Author Interviews, Emergency Care, Mental Health Research / 19.02.2016

MedicalResearch.com Interview with: Paul E Ronksley, PhD Assistant Professor Department of Community Health Sciences Cumming School of Medicine University of Calgary Calgary, AB Canada Medical Research: What is the background for this study? Response: Numerous studies have shown that high users of the emergency department (ED) are often patients with complex medical needs and limited personal and social resources. It is also recognized that high users are a heterogeneous group driven by variability in the operational definition used to define this patient population. “High use” of ED services is often defined by the number of visits per year (namely ≥3 or ≥4 visits to the ED in a 1-year period) with little exploration of the distribution/pattern of these visits over time. The purpose of our study was to examine patient and encounter-level factors and costs related to periods of short-term resource intensity (clustered ED visits) among high users of the ED within a tertiary-care teaching facility. This is important as it may inform interventions that can focus on a more defined group with the goal of providing the needed care in a setting outside of the ED. Medical Research: What are the main findings? Response: Our main findings demonstrate that among high  emergency department users (i.e. patients with 3 or more ED visits in a 1-year period), approximately 1 in 7 patients had a period of high-intensity ED use (3 or more visits clustered within a week). These patients with clustered visits were more likely to be homeless, require psychiatric emergency services, and revisit the  emergency department for the same presenting complaints. The high-intensity users were also less likely to be admitted, more likely to leave without being seen and had lower costs per encounter, although their total ED cost across all visits was higher. (more…)
Author Interviews, Autism, JAMA, Pediatrics / 18.02.2016

MedicalResearch.com Interview with: Dr. David Grossman MD MPH Vice chair of the U.S. Preventive Services Task Force Professor at the University of Washington Schools of Public Health and Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Grossman: The Task Force cares deeply about the challenges that children affected by autism and their families face in getting the care and support they need. This was the first time that we assessed the evidence around screening young children for autism, and our recommendation was informed by a review of the most up-to-date science, which included randomized trials, observational studies, and research from a number of Federal health agencies. We concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for autism spectrum disorder in children for whom no concerns of autism have been raised by their parents or a clinician. This is an I statement, which is not a recommendation against screening, but a call for more research on screening and treatment in young children who don’t have obvious symptoms. It is important to note that this recommendation will not affect insurance coverage for autism screening, which is currently covered under the Affordable Care Act as a result of the American Academy of Pediatrics’ Bright Futures Guidelines. (more…)
Alzheimer's - Dementia, Author Interviews, Dental Research, Infections, Stroke / 18.02.2016

MedicalResearch.com Interview with: Dr. Robert Friedland MD Mason C. and Mary D. Rudd Endowed Chair In Neurology Professor, Dept. of Neurology University of Louisville Health Care Outpatient Center Louisville, KY 40292 Medical Research: What is the background for this study? What are the main findings? Dr. Robert Friedland: Oral infectious diseases are associated with stroke. Previous research by this group has shown that oral bacteria, cnm-positive Streptococcus mutans, was associated with cerebral microbleeds and intracerebral hemorrhage. We developed this study to investigate the roles of this bacteria in patients entering the hospital for all types of stroke. Among the patients who experienced intracerebral hemorrhage (ICH), 26 percent were found to have a specific bacterium in their saliva, cnm-positive S. mutans. Among patients with other types of stroke, only 6 percent tested positive for the bacterium. We also evaluated MRIs of study subjects for the presence of cerebral microbleeds (CMB), small brain hemorrhages which may cause dementia and also often underlie ICH. We found that the number of CMBs was significantly higher in subjects with cnm-positive S. mutans than in those without. (more…)
Author Interviews, Cannabis, Genetic Research, Memory / 17.02.2016

MedicalResearch.com Interview with: Prof. Celia Morgan PhD Professor of Psychopharmacology University of Exeter  Medical Research: What is the background for this study? What are the main findings? Dr. Morgan: We know cannabis increases the risk of psychosis but it is unclear how we can predict who is vulnerable to these negative effects. This study suggested that cannabis may have stronger effects in people carrying a particular genetic variant. This might be related to their risk of developing psychosis. We also found that women are more susceptible to the short term memory impairing effects of cannabis. (more…)
Alzheimer's - Dementia, Author Interviews, JAMA, Pharmacology / 15.02.2016

