Focus on Neurology and Psychiatry

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Combination Drug Treatment Reduces Agitation in Patients with Alzheimer's Disease Sep 22, 2015

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Agitation is common in patients with dementia and can contribute to distress for patients and caregivers and an increased risk of institutionalization. Nonpharmacological interventions are recommended as first-line therapy, but many patients fail to respond, and medications are often needed. Currently available medications don't work very well and can have serious side effects. A new study tested a combination of two existing medications, dextromethorphan hydrobromide and quinidine sulfate, to see if this would help control agitation in patients with Alzheimer's dementia.
Researchers from the Cleveland Clinic recruited 220 patients with Alzheimer's dementia and agitation. During a preliminary 10 week trial, participants were randomly assigned to receive either the dextromethorphan- quinidine combination or a placebo.
Results showed that patients receiving the combination medication demonstrated fewer episodes of agitation compared to patients who received the placebo. When agitation did occur, it tended to be less severe. Researchers also found that not only is the combined drug effective, but safe.

[Watch more videos of The JAMA Report]

Low Vitamin D Associated with Faster Decline in Cognitive Function Sep 15, 2015

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[Read the Article]

About 42 percent of the general U.S. population has low vitamin D levels. In addition to promoting calcium and bone health, vitamin D may also affect the brain and cognitive function. A new study by JAMA Neurology looked at the association between baseline vitamin D levels and the rate of cognitive decline in a group of ethnically diverse older adults.
A researcher from Rutgers University, along with colleagues from the University of California Davis, studied 382 older adults with an average age of 75. Among the group, 61 percent of participants were women, 41 percent white, about 30 percent were African American and 25 percent were Hispanic. At study enrollment, about 18 percent had dementia, 33 percent had mild cognitive impairment and half were cognitively normal.
Vitamin D levels and cognitive function were measured at baseline. Cognitive function was also followed in 318 of the participants for an average of 5 years.
Researchers found:
- About 60 percent of the group, regardless of their race or ethnicity, was low in vitamin D.
- Vitamin D levels were lower for African American and Hispanics, compared with their white counterparts.
- …

Can Exercise Improve Cognitive Function in Older Adults? Sep 08, 2015

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[Read the Article]

Some evidence suggests that physical activity can help slow cognitive decline. A new study evaluated whether a program of moderate physical activity would result in better cognitive function, lower risk of dementia, or both, for older adults compared with a health education program.
Researchers from Wake Forest School of Medicine, Winston-Salem, North Carolina evaluated more than 1,600 sedentary adults, between the ages of 70 and 89, and randomly assigned them to either physical activity or a health education program. The participants were monitored for 24 months, during which their cognitive function was measured using a variety of clinical tests.
Results found that both groups preserved their cognitive function over the two year study period. Although there was no difference between the groups, the outcomes still prove notable, since steady decline in cognitive function would generally be expected within this age group.

[Watch more videos of The JAMA Report]

Mindfulness-Based Therapy Decreases Posttraumatic Stress Disorder Symptoms for U.S. Veterans Sep 08, 2015

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[Read the Article]

Posttraumatic stress disorder (PTSD) affects twenty-three percent of veterans returning home from deployments in Afghanistan and Iraq. Left untreated, PTSD is associated with high rates of other disorders, disabilities, and poor quality of life. A new study evaluated a different approach to managing PTSD related symptoms, a mindfulness-based stress reduction therapy.
Researchers at the Minneapolis Veterans Affairs Health Care System randomly assigned 116 veterans with PTSD to receive nine sessions of mindfulness-based stress reduction therapy, which teaches participants to be present in the moment in a nonjudgmental, accepting manner. The others attended group therapy, primarily focusing on current life problems. The veterans were monitored before, during and after treatment.
Results found that among veterans with PTSD, mindfulness-based stress reduction therapy, compared to group therapy, resulted in a greater decrease in PTSD symptom severity.

[Watch more videos of The JAMA Report]

Stroke Associated with Both Immediate and Long-term Decline in Cognitive Function Sep 08, 2015

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[Read the Article]

Each year, nearly 800,000 Americans experience a stroke, and for survivors, cognitive decline including memory and thinking speed, is a major cause of disability. Many patients experience these declines immediately after a stroke, but a new study examined whether cognitive decline continues several years after the initial stroke.
Researchers from the University of Michigan Medical School, Ann Arbor examined changes in cognitive function in more than 23,000 individuals who were 45 years of age or older. All participants were free of cognitive impairment at the start of the study. Memory and other measures of cognitive function were recorded at the beginning and at regular intervals throughout a six year follow up period. 515 participants experienced a stroke during the study, the rest remained stroke free.
Results found that stroke survivors had a faster rate of cognitive decline after stroke compared with the pre-stroke rate. Stroke was associated with an early decline in cognitive function and also accelerated and persistent cognitive decline over the next six years.

[Watch more videos of The JAMA Report]

The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma Jul 06, 2015

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Host: Maurice Pickard, MD

Renowned trauma expert Dr. Bessel van der Kolk has spent over three decades working with trauma survivors. In his book, The Body Keeps the Score, Dr. van der Kolk adds to modern understandings of traumatic stress, revealing how it literally rearranges the brain’s wiring—specifically areas dedicated to pleasure, engagement, control, and trust. He discusses how these areas can be reactivated through innovative treatments including neurofeedback, mindfulness techniques, play, yoga, and other therapies.

Management of Acute Stroke: Perspectives from a Neurointerventional Radiologist Mar 09, 2015

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Host: Brian P. McDonough, MD, FAAFP

Dr. McDonough welcomes Dr. Donald Frei, neuroradiologist and Director of Neurointerventional Surgery at Radiology Imaging Associates in Denver, CO. Dr. Frei is working towards establishing state-of-the-art diagnosis and management strategies in treating patients with acute stroke. His procedural specialties include acute catheter directed stroke intervention, angioplasty/stent revascularization of cerebrovascular stenosis and minimally invasive treatment of cerebral aneurysms and arteriovenous malformations.

Insulin Resistance and the Risk of Ischemic Stroke Oct 27, 2010

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Guest: Tatjana Rundek, MD, PhD
Host: Maurice Pickard, MD

Hundreds of millions of people may have insulin resistance worldwide. What is the connection between insulin resistance and the risk of ischemic stroke? Dr. Tatjana Rundek, associate professor of neurology and director of the clinical translational research division in the department of neurology of the Miller School of Medicine at the University of Miami, Florida, discusses her research on the risk of developing ischemic stroke among non-diabetic patients with insulin resistance with host Dr. Maurice Pickard. How can lipid-lowering medications help reduce the risk of stroke for non-diabetic patients with insulin resistance, and are any other medications on the horizon for these patients?

Attachment-based Family Therapy for Treating Adolescent Depression Jul 20, 2010

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Guest: Guy Diamond, PhD
Host: Maurice Pickard, MD

Depression is one of the most common mental health conditions in the US, affecting 4-6% of adolescents. Suicide is also a significant issue in this age group, and is the the third leading cause of death among adolescents. How effective are the various types of psychotherapy and medications typically used to treat adolescent depression, and how is a newer form of therapy, attachment-based family therapy, aimed at engaging this patient population more effectively? Dr. Guy Diamond, director of the Center for Family Intervention Science at the Children's Hospital of Philadelphia, and associate professor of psychology at Penn Medicine, joins host Dr. Maurice Pickard to discuss the theory behind attachment-based family therapy, which is intended to address the patient's environment and stressors that may be contributing to their depression. When might attachment-based family therapy be more beneficial than enhanced usual care (including cognitive-behavioral therapy and medications)?

New Frontiers and Challenges for Alzheimer's Drugs May 19, 2010

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Guest: William Thies, PhD
Host: Bruce Japsen

Some 5 million Americans have Alzheimer's disease, with more cases sure to develop as the baby boomer generation ages. New potential discoveries are on the horizon. But, as Dr. William Thies, chief medical and scientific officer for the national office of the Alzheimer's Association, tells host Bruce Japsen, significant challenges and obstacles also lie ahead for these potential ground-breaking discoveries.

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