Dr. Severnini[/caption]
Edson R. Severnini PhD
Assistant Professor Of Economics And Public Policy
Carnegie Mellon University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although lead has been banned from gasoline, paint, and other substances in the United States and many other countries around the world, the legacy of lead use is a critical environmental and public health issue. Surface soil contamination, in particular, has been long recognized as an important pathway of human lead exposure, and is now a worldwide health concern.
This study estimates the causal effects of exposure to lead in topsoil on cognitive ability among 5-year-old children. We draw on individual level data from the 2000 U.S. Census, and USGS data on lead in topsoil covering a broad set of counties across the United States.
We find that higher lead in topsoil increases considerably the probability of 5-year-old boys experiencing cognitive difficulties such as learning, remembering, concentrating, or making decisions. Living in counties with topsoil lead concentration above the national median roughly doubles the probability of 5-year-old boys having cognitive difficulties. This harmful effect does not seem to extend to 5-year-old girls, potentially due to the natural protection of estrogen.
Dr. Aartsen[/caption]
Marja Aartsen, PhD
Research professor at NOVA
Norwegian Social Research / OsloMet
Oslo Metropolitan University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our study is part of a larger project “Life course influences on health trajectories at older age” conducted at the University of Geneva, of which dr. Stéphane Cullati is the principle investigator (see for more information on the project https://cigev.unige.ch/index.php?cID=887). The aim of that research project is to examine in what way retrospective life course precursors from childhood to late adulthood have long-term impacts on current health trajectories at older age. A number of studies in this project are now published among which our study on childhood conditions and cognitive functioning and cognitive decline in later life.
In our research, we were particularly interested in the origins of cognitive decline in later life. Studies among children show that the childhood is an important phase in the development of the brain. Growing up in environments in which people are cognitively stimulated stimulates the brain to develop more complex neuronal networks and larger brain reserves, which may compensate for the neuronal losses that occur when people get older. This effect is long visible, even at old age as a number of important studies recently provided quite solid evidence for the beneficial effect of advantaged childhood conditions on level of cognitive functioning in later life. However, not many studies investigated the relation between childhood conditions and the speed of cognitive decline in later life. Those that did found inconsistent results. We reasoned that part of the inconsistencies in study findings might stem from differences in the analytical approach (not sensitive enough), too little cognitive change because of a short follow-up, too young people, or too small sample (all causing too little power to find statistically significant effects) or differences in the measurement of the childhood conditions. To overcome these potential limitations, we used a large study sample with long follow-up, used a multidimensional measurement of childhood condition, and applied a powerful analytical technique.
Dr. Parish[/caption]
Sarah Parish, MSc, DPhil
Professor of Medical Statistics and Epidemiology
MRC Population Health Research Unit
Nuffield Department of Population Health
University of Oxford
MedicalResearch.com: What is the background for this study?
Response: Acquiring reliable randomized evidence of the effects of cardiovascular interventions on cognitive decline is a priority. In this secondary analysis of 3 randomized intervention trials of cardiovascular event prevention, including 45 029 participants undergoing cognitive testing, we estimated the association of the avoidance of vascular events with differences in cognitive function in order to understand whether reports of non-significant results exclude worthwhile benefit.
Dr. Williamson[/caption]
Jeff D. Williamson, MD
Geriatric Medicine - Sticht Center
Wake Forest Baptist Medical Center
MedicalResearch.com: What is the background for this study?
Response: A growing amount of epidemiologic research has suggested that higher blood pressure is associated with higher risk for dementia, including Alzheimer’s dementia.
MedicalResearch.com: What are the main findings?
Response: More than 9,300 ambulatory, community dwelling persons over age 50, 30% of whom were over the age of 75, were randomly assigned to a blood pressure goal of 120 vs 140. Persons in the 120 group had a 19% lower risk for developing MCI an transitional stage between normal and dementia (P<.008). There was a 17% lower risk for developing dementia but this only achieved a p value = 0.10. The combined risk for both MCI and dementia was 15% lower in the 120 group (p<0.04). The dementia outcome was the primary outcome but all the outcomes were pre-specified in the protocol at the beginning of the trial. Unfortunately the blood pressure intervention was stopped after only 3.3 years due to CVD and mortality benefit and this may well have influenced the ability to reach the expected number of dementia cases.
