Chronic Valvular Heart Disease Linked To White Matter Brain Changes

MedicalResearch.com Interview with:
Dr. Keun-Hwa Jung MD PhD

Program in Neuroscience, Neuroscience Research Institute of SNUMRC
College of Medicine
Seoul National University
First author: Dr. Woo-Jin Lee MD
Department of Neurology
Seoul National University Hospital
Seoul, South Korea 

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

Response: Cerebral white matter hyperintensity is a prevalent consequence of brain aging process and associated with various complications. One of the main mechanisms underlying the progression of white matter hyperintensity is chronic dysfunction of the glymphatic system which maintains metabolic homeostasis in brain. Glymphatic system is the route where the cerebrospinal fluid enters into the brain parenchyma and is cleared out with soluble wastes to the perivascular space of the cerebral small veins, peri-meningeal lymphatic vessels, deep cervical lymph nodes, and finally to the right atrium.

Although the integrity of the glymphatic system is dependent on the adequate drainage of cerebral veins and lymphatics to the downstream chamber, the right atrium, the impact of hemodynamic changes in right-sided cardiac chambers on the development of white matter hyperintensity have not been elucidated.

Continue reading

Marijuana Use Linked To Cognitive Impairment In HIV Patients

MedicalResearch.com Interview with:

Richard Saitz, MD, MPH, FACP, DFASAM Department of Community Health Sciences Boston University School of Public Health Clinical Addiction Research and Education (CARE) Unit Section of General Internal Medicine, Department of Medicin Boston University School of Medicine and Boston Medical Center Boston , Massachusetts

Dr. Saitz

Richard Saitz, MD, MPH, FACP, DFASAM
Department of Community Health Sciences
Boston University School of Public Health
Clinical Addiction Research and Education (CARE) Unit
Section of General Internal Medicine, Department of Medicin
Boston University School of Medicine and Boston Medical Center
Boston , Massachusetts

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

Response: Many people living with HIV infection use alcohol and other drugs including marijuana. People with HIV infection are also susceptible to cognitive dysfunction from many causes from HIV infection itself to aging.

The main findings were that among people with HIV and substance use disorder, lifetime marijuana and alcohol use were not associated with cognitive dysfunction, likely due to competing risks.  But current marijuana use was associated with cognitive dysfunction.

Continue reading

Sleep-Disordered Breathing Associated With Increased Risk of Cognitive Impairment

MedicalResearch.com Interview with:
Yue Leng, M.Phil, MD, PhD

Postdoctoral Research Fellow
Department of Psychiatry,
University of California, San Francisco
SFVAMC 

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

Response: Sleep-disordered breathing (SDB) is a very common but treatable condition in older adults. Recent evidence has suggested a link between SDB and cognitive decline in the elderly, but previous studies have been conflicting and have used different methods to examine SDB or cognition. Therefore, it is difficult to draw conclusion on the consistency of this association based on each individual study. Moreover, because each study has reported on specific domains using different scales, it is unclear if Sleep-disordered breathing has differential effects on cognitive domains.

The current study is the first to quantitively synthesize all published population-based studies, which covers a total of over 4 million adults, and concluded that people with Sleep-disordered breathing were 26% more likely to develop cognitive impairment than those without SDB. They also had slightly worse performance in executive function but not in global cognition or memory.  Continue reading

Hip Fractures Increase Mortality Risk in Cognitively Impaired Men

MedicalResearch.com Interview with:

Ann L. Gruber-Baldini, Ph.D. Professor, Division of Gerontology Director, Program in Epidemiology and Human Genetics  Department of Epidemiology & Public Health University of Maryland School of Medicine

Dr. Ann Gruber-Baldini

Ann L. Gruber-Baldini, Ph.D.
Professor, Division of Gerontology
Director, Program in Epidemiology and Human Genetics
Department of Epidemiology & Public Health
University of Maryland School of Medicine 

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

Response: While men make up only about 25% of all hip fractures, the number of men who fracture their hip is increasing and we know men are more likely to die than women after a hip fracture. It is also known that those with cognitive impairments, typically due to delirium and Alzheimer’s disease and related dementia, are more likely to do more poorly after the fracture. The impact of both sex and cognition on outcomes after hip fracture has not been fully explored.

