There are some interesting and encouraging results from the Rush Memory and Aging Project in the Journal Neurology. The researchers used an actigraph to measure activity. The 716 participants were on average 82 years old without Dementia at the study onset. The researchers used the activity data from a one-week period to stratify subjects according to their levels of activity. As this was a longitudinal study they were then able to correlate the activity data with the risk of subsequently developing Alzheimer’s Disease. After 3.5 years of follow-up, the researchers found that the 10% of people with the lowest levels of activity were 2.3 times more likely to develop Alzheimer’s Disease than the 10% of people with the highest levels of activity. These included household activities such as cooking and cleaning (classed as non-exercise physical activity) for those who were unable to engage in exercise.
However it should be noted that the activity results are based on a one-week period of observation and it will be interesting to see if this is further explored with extensive periods of observation of activity. Nevertheless these results are quite convincing and are consistent with a body of emerging evidence on the benefits of exercise on cognition.
NMDA-receptor encephalitis is a recently characterised condition. In one recent study, the researchers looked at the treatment of 565 people with this condition and found that early treatment (classed as treatment within the 1st month) led to better outcome. There was also an improved response on switching treatment after failure to respond to the initial treatment (compared to either repeating the first treatment or no additional treatment). As this form of encephalitis is associated with tumours in 59% of cases, treatment included tumour removal or immunotherapy depending on the presentation.
Dr Thomas Insel, NIMH Director in the United States writes in a recent post that psychiatry is becoming more popular with American medical students and that there is a higher proportion entering psychiatry with PhD’s particularly in the neurosciences.
There is a case report on a man with a PSEN1 mutation which is associated with early-onset Alzheimer’s Disease. The researchers used Positron Emission Tomography with a radioactive tracer compound F-AV45 that was approved for use last year by the FDA. The researchers were able to detect Amyloid plaques at an early stage using this approach. and that the plaque appeared in the Striatum and posterior Cortex.
In an analysis of 9 clinical trials of Memantine in moderate to severe Alzheimer’s Disease including a cumulative total of 2506 participants, the researchers found that Memantine was associated with a delay in worsening of cognition compared to Placebo on three outcome measures – cognition, activities of daily living and global impression of change.
A visual rating score for atrophy in different Cortical regions was used to predict conversion from Mild Cognitive Impairment to Dementia in one study. The researchers were interested in the contribution of atrophy in the Medial Temporal Lobe and posterior Cortex. They found a stronger effect for Medial Temporal Lobe atrophy in keeping with the findings from previous studies. However they also found that there was an association between posterior Cortical atrophy and conversion in late-onset Dementia. Furthermore they found that posterior Cortical atrophy was also correlated with CSF Tau levels and suggest that the latter is a marker of a more widespread disease process which may explain these findings.
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