Dr. Fralick[/caption]
Michael Fralick, MD, FRCPC, SM, PhD (Cand)
Clinical Associate, General Internal Medicine
St Michael’s Hospital
Phillipson Scholar, Clinician Scientist Program, University of Toronto
PhD Candidate, IHPME, University of Toronto
Affiliated Faculty, Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics
Brigham and Women’s Hospital, Harvard University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This medication is a pill that combines two ingredients: dextromethorphan (the active ingredient in cough syrup) and quinidine (used to increase the concentration of dextromethorphan). The medication was primarily studied and evaluated in patients with amyotrophic lateral sclerosis (ALS) or (multiple sclerosis) MS, but anecdotal evidence suggested it was being prescribed to patients with dementia. We used data from two nationwide healthcare databases to understand how the medication was being used in routine care.
Dr. Velikonja[/caption]
Tjasa Velikonja, PhD
Department of Psychiatry
The Seaver Autism Center for Research and Treatment
Icahn School of Medicine at Mount Sinai
New York, New York
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Autism is a lifelong condition, and challenges associated with autism persist from childhood into adulthood. Despite this, research and treatment have been largely dedicated to children. Because of that, we had very little understanding of what areas – what cognitive domains - are most severely impacted in adults with autism. Importantly, the lack of such information also limits treatment development in this area.
What is known already is that adults with autism display deficits in social cognition (which refers to the role that cognitive processes play in our social interactions). Although our meta-analysis supported these theories, it also highlighted several other challenges in cognitive processing, such as deficits in processing speed and verbal learning and memory. And these impairments were observed in adults with autism without an overall intellectual disability.
Dr. McLaughlin[/caption]
Ryan J. McLaughlin, PhD
Assistant Professor
Department of Integrative Physiology & Neuroscience
College of Veterinary Medicine
Washington State University
Pullman, WA 99164-7620
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The use of cannabis during pregnancy is a growing health concern, yet the long-term cognitive ramifications for developing offspring remain largely unknown. Human studies exploring the long-term effects of maternal cannabis use have been sparse for several reasons, including the length and cost of such studies, as well as the fact that experimentally assigning mothers to smoke cannabis during pregnancy is obviously ethically impractical. Animal models of maternal cannabis use have been advantageous in this respect, but they have been limited by the drugs used (synthetic cannabinoids vs. THC vs. cannabis plant) and the way that they are administered. In our study, we used a more translationally relevant animal model of maternal cannabis use that exposes pregnant rat dams to whole plant cannabis extracts using the intra-pulmonary route of administration that is most common to human users. Our preliminary data indicate that twice-daily exposure to a high-dose cannabis extract during pregnancy may produce deficits in cognitive flexibility in adult rat offspring. Importantly, these rats did not experience general learning deficits, as they performed comparably to non-exposed offspring when required to follow a cue in their environment that dictate reinforcer delivery. Instead, deficits were observed only when rats were required to disregard this previous cue-based strategy and adopt a new egocentric spatial strategy in order to continue receiving the sugar reinforcers.
Dr. Truman Pun[/caption]
Brenda Truman Pun, DNP, RN
Program Clinical Manager
Vanderbilt University Medical Center
MedicalResearch.com: What is the background for this study?
Response: Delirium is a serious problem in Intensive Care Units around the world. Approximately 80% of mechanically ventilated patients develop delirium, acute confusion, while in the ICU. Once thought to be a benign side effect of the ICU environment, research now shows that delirium is linked to a myriad of negative outcomes for patients which include longer ICU and Hospital stays, prolonged time on the ventilator, increased cost, long-term cognitive impairment and even mortality. For a half a century clinicians have been using haloperidol, an typical antipsychotic, to treat delirium in the ICU. However, there has never been evidence to support the use of haloperidol or its pharmacologic cousins, the atypical antipsychotics, to treat delirium. These drugs have serious side effects that include heart arrhythmias, muscle spasms, restlessness and are associated with increased mortality when given for prolonged periods in the outpatient settings leading to a black box warning for their use in this setting.
The MIND-USA study was a double blind placebo controlled trial which evaluated the efficacy and safety of antipsychotics (i.e., haloperidol and ziprasidone) in the treatment delirium in adult ICU patients.
Heather Boyd, Ph.D.
