ADHD, Author Interviews, Cost of Health Care, Eating Disorders, Pharmacology / 09.01.2022
Billions Spent on Prescription Stimulants, Likely Driven by ADHD Diagnoses
MedicalResearch.com Interview with:
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Sneha Vaddadi[/caption]
Sneha Vaddadi, BS
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, Pennsylvania
MedicalResearch.com: What is the background for this study?
Response: The prescription stimulants methylphenidate, amphetamine, and lisdexamfetamine, classified as Schedule II substances, are sympathomimetic drugs with therapeutic use widely used in the US for Attention Deficit Hyperactivity Disorder. Changes in criteria for diagnosis of Attention Deficit Hyperactivity Disorder in 2013 and approval of lisdexamfetamine for binge eating disorder in 2015 may have impacted usage patterns.
The goal of this study1 was to extend upon past research2 to compare the pharmacoepidemiology of these stimulants in the United States from 2010–2017, including consideration to variation within geographic regions, the Hispanic population, and the Medicaid population.
Sneha Vaddadi[/caption]
Sneha Vaddadi, BS
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, Pennsylvania
MedicalResearch.com: What is the background for this study?
Response: The prescription stimulants methylphenidate, amphetamine, and lisdexamfetamine, classified as Schedule II substances, are sympathomimetic drugs with therapeutic use widely used in the US for Attention Deficit Hyperactivity Disorder. Changes in criteria for diagnosis of Attention Deficit Hyperactivity Disorder in 2013 and approval of lisdexamfetamine for binge eating disorder in 2015 may have impacted usage patterns.
The goal of this study1 was to extend upon past research2 to compare the pharmacoepidemiology of these stimulants in the United States from 2010–2017, including consideration to variation within geographic regions, the Hispanic population, and the Medicaid population.
Sean C. Rose, MD
Child Neurology
Nationwide Children’s Hospital
The Ohio State University, Columbus
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: There is conflicting evidence regarding the association between repetitive head impacts during youth contact sports and worse neurocognitive outcomes. Most research has been conducted in older adults, while the research in children is mostly limited to 1-2 sports seasons.
Dr. van Dalen[/caption]
Jan Willem van Dalen, PhD
Department of Neurology
Donders Institute for Brain, Behaviour and Cognition
Radboud University Medical Centre Nijmegen
Department of Neurology
The Netherlands3Department of Public and Occupational Health
Amsterdam UMC, University of Amsterdam, Amsterdam
MedicalResearch.com: What is the background for this study?
Response: Although high systolic blood pressure in midlife has consistently been reported as a condition that increases the risk of developing dementia in old age, reports regarding this relationship in older people have been inconsistent. One potential reason for this, is that the relationship between systolic blood pressure and dementia in later life may be U-shaped, meaning that both individuals with low and with high systolic blood pressure are at increased incident dementia risk.
This study combined data from several longitudinal cohort studies specifically designed to study incident dementia in older people, to investigate whether these U-shaped relationships exist, and in which age ranges they appear. We included more than 16,500 people aged 60 and older, with over 2,700 incident dementia cases.
Also, we aimed to investigate whether these observational associations might be caused by confounding, differences in mortality, or result from opposite relationships between certain subgroups of individuals.
Dr. Lee[/caption]
Cecilia S. Lee, MD, MS
Associate Professor,Director, Clinical Research
Department of Ophthalmology
Harborview Medical Center
University of Washington Seattle, WA
MedicalResearch.com: What is the background for this study?
Response: Cataract is a natural aging process of the eye and affects the majority of older adults who are at risk for dementia. Sensory loss, including vision and hearing, is of interest to the research community as a possible risk factor for dementia, and also as a potential point of intervention. Because cataract surgery improves visual function, we hypothesized that older people who undergo cataract surgery may have a decreased risk of developing Alzheimer disease and dementia.
We used the longitudinal data from an ongoing, prospective, community based cohort, Adult Changes in Thought (ACT) study. The ACT study includes over 5000 participants to date who are dementia free at recruitment and followed until they develop Alzheimer disease or dementia. We had access to their extensive medical history including comprehensive ophthalmology visit data. We investigated whether cataract surgery was associated with a decreased risk of developing Alzheimer disease and dementia. 
Dr. Smyth[/caption]
Professor Andrew Smyth MB, BCh, BAO, MMedSc, MRCPI, PhD
Professor of Clinical Epidemiology
NUI Galway
Director of the HRB-Clinical Research Facility Galway
Consultant Nephrologist at Galway University Hospitals
MedicalResearch.com: What is the background for this study?
