No Convincing Evidence of Memory Dysfunction Due To Statins

MedicalResearch.com Interview with:

Dr-Beth-Taylor

Dr. Taylor

Beth A. Taylor, PhD
Director of Exercise Physiology Research, Hartford Hospital Associate Professor, Kinesiology
University of Connecticut

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Hydroxy-methyl-glutaryl (HMG) CoA reductase inhibitors (statins) are the most effective medications for managing elevated concentrations of low-density lipoprotein cholesterol (LDL-C).  Although statins are generally well-tolerated, they are not without side effects, and mild central nervous system (CNS) complaints such as memory loss and attention decrements are the second most commonly reported adverse effect of these drugs.

Studies assessing cognitive effects of statins vary widely and have produced inconclusive findings. Despite the equivocal data on adverse cognitive side effects with statin therapy, in 2012 the FDA announced a safety label change for statins, based on published case reports of memory loss and confusion and data from the Adverse Events Reporting System. One possibility for these equivocal findings is that studies involving the effects of statins on cognition typically have assessed cognitive function using traditional cognitive tests, which may yield small effect sizes and demonstrate high intra-participant variability. This may explain the discrepancy between clinical trials and patient self-reports, and could be addressed by utilizing CNS tests that directly assess brain parameters.

To the best of our knowledge and literature review, this study is the first to investigate the effects of statins on the central nervous system by utilizing fMRI to assess brain neural activation in healthy adults treated with 80 mg atorvastatin or placebo.

We detected few changes attributable to statin therapy with standardized neuropsychological tests, a finding similar to that from previous clinical trials. However, participants on atorvastatin demonstrated altered patterns of neural activation on vs. off statin compared to participants treated with placebo. Unexpectedly, the treatment groups differed at both timepoints. The clinical implications of these findings are unclear and warrant additional clinical trials.

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Amyloid Deposits In Persons Without Dementia May Be First Sign of Alzheimer’s Disease 

MedicalResearch.com Interview with:

Willemijn Jansen, PhD  Postdoctoral researcher Department of Psychiatry & Neuropsychology Maastricht University Medical Center School for Mental Health and Neuroscience Alzheimer Center Limburg 

Dr. Jansen

Willemijn Jansen, PhD
Postdoctoral researcher
Department of Psychiatry & Neuropsychology
Maastricht University Medical Center
School for Mental Health and Neuroscience
Alzheimer Center Limburg 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cerebral amyloid-β aggregation is an early pathological event in Alzheimer’s disease (AD), starting decades prior to dementia onset. About 25% of cognitively normal elderly and 50% of patients with mild cognitive impairment (MCI) have biomarker evidence of amyloid pathology. These persons are at increased risk for developing AD-type dementia, but the extent to which amyloid-β aggregation affects cognitive function in persons without dementia is unclear. This is important to know for a better understanding of the course of Alzheimer’s disease and for the design of AD prevention trials.

We here investigate the association between amyloid plaques and memory scores, using data from 53 international studies included in the Amyloid Biomarker study. Cognitively healthy elderly people with plaques have a low memory score twice as often as these persons without plaques. MCI patients with plaques had 20% more often low memory and low global cognition scores than MCI patients without plaques.

We further observed 10- to 15-year intervals between the onset of amyloid positivity and emergence of low memory scores in cognitively healthy persons.

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Thinking Abilities May Decline After Treatment For Head and Neck Cancers

MedicalResearch.com Interview with:

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 Adjunct Faculty, Graduate Program in Psychology, York University

Dr. Bernstein

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 background for this study? What are the main findings?
Response: Despite the increasing role of (chemo-)radiation treatment for head and neck cancer (HNC), and involvement of central nervous system structures in the radiation field, we don’t know a lot about whether there are short or long term consequences in thinking abilities in survivors. So our question was this: Do people treated for head and neck cancer with radiation or chemoradiation have short or long term neurocognitive deficits after treatment?

We assessed head and neck cancer patients and healthy non-cancer controls four times, first at baseline (after diagnosis but before treatment), and then again 6, 12, and 24 months later. We found that compared to the controls, patients decline over time in several different neurocognitive domains, including concentration, verbal memory, and executive function. We found that as many as 38% of patients suffered from impaired global neurocognitive functioning by two years after treatment compared to none of the controls.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: The findings indicate that some (but not all) head and neck cancer survivors are at risk of suffering from declines in thinking abilities such as attention and memory. These changes can be subtle and increase gradually. We didn’t follow people beyond 2 years after treatment, so we don’t know whether these deficits would improve, worsen, or stabilize after that.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Longer longitudinal follow-up is needed to determine if symptoms change after 2 years. More investigation of the relationships between treatment variables such as radiation dosing and long term neurocognitive function is important. Further research is also needed to find ways to avoid, reduce and compensate for declines.