MedicalResearch.com Interview with: Dr. Britta Haenisch PhD German Center for Neurodegenerative Diseases (DZNE)  Medical Research: What is the background for this study? Dr. Haenisch: Proton pump inhibitors (PPIs) are widely used for the treatment of gastrointestinal diseases, but have also been shown to be potentially involved in cognitive decline: There were hints from recent other studies that PPIs might affect cognition, e.g. Lam et al. (2013) report a significant association of PPI use with vitamin B12 deficiency in a population-based sample. Vitamin B12 deficiency has been shown to be associated with cognitive decline. In another study, PPIs were observed to enhance amyloid beta peptide (Aβ) levels in mouse brain by affecting the enzymes β- and γ-secretase which leads to increased Aβ levels in mice. Medical Research: What are the main findings? Dr. Haenisch: The current study provides a statistical association (applying a time-dependent analysis) between proton pump inhibitors prescription and occurrence of dementia with a focus on long-term regular PPI prescription in patients aged 75 years and older. In our analysis we focused on long-term regular PPI prescription for at least 18 months. It does not prove that proton pump inhibitors cause dementia. References -Lam JR, Schneider JL, Zhao W, Corley DA. Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. JAMA. 2013;310(22):2435-2442. -Badiola N, Alcalde V, Pujol A, et al. The proton-pump inhibitor lansoprazole enhances amyloid beta production. PLoS One. 2013;8(3):e58837 (more…)
Author Interviews, Cognitive Issues, NEJM / 11.02.2016

MedicalResearch.com Interview with: Claudia L. Satizabal, PhD Instructor in Neurology Boston University School of Medicine The Framingham Heart Study Boston, MA 02118-2526 MedicalResearch: What is the background for this study? What are the main findings?   Dr. Satizabal: Our societies are expected to face an increasing burden of dementia in the next decades due to increasing life expectancies and the aging of a big proportion of the population, the so called “baby boomers”. However, some studies conducted in high-income countries have suggested a decline in the total number of cases (prevalence) as well as new cases (incidence) of dementia at any given age. Yet the findings of these studies were not seen as definitive, either because results were of borderline significance or because they were based on survey data, and stronger evidence was lacking. We used information collected since 1975 in the Framingham Heart Study to estimate the trends in dementia incidence. One of the strengths of this study is that investigators have been careful to use the same diagnostic criteria for over the past 30 decades, which allows us to provide more robust evidence of dementia trends over time. We found that there has been a progressive decline in the incidence of dementia at any given age over the past 30 decades. Compared to the late 1970s, we observed a decline of 22% in the late 1980s, 38% in the 1990s and 44% in the 2000s. This beneficial trend was only seen among persons with at least a high school diploma. We also explored trends in vascular risk factors such as blood pressure, smoking, diabetes, and others; however, these trends did not completely explain the decline in dementia incidence. One interesting finding was that the risk of dementia associated with cardiovascular diseases, such as stroke or atrial fibrillation, decreased dramatically over the course of time from the late 1970s to the 2000s. (more…)
Author Interviews, End of Life Care, JAMA, Mental Health Research, NIH / 11.02.2016

MedicalResearch.com Interview with: Scott Y. H. Kim, MD, PhD Department of Bioethics, National Institutes of Health Bethesda, MD 20892 Medical Research: What is the background for this study? Dr. Kim: Euthanasia and/or physician assisted suicide (EAS) of persons suffering from psychiatric disorders is increasingly practiced in some jurisdictions such as Belgium and the Netherlands but very little is known about the practice.  There is an active debate over whether to legalize such a practice in Canada, after a Supreme Court ruling last year that struck down laws banning physician assisted death.  Medical Research: What are the main findings? Dr. Kim: The main findings are that:
  1. Most patients who receive psychiatric euthanasia and/or physician assisted suicide are women, of diverse ages, with a variety of chronic psychiatric conditions accompanied by personality disorders, significant physical problems, and social isolation/loneliness, often in the context of refusals of treatment.  A minority who are initially refused EAS ultimately receive euthanasia and/or physician assisted suicide through a mobile euthanasia clinic.
  2. Given that the patients have chronic, complicated histories requiring considerable physician judgment, extensive consultations are common. But independent psychiatric input does not always occur; disagreement among physicians occurred in one in four cases; and the euthanasia review committees generally defer to the judgments of the physicians performing euthanasia and/or physician assisted suicide.
(more…)
Author Interviews, Brain Injury, CMAJ, Mental Health Research / 09.02.2016

MedicalResearch.com Interview with: Dr. Donald Redelmeier MD, MSHSR, FRCPC, FACP Senior core scientist at the Institute for Clinical Evaluative Sciences (ICES) Physician at Sunnybrook Health Sciences Centre Toronto, Ontario Medical Research: What is the background for this study? What are the main findings? Dr. Redelmeier: Head injury can lead to suicide in military veterans and professional athletes; however, whether a mild concussion acquired in community settings is also a risk factor for suicide is unknown. Medical Research: What should clinicians and patients take away from your report? Dr. Redelmeier: We studies 235,110 patients diagnosed with a concussion and found that  667 subsequently died from suicide. The median delay was about 6 years. This risk was about 32 per 100,000 patients annually, which is 3x the population norm and especially high if the concussion occurred on a weekend (from recreation) rather than a weekday (from employment). (more…)
Author Interviews, BMJ, Karolinski Institute, Mental Health Research, Psychological Science, Technology / 06.02.2016