Continue reading

Older Adults with Dementia Face Potentially Unsafe Living Conditions

MedicalResearch.com Interview with:

Halima Amjad, MD, MPH Post-doctoral Fellow Johns Hopkins University School of Medicine Division of Geriatric Medicine and Gerontology

Dr. Halima Amjad

Halima Amjad, MD, MPH
Post-doctoral Fellow
Johns Hopkins University School of Medicine
Division of Geriatric Medicine and Gerontology

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

Dr. Amjad: Safety is an important aspect of dementia care. Dementia is underdiagnosed, however, and there is limited understanding of safety issues in people with undiagnosed dementia. We wanted to better understand potentially unsafe activities and living conditions in all older adults with dementia and specifically examine these activities in undiagnosed dementia. We found that in all study participants with probable dementia, the prevalence of driving, cooking, managing finances, managing medications, or going to physician visits alone was over 20%. The prevalence was higher in older adults with probable dementia without a diagnosis, and even after accounting for sociodemographic, medical, and physical impairment factors, the odds of engaging in these activities was over 2.0 in undiagnosed versus diagnosed probable dementia. Potentially unsafe living conditions including unmet needs and performance on cognitive tests were similar between these groups.

Continue reading

Study Addresses Why Blacks Are At Higher Risk of Cognitive Impairment in Later Life

MedicalResearch.com Interview with:

Zhenmei Zhang, Ph.D. Associate Professor Department of Sociology Michigan State University East Lansing, MI48824

Dr. Zhenmei Zhang

Zhenmei Zhang, Ph.D.
Associate Professor
Department of Sociology
Michigan State University
East Lansing, MI48824

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

Dr. Zhang: Blacks are especially hard hit by cognitive impairment and dementia. Recent estimates of dementia prevalence and incidence were substantially higher for blacks than whites. Reducing racial/ethnic disparities in dementia has been identified as a national priority by the National Alzheimer’s Project Act, which was signed into law by President Obama in 2011. So I really want to contribute to the ongoing discussion of the origins and pathways through which racial disparities in cognitive impairment is produced. If we have a better understanding of the factors contributing to racial disparities in cognitive impairment in later life, more effective interventions can be conducted to reduce the racial disparities.
Continue reading

ChemoBrain Linked to Decreased Dopamine Release

MedicalResearch.com Interview with:

Michael A. Johnson Ph.D Associate Professor Department of Chemistry University of Kansas

Dr. Michael Johnson

Michael A. Johnson Ph.D
Associate Professor
Department of Chemistry
University of Kansas

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

Dr. Johnson: We undertook these studies because chemotherapy induced cognitive dysfunction, also known as ‘chemobrain’, has become a major health issue in recent years. For example, up to a third of patients who have undergone chemotherapy treatment for breast cancer have reported symptoms of chemobrain. These symptoms may include loss of verbal and visual memory as well as decreased mental flexibility and difficulty focusing.

For this study, we wanted to understand how treatment with chemotherapeutic agents affects the ability of neurons to communicate. An impairment of neurotransmitter release would imply that communication is hindered. This inability to communicate normally could contribute to cognitive dysfunction.
We initially measured the release of dopamine in a region of the brain called the striatum. Our measurement of dopamine in this region was motivated by two key issues: its importance in cognitive function and our ability to measure it with high temporal resolution. From a cognitive standpoint, dopamine is important because the striatum helps translate signals, received from the cortex, into plans by forwarding wanted signals to other parts of the brain and suppressing unwanted signals. Fortunately, we can easily measure dopamine release using an electrochemical technique called fast-scan cyclic voltammetry. This method allows us to not only measure how much dopamine is released from a living brain slice, but also it affords us the capability to measure how quickly dopamine is taken back up. We also measured serotonin release using this method.

Our main finding was that the ability of neurons to release dopamine was impaired after carboplatin treatment. We also found that serotonin release was similarly impaired. These release impairments corresponded to a decrease in cognitive ability of the treated rats.

Continue reading

Higher Blood Pressure Variability Predicts Faster Cognitive Decline

MedicalResearch.com Interview with:

Bo (Bonnie) Qin, Ph.D. Postdoctoral Scholar Rutgers Cancer Institute of New Jersey New Brunswick, NJ 08903

Dr. Bo Qin

Bo (Bonnie) Qin, Ph.D.
Postdoctoral Scholar
Rutgers Cancer Institute of New Jersey
New Brunswick, NJ 08903

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

Dr. Qin: Preventing or delaying the age-related cognitive decline that typically precedes the onset of dementia is particularly important considering that no effective strategies for dementia treatment have been identified. Vascular conditions such as hypertension are thought to be risk factors for cognitive decline, but important gaps in the literature on this topic remain.

Randomized clinical trials of blood pressure-lowering treatments for reducing the risk of cognitive decline or dementia have largely failed to achieve beneficial effects. However, over the past 6 years, scientific evidence has accumulated that blood pressure variability over monthly or yearly visits may lead to greater risk of stroke and small and larger vessel cerebrovascular diseases. They could lead to subsequent changes related to cognitive dysfunction among older adults. We, therefore, hypothesized that blood pressure variability between visits is associated with a faster rate of cognitive function among older adults.