MedicalResearch.com: Is there anything else you would like to add?

Response: We are extremely grateful to the people who participated in this study. We plan to reassess participants for several more years, so we hope to know more about even longer term cognitive function in people treated for head and neck cancer. In addition, I want to acknowledge that we could not have done this work without the support of the Princess Margaret Cancer Foundation and The Canadian Institutes of Health Research.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Alona Zer, Gregory R. Pond, Albiruni R. Abdul Razak, Kattleya Tirona, Hui K. Gan, Eric X. Chen, Brian O’Sullivan, John Waldron, David P. Goldstein, Ilan Weinreb, Andrew J. Hope, John J. Kim, Kelvin K. W. Chan, Andrew K. Chan, Lillian L. Siu, Lori J. Bernstein. Association of Neurocognitive Deficits With Radiotherapy or Chemoradiotherapy for Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. Published online November 22, 2017. doi:10.1001/jamaoto.2017.2235

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

 

 

 

Eye-Tracking Uncovers Cognitive Mechanisms Underlying High Level Human Judgments

MedicalResearch.com Interview with:
Tobias Gerstenberg, PhD

MIT

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The question of how causation is best understood has been troubling philosophers for a long time. As psychologists, we are particularly interested in understanding how people make causal judgments.

In our experiments, we showed participants video clips of colliding billiard balls. Participants were asked to say whether one ball (ball A) caused another (ball B) to go through a gate, or prevented it from going through. We used eye-tracking technology to record participants’ eye-movements as they were watching the clips.

The results showed that participants spontaneously engaged in counterfactual simulation when asked to make causal judgments. They not only looked at what actually happened, but also tried to anticipate where ball B would have gone if ball A hadn’t been present. The more certain participants were that ball B would have missed the goal if ball A hadn’t been there, the more they agreed that ball A caused ball B to go through the gate.

In a control condition we asked participants about what actually happened. In this condition, participants were much less likely to simulate where ball B would have gone. Together, these findings demonstrate a very close link between counterfactual simulation and causal judgment.

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Moderate Drinking Linked To Faster Cognitive Decline

MedicalResearch.com Interview with:

Dr. Anya Topiwala, BA (Hons) BMBCh (Oxon) MRCPsych DPhil Clinical lecturer Department of Psychiatry University of Oxford

Dr. Topiwala

Dr. Anya Topiwala, BA (Hons) BMBCh (Oxon) MRCPsych DPhil
Clinical lecturer
Department of Psychiatry
University of Oxford

MedicalResearch.com: What is the background for this study?

Response: I thought the question of whether moderate alcohol consumption is harmful or protective to the brain was a really interesting and important one, particularly because so many people drink this amount. There were a few studies reporting that a little alcohol may protect against dementia or cognitive decline, but the few brain imaging studies were conflicting in their results and had methodological limitations.

We examined whether alcohol consumption over a 30-year period was associated with brain imaging and memory decline in a group of 550 non-alcohol dependent individuals from the remarkable Whitehall II cohort. Subjects completed questionnaires and had clinical examinations approximately every 5 years over the 30 years of the study, and had detailed brain scans at the end.

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Visual Processing Speed Predicts Executive Functioning

Catherine Mewborn, B.A. Neuropsychology and Memory Assessment Laboratory Department of Psychology University of Georgia

Ms. Mewborn

MedicalResearch.com Interview with:
Catherine Mewborn, B.A.
Neuropsychology and Memory Assessment Laboratory
Department of Psychology
University of Georgia

Medical Research: What is the background for this study?

Response: Vision and cognitive functioning both tend to decline as individuals age. Processing speed, or the speed at which an individual can process information, is particularly vulnerable to age-related declines. In previous studies, cognition has typically been measured using traditional paper-and-pencil tests; however, these tests can be quite complex and recruit many different abilities. We wanted to use a simpler test to assess processing speed in the hopes of tapping into the more basic abilities that underlie performance on more complex cognitive tasks. For this study, we chose a measure of visual processing speed called critical flicker fusion, or CFF. We tested how well CFF could predict cognition in both younger and older adults.

Medical Research: What are the main findings?

Response: As expected, younger adults had better visual processing speed than older adults. Interestingly, in both age groups, CFF significantly predicted performance on a test of executive functioning, which assess abilities such as problem-solving and shifting attention between different tasks.

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Beetroot Juice Enabled Better Sprint and Decision Making Times

Beetroot juice WikipediaMedicalResearch.com Interview with:
Chris Thompson BSc MSc ANutr AFHEA

University of Exeter
St. Luke’s Campus
Exeter Devon

Medical Research: What is the background for this study?

Response: Dietary nitrate has been shown to favourably alter the contractility of type II muscle fibres and enhance blood flow to working muscles that are predominantly type II. Dietary nitrate may also improve perfusion to areas of the brain responsible for cognitive function. It is therefore possible that through these mechanisms, nitrate-rich beetroot juice supplementation may improve both physical and cognitive performance during exercise which reflects the high intensity intermittent nature of team sport play.

Medical Research: What are the main findings?

Response: Participants were able to complete greater total work during an intermittent sprint test following nitrate-rich beetroot juice supplementation. We also found that dietary nitrate enabled a reduction in response time to decision making during the cognitive tasks performed throughout the exercise test.

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Discontinuing Blood Pressure Medication In Older Adults Did Not Improve Cognition

MedicalResearch.com Interview with:
Justine Moonen and Jessica Foster-Dingley

On behalf of the principal investigators:
Roos van der Mast, Ton de Craen, Wouter de Ruijter and Jeroen van der Grond
Department of Psychiatry, Leiden University Medical Center
Leiden, the Netherlands

Medical Research: What is the background for this study? What are the main findings?

Response: Mid-life high blood pressure is a well-known risk factor for cerebrovascular pathology and, consequently, cognitive decline in old age. However, the effect of late-life blood pressure on cognition is less clear. It has been suggested that at old age not a higher, but a lower blood pressure increases the risk of cognitive decline as well as neuropsychiatric symptoms. Older persons are at risk for impaired regulation of their cerebral blood flow, and stringently lowering their blood pressure may compromise cerebral blood flow, and thereby cognitive function. Therefore, we hypothesized that increasing blood pressure by discontinuation of antihypertensive treatment would improve cognitive and psychological functioning. We performed a community-based randomized controlled trial in a total of 385 participants aged ≥75 years with mild cognitive deficits and without serious cardiovascular disease, and who were all receiving antihypertensive treatment. Persons were randomized to continuation or discontinuation of antihypertensive treatment. Contradictory to our expectation, we found that discontinuation of antihypertensive treatment in older persons did not improve cognitive functioning at 16-week follow-up.

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Type 2 Diabetes Linked to Decreased Brain Blood Flow and Cognitive Ability

Vera Novak, MD PhD Associate Professor of Neurology Dept. of Neurology, Stroke Division Director Syncope and Falls in the Elderly Laboratory Beth Israel Deaconess Medical Center Boston, MAMedicalResearch.com Interview with:
Vera Novak, MD PhD
Associate Professor of Neurology
Dept. of Neurology, Stroke Division
Director Syncope and Falls in the Elderly Laboratory
Beth Israel Deaconess Medical Center
Boston, MA

MedicalResearch: What is the background for this study?

Dr. Novak: Diabetes mellitus (DM) is a major contributor to morbidity and mortality.
Type 2 diabetes mellitus affects more than 44 million people in the U.S., and its numbers are growing rapidly, affecting up to 27% of older adults. Diabetes mellitus accelerates brain aging by about 5 years1, manifests as a widespread generalized atrophy2, and promotes earlier onset of vascular dementia and Alzheimer’s disease (AD).3,4 Diabetes mellitus -related atrophy manifests as worse cognitive function, memory, and gait, especially during a dual task, 5,6 and even a tight glycemic control did not improve cognitive function in participants of the large clinical trials 7.

MedicalResearch: What are the main findings?

Dr. Novak: Sixty-five participants (aged 66± 9.2 years) 35 with T2DM and 30 non-diabetic controls participated in this study. After 2 years of follow-up, participants with T2 Diabetes mellitus had diminished vascular reactivity in the brain (an ability to increase blood flow in responses to a task or metabolic demands) and performed worse on multiple cognitive tasks (in particular verbal learning and memory). In T2DM group, lower cerebral vasoreactivity correlated with worse performance on daily living activities. Specifically, the lower vasodilatation (ability to increase blood flow) was associated with worse mental functions. In addition, those with higher markers of inflammation had greater decline in vascular function in the brain.

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Post Menopausal Hormones Improve Mood But Not Cognition

Dr.Carey Gleason Ph.D School of Medicine and Public Health, University of Wisconsin Geriatric Research, Education and Clinical Center William S. Middleton Memorial Veterans Hospital Wisconsin Alzheimer's Disease Research Center, Madison, WisconsinMedicalResearch.com Interview with:
Dr.Carey Gleason Ph.D

School of Medicine and Public Health, University of Wisconsin
Geriatric Research, Education and Clinical Center
William S. Middleton Memorial Veterans Hospital
Wisconsin Alzheimer’s Disease Research Center, Madison, Wisconsin

Dr. Gleason: In this response I refer to hormone therapy (HT), which was formally called hormone “replacement” therapy. In particular, we examined menopausal HT, i.e., the use of HT during the menopausal transition to address menopausal symptoms.

Medical Research: What is the background for this study? What are the main findings?

Dr. Gleason: The WHI Memory Study (WHIMS) suggested that HT was associated with cognitive harm for women age 65 and older. In contrast, we found that the cognitive performance of women randomized to receive menopausal hormone therapy did not differ from that of women randomized to receive the placebo. On a measure of mood states, women treated with conjugated equine estrogens showed improvements compared to those on placebo.

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Strict Systolic Blood Pressure Control Might Impact Cognition In Elderly

MedicalResearch.com Interview with:
Dr. Enrico Mossello

Research Unit of Medicine of Ageing
Department of Experimental and Clinical Medicine
University of Florence

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Mossello: In spite of the high prevalence of high blood pressure (HBP) and cognitive impairment in old age, their relationship is still controversial. While several (but not all) studies have identified high blood pressure as a risk factor for incident cognitive impairment, evidence regarding the prognostic role of blood pressure in cognitively impaired older subjects is scarce and inconsistent. To our knowledge, no longitudinal study has been published up to now regarding Ambulatory Blood Pressure Monitoring (ABPM) in subjects with cognitive impairment. Moreover recent European and American guidelines on HBP leave decisions on antihypertensive therapy of frail elderly patients to the treating physician and do not provide treatment targets for cognitively impaired patients.

In the present cohort study of subjects with dementia and Mild Cognitive Impairment (MCI) low values of day-time systolic blood pressure measured with ABPM were associated with greater progression of cognitive decline after a median 9-month follow-up. This association was limited to subjects treated with anti-hypertensive drugs and was independent of age, vascular comorbidity and baseline cognitive level, holding significant both in dementia and in Mild Cognitive Impairment subgroups. A similar trend of association was observed for office systolic blood pressure, although this was weaker and did not reach statistical significance in all analyses.

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Sleep in Young Adults Important For Later Life Cognitive Function

Michael K. Scullin, Ph.D. Principal Investigator of the Sleep Neuroscience & Cognition (SNaC) Laboratory and an Assistant Professor of Psychology & Neuroscience Director Sleep Neuroscience and Cognition Laboratory Baylor UniversityMedicalResearch.com Interview with:
Michael K. Scullin, Ph.D.
Principal Investigator of the Sleep Neuroscience & Cognition (SNaC) Laboratory and an Assistant Professor of Psychology & Neuroscience Director Sleep Neuroscience and Cognition Laboratory Baylor University

Medical Research: What is the background for this study? What are the main findings?

Dr. Scullin: One of the purposes of sleep in healthy adults is to optimize cognitive functioning. When we lose out on a few hours of sleep we tend not to be able to focus or think as well as when we get enough sleep (typically 8 hours). Even more interesting is that particular aspects of sleep physiology—our deepest levels of sleep known as slow wave sleep and rapid eye movement sleep—are essential to our brain’s ability to take the information that we learn during the day and stabilize those memories so that we can use them in the future.

Sleep quantity and quality change markedly across the lifespan, though there are individual differences in how much one’s sleep changes. Our work was concerned with the possible long-term repercussions of cutting back on sleep and getting lower quality sleep (less slow wave sleep and rapid eye movement sleep).  We reviewed approximately 200 scientific articles on this topic and we found that the amount of total sleep and the quality of that sleep is important to cognitive and memory functioning in young adults and middle-aged adults and can even predict how well someone’s cognitive functioning will be decades later. Thus, if you’re sleeping well when you are 40 then you are investing in preserving your mental functioning at age 50.

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Hardening of Aorta Linked To Poor Cognitive Performance

Jose Gutierrez MD, MPH Assistant Professor of Neurology Division of Stroke and Cerebrovascular Disease Columbia University Medical Center NY, NYMedicalResearch.com Interview with:
Jose Gutierrez MD, MPH
Assistant Professor of Neurology
Division of Stroke and Cerebrovascular Disease
Columbia University Medical Center NY, NY

Medical Research: What is the background for this study? What are the main findings?

Dr. Gutierrez: There is growing interest in the effects of vascular health in cognition. The prevailing thought is that vascular disease leads to worse cognition due to direct structural damage of the brain, as in the case of brain infarcts, microhemorrhages or white matter hyperintensities, which are themselves associated with traditional cardiovascular risk factors such as hypertension, diabetes, smoking etc. Arterial stiffness, particularly of the aorta, has gained interest among researchers as predictors of vascular disease and worse cognition, but it is not clear whether arterial stiffness in the absence of traditional definition of vascular disease may be associated with worse cognition.

We investigated in a representative sample of the US among adults 60 years or older who underwent cognitive testing with the Digit Symbol Subtraction test and who also had other measures of vascular disease, including blood workup, blood pressure measurement and Pulse pressure. We hypothesized that indirect measures of arterial stiffness such as ABI > 1.3 or pulse pressure would be associated with worse cognition, even among those without any clinical vascular disease or traditional vascular risk factors. We Included 2573 US adults in the sample, segregated those with any self-reported vascular disease or vascular risk factors and we found that among those without vascular disease or risk factors, an ABI > 1.3 and increased intra-visit blood pressure variability were predictors of worse cognitive performance compared with those without these indicators. Among participants with both indirect markers of arterial stiffness, their cognitive performance was worse that having only one of them suggesting additive effects of these two variables.
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Bilingualism Can Preserve White Matter in Brain

Dr Christos Pliatsikas PhD Lecturer in Cognitive Psychology School of Psychology University of Kent Canterbury KentMedicalResearch.com Interview with:
Dr Christos Pliatsikas
PhD
Lecturer in Cognitive Psychology School of Psychology
University of Kent Canterbury Kent

Medical Research: What is the background for this study? What are the main findings?

Response: It has been proposed that lifelong bilingualism preserves the white matter structure of older bilinguals because of the increased cognitive demands that come with handling two languages for their entire life. We wanted to extend this by investigating whether active (or “immersive”) bilingualism in younger late bilinguals would give similar results.

We showed increased white matter integrity (or myelination) in several white matter tracts that have also been shown to be better preserved in older lifelong bilinguals, compared to monolinguals.  Based on our findings, we propose that any benefit of bilingualism to the brain structure is simply an effect of actively handling two languages without presupposing lifelong usage- our participants were only about 30 years old and had been active bilinguals for only about 7-8 years. In other words, immersive bilingualism, even in late bilinguals, leads to structural changes that can bring about benefits in older age, by assisting in the preservation of the white matter structure in the brain.

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Cognitive Effects of Statins

MedicalResearch.com Interview with:
Dr. Seth S. Martin, MD
Division of Cardiology, Johns Hopkins Hospital
600 North Wolfe Street
Baltimore, Maryland 21287
Johns Hopkins Hospital
Baltimore, MD 21287.

MedicalResearch.com: What are the main findings of the study?

Dr. Martin: Our systematic review identified 16 studies for qualitative synthesis and 11 for quantitative synthesis. In individuals without baseline cognitive dysfunction, statins did not adversely affect memory when used in the short-term (<1 year). Long-term cognition studies including 23,433 patients with a mean exposure duration of 3 to 24.9 years showed a 29% relative reduction in incident dementia related to statin use (hazard ratio, 0.71; 95% CI 0.61-0.82) and a 2% absolute risk reduction (number needed to treat for 6.2 years: 50). Continue reading

Cognitive function and other risk factors for mild traumatic brain injury in young men

 Dr. Anna Nordström MD Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-901 87 Umeå, SwedenMedical Research.com Interview with
Dr. Anna Nordström MD

Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-901 87 Umeå, Sweden

Medical Research.com: What are the main findings of the study?

Dr. Nordström: We have found that low cognitive function and factors related to low socioeconomic status and intoxications are strong independent risk factors for mild traumatic brain injury in men.

Medical Research.com: Were any of the findings unexpected?

Dr. Nordström:  Our knowledge of risk factors that predispose people to sustaining such injury is limited. Previous research has inferred that mild traumatic brain injuries have important long-term consequences on cognitive function. However, we found similar deficits in cognitive function in subjects that sustained a mild traumatic brain injury before and after cognitive testing. Thus our data suggest that the injury itself may not reduce cognitive function.

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