multiple sclerosis, so the cost of the drugs was warranted and “paid off” when the patients did not have to incur hospitalization costs.

Studies that discuss the high cost of multiple sclerosis drugs should not lose sight of the high need for treatment in our patients, and should focus our attention on the need to rein in the pharmaceutical industry with regard to cost.

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Olive Oil Associated with Lower Risk of Ischemic Stroke

Richard Libman, MD

Previous studies have shown that a Mediterranean-style diet has been associated with protection against dementia, as well as stroke. However, the exact components of the Mediterranean diet which may be protective have not been clarified by the studies. 

We know that olive oil, an important component of a Mediterranean diet, has previously been shown to be associated with a lower risk of heart attacks. A recent study published in Neurology, reported that olive oil was associated with a lower risk of ischemic stroke  (a blood clot in the brain). 
In the study, French researchers from the University of Bordeaux and the National Institutes of Health and Medical Research looked at the medical records of 7, 625 people ages 65 and older from three cities in France. Participants had no history of stroke. Olive oil consumption was categorized as “no use,” “moderate use,” and “intensive use.” After five years, there were 148 strokes. The study found that those who regularly used olive oil for both cooking and as a dressing had a 41 percent lower risk of stroke compared to those who never used olive oil in their diet. Most of the study participants used extra virgin olive oil.
This is most encouraging and may be useful in the general population to decrease the risk of stroke. A major caveat, however, exists with this type of study in that it is an observational study, not a randomized trial. For this reason, it is subject to multiple sources of bias, both measured and unmeasured, which can potentially give false results. As such, the study findings should not be taken as the final answer, but should stimulate further research. Full Post - to Detail View

Not Enough Who Suffer Ischemic Stroke Get Clot-Busting Drug

David Langer, MD

Stroke remains one of the leading causes of death and disability in the United States. Unfortunately, the treatment of stroke remains problematic due to the difficulties involved in getting patients diagnosed and treated in a timely fashion. The clot-busting drug tPA remains the only Food and Drug Administration (FDA)-approved drug for acute ischemic stroke (AIS) which is caused by a blood clot in the brain. In order for tPA to be effective, it should be administered within the first three hours after the initial onset of stroke symptoms.

Recently, researchers from the University of Cincinnati reported in the American Heart Association’s Stroke journal that 3.4 percent to 5.2 percent of Americans who suffered from an ischemic stroke in 2009 received tPA compared to 1.8 percent to 2.1 percent in 2005. While this finding is a sign of improvement, it is still very low. As such, we must continue to improve our treatment of stroke patients. Time remains a critical element in stroke management.

Current efforts both in basic science, as well as in system-based work flows in stroke management, are ongoing in efforts to improve the outcome of stroke patients. The goal is to preserve the brain, while improving identification of stroke and treatment.

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