New Uncertainties Around Irreversible Brain Cell Death Following Oxygen Deprivation? (BBC News / Nature)

Summary

Conventional medical wisdom holds that brain cells and working brain circuitry are prone to irreversible damage following merely minutes of interrupted blood flow and disrupted oxygen supply.

Researchers at Yale University used an extracorporeal pulsatile-perfusion system to restore circulation in intact pig brains several hours after decapitation. It was found possible halt brain cell death and restore some working connections in the brain (although not consciousness). The processes of brain cell death may apparently be postponed, preserved or reversed under suitable circumstances.

It now seems evident that:

“ …large mammalian brains possess an under-appreciated capacity for restoration of microcirculation and molecular and cellular activity after a prolonged post-mortem interval”.

The implications are uncertain, at this stage.

Full Text Link

Reference

Gallagher, J. (2019). Pig brains partially revived four hours after death. London: BBC Health News, April 17th 2019.

This relates to:

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).

Reference

Vrselja, Z. Daniele, SG. [and] Silbereis, J. [et al] (2019). Restoration of brain circulation and cellular functions hours post-mortem. Nature. April 2019; 568(7752): 336-343.

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Non-Pharmacological Treatments for Lewy Body Dementia (Psychological Medicine / International Psychogeriatrics)

Summary

Lewy Body Dementia (dementia with Lewy bodies and Parkinson’s Disease Dementia) involves visual hallucinations, fluctuating cognition / attention, motor disturbances, falls, and extreme sensitivity to antipsychotics. Caution in the use of pharmacological treatments such as antipsychotics is advised in recent guidelines. A systematic review investigates the effectiveness of non-pharmacological interventions for patients with Lewy Body Dementia (and / or their carers). A number of different possible interventions considered include:

  • Interventions to prevent aspiration of fluids in patients with dysphagia.
  • Exercise (high-intensity functional exercises).
  • Exercise (stationary cycling).
  • Interventions to improve gait (auditory cueing of gait with a metronome and verbal instructions).
  • Physical therapy (Lee Silverman voice treatment).
  • Multi-component intervention including carer education and tailored environmental modification.
  • Psychological intervention for visual hallucinations, including psychoeducation and environmental modification.
  • Environmental modification to reduce mirrored self-misidentification delusion (reducing the mirror size and personalising it with artwork).
  • Music therapy.
  • Simulated presence.
  • Occupational therapy (‘skill building through task-oriented motor practice’; STOMP).
  • Occupational therapy (system-based intervention focused on improving the patient’s functional abilities and carer behaviours).
  • Electroconvulsive therapy (unilateral).
  • Electroconvulsive therapy (bilateral).
  • Electroconvulsive therapy.
  • Electroconvulsive therapy (bifrontotemporal).
  • Transcranial magnetic stimulation (dorsolateral prefrontal cortex bilaterally).
  • Transcranial direct current stimulation.
  • Deep brain stimulation (two electrodes in the nucleus basalis of Meynert; two electrodes in the subthalamic nucleus).
  • Deep brain stimulation (single electrode in the left internal segment of globus pallidus).
  • Deep brain stimulation (unilateral stimulation of the pedunculopontine nucleus).

No definite recommendations could be made, so more research is needed.

“Overall, given the heterogeneity of interventions, small sample sizes, and poor quality of research, no treatment recommendations can be offered”. p.1756.

Full Text Link

Reference

Connors, MH. Quinto, L. [and] McKeith, I. [et al] (2018). Non-pharmacological interventions for Lewy body dementia: a systematic review. Psychological Medicine. August 2018; 48(11): 1749-1758.

A different systematic review on the same subject appeared slightly earlier:

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).

Reference

Morrin, H. Fang, T. [and] Servant, D. [et al] (2018). Systematic review of the efficacy of non-pharmacological interventions in people with Lewy body dementia. International Psychogeriatrics. March 2018; 30(3): 395-407.

Posted in Community Care, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), International, Non-Pharmacological Treatments, Parkinson's Disease, Quick Insights, Systematic Reviews, UK, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Precise Transcranial Brain Stimulation Improves Working Memory? (BBC News / Nature Neuroscience)

Summary

Working memory (short-term memory) declines with age, but it appears that a new technique involving transcranial brain stimulation may have some potential for helping to restore working memory to levels typical of more youthful individuals.