Continue reading

Cognitive Impairment Linked to Readmissions For Heart Failure

MedicalResearch.com Interview with:

Thomas H. Marwick, MBBS, PhD, MPH Baker IDI Heart and Diabetes Institute Melbourne, Australia

Dr. Thomas Marwick

Thomas H. Marwick, MBBS, PhD, MPH
Baker IDI Heart and Diabetes Institute
Melbourne, Australia

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

Dr. Marwick: Readmission for heart failure (HF) remains common and the risk of this remains hard to predict. It’s possible that existing risk scores don’t cover all important patient features. We confirmed that cognitive impairment was an unmeasured contributor and incorporated this measurement in a prediction model. The resulting model was the most reliable reported to date and could be used to identify patients who need the closest follow up to avoid readmission.

Continue reading

Fewer Teeth Linked To Greater Cognitive Decline

MedicalResearch.com Interview with:

Elham Emami, DDS, MSc, PhD Professeure agrégée Faculté de médecine dentaire École de santé publique, Département de médecine sociale et préventive Université de Montréal Montréal (Québec) Canada

Dr. Elham Emami

Elham Emami, DDS, MSc, PhD
Director , Oral Health and Rehabilitation Research Unit & Associate Professor
Faculty of Dental Medicine & School of Public Health
Université de Montréal
Adjunct Professor McGill University

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

Dr. Emami: Over the past 20 years, scientific evidence has shown that oral and general health are closely linked. Recently, studies have shown that there is also a link between the number of teeth an older person has and his/her cognitive status.

We carried out a meta-analysis using the data from these latter studies. Our results indicate that, taking into account socioeconomic differences and other potential confounding variables, a person with less than 20 teeth has a 20% greater risk of having cognitive decline (HR= 1.26, 95% CI = 1.14 to 1.40) and dementia (HR = 1.22, 95% CI = 1.04 to 1.43) than someone who has 20 or more teeth.

Continue reading

Midlife Weight Loss Linked to Mild Cognitive Impairment

Rosebud O. Roberts, M.B., Ch.B. Mayo Clinic Rochester, Minn.

Dr. Rosebud Roberts

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.

Continue reading

Unrecognized Cognitive Impairment in Heart Failure Patients Increases Costs and Readmissions

MedicalResearch.com Interview with:

Mark W Ketterer PhD, ABPP Health Psychology Henry Ford Hospital Detroit Michigan

Dr. Mark Ketterer

Mark W Ketterer PhD, ABPP
Health Psychology
Henry Ford Hospital
Detroit Michigan

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

Dr. Ketterer:  Reducing wasteful healthcare costs is a high priority For Medicare/Medicaid, Obamacare and all third party payors.  Cognitive impairment (CI) is highly prevalent in patients  with chronic illnesses identified as having high readmission rates by the Center for Medicare and Medicaid Services (1,2,3), such as Congestive Heart Failure (4,5), End Stage Renal Disease (6,7) and Chronic Obstructive Pulmonary Disease (8-14). CI  is also a known prospective predictor of longer term admissions and deaths (15-18). Poor adherence is a frequent consequence of cognitive impairment (19,20), particularly when the family and/or patient have not yet recognized and intervened for the evolving problem, or the patient is not in a setting (e.g., Nursing Homes) that supervises medication administration

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

Dr. Ketterer:  

  • Aggressive evaluation of heart failure patients for cognitive impairment.
  • Involvement of family in maximizing adherence is better care, and more efficient care.

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

Dr. Ketterer:  A randomly-assigned, controlled clinical trial of this intervention is warranted, needed and should be a high priority in healthcare research.

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

Dr. Ketterer:  As currently constructed, our healthcare system neglects common behavioral causes of waste, misdiagnosis and treatment failure.  Nonrecognition of cognitive impairment in heart failure patients is about 90%.  This can be a catastrophic failure for a given patient, resulting in a preventable death.

Citation:

Cognitive Impairment and Reduced Early Readmissions in Congestive Heart Failure? –

Mark W. Ketterer, PhD; Jennifer Peltzer, PsyD; Usamah Mossallam, MD; Cathy Draus, RN; John Schairer, DO; Bobak Rabbani, MD; Khaled Nour, MD; Gayathri Iyer, MD; Michael Hudson, MD; and James McCord, MD –

American Journal Managed Care Published Online: January 25, 2016

Mark W Ketterer PhD, ABPP (2016). Unrecognized Cognitive Impairment in Heart Failure Patients Increases Costs and Readmissions 

Chemotherapy-induced Peripheral Neuropathy Linked To Cognitive Dysfunction In Breast Cancer Patients

MedicalResearch.com Interview with:
Kelly N. H. Nudelman, Ph.D.
Department of Radiology and Imaging Sciences
Indiana University-Purdue University Indianapolis (IUPUI)
Indianapolis, IN 46202

Medical Research: What is the background for this study?