Senior researcher
Department of Epidemiology Research
Copenhagen Denmark
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We have known for a while that women who have had preeclampsia report different types of cognitive impairment (difficulties with short-term memory, attention deficits) in the years and decades after their pregnancies, and there are a few imaging studies suggesting that these women may have more white matter lesions in the brain and more signs of brain atrophy than women with uncomplicated pregnancies. We also know that women who have had preeclampsia are at increased risk of cardiovascular disease in the years and decades after delivery. Taken together, it was not a great leap to hypothesize that women with a history of preeclampsia might also be at increased risk of dementia later in life. However, the existing epidemiological data were unconvincing, possibly because it takes a great deal of power (a very large study population) to study links between two conditions that often occur decades apart.
Dr. Oldham[/caption]
Mark Oldham, M.D.
Assistant Professor of Psychiatry
Medical Director, PRIME Medicine
Proactive Integration of Mental Health Care in Medicine
University of Rochester Medical Center
MedicalResearch.com: What is the background for this study?
Response: Patients who have undergone coronary artery bypass graft (CABG) surgery and, specifically, those who have been placed on cardiopulmonary bypass (CPB) have received attention for the potential effects of such procedures on brain health. Heart valve surgery patients have received far less attention, which often leaves clinicians to extrapolate the data from CABG cohorts to their patients preparing to undergo valve surgery. However, there are many reasons why this is far less than ideal, especially as the CABG literature increasingly points to person- and procedure-specific factors as the determinants of postoperative cognitive outcomes.
Ana Maria Sebastião, PhD
Professor of Pharmacology and Neurosciences
Director Institute of Pharmacology and Neurosciences, Faculty of Medicine and
Francisco Mouro, PhD
Unit of Neurosciences, Institute of Molecular Medicine
University of Lisbon, Portugal
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is pressing need to comprehend how cannabinoid exposure impacts brain functioning. While cannabinoid-related research has increased exponentially in the last decade, the mechanisms through which cannabinoids affect brain functioning are still elusive. Specifically, we need to know how prolonged cannabinoid exposure affects important cognitive processes, such as memory, and also find the roots of those effects. This is particularly relevant considering that several countries have already approved cannabis-based medicines.
In this sense, our work sheds new light into the mechanisms underlaying the memory-deficits provoked by a continuous exposure to a cannabinoid drug. More precisely, using brain imaging techniques, we found that long-term exposure to a synthetic cannabinoid drug impairs the ability of key brain regions involved in learning and memory to communicate with each other. Our data points to the necessity of considering cannabinoid actions in a broader perspective, including brain circuitry and communication.
Dr. Pereira[/caption]
Dr Antonina Pereira - CPsychol, PhD, FHEA, AFBPsS
Head of Department of Psychology & Counselling
University of Chichester
Chichester, West Sussex UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Prospective memory (PM) is the ability to remember to perform future activities, such as remembering to take medication or remembering to attend an appointment. Prospective memory tasks pervade our daily lives, and PM failures, although sometimes merely annoying (e.g., forgetting an umbrella at home on a rainy day), can have serious and even life-threatening consequences (e.g., forgetting to turn off the stove).
The fulfilment of such delayed intended actions can indeed be an early indicator of Alzheimer’s disease, with prospective memory failures representing one of the most prominent memory concerns in older adulthood and a fundamental requirement for independent living across the lifespan.
We aimed to address this issue by exploring the potential benefits of a purposefully designed technique, encoded enactment, where participants were encouraged to act through the activity they must remember to do.
This particular study was the fruit of an international research collaboration led by the University of Chichester and including members from Radboud University Nijmegen, Sussex Partnership NHS Foundation Trust and the Faculty of Medicine of the University of Lisbon.
Our team has explored the potential benefits of this specific encoding strategy for healthy younger adults, healthy older adults as well as for patients with mild cognitive impairment.
Results were very encouraging: All age groups reported improvement in prospective memory, but this was particularly evident in older patients with mild cognitive impairment, that is, potentially in the early stages of Alzheimer’s disease.
The study suggests that encouraging people in this category to adopt enactment as a means to enhance prospective memory could result in them leading independent, autonomous lives for longer.
Dr. Vuoksimaa[/caption]
Dr. Eero Vuoksimaa PhD
Institute for Molecular Medicine
University of Helsinski
Finland
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There are many previous reports indicating a positive association between height and cognitive ability but the underlying mechanisms behind this correlation are not well known. We used a mediation model to test if this association is explained by brain size as measured with cortical grey matter size.
We found that total cortical surface mediated the relationship between height and cognitive ability.