MedicalResearch.com Interview with: Dr. Jesper Enander Department of Clinical Neuroscience Karolinska Institutet MedicalResearch: What is the background for this study? Dr. Enander: Body dysmorphic disorder (BDD) is a common anxiety disorder affecting about 2% of the general population, and is associated with hospitalization, substance dependence and suicidality. The disorder is characterized by a intense preoccupation with perceived defects in physical appearance, despite looking perfectly normal. It is common for people with BDD to seek non-psychiatric care, such as dermatological treatment or plastic surgery, however, such treatments rarely work, and can even lead to a deterioration of symptoms. The National Institute for Health and Clinical Excellence (NICE) in the UK recommends that patients with Body dysmorphic disorder should be offered cognitive behavior therapy (CBT), however, there is a gap between supply and demand of CBT. One way of increasing access to CBT is to deliver it using the Internet. In this randomized clinical trial we tested the efficacy of a Internet based CBT program for Body dysmorphic disorder called BDD-NET and compared it to supportive therapy. MedicalResearch: What are the main findings? Dr. Enander: Our study shows that BDD-NET was associated with large and significant improvements in  Body dysmorphic disorder symptom severity. 56% of those receiving BDD-NET were responders (defined as at least a 30% reduction in symptoms), compared to 13% of those receiving supportive therapy. At the six months follow-up, 39% of those who received BDD-NET no longer met diagnostic criteria for Body dysmorphic disorder. No serious adverse events were reported, and most participants were satisfied with BDD-NET, despite no face-to-face contact with a therapist, and deemed the treatment as highly acceptable. (more…)
Author Interviews, Genetic Research, JAMA, Schizophrenia / 04.02.2016

MedicalResearch.com Interview with: Hannah J. Jones, PhD Centre for Academic Mental Health, School of Social and Community Medicine, Medical Research Council (MRC) Integrative Epidemiology Unit University of Bristol, Bristol, England MedicalResearch: What is the background for this study? What are the main findings? Dr. Jones: Schizophrenia is a highly heritable condition characterised by relatively diverse symptoms and frequent comorbid disorders. However, at present we don’t know how genetic risk for schizophrenia is expressed in children/adolescents in the general population. To investigate this, we studied data from individuals within the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort which consists of approximately 14,000 children born to women living in the former Avon Health Authority area in England with an expected delivery date from April 1, 1991, to December 31, 1992. We used genetic data from approximately 5,000 ALSPAC children and measures from adolescence relating to psychopathology to determine whether genetic risk for schizophrenia is associated with variation in psychotic experiences (e.g. delusions, hallucinations), negative symptoms (e.g. apathy, withdrawal), depressive disorder and anxiety disorder during this developmental period. We derived a score of genetic risk for schizophrenia in each individual within our study. This score is normally distributed such that most people have some genetic risk and a few people have very high or very low genetic risk. We found very weak evidence of an association between genetic risk for schizophrenia and psychotic experiences in adolescence and no evidence of an association with depressive disorder. However, we found strong evidence of association between genetic risk for schizophrenia and negative symptoms and anxiety disorder.  (more…)
Alzheimer's - Dementia, Author Interviews, Blood Pressure - Hypertension, NIH / 03.02.2016

MedicalResearch.com Interview with: Dr. Juan M. Saavedra, MD and Dr. Abdel Elkahloun PhD Comparative genomics and Cancer Genetics Branch National Human Genome Research Institute, National Institutes of Health, Bethesda, MD MedicalResearch: What is the background for this study? What are the main findings? Response: Alzheimer’s disease is the most frequent age-related dementia, a progressing, devastating illness without effective treatment. By the time it is diagnosed, major and irreversible cell injury has already occurred. It is therefore imperative to identify therapeutic agents effective against early, pre-symptomatic injury mechanisms and risk factors increasing vulnerability the disease. We focused on a class of compounds blocking receptors for Angiotensin II, the Angiotensin Receptor Blockers (ARBs). These compounds are commonly used for the treatment of hypertension, a major risk factor for Alzheimer’s disease. We and others have found that in addition to their cardiovascular benefits, ARBs are strongly neuroprotective. The present study was designed to explore in depth the neuroprotective effects of one member of the ARB class, candesartan. To this effect we cultured neurons extracted from the rat brain. These neurons were exposed to high concentrations of glutamate, a recently identified early injury mechanism in Alzheimer’s disease. We found that candesartan prevented glutamate-induced neuronal injury. We conducted in-depth examination of our results by genome-wide expression profile analysis. We found that candesartan normalized glutamate-induced alterations in expression of hundreds of genes, including many involved in neuronal inflammation, cardiovascular disease, diabetes and alterations in amyloid metabolism a hallmark for Alzheimer’s disease. This was evidence of direct neuroprotective effects of relevance for this disorder. When we compared our results with published databases obtained from autopsy samples from Alzheimer’s disease patients, we found impressive correlations. The expression of more than 400 genes altered by glutamate and normalized by candesartan in our cultures was similarly changed in the Alzheimer’s databases. The conclusion was that our cell culture results represented alterations found in the human condition. Our observations provide novel evidence of neuroprotection from early mechanisms of injury in Alzheimer’s disease and support testing candesartan in controlled clinical studies including individuals at the early stages of the illness, to unequivocally demonstrate their therapeutic effect. (more…)
Author Interviews, Depression, JAMA, NYU, Pediatrics / 01.02.2016