“The results provide insight into the physiological foundations of age-related cognitive impairment and contribute to groundwork for future non-pharmacological interventions targeting aspects of cognitive decline”.

This research is at an early stage and will require careful evaluation before being approved as a non-invasive intervention to reverse age-related cognitive decline, even in healthy individuals. Further:

“It would be premature to extrapolate the findings to everyday functioning in individuals with clinically significant memory problems”. Dorothy Bishop, Professor of Developmental Neuropsychology at University of Oxford.

Full Text Link

Reference

Gallagher, J. (2019). Precise brain stimulation boosts memory. London: BBC Health News, April 9th 2019.

This relates to:

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).

Reference

Reinhart, RMG. [and] Nguyen JA. Working memory revived in older adults by synchronizing rhythmic brain circuits. Nature Neuroscience. April 9th 2019. [Epub ahead of print].

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The Estimated Health Impact of Poor Diets (BBC News / Lancet / NHS Digital)

Summary

Poor diet has been estimated to be a bigger killer than smoking. Malnutrition (resulting from poor quality diets) may play a role in one in five premature deaths world-wide; an estimated 11 million people. The most dangerous diets contain:

  • Excess salt; calculated to be involved in an estimated three million deaths.
  • Insufficient whole grains; calculated to be involved an estimated three million deaths.
  • Insufficient fruit; calculated to be involved an estimated two million deaths.
  • Insufficient consumption of nuts, seeds, vegetables, omega-3 (seafood) and fibre are other common features of bad diets contributing to premature mortality.

Full Text Link

Reference

Gallagher, J. (2019). The diets cutting one-in-five lives short every year. London: BBC Health News, April 4th 2019.

This relates to:

Full Text Link

Reference

GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. April 3rd 2019. [Epub ahead of print].

“We did not evaluate the effect of other forms of malnutrition (ie, undernutrition and obesity)”. p.12.

Further analysis appears in an NHS Behind the Headlines critical appraisal of this research:

Full Text Link

Reference

Poor diet now killing more than smoking. London: NHS Digital (previously NHS Choices); Behind the Headlines, April 4th 2019.

Posted in BBC News, Community Care, For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), In the News, International, NHS, NHS Digital (Previously NHS Choices), Non-Pharmacological Treatments, Statistics, Systematic Reviews, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

No Safe or Protective Level of Alcohol Consumption? (BBC News / Lancet)

Summary

Light-to-moderate drinking increases blood pressure and the risk of stroke.

“I have always been reasonably convinced that moderate alcohol consumption was protective for cardiovascular disease, but now I am having my doubts”. Professor David Spiegelhalter: Winton Professor for the Public Understanding of Risk, University of Cambridge.

Full Text Link

Reference

Even one drink a day increases stroke risk, study finds. London: BBC Health News, April 5th 2019.

This relates to:

Full Text Link

Reference

Millwood, I. Walters, RG. [and] Mei, X. [et al] (2019). Conventional and genetic evidence on alcohol and vascular disease aetiology: a prospective study of 500 000 men and women in China. Lancet. April 4th 2019. [Epub ahead of print].

Posted in Acute Hospitals, BBC News, Community Care, For Carers (mostly), For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), In the News, International, Quick Insights, Statistics, Stroke, Universal Interest | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Optometric and Ophthalmological Tests for Visual Symptoms of Posterior Cortical Atrophy (BMJ Open)

Summary

Research by the College of Optometrists on Posterior Cortical Atrophy (PCA) has investigated the suitability of certain vision assessment tests to help differentiate between cortical and optical / ocular causes of visual impairment. An awareness of PCA helps to avoid choice of unsuitable tests and the potential risk of misdiagnosis. Certain tests, including the Amsler Grid and visual field analysis appear to be problematic for patients with PCA.

Full Text Link

Reference

Bowen, M. Zutshi, H. [and] Cordiner, M. [et al] (2018). Qualitative, exploratory pilot study to investigate how people living with posterior cortical atrophy, their carers and clinicians experience tests used to assess vision. BMJ Open. March 20th 2019; 9(3): e020905.

Posted in Diagnosis, For Doctors (mostly), For Nurses and Therapists (mostly), For Researchers (mostly), Quick Insights, UK | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment