In this week is a new paradigm for investigating Parkinson’s Disease as well as some findings on the significance of symptoms of mania in Bipolar Depression.
Research in Dementia
One of the difficulties that can occur in research in dementia is when the potential subject does not have the capacity to consent although there is appropriate guidance in this area. In a recent survey of 538 people over the age of 65, 92% of people were found to be willing to give blood and 75% to give blood and undergo lumbar punctures as part of a research study at a future point if they no longer had capacity, even if the research didn’t benefit them directly. An emerging theory with supporting data is that there are cortical hubs in the brain, areas which are well connected in which ABeta plaques are more likely to form (using PIB-PET). A study of people with probable Alzheimer’s Disease, 140 were prescribed memantine and a cholinesterase inhibitor, 387 a cholinesterase inhibitor only and 416 were prescribed neither. Although there was no significant effect on time to death, ChEI’s significantly delayed time to nursing home admission compared to without ChEI’s and the addition of memantine significantly delayed admission compared to the ChEI alone group (STT2).
A group from Oxford have presented the results of a novel approach to diagnosing Parkinson’s Disease. They hypothesise that the distribution of metal ions in neurons in Parkinson’s Disease is affected by the disease process and that it can be used in identifying the disease at an early stage. They argue that the method of preparing tissue before analysis has the potential to influence the iron content of cells and they have developed and are using a method that they state does not alter the iron composition of cells. They then used the UK National Synchotron which can focus beams in a small area of the tissue to characterise the form in which the iron is stored very precisely using a technique referred to as Microfocus Spectroscopy. They are due to formally announce their findings at the AAS in which they have identified an altered distribution of iron in cells in Parkinson’s Disease. The next stage is to use this information to interpret MRI studies. While this novel approach is encouraging it will be interesting to see the published research and to see the results of MRI interpretations (STT5).
Research in Mood Disorders
In an analysis from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) of 1380 people who met criteria for Bipolar I or II, 2/3 of people with bipolar depression were found to have concurrent manic symptoms and a number of associations with this group were found including earlier age at onset, rapid cycling in past year and bipolar I (STT2). In a 10-week trial of 176 adults with bipolar disorder, treatment emergent mania was associated with significantly higher baseline scores on the Young Mania Rating Scale (STT1).
Research in Psychosis
A recent meta-analysis of blinded studies of head-to-head 2nd generation antipsychotics found that there were differences in efficacy. The authors utilised metaregression and sensitivity analyses to examine bias for factors such as industry sponsorship and concluded that the differences remained.
At the AAAS meeting, a study of children in 50 familes was presented in which gesturing at age 14/12 was associated with a larger vocabulary at age 4.5 years. Further examination of an association between gesturing and vocabulary is of potential relevance to conditions where gesturing is reduced (STT5). There is a commentary in the American Journal of Psychiatry about publication bias and the effectiveness of antidepressants partially in response to the Kirsch study and following another editorial in the British Journal of Psychiatry last month.
I couldn’t resist the opportunity to mention some recent research about Neanderthals. The first is that a study of the genome obtained from Neanderthal specimens from Croatia reveal that a specific gene – Microcephalin 1 suggests that they did not interbreed with Homo Sapiens. The group however are examining possible speech capabilities given that they share the FOX-1 gene that is one of many genes associated with speech. These findings though do have relevance to psychiatry as we share between 99.5 and 99.9% of our genome with Neanderthals and any differences in genes could help to identify those with an important role in Home Sapien specific cognition (STT6). The other piece of research looks at climate changes in the Iberian Peninsula (using marine core samples which allow determination of sea level) where it was found that there was a drop in sea level coinciding with the presumed extinction date of Neanderthals in that area (in the absence of evidence to the contrary). The hypothesis is that Neanderthals in that area would have been exposed to a drought which led to their extinction rather than competition with Homo Sapiens who did not arrive in that region until much later.
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