MedicalResearch.com Interview with: Briannon O'Connor PhD New York University Child Study Center Department of Child and Adolescent Psychiatry New York University School of Medicine New York Medical Research: What is the background for this study? What are the main findings? Dr. O'Connor: a.      As the health care system continues to emphasize accountability for providing high quality care, the development of meaningful quality standards is critical.  This study came from NCQA’s work to develop these quality measures for adolescent depression care.  Prior to this study, little was known about what routine care looked like for adolescents who showed up at their primary care visits with significant symptoms of depression. This study looked at follow up care documented in an electronic health record in the three months after an adolescent was first identified with significant symptoms of depression. Medical Research: What is the background for this study? What are the main findings? Dr. O'Connor:    Key findings from this study include:
  1. Most adolescents (nearly two-thirds) with newly prescribed depression symptoms received some treatment, usually including psychotherapy, within the first 3 months after depression symptoms were first identified.
  2. Among those adolescents who were prescribed antidepressant medications, 40% had no other follow up care in three months, which is quite concerning since current black box warnings highlight the risk for increased suicidality for youth prescribed antidepressants and clearly recommend close monitoring in the few months following initial prescription.
  3. There were low rates of other follow up care events in the three month follow up period:  19% of adolescents  did not receive any follow up care at all, 36% did not receive any treatment, and the majority (68%) lacked documentation that symptoms were monitored or re-assessed using a valid questionnaire
  4. The sites that participated in the study are highly regarded health care institutions, often looked to as leaders in cutting-edge care. Thus, results from this study, discouraging as they are, may overstate the quality of care in other settings.
(more…)
Aging, Author Interviews, Cognitive Issues, JAMA, Mayo Clinic, Weight Research / 01.02.2016

MedicalResearch.com Interview with: Rosebud O. Roberts, M.B., Ch.B. Mayo Clinic Rochester, Minn.  Medical Research: What is the background for this study? Dr. Roberts: Decline in weight has been observed 10-20 years prior to onset of dementia. We wanted to study whether this decline also occurs for mild cognitive impairment (an intermediate stage in the progression from normal cognition to dementia). Medical Research: What are the main findings? Dr. Roberts: The main finding was that there was indeed a decline in weight (from the maximum weight in midlife to weight assessed in late life) was associated with a increased risk of mild cognitive impairment. (more…)
Author Interviews, Autism, Genetic Research, JAMA, Schizophrenia / 30.01.2016

MedicalResearch.com Interview with: Andrea J. Gonzalez-Mantilla, M.D. Postdoctoral Fellow Andres Moreno-De-Luca, M.D. Investigator I Autism & Developmental Medicine Institute Department of Radiology Geisinger Health System Danville, PA 17822 Medical Research: What is the background for this study? What are the main findings? Response: Developmental brain disorders (DBD), such as autism, intellectual disability, and schizophrenia are a group of heterogeneous conditions characterized by deficits that affect multiple functional domains, such as cognition, behavior, communication, and motor skills. Previous studies provide strong evidence of common underlying molecular pathways and shared genetic causes among apparently different DBDs. Large-scale genomic studies of individuals with developmental brain disorders have found that identifying multiple, independent de novo pathogenic loss-of-function (pLOF) variants in the same gene among unrelated individuals is a powerful statistical approach to reliably identify disease-causing genes. However, genomic data from smaller cohorts and case reports are not routinely pooled with data from larger studies. Moreover, most previous studies have been restricted to cohorts of individuals ascertained based on a single diagnosis (e.g., a study will focus on only individuals with a diagnosis of autism and not consider other genomic data from individuals with a different diagnosis). Therefore, genomic data from individuals across DBD are not being jointly analyzed in search of pLOF variants in the same gene that may help build evidence for a causative role in developmental brain disorders. In this study, we carried out data mining of previously published data to identify genes related to the DBD phenotype. We expanded the aforementioned method and developed a multilevel data-integration approach, which capitalizes on three genotype-phenotype data sources: (1) genomic data from structural and sequence pLOF variants, (2) phenotype data from six apparently distinct DBD (autism, intellectual disability, epilepsy, schizophrenia, bipolar disorder and attention-deficit/hyperactivity disorder), and (3) data from large scale studies, smaller cohorts, and case reports. We identified 241 candidate genes for developmental brain disorders, including 17 genes that had not previously been associated with developmental brain disorders. (more…)
Abuse and Neglect, Accidents & Violence, Author Interviews, JAMA, Mental Health Research / 29.01.2016

MedicalResearch.com Interview with: Tracie O. Afifi, PhD Associate Professor of Epidemiology CIHR New Investigator (2013-2018) Departments of Community Health Sciences and Psychiatry College of Medicine, Faculty of Health Sciences University of Manitoba  Medical Research: What is the background for this study? Dr. Afifi: Recent studies in the US have examined predictors and correlates of suicide among solider, but none of these studies have investigated the potential role that child abuse exposure may play in suicide-related outcomes. In addition no representative military and civilian comparisons from any country have examined possible differences in the prevalence of child abuse exposure and the potential differences in the relationships between child abuse exposure and suicide-related outcomes in these populations. This study uses nationally representative military and civilian samples from Canada. Medical Research: What are the main findings? Dr. Afifi: Child abuse was more prevalent among Regular Forces personnel (47.7%) and Reserve Forces personnel (49.4%) compared to the Canadian general population (33.1%). Child abuse exposure was associated with an increased likelihood of suicidal thoughts, plans, and attempts in military and civilian populations, with associations weaker for many outcomes in military personnel relative to civilians. Deployment-related trauma was associated with past-year suicidal thoughts and suicide plans. However, relative to deployment-related trauma, child abuse exposure had a more robust association with suicide-related outcomes. (more…)
Author Interviews, BMJ, Mental Health Research, Pediatrics, Pharmacology / 29.01.2016

MedicalResearch.com Interview with: Tarang Sharma, PhD candidate  Nordic Cochrane Centre, Rigshospitalet University of Copenhagen, Faculty of Health and Medical Sciences, Denmark Medical Research: What is the background for this study? What are the main findings? Response: These newer antidepressants are some of the most prescribed medications in the world and previous research in the area has suggested an increased suicide risk on these drugs in young people, but only when unpublished clinical study report data is used. Such risk is missing when the published articles are considered due to severe selective reporting and publication bias. In our study we found that the research design of most of the trials was very poor and there were major discrepancies in the reporting, leading to the under-estimation of harms. Despite these problems we still found that both suicidality and aggression were more than doubled in children and adolescents on antidepressants compared to those on placebo. (more…)
Addiction, ADHD, Author Interviews, Eating Disorders / 29.01.2016

MedicalResearch.com Interview with: Dr. Kenneth Koblan PhD Sunovion Pharmaceuticals Inc. Fort Lee, NJ and Marlborough, MA Medical Research: What is the background for this study? Dr. Koblan: Assessing abuse potential is important in the clinical development process for any therapy affecting the central nervous system, especially those that may act on dopamine and norepinephrine neurotransmitter systems. Human abuse liability studies are conducted to evaluate the abuse potential associated with drugs that affect the central nervous system. Drugs that increase dopamine levels may be associated with stimulant effects and abuse (e.g., cocaine and amphetamine), whereas drugs that increase serotonin and/or norepinephrine levels are not generally associated with recreational abuse (e.g., selective serotonin reuptake inhibitors). Among drugs with effects on dopamine neurotransmission, slowing the rate of absorption is thought to reduce abuse potential, and increasing the rate of elimination is thought to reduce rewarding effects and abuse liability due to sustained elevations in drug concentrations resulting in sustained inhibition of dopamine transporters (DAT). Dasotraline is an investigational dopamine and norepinephrine reuptake inhibitor from Sunovion in late-stage development to evaluate its use in treating the symptoms of attention deficit hyperactivity disorder (ADHD) and binge-eating disorder (BED). Dasotraline has slow absorption and elimination that supports the potential for plasma concentrations yielding a continuous therapeutic effect over the 24-hour dosing interval at steady state. (more…)
Author Interviews, Heart Disease, Mental Health Research / 29.01.2016

