In a 1-year longitudinal study people with Non-Insulin Dependent Diabetes Mellitus (NIDDM) and Depression were treated in primary care using an integrated care approach. Having a Depressive illness can worsen the course of Diabetes if the Depression is left untreated. There are many reasons for this. For instance having Depression can mean that a person is less motivated to manage their medication for Diabetes as well as their diet. The researchers in this study wanted to see if focusing on the treatment of both conditions could improve the outcomes. The researchers included 180 people in their study and used the Patient Health Questionnaire-9 to monitor mood, the Glycosylated Haemoglobin as a proxy marker of compliance with Diabetes treatment as well as a Medication Event Monitoring System (MEMS). Integrated care managers worked with the GP’s to educate patients, to ensure treatment was followed according to protocols and to monitor the patient’s presentation. The researchers found that there compared to treatment as usual, the integrated approach led to a statistically significant improvement that was clinically meaningful. Thus HbA1c levels of less than 7% were achieved in 60.9% of the treatment group but only 35.7% of the ‘usual care’ group (p < 0.001). A PHQ-9 score of less than 5 was used a proxy marker for remission from depression and again 58.7% of the treatment group achieved scores of less than 5 compared to 30.7% in the usual care group (p < 0.001).
In a small study (via @MariaPage) involving 17 subjects, researchers used Transcranial Direct Current Stimulation in Stage 2 of sleep. The stimulation was applied with electrodes over the Frontal and Parietal lobes. There were two courses of stimulation applied. In the first course, high and low intensity followed by no stimulation were applied during stage 2 sleep. In the second course, high intensity and no stimulation were followed by reversing the polarity of the stimulation and also by stimulating in alternative directions. The researchers found that with the first course, the subjects would experience an increase in their reports of dreams with visual images on waking. The application of a direct current across the cortex during sleep is therefore either influencing dreams or the recall of dreams. This was a small study and it will need replication but potentially has very interesting implications although it is unclear what clinical application this will have if these initial results are replicated.
In another study, researchers used Positron Emission Tomography investigated changes in the brain occurring with alcohol use. They found evidence that endorphins were released in the Nucleus Accumbens and Orbitofrontal Cortex and that the amount released correlated with the pleasure experienced. The amount of endorphins released differed between people who were alcohol dependent and a control group however.
The neurodevelopmental condition Angelman’s Syndrome results from a gene disorder in which the gene UBE3A is not expressed. In an experimental model of Angelman’s Syndrome, an FDA approved drug has been used to regain the expression of this DNA when the expression has been disrupted by antisense RNA (there are also other causes including gene deletions however). This research is at an early stage but shows a theoretical success which will need to be followed up with replication and the establishment of clinical trials to see if this research translates into the clinical results.
In one study, the researchers looked at the arteries supplying blood to the brain – the Carotid Arteries using Doppler Ultrasound. The researchers were interested in the factors that causes conversion from Mild Cognitive Impairment to Dementia. They found that a combination of the thickness of the wall of the Common Carotid Arteries as well as a measure of the reactivity of the Middle Cerebral Artery significantly influenced the risk of conversion from MCI to Dementia.
There is a freely available review of the differential diagnosis of visual hallucinations in Parkinsonism here. The authors of a literature review concluded that Vitamin B12 is effective in improving cognitive impairment in Dementia only if there is a Vitamin B12 deficiency on the basis of their evidence. In another literature review, the authors found evidence of impaired recognition of emotions in Mild Cognitive Impairment. There is a freely available review of pharmacological treatment options in Alzheimer’s Disease here.
In one study, White Matter Hyperintensities in the Cholinergic Pathway in Parkinson’s Disease were inversely correlated with cognitive performance and specifically executive function. They were correlated with the motor score on the UPDRS (Unified Parkinson’s Disease Rating Scale).
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