Medicine in the News – April 2015

APOE ε4 Gene—Predictor of Cognitive Performance in Parkinson Disease
Among PD patients without dementia, the APOE ε4 allele was only associated with lower performance on word list learning and semantic verbal fluency, a pattern more typical of the cognitive deficits seen in early Alzheimer disease than PD. – JAMA, September 2014
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The Preclinical Alzheimer Cognitive Composite Measuring Amyloid-Related Decline
Analyses of at-risk cognitively-normal populations suggest that we can reliably measure the first signs of cognitive decline with the ADCS Preclinical Alzheimer Cognitive Composite (ADCS-PACC). The ADCS-PACC combines tests that assess episodic memory, timed executive function, and global cognition. – JAMA, September 2014

Obsessive-Compulsive Disorder as a Risk Factor for Schizophrenia
In a national cohort study, an elevated risk of schizophrenia and schizophrenia spectrum disorders was observed in association with a prior diagnosis of OCD in the patients and the parents. The observed increase in risk suggests that OCD, schizophrenia, and schizophrenia spectrum disorders probably lay on a common etiological pathway. – JAMA, September 2014

Brain Morphometric Biomarkers Distinguishing Unipolar and Bipolar Depression
A cross-sectional study has shown that individuals with Unipolar Depression and those with Bipolar Depression are differentiated by structural abnormalities in neural regions supporting emotion processing, based on neuroimaging and multivariate pattern classification techniques. – JAMA, September 2014
Apolipoprotein E Genotype and the Diagnostic Accuracy of Cerebrospinal Fluid Biomarkers for Alzheimer Disease
Several studies suggest that cerebrospinal fluid levels of Aβ42 are strongly associated with the diagnosis of Alzheimer’s disease and cortical Aβ accumulation independent of APOE genotype. – JAMA, August 2014

High-Frequency Deep Brain Stimulation for Treatment of Parkinson Disease
High-frequency stimulation of the subthalamic nucleus improves motor function and quality of life, and provides better results than the best medical therapy for advanced Parkinson’s disease. – JAMA, September 2014

Higher Working Memory Predicts Slower Functional Decline in AD
Preservation of working memory, but not episodic memory, in the mild cognitive impairment and early dementia stages of Alzheimer’s disease relates to slower rate of functional decline. – Dementia and Geriatric Cognitive Disorders, August 2014

Association of Poor Subjective Sleep Quality With Risk for Death by Suicide During a 10-Year Period
A longitudinal case-control cohort study of late-life suicide indicates that poor subjective sleep quality is associated with increased risk for death by suicide 10 years later, even after adjustment for depressive symptoms. – JAMA, September 2014

Glucose Levels and Risk of Dementia
Studies from the National Institutes of Health suggest that higher glucose levels may be a risk factor for dementia, even among persons without diabetes. – NEJM, September 2014


Half of Dementia Patients Prescribed Medications of Questionable Benefit
Pharmacy records revealed that 54% of elderly nursing home patients received at least one of what the researchers called “medications of questionable benefit”: more than a third were given a cholinesterase inhibitor (Aricept), a quarter received memantine (Namenda), more than 20% were on statins to lower cholesterol, and 7% were on blood thinners. All of these drugs were deemed “never appropriate” for palliative care patients with advanced dementia, in a list developed by a panel of geriatricians and published in the Journal of the American Geriatrics Society. – JAMA, September 2014


Omega-3 Fatty Acids Linked to Heart Benefits
Mice genetically altered to produce their own eicosapentaenoic (EPA), an n-3 or omega-3 polyunsaturated fatty acid, were protected against heart disease and had improved cardiac function in a recent study. Direct treatment with EPA metabolite 18-hydroxyeicosapentaenoic acid (18-HEPE) provided similar heart-protective effects. – JAMA, September 2014


Weight Loss Drugs
Both lorcaserin (Belviq) and the phentermine/topiramate ER combination (Qsymia) taken as adjuncts to diet and exercise may be effective in increasing weight loss in the first year of use, but much less so in the second year. Qsymia appears to be more effective than locaserin, but may cause more troublesome adverse effects. – JAMA, September 2014


Potassium-Rich Foods Help Reduce Stroke Risk in Older Women
Eating more high-potassium foods such as sweet potatoes, beet greens, white beans, bananas, and nonfat plain yogurt may help postmenopausal women reduce their stroke risk, a new study suggests. – JAMA, September 2014


Statins and Cognitive Function
Despite the FDA warning regarding cognitive impairment, published data do not suggest an adverse effect of statins on cognition; however, the strength of available evidence is limited, particularly with regard to high-dose statins. – Anals of Internal Medicine, August 2014


Serum 25-Hydroxyvitamin D and Cognitive Decline
A longitudinal study among non-demented older adults indicates that low levels of Vitamin D might be associated with cognitive decline and poorer mental flexibility. – Dementia and Geriatric Cognitive Disorders, August 2014


Phosphatidylserine Containing Omega-3 fatty Acids May Improve Memory
Consumption of 100mg/day of PS-DHA (Phosphatidylserine enriched with docosahexaenoic acid) might be associated with improving or maintaining cognitive status in elderly subjects with memory complaints. – Dementia and Geriatric Cognitive Disorders, August 2014


Self-reported Head Injury Linked to Early Dementia
Self-reported head injury is associated with earlier onset and increased risk of cognitive impairment and dementia, increased risk of mortality, and Alzheimer’s disease-type pathological changes. – Dementia and Geriatric Cognitive Disorders, August 2014


Sodium Intake Linked to Increased Activity in MS
A higher sodium intake is associated with increased clinical and radiological disease activity in patients with multiple sclerosis. – Journal of Neurology, neurosurgery and Psychiatry, August 2014


Effect of Physical Exercise on Cognitive Performance in Older Adults with Mild Cognitive Impairment or Dementia
Numerous studies have shown that physical exercise has positive effects on cognition in healthy adults, and randomized controlled studies on older subjects with MCI reported some positive effects on cognition, mainly on global function, attention, and delayed recall. However, most studies performed on older subjects with dementia showed no effect of exercise on cognition. – Dementia and Geriatric Cognitive Disorders, August 2014


Association of Lifetime Intellectual Enrichment with Delayed Cognitive Decline in the Older Population
Lifetime intellectual enrichment might delay the onset of cognitive impairment and be used as a successful preventive intervention to reduce the impending dementia epidemic. Higher education/occupation scores were associated with higher levels of cognition. Higher levels of mid/late-life cognitive activity were also associated with higher levels of cognition, but the slope of this association slightly increased over time. – JAMA, August 2014

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