MedicalResearch.com Interview with: Dr Jodie Ingles GradDipGenCouns MPH PhD Heart Foundation Future Leader Fellow Conjoint Senior Lecturer, Sydney Medical School, University of Sydney National Coordinator, Australian Genetic Heart Disease Registry Research Officer, Molecular Cardiology Centenary Institute Newtown Australia Medical Research: What is the background for this study? What are the main findings? Dr. Ingles : Sudden cardiac death of a young relative is devastating for the family. Not only are they grieving, but must come to terms with the familial risk to other family members. The clinical and genetic aspects of family management are beginning to be better understood, but there has been a lack of research regarding the psychological impact to family members. We found 1 in 2 family members report significant symptoms of prolonged grief and posttraumatic stress warranting need for specialized intervention by a clinical psychologist. Furthermore, we found those family members who witnessed the death or discovered the decedents body were 3 to 4 times more likely to report these symptoms. (more…)
Aging, Author Interviews, Columbia, Depression, Geriatrics / 27.01.2016

MedicalResearch.com Interview with: Stanford Chihuri MPH Center for Injury Epidemiology and Prevention Department of Anesthesiology Columbia University Medical Center New York City, New York  Medical Research: What is the background for this study? What are the main findings? Response: For many older adults, driving is instrumental to their daily living and is a strong indicator of self-control, personal freedom and independence. This study assesses and synthesizes evidence in the research literature on the impact of driving cessation on subsequent health and well-being of older adults. The main findings are that driving cessation in older adults appears to contribute to a variety of health problems, particularly depression. (more…)
Alzheimer's - Dementia, Author Interviews, Diabetes / 27.01.2016

MedicalResearch.com Interview with: Dr. Erin L. Abner PhD Sanders-Brown Center on Aging and Alzheimer's Disease Center College of Public Health, University of Kentucky Lexington, KY  Medical Research: What is the background for this study? What are the main findings? Dr. Abner: Diabetes is an important public health concern, and it has been linked to cognitive impairment and dementia, including dementia due to Alzheimer’s disease, in multiple studies of aging and cognition. Diabetes is considered by many to be a risk factor for Alzheimer’s disease, and there are many good reasons for scientists to have come to this conclusion. But, there are many brain diseases other than Alzheimer’s that cause dementia, and correctly identifying Alzheimer’s in a clinical patient can be deceptively difficult. When we looked at a very large sample of autopsied research volunteers (>2000 persons), we found that brain infarcts were more common among people with diabetes compared to people without, but Alzheimer’s pathology was about the same in both groups. Others have made this observation before, but in much smaller samples. Replicating this finding in a large sample is strong evidence that it is in fact cerebrovascular disease and not Alzheimer’s pathology that should be the primary concern among people with diabetes. In addition, we found that having diabetes was predictive of worsened global cognition at the end of life. (more…)
Alzheimer's - Dementia, Author Interviews, Cognitive Issues, Memory / 26.01.2016

MedicalResearch.com Interview with: Dr. Brian K. Lebowitz, PhD ABPP-CN DIRECTOR OF NEUROPSYCHOLOGY TRAINING Clinical Neuropsychologist Clinical Assistant Professor, Neurology Stony Brook University Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Lebowitz: As a lifespan neuropsychologist, my clinical work involves evaluating cognitive concerns in both children and adults.  We know that children with learning disorders, such as dyslexia, often demonstrate difficulties on neuropsychological tests that are seemingly unrelated to reading.  For example, children with dyslexia may have difficulty with auditory processing and short-term memory.  We also know that, for many individuals, learning disorders remain present throughout the lifespan.  Despite awareness of the relationship between reading disorder and other areas of cognitive weakness, many clinicians who work with older adults do not routinely ask about academic/neurodevelopmental history.  Further, little research has assessed the potential impact of lifelong learning disorder on later life neuropsychological test performance. Our study attempted to assess whether or not a history of possible reading disorder increased the likelihood that an individual's performance would fall at a level suggestive of possible Mild Cognitive Impairment MCI), a diagnosis associated with increased risk for Alzheimer’s disease.  Individuals with MCI continue to function normally in everyday life but experience subjective memory problems and identified weaknesses on neuropsychological tests.  Our study found a strong relationship between poor reading ability and low memory test scores on two tests commonly used to evaluate memory complaints in older adults.  Depending on the test, individuals with a suspected reading disorder were two to three-and-one-half times more likely than their peers to score at a level indicative of Mild Cognitive Impairment. (more…)
Aging, Author Interviews, Autism, Mental Health Research, PLoS, Schizophrenia / 25.01.2016