Response: We know that there are multiple medium to long-term risk factors for stroke, as people with conditions such as hypertension (high blood pressure) or diabetes mellitus (high blood glucose levels) and those with risk factors (such as smoking, obesity, poor diet quality and others) are at increased risk of stroke. However, we still find it difficult to predict who will have a stroke.
We were interested in exploring if short-term exposures to anger or emotional upset or a period of heavy physical exertion might lead to, or ‘trigger’ a stroke. We looked at this previously for myocardial infarction (heart attack) in a study called INTERHEART. Some smaller studies have looked at this before, with less people experiencing a stroke and often confined to one country or geographical region. Here, in INTERSTROKE, we included over 13,000 people who had a stroke and asked about the one hour period before the onset of the stroke and also about the same period on the day before.
Dr. Shiou Liang[/caption]
Wee Shiou Liang, PhD
Associate Professor | Health and Social Sciences, Singapore Institute of Technology
Faculty | Geriatric Education and Research Institute
Singapore
MedicalResearch.com: What is the background for this study?
Response: This study was funded by Singapore’s Ministry of Health Geriatric Education and Research Institute.
We randomly recruited 500+ adults aged 21-90+ from the residential town of Yishun. We performed detailed assessments of physical and cognitive performance, body composition using DEXA, and participants also provided information on their levels and frequencies of physical activities (PA) including recreational PA/exercise, commuting, housework and other occupational related PA. The demographics of the sample of participants is the same as that of Singapore in terms of age and ethnic composition. Comparing the results of those aged 21-<65 and those >=65 years, only around a third (36%; 90) of those in the younger group and only around half (48%;116) of those in the older age group, met guidelines recommended physical activity quota exclusively from recreational PA/exercise. But nearly two thirds (61% younger; 152 and 66% older; 159) met this target exclusively through housework.
Dr. Mahncke[/caption]
Dr. Mahncke earned his PhD at UCSF in the lab where lifelong brain plasticity was discovered. At the request of his academic mentor, he currently leads a global team of more than 400 brain scientists engaged in designing, testing, refining, and validating the computerized brain exercises found in the BrainHQ app from Posit Science, where he serves as CEO.
Earlier this year, MedicalResearch.com interviewed Dr. Henry Mahncke about the BRAVE Study he led, which showed a digital health app (BrainHQ) was effective in addressing chronic cognitive issues in servicemembers who had been diagnosed with “mild” Traumatic Brain Injury. This week, MedicalResearch.com interviews Dr. Mahncke again about a new independent study among civilians showing similar results in patients with all kinds of Brain Injuries.
MedicalResearch.com: What is the background for this study?
Response: The Centers for Disease Control (CDC) estimates that about 5.3 million people currently live with a chronic disability from a Traumatic Brain Injury (TBI). While most people who suffer a blow to the head recover in a couple days or weeks, for some (estimated as high as 15 percent) the injury persists with a variety of life-disrupting symptoms, including impairments in cognitive abilities, behavior, emotions, and motor function affecting work, relationships, and daily function.
TBIs have been the signature injury of recent wars. Nearly 400,000 service members have been diagnosed with TBIs, of which 82% were diagnosed with so-called “mild” TBIs from concussions and blast injuries. More than a decade ago, we began being asked by military and Veterans organizations, to study whether our brain exercises – which had shown positive effects in measures of cognition, everyday function, mood, and motor function in healthy older adults – could have an impact on people with chronic symptoms from TBIs.
We talked earlier this year, when an 83-person, gold-standard, randomized controlled trial on mTBI (called the BRAVE Study) announced quite positive results from using BrainHQ exercises. That study was funded by the Department of Defense and run as five military and Veterans medical centers. The BRAVE Study found the BrainHQ group showed a statistically and clinically significant improvement on a standard measure of overall cognitive function (compared to a computer games control), and this benefit persisted for at least 12 weeks after training completed. Cognitive function improvements were nearly four times larger in the BrainHQ group than the control (as measured immediately following training) and grew to nearly five times larger (when measured again 12 weeks after training ended). On average, participants in the BrainHQ group improved on the cognitive performance composite measure by 24 percentile ranks – as though they went from the 50th percentile to the 74th percentile.
One large question left unanswered from the BRAVE study was whether this approach might also work for other categories of TBIs, such as moderate and severe TBIs. A new study from independent researchers at NYU answers that question.