Medicalresearch.com Interview with: [caption id="attachment_41413" align="alignleft" width="132"] Prof. Myint[/caption] Professor Phyo Kyaw Myint Chair in Old Age Medicine University of Aberdeen Medicalresearch.com: What is the background for this study? Response: We have previously studied the potential harmful effects of a group of medications called anticholinergics. They can have side effects on central as well peripheral...
Juliana F. W. Cohen, ScM, ScD
Department of Health Sciences
Merrimack College
North Andover MA 01845.
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Sugar consumption among Americans is above recommended limits and this excess intake may have important health implications.
This study examined the associations of pregnancy and offspring sugar consumption, as well as sugar-sweetened beverages, other beverages (diet soda, juice), and fruit consumption with child cognition.
This study found that when pregnant women or their children consumed greater quantities of sugar, as well as when women consumed diet soda during pregnancy, this was associated with poorer childhood cognition. However, children’s fruit consumption was associated with higher cognitive scores.
Sabrina Twilhaar[/caption]
Sabrina Twilhaar, MS, PhD candidate
Child Study Group, sectie Klinische Neuropsychologie
Vrije Universiteit Amsterdam
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: It is well-known that preterm birth has negative consequences for cognitive development.
During the early 1990s important progress in neonatal health care resulted in a considerable increase in the survival of preterm infants. Earlier meta-analyses showed large differences in intelligence between very preterm and full-term born children. However, these meta-analyses included mostly studies on children born before 1990. Because of the advances in neonatal health care since that time, it was important to update our knowledge on the outcomes of more recently born preterm infants. We combined the results of 71 studies, together including 7752 very preterm and 5155 full-term born children, and found a difference in intelligence between very preterm and full-term children that was still large.
Interestingly, despite advancing neonatal health care, we also found no indication of improvement in the cognitive outcomes of very preterm born children during the period from 1990 to 2008. In addition, we searched for factors that increase the risk for poor cognitive outcomes in these children and we found that children with a chronic lung disease that is amongst others caused by mechanical ventilation of the immature lungs are even more at risk for poor cognitive outcomes.
Michaël Schwarzinger, MD, PhD
Translational Health Economics Network (THEN)
Paris
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The association of heavy drinking with dementia has been known for decades. For instance, there is about no Wernicke–Korsakoff syndrome without heavy drinking and the syndrome was described in 1890. But this type of dementia is very rare. Also, heavy drinking is knowingly associated with multiple risk factors for dementia onset such as hypertension or diabetes. But heavy drinkers generally refuse to participate to cohort studies and declaration of alcohol use among participants is generally biased downward... So the study rationale is very strong, but supporting empirical evidence is quite scarce.
This nationwide study included all 31+ million adults discharged from hospitals over 6 years, i.e., 50% of the French population before 65 years old and 80% above that age. Of 1.1+ million adults diagnosed with dementia, one in twenty had an early-onset (before 65 years old). Heavy drinking was recorded in most (56%) early-onset dementia cases: two-third in men; one-third in women. In addition, the association of heavy drinking with dementia goes far beyond 65 years old, both directly (>3 times higher risk for dementia onset after controlling for more than 30 known risk factors for dementia) and indirectly as heavy drinking was associated with all other independent risk factors for dementia onset. Accordingly, heavy drinking had the largest effect on dementia risk of all independent modifiable risk factors such as hypertension or diabetes.
The effects were found whatever dementia case definition or population studies.
Dr. Nowak[/caption]
Dr. Kristen L. Nowak PhD
Division of Renal Diseases and Hypertension
University of Colorado Anschutz Medical Campus
Aurora, CO 80045
MedicalResearch.com: What is the background for this study?
Response: Subtle impairments in cognition are common with aging, even in the absence of clinically apparent dementia. Mild hyponatremia is a common finding in older adults; however, the association of lower serum sodium with cognition in older adults is currently uncertain.
We hypothesized that lower normal serum sodium would be associated with prevalent cognitive impairment and the risk of cognitive decline over time in asymptomatic, community-dwelling older men.