MedicalResearch.com Interview with: Dr. Richard Deth PhD Professor of Pharmacology Department of Pharmaceutical Sciences Nova Southeastern University Medical Research: What is the background for this study? Dr. Deth: Vitamin B12 plays a crucial role in regulating and promoting methylation reactions (the attachment of a carbon atom to molecules), including DNA methylation. Recent research has identified methylation of DNA and consequential changes in gene expression as crucial factors in brain development, as well as in memory formation and maintenance of brain function during aging. More specifically, the cause(s) of neurodevelopmental disorders such as autism remain obscure, although numerous studies have demonstrated oxidative stress and low plasma levels of the antioxidant glutathione (GSH) in autism.  Medical Research: What are the main findings? Dr. Deth: We found that brain levels of vitamin B12, especially the methylation-regulating form known as methylB12, decrease significantly with age, even though blood levels don’t show a similar decrease. Importantly, much lower levels of methylB12 were found in subjects with autism and schizophrenia compared to normal subjects of a similar age. Animal studies showed that impaired GSH formation is associated with decreased brain B12 levels. (more…)
Author Interviews, Depression / 22.01.2016

More on Depression on MedicalResearch.com MedicalResearch.com Interview with: Prof. Steven LoBello, Professor of Psychology Auburn University at Montgomery Study co-authors: Megan Traffanstedt (graduate student) and Dr. Sheila Mehta Medical Research: What is the background for this study? What are the main findings? Response: Looking at a large sample of the U.S. population who completed the PHQ-8 depression scale we found that there is no relation between different seasons and prevalence of depression. Sunlight exposure is supposed to be the key variable at work here, so we also obtained sunlight data from the US Naval Observatory about sunlight exposure time in the communities of survey respondents on the date of their interviews.  We found no relationship between amount of available sunlight and prevalence of depression. Finally we also evaluated prevalence of depression in 3 different latitude bands, latitude being an often-used proxy for sunlight exposure. Again, we found no relationship between prevalence and latitude of residence.  Our findings pertain to the DSM 5 diagnostic category of major depression with seasonal variation. (more…)
Author Interviews, Diabetes, JAMA, Mental Health Research, Pediatrics, Pharmacology / 20.01.2016

More on Mental Health on MedicalResearch.com MedicalResearch.com Interview with: Christoph U. Correll, MD Professor of Psychiatry and Molecular Medicine Hofstra Northwell School of Medicine Hempstead, New York, USA Investigator, Center for Psychiatric Neuroscience Feinstein Institute for Medical Research Manhasset, New York, Medical Director, Recognition and Prevention The Zucker Hillside Hospital, Department of Psychiatry  Medical Research: What is the background for this study? Dr. Correll: Antipsychotics have been used increasingly for psychotic, but also for many non-psychotic conditions, including for disorders and conditions for which they have not received regulatory approval. Moreover, antipsychotics have been associated with weight gain and abnormalities in blood fat and blood glucose levels. Although data in youth have been less available than in children and adolescents, youth appear to be more sensitive to the cardiometabolic adverse effects of antipsychotics than adults in whom significant weight gain might have already occurred due to long-term prior antipsychotic treatment. Nevertheless, type 2 diabetes, which is related to weight gain, overweight and obesity, seemed to be more common in adults than youth, likely due to the fact that it takes a long time for the body to develop diabetes. Recently, several individual epidemiologic or database studies with sufficient long-term follow-up durations suggested that the type 2 diabetes risk was higher in youth exposed to antipsychotics than healthy control youth and, possibly, even compared to psychiatrically ill patients treated with non-antipsychotic medications. However, a meta-analytic pooling of all available data has not been available to estimate the absolute and relative risk of type 2 diabetes in youth receiving antipsychotic treatment.  Medical Research: What are the main findings? Dr. Correll: The main findings of the study that meta-analyzed data from 13 studies with 185,105 youth exposed to antipsychotics (average age 14.1 and 59.5 percent male) are that the absolute rates of type 2 diabetes are fortunately still relatively low, i.e. a cumulative type 2 diabetes  risk of 5.7/1,000 patients and an exposure adjusted incidence rate of 3.1/1,000 patient-years. Nevertheless, the cumulative risk of type 2 diabetes and its exposure adjusted incidence rate per patient were 2.6 times and three times higher compared with 298,803 healthy controls. Furthermore, the cumulative risk of type 2 diabetes and its exposure adjusted incidence rate per patient were 2.1 times and 1.8 times higher compared with 1,342,121 psychiatric patients not exposed to antipsychotics. Main modifiable risk factors for type 2 diabetes development in antipsychotic-treated youth were treatment with the antipsychotic olanzapine and longer antipsychotic exposure time. (more…)
Author Interviews, Eating Disorders, Psychological Science, Weight Research / 18.01.2016