Prof. Stewart[/caption]
Willie Stewart, MBChB, PhD, DipFMS, FRCPath, FRCP Edin
Consultant Neuropathologist
Honorary Professor
Department of Neuropathology
Queen Elizabeth University Hospital
Glasgow, UK
MedicalResearch.com: What is the background for this study?
Response: There is concern over the association between participation in contact sports and later life risk of dementia and associated neurodegenerative disease. Much of this comes from observations of a specific form of neurodegenerative pathology - chronic traumatic encephalopathy (CTE)- linked to history of traumatic brain injury (TBI) and repetitive head impacts in autopsy studies of relatively small numbers of former athletes, including boxers and soccer players. Nevertheless, although this brain injury linked pathology is described, surprisingly little is known about what this might mean for later life health, specifically risk of dementia.
In a previous study published from our programme of research looking at "Football's Influence on Lifelong health and Dementia risk' (the FIELD Study), we demonstrated that former professional soccer players had an approximately three-and-a-half-fold higher mortality from neurodegenerative disease than matched general population controls. However, these mortality data did not allow us to consider the relationships between varying head injury/impact exposure variables, such as player position and career length, and risk of neurodegenerative disease. 
Dr. Kelley[/caption]
Mireille E. Kelley Ph.D.
Staff Consultant for Engineering Systems Inc.
MedicalResearch.com: What is the background for this study?
Response: Youth and high school football players can sustain hundreds of head impacts in a season and while most of these impacts do not result in any signs or symptoms of concussion, there is concern that these repetitive subconcussive impacts may have a negative effect on the brain.
The results of this study are part of an NIH-funded study to understand the effects of subconcussive head impact exposure on imaging data collected at pre- and post-season time points. The present study leveraged the longitudinal data that was collected in the parent study to understand how head impact exposure changes among athletes from season to season and how that relates to changes measured from imaging.
Dr. Begdache[/caption]
Lina Begdache, PhD, RDN, CDN, CNS-S, FAND
Assistant Professor
Health and Wellness Studies Department GW 15
Decker School of Nursing
Binghamton University
MedicalResearch.com: What is the background for this study?
Response: My research focuses on understanding the link between the modifiable risk factors (such as diet, sleep and exercise) and mental distress. In this study, adults of different age-groups (18 years and older) were followed for 4 weeks. Participants recorded their dietary intake, sleep quality, exercise frequency, their physical and mental wellbeing on a daily basis.
Another research interest of mine is to assess these factors in relation to sex (different brain morphology) and age-groups (based on brain maturity). The rationale of this categorization is that brain morphology and brain development vs maintenance and repair may require a different repertoire of food and environmental factors. Therefore, we also studied the sex and age-groups effect.
We also added the season factor as one of our 
Dr. Nation[/caption]
Daniel A. Nation, Ph.D.,
Associate Professor of Psychological Science
Institute for Memory Impairments and Neurological Disorders
University of California, Irvin
MedicalResearch.com: What is the background for this study?
Response: Hypertension is a risk factor for cognitive decline and dementia, and treatment of hypertension has been linked to decreased risk for cognitive impairment.
Prior studies have attempted to identify which specific type of antihypertensive treatment conveys the most benefit for cognition, but findings have been mixed regarding this question. We hypothesized that antihypertensive drugs acting on the brain angiotensin system may convey the greatest benefit since they affect the brain angiotensin system that has been implicated in memory function.
Dr. Dunietz[/caption]
Galit Levi Dunietz MPH, PhD
Assistant Professor
Dr. Braley[/caption]
The first step that you should take to finding inner peace is to practice yoga and meditation regularly. Yoga and meditation can give you the chance to slow down and reflect, as well as to clear your mind of the worries and negative thoughts that are concerning you. Not only this, but deep breathing is also an important aspect of both yoga and meditation as this can help you to ground yourself and to reconnect with the world around you.
Dr. Rettew[/caption]
David C. Rettew, MD
Child & Adolescent Psychiatrist
Associate Professor of Psychiatry and Pediatrics
University of Vermont Larner College of Medicine
MedicalResearch.com: What is the background for this study?
Response: Our group, the Wellness Environment Scientific Team at the University of Vermont, hadn’t planned to look at COVID at the outset of this study and instead were going to look at mental health and engagement in wellness activities in college students across a semester. The pandemic disrupted that plan when students were abruptly sent home but fortunately, they continued to do their daily app-based ratings of their mood, stress levels, and engagement in healthy activities. We then realized we had some interesting pre-COVID to COVID data that was worth exploring. 