10 Aug Orthostatic Hypotension Linked to Increased Dementia Risk
Posted at 22:03h
in Alzheimer's - Dementia, Author Interviews, Blood Pressure - Hypertension, Neurology, UCSF
MedicalResearch.com Interview with:
Laure Rouch, PharmD PhD
Department of Psychiatry
Dr. Kristine Yaffe, MD (Senior Author)
Departments of Psychiatry, Neurology, and Epidemiology
University of California
San Francisco, San Francisco VA Medical Center, San Francisco, CA, USA
MedicalResearch.com: What is the background for this study?
Response: Worldwide, around 50 million people have dementia and this number is set to triple by 2050. Prevention of dementia and identification of potentially modifiable risk factors are, therefore, critically important. Postural changes in blood pressure increase with advancing age and affect 20% to 30% of older adults.
Yet it has not been explored deeply how orthostatic hypotension and blood pressure postural changes variability over time are associated with dementia risk. As multiple pharmacologic and nonpharmacologic interventions may improve orthostatic symptoms, this question has major public health implications.
Dr. Schreiber[/caption]
Darren Schreiber JD PhD
Senior Lecturer
Exeter
MedicalResearch.com: What is the background for this study?
Response: My co-authors and I saw an opportunity to match existing functional brain imaging data with publicly available voter registration data so that we could look for patterns that distinguish brain activity in nonpartisans from partisans. While a number of studies have found differences in both brain structure and function between partisans on the left and right and there is a massive amount of scholarship in political science on partisans and polarization, no brain imaging work had focused on nonpartisans. Around 40% of Americans do not affiliate with a political party and one important campaign strategy has been to persuade these voters to support party candidates. However many political scientists are skeptical about voters claims to be nonpartisans and will instead treat them as if they were merely covert partisans. 
Dr. Factor[/caption]
Stewart A. Factor, D.O.
Professor of Neurology
Director of the Movement Disorders Program
Vance Lanier Chair of Neurology
Emory University School of Medicine
MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by OFF episodes.
Response: Parkinson’s disease (PD) is a chronic, progressive neurodegenerative disease characterized by motor symptoms, including tremor at rest, rigidity and impaired movement, as well as significant non-motor symptoms, such as cognitive impairment, psychiatric symptoms and autonomic symptoms (i.e. urinary issues, constipation, low blood pressure). It is the second-most common neurodegenerative disease after Alzheimer’s disease and it is predicted that the prevalence of Parkinson’s disease will double by the year 2040. The symptoms of PD are in substantial part, due to loss of dopamine nerve cells in the brain. The current standard of care for PD includes replacing the dopamine loss by the use of oral carbidopa/levodopa. Levodopa is a precursor of dopamine, converted in the brain.
OFF episodes have been a significant unmet need in Parkinson’s disease since the emergence of levodopa. Initially, levodopa controls PD symptoms in a continuous fashion throughout the day. With time the response becomes less predictable and patients experience a re-emergence or worsening of PD symptoms. These episodes are what we mean by OFF episodes. OFF episodes can be characterized, in part, by re-emergence of motor symptoms including tremor, stiffness or slowed movement that can happen at any point during the day. OFF episodes typically begin within the first five years of treatment and occur at the end of a dose. This is referred to as end of dose failure or wearing off. Within the first four to six years after diagnosis, regardless of disease severity, up to 60 percent of people with PD experience OFF episodes. With time these episodes become longer, more severe and disabling, more frequent and less predictable as PD progresses. They can take up more than half the day
OFF episodes may alter a persons’ ability to perform everyday activities by slowing or even precluding their completion. The result is significant burden and distress for people living with Parkinson’s disease (PD) and their care partners.
CTH-300 was a Phase 3, 12-week, randomized, double-blind, placebo-controlled, parallel group, study examining the efficacy, safety and tolerability of apomorphine hydrochloride sublingual film (KYNMOBI) in people with levodopa-responsive PD complicated by OFF episodes. The primary endpoint was a mean change in the score from pre-dose in the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III Motor Examination at 30 minutes after dosing at the 12-week visit of the maintenance treatment phase. The key secondary endpoint was the percentage of people with PD with a patient-rated full ON (or best) response within 30 minutes at the 12-week visit of the maintenance treatment phase.
Dr. Yancy[/caption]
Holly Yancy, DO
Headache medicine specialist
Banner – University Medicine Neuroscience Institute
Phoenix, AZ
Dr. Yancy comments on the recent Neurology journal article on the potential impact of yoga on migraine.
MedicalResearch.com: What is the background for this study? How might yoga reduce migraine intensity or frequency?
Response: The authors of this trial have studied the benefits of yoga when added to medical management of episodic migraine. They expand on prior, smaller reports of the potential benefit of yoga and mindfulness to migraine patients with a well-designed study that shows yoga, as an adjunct to preventive medication, can lower the intensity, frequency and impact of migraines. Participants even used less abortive medication.
The authors propose multiple potential mechanisms of action, including an increase in parasympathetic / decrease in sympathetic nervous system activity, decreased muscle tension, and stress management. 
Dr. Mishra[/caption]
Santosh K. Mishra M.Tech., PhD
Assistant Professor of Neuroscience
Department of Molecular Biomedical Sciences
NC State Veterinary Medicine
Raleigh, NC 2760
MedicalResearch.com: What is the background for this study? Would you briefly explain what is meant by atopic dermatitis?
Response: Chronic allergic itch is a worldwide problem that leads to substantial health expenses,but what causes this universal urge to scratch remains elusive in chronic allergic itch. Atopic dermatitis is a common allergic skin disease that often associated with extremely itchy and inflamed skin.
In our study, we showed, for the first time, a molecular pathway that is involved in chronic allergic itch as we identified an endogenous mediator (periostin) and a new role for its sensory neuron receptor, the integrin αVβ3, which drives the excitability and transmission of itch signal to the spinal cord. 