MedicalResearch.com Interview with: Samuel Chng PhD Researcher in Psychology Applied to Health University of Exeter Medical School St Luke’s campus Exeter, EX1 2LU, United Kingdom Medical Research: What is the background for this study? What are the main findings? Response: The study was conceptualised from the curious question from my childhood, “How did my parents influence my behaviours?” Together with my co-author, Dr. Daniel Fassnacht, we decided to explore how a specific form of parental influence, their comments, would influence the development of disordered eating symptoms. From studies conducted with Western samples that parental comments play a role in the development of eating disorder symptoms, and body dissatisfaction is one of the more studied mediator of this relationship. However, we could not find any study that investigated the influential nature of parent comments in Asia. So, we decided to focus our study on Asian parents and their children. Singapore, a developed Asian country that continues to have strong familial roots, provided an ideal population for our study, and we would expect, the relationships we found indicated some potential differences in amongst Asian families. We found that young women, compared to young men, in Singapore generally reported higher levels of parental comments (about their weight, body shape and eating habit), body dissatisfaction and disordered eating symptoms. However what we found for both young women and men was that negative comments from mothers (for example, ‘You need to lose weight’) was the only category of comments that predicted disordered eating and this was mediated by the presence of body dissatisfaction. Positive comments from parents, though suggested from past studies to be a protective factor, did not influence body dissatisfaction and disordered eating. (more…)
Author Interviews, Eating Disorders, JAMA, Karolinski Institute, Mental Health Research / 17.01.2016

More on Eating Disorders from MedicalResearch.com MedicalResearch.com Interview with: Shuyang Yao, MSc Department of Medical Epidemiology and Biostatistics Karolinska Institutet, Stockholm, Sweden Medical Research: What is the background for this study? Response: Suicide risk is much higher in individuals with eating disorders than individuals without the disorders. The mechanism underlying the high suicide risk in eating disorders (i.e., why?) is not clear. Large studies and genetically informative designs can help us understand the nature of the association between suicide attempts and eating disorders. Medical Research: What are the main findings? 1) Eating disorders are associated with increased risk of suicide attempts and death by suicide. 2) Increased risk of suicide attempts is also found in relatives of individuals with eating disorders. 3) Some, but not all of the increased risk for suicide in individuals with eating disorders is accounted for by the presence of comorbid major depressive, anxiety, and substance use disorders. (more…)
ALS, Alzheimer's - Dementia, Author Interviews, JAMA, Multiple Sclerosis, Neurological Disorders, Stem Cells / 12.01.2016

MedicalResearch.com Interview with: Prof. Dimitrios Karussis M.D., Ph.D. Professor of Neurology Head, Multiple Sclerosis Center Hadassah BrainLabs Medical Research: What is the background for this study? What are the main findings? Prof. Karussis: BrainStorm Cell Therapeutics is developing innovative, autologous stem cell therapies for highly debilitating neurodegenerative diseases such as Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS), and Parkinson’s Disease (PD).  Our technology, NurOwn™ is a first-of-its-kind approach that induces autologous bone marrow-derived Mesenchymal Stem Cells (MSCs) to secrete Neurotrophic Growth Factors (NTFs).  These MSC-NTF cells have been shown to be protective in several animal models of neurodegenerative diseases. Data from the clinical trials described in the recent issue of the Journal of American Medicine – Neurology (JAMA Neurology), suggest that NurOwn can help patients with ALS.  The two trials featured in the article, a phase 1/2 and a phase 2a, studied the transplantation NurOwn cells in ALS patients.  These trials confirmed the excellent safety profile of NurOwn and suggest a clinically meaningful effect. The investigators used two well established clinical endpoints that measure disease activity in ALS, the Revised ALS Functional Rating Scale and Forced Vital Capacity, and were able demonstrate a slowing of disease activity in the period following treatment. (more…)
Author Interviews, Depression, JAMA, Surgical Research, UCLA, Weight Research / 12.01.2016

MedicalResearch.com Interview with: Aaron J. Dawes, MD Fellow, VA/RWJF Clinical Scholars Program Division of Health Services Research University of California Los Angeles Los Angeles, CA 90024 Medical Research: What is the background for this study? What are the main findings? Dr. Dawes: We reviewed the published literature to answer three basic questions about bariatric surgery and mental health conditions. First, how common are mental health conditions among patients being referred for or undergoing bariatric surgery?
  • Second, do patients who carry a diagnosis of one of these conditions lose less weight after surgery than patients without these conditions?
  • And, third, what happens to the clinical course of mental health conditions after patients undergo surgery? Do they get better, worse, or stay the same?
We found that mental health conditions are surprisingly common among bariatric patients, especially depression and binge eating disorder, which occur at almost twice the rate among bariatric patients than in the general U.S. population. We also found no strong evidence to suggest that patients with depression lose less weight after surgery and some evidence that the condition may actually improve after surgery. Eleven of the twelve studies on the topic found either lower rates or fewer symptoms of depression, at least during the first 3 years post-operatively. (more…)