Dr. Lily Yan[/caption]
Dr. Lily Yan MD PhD
Department of Psychology & Neuroscience Program
Michigan State University
East Lansing, MI 48824
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Caselli[/caption]
Richard J. Caselli MD
Department of Neurology
Mayo Clinic Arizona
Scottsdale, AZ
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Personality changes are common in patients with a variety of dementing illnesses, and underlie the behavioral disturbances that complicate the course of dementia patients. We have a been conducting a large longitudinal study of cognitive aging in individuals at genetically defined risk for Alzheimer’s disease (AD) based on their APOE genotype, and have been administering a large battery of neuropsychological tests as well as the gold standard personality questionnaire (the NEO-PI-R) in order to determine whether personality changes during the transition from normal cognition/preclinical AD to mild cognitive impairment.
Dag Alnaes, PhD
Norwegian Centre for Mental Disorders Research
KG Jebsen Centre for Psychosis Research
Division of Mental Health and Addiction, Oslo University Hospital
Oslo, Norway
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The transition from childhood to adulthood is characterized by swift and dramatic changes, both in our environment and in our brains. This period of life also coincides with the onset of many mental disorders.
To gain a better understanding of why, the clinical neurosciences must attempt to disentangle the complex and dynamic interactions between genes and the environment and how they shape our brains. The ultimate goal is to be able to predict which individuals are at risk before clinical symptoms appear. Advanced brain imaging has been proposed to represent one promising approach for such early detection, but there is currently no robust imaging marker that allows us to identify individuals at risk with any clinically relevant degree of certainty.
Our study shows that self-reported early signs of mental illness are associated with specific patterns of brain fiber pathways in young people, even if they may not fulfill criteria for a formal diagnosis or are currently in need of treatment.
Michelle Brasure, MSPH, PhD, MLIS
Evidence-based Practice Center
School of Public Health
University of Minnesota
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We conducted a large systematic review to assess the evidence relating to interventions to prevent cognitive decline and dementia. We included experimental studies with follow up times of at least six months. This paper analyzes the physical activity interventions; other papers in this issue address other types of interventions.
David G. Loughrey, BA(Hons)
NEIL (Neuro Enhancement for Independent Lives) Programme
Trinity College Institute of Neuroscience, School of Medicine
Trinity College Dublin, Dublin, Ireland
MedicalResearch.com: What is the background for this study?
Response: Age-related hearing loss, a common chronic condition among older adults, has emerged in the literature as a potential modifiable risk factor for dementia. This is of interest as current pharmacological therapies for dementias such as Alzheimer’s disease only offer symptom-modifying effects. Treatment of risk factors such as hearing loss may help delay the onset of dementia and may provide an alternate therapeutic strategy. However, there is variance in the research on hearing loss and cognition with some studies reporting a small or non-significant association. In this meta-analysis, we investigated this association and we only included observational studies that used standard assessments of cognitive function and pure-tone audiometry (the clinical standard).
MedicalResearch.com Interview with: [caption id="attachment_38553" align="alignleft" width="128"] Dr. Bernstein[/caption] Lori J Bernstein, PhD, CPsych Neuropsychologist, Dept. of Supportive Care Core Member, Cancer Rehabilitation & Survivorship Program ELLICSR Centre for Health Wellness and Cancer Survivorship Princess Margaret Cancer Centre, UHN Clinical Research Unit Member, Princess Margaret Research Institute Assistant Professor, Dept. of Psychiatry, Faculty of Medicine University of Toronto MedicalResearch.com: What is...
The brain of one patient who died from sporadic Creutzfeldt-Jacob disease (sCJD) appears nearly identical to the brain of a mouse inoculated with infectious prions taken from the skin of patients who died from sCJD.
Ryan Sanford[/caption]
Ryan Sanford, MEng
Department of Neurology and Neurosurgery
Montreal Neurological Institute
McGill University, Montréal, Québec, Canada
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: With the introduction of combination antiretroviral therapy (cART) the outlook for HIV+ individuals has dramatically shifted from a fatal disease to a chronic manageable condition. However, HIV-associated neurocognitive disorders are still prevalent. The etiology of this dysfunction remains unknown. Previous work has reported progressive brain atrophy in HIV+ individuals with advanced disease and poor viral suppression, but it is unclear whether stable treatment and effective viral suppression can mitigate the progression of brain atrophy. To examine this issue, we followed well-treated HIV+ individuals with good viral suppression and well-matched controls, and assessed whether ongoing brain atrophy occurs over time.
The main finding in this study was the HIV+ participants had reduced brain volumes and poorer cognitive performance compared to the control group, but the changes in brain volumes and cognitive performance were similar between the groups.