Dr. Nudelman: Varying levels of cognitive problems and related changes in brain structure and function have been reported in breast cancer patients treated with chemotherapy. Pain has also been associated with altered brain structure and function. However, the association of chemotherapy-induced peripheral neuropathy (CIPN), a side-effect of chemotherapy treatment characterized by nerve damage primarily in the extremities, has not been specifically investigated for association with cognitive symptoms in breast cancer. We used data from a prospective, longitudinal breast cancer cohort to investigate the relationship of CIPN and neuroimaging measures of cognitive dysfunction. 

Medical Research: What are the main findings?

Dr. Nudelman: We found that increased chemotherapy-induced peripheral neuropathy symptoms were associated with resting brain blood flow increase in regions known to be involved in pain processing. We also found that decreased frontal lobe gray matter density was correlated with these changes, suggesting a link between chemotherapy-induced peripheral neuropathy and cognitive dysfunction.

Continue reading

‘Chemobrain’: Cognitive Impairment May Be a Form Of Cancer-Related PTSD

Dr. Kerstin Hermelink Senior psychologist  Dept. of Gynecology and Obstetrics Ludwig Maximilian University of MunichMedicalResearch.com Interview with:
Dr. Kerstin Hermelink
Senior psychologist
Dept. of Gynecology and Obstetrics
Ludwig Maximilian University of Munich

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

Dr. Hermelink: Many breast cancer patients report problems of cognitive functioning that interfere considerably with their professional and private lives. In the last two decades, a number of studies have confirmed that subgroups of breast cancer patients show at least subtle cognitive impairment. Initially, the condition has entirely been attributed to chemotherapy effects and has therefore colloquially been named “chemobrain”. Meanwhile, however, cognitive impairment has also been found in patients who were managed without chemotherapy and, surprisingly, even in patients who had not yet received any systemic treatment at all.

Several hypotheses on the causation of cognitive impairment that occurs already pretreatment have been put forward; for instance, biological effects of the cancer itself might affect cognitive functioning, or there might be shared genetic vulnerability for cancer and cognitive impairment. None of these hypotheses have been empirically confirmed; thus, pretreatment cognitive impairment is as yet unexplained.

Our study was designed to investigate the effects of cancer-related post-traumatic stress on cognitive function in breast cancer patients before the start of treatment. Stress has a substantial influence on cognitive functioning, and post-traumatic stress disorder (PTSD) is associated with impairment of cognitive function. While the incidence of full diagnosis of stress disorder is low among breast cancer patients, many of these patients show symptoms of PTSD, with a peak shortly after diagnosis.

We did not find an elevated risk of overall cognitive impairment in pretreatment breast cancer patients compared with matched non-cancer controls; however, the cancer patients scored worse than the controls on a small fraction of the cognitive indices that were used. Performance on these indices was indeed robustly associated with PTSD symptoms.

Our results therefore indicate that pretreatment cognitive impairment in breast cancer patients may be largely caused by the stress of being diagnosed with cancer.

Continue reading

More Attention To Cognitive Effects of Anesthesia May Be Needed

MedicalResearch.com Interview with:
Jan G. Jakobsson
Institution for Clinical Science
Karolinska Institutet, Danderyds Hospital
Stockholm, Sweden

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

Dr. Jakobsson:  We found that anaesthesiologists and nurse anaesthetists were concerned about the risk for neurocognitive side effects, but there routines and practice for preoperative identification of patients at risk, intraoperative management to minimise risk and assessment and management of patients showing signs and/or symptoms of neurocognitive side effects after anaesthesia was rarely at place.
Continue reading

Diabetes: Insulin Resistance May Link Brain Disconnections and Cognitive Dysfunction

MedicalResearch.com Interview with:
Gao-Jun Teng, MD
Chair and Professor, Dept of Radiology
Zhongda Hospital, Southeast University
Nanjing 210009, China

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

Answer: This current study demonstrates that the aberrant resting-state functional connectivity among default mode network (DMN) regions, especially the posterior cingulated cortex (PCC) to right middle temporal gyrus (MTG), is associated with insulin resistance and cognitive performance, which might be the key to understanding the cognitive impairment in type 2 diabetes (T2DM).

Continue reading

Diabetes: (Hp) 1-1 genotype Less Favorable Cardiac, Cognitive Profiles

MedicalResearch.com Interview with:

Ramit Ravona-Springer M.D., Psychiatrist
Director of Memory Clinic,
Sheba Medical Center, Tel Hashomer, Israel

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

Answer: In a cohort of elderly, cognitively normal type 2 diabetes (T2D) subjects, those with Haptoglobin (Hp) 1-1 genotype present lower cognitive performance compared to Hp 2 carriers (Hp 1-2 and Hp 2-2). The contribution of cardiovascular risk factors to cognition was significantly higher in subjects with Hp1-1 genotype compared to Hp 2 carriers.

Continue reading