Meet the brains behind the push to get more women in neurosurgery – CBC.ca

As the medical director of Toronto's KrembilBrain Institute, Dr. Gelareh Zadehis at the top of the neurology more specifically, neurosurgery industry. But throughout most of her journey toget there, she says she's been the only woman in the room.

"When I was younger and in residency I kept thinking one day it'll change," she said.

"And then I'd go to these skull base conferences and of the hundreds of people in the room there'd be three women. Now it's 2020 and I go to these conferences and there's maybe six."

Part of the reason operating rooms are lagging in diversity, Zadeh says, is becausemen at the top are not making space for it.

According to the Canadian Medical Association, only 11 per cent of the 333 total neurosurgeons practicing in Canada arewomen.

But strides are being made at the hospital level to change that.

St. Michael's Hospital, for example, usually sees one woman resident training in the neurosurgery specialty. This year there are seven.

Dr. Michael Cusimano,the hospital's neurosurgery department lead, says it's up to people in the industry to make space for diversity.

"The talent has always been there but we haven't been making the space for it," he said.

So, when it came time to accepting neurosurgical residents into this year's program, Cusimano sought to do just that.

"Society has been lagging behind in attracting women to the [brain surgery] specialty and bringing them up through the ranks and taking on leadership positions as things move along."

Zadeh, meanwhile, is still doing all-day operations whileseven-and-a-half months pregnantwith her second child.

Brain surgery is often an on-calllife, full ofhigh stakes surgeries where doctors work for hours holding a patient's life, or at the very least their motor function or cognition, in their hands.

One false move and the patient can wake up with a different personality.

"It's that acuity that made me choose neurosurgery," said resident Dr. Han Yan.

She says the balance will improveas soon as more operating roomdoors (so to speak) areopened to women.

"I remember when I was a medical student there was a male resident who was like 'Oh I developed a great relationship with my mentor we use to go to hockey games and grab beers after work,' and I remember thinking am I going to have that opportunity?"

Now that she's in her third year of residency and working alongside sixother women, Yansays she feelsencouraged.

"Just being able to see more women who will become staff one day with whom I can develop a close relationship with is very valuable."

Dr. Teresa Purznersays a decade ago she was the only woman in any of her placements.

She's married to a brain surgeon so she didn't just hear about how demanding the work was, she experienced it by proxy through her husband.

"I actually tried every other surgical specialty desperately hoping that anything else would stick," said Purzner.

"I just didn't like anything else like I liked neurosurgery. So ultimately, I begrudgingly went into the specialty."

She's a sixth-year resident at St. Michael's Hospital and says being surrounded by more women has helped in establishing a work-life balance at least, or at least a brain surgeon's version of it.

"There are certainly challenges unique to being a mother so it's nice to have women around to bounce ideas off. Sometimes pragmatic ones like how do you find a nanny who works neurosurgical hours," Purznersaid with a laugh.

"I'm not sure a work-life balance is really something that's attainable [in this discipline]," says second-year resident Dr. Nardin Samuel, who's recently come back to work after giving birth to her son Theo.

"Maybe it's not about conceptualizing it as abalancebut an integration into your life," she said.

"But at the same time it's challenging to leave your kids in the morning or at night when you're on call. But on the other side of that, it's rewarding when you're doing something for yourself something that you're really enjoying as well."

And for any medical students out there, Purzner has a message:

"There can be specific challenges for women but just know that there are a lot of other females now in neurosurgery who are really rooting for you."

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Neurologist Deborah Boland, DO, MSPT, Named "Physician of the Year" – Benzinga

Tampa, FL, December 18, 2019 --(PR.com)-- The Hillsborough County Osteopathic Medical Society (HCOMS) has named Dr. Deborah Boland, D.O., MSPT, Neurologist, Diplomate of the American Board of Psychiatry and Neurology, and owner of Be Mobile Neurology, as their "Physician of the Year" for 2019. This prestigious award is presented to a Doctor of Osteopathic Medicine (D.O.) who has made significant contributions to both the osteopathic profession and the local community. Dr. Boland is one of only a handful of Movement Disorder specialists in the Tampa Bay area and is a pioneer in the mobile delivery of neurological services.

Dr. Boland said, I am so honored and humbled to be recognized by my colleagues and friends with this award. Healthcare is rapidly changing, and Im proud to be leading the movement back to patient-centered, individualized care. Through my practice, Be Mobile Neurology, I am working to offer a more personalized and affordable approach to healthcare, improving outcomes for my patients.

Over the course of her medical career, Dr. Boland witnessed the limitations and stress that traditional physician office visits placed on both patients with neurological issues and their caregivers. Through in-home visits and telemedicine, Be Mobile Neurology presents a solution, offering patients a membership model for healthcare services that allows them to receive focused attention in a comfortable setting. Be Mobile Neurology is the only mobile neurology practice in Tampa Bay and is leading trends nationally.

Dr. Boland started in healthcare as a Physical Therapist, receiving her masters degree in Physical Therapy from Andrews University in Berrien Springs, Michigan, and practicing for 10 years before going to medical school. Dr. Boland earned her medical degree from Des Moines University College of Osteopathic Medicine, which has a rich osteopathic history and is one of the oldest osteopathic medical schools in the country.

Following medical school, she completed her internship and neurology residency at the University of Illinois College of Medicine/OSF Saint Francis Medical Center. Dr. Boland went on to complete fellowship training specializing in Movement Disorders at Duke University, and she served as an Assistant Professor of the Movement Disorders Center at Georgia Regents Universitys Department of Neurology.

Since January 2018, Dr. Boland has served as a Governor on the Hillsborough County Osteopathic Medical Society Board. She also is a member of the International Parkinson and Movement Disorder Society, the American Academy of Neurology, the American Osteopathic Association, and Working Women of Tampa Bay.

If youre interested in learning more about Dr. Boland or her ground-breaking neurological practice, please call (813) 981-4403 or visit http://www.bemobileneurology.com.

About Be Mobile Neurology:Founded by Dr. Deborah Boland in 2017, Be Mobile Neurology is Tampa Bays only mobile neurology private practice, blending cutting-edge care with a touch of old-fashioned medicine. As an innovative response to traditional medicine, Be Mobile Neurology offers individualized care in the comfort of the patients residence with unparalleled access to the neurologist. Learn more at http://www.bemobileneurology.com.

About Hillsborough County Osteopathic Medical Society:The Hillsborough County Osteopathic Medical Society (HCOMS) is a non-profit organization serving the Osteopathic medical profession and associates within this geographic area. HCOMS is affiliated with the American Osteopathic Association and the Florida Osteopathic Medical Association. Learn more at http://www.hcoms.org/home.html.

Contact Information:Audra Butler813-337-0893Contact via Email

Read the full story here: https://www.pr.com/press-release/801773

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Neurologist Deborah Boland, DO, MSPT, Named "Physician of the Year" - Benzinga

This neurologist is taking healthcare to the remotest parts of Andhra Pradesh through Neurology on Wheels – YourStory

Healthcare remains out of reach for many poor and marginalised communities in India. Most of the time, proper healthcare services do not reach the remotest areas of the country. But many initiatives by states and the Centre, including Ayushman Bharat and Mohalla Clinic, are bringing about change in this direction.

Individuals and organisations are also doing their bit for this cause.

Bindu Menon, a neurologist, is taking healthcare services to remote areas of Andhra Pradesh through her foundation, Neurology on Wheels. Bindu travels through these areas in her medical van, which is capable of providing free neurological treatment, and also conducts awareness programmes.

Bindu Menon treats patients in her medical van. (Image: The Logical Indian)

Since 2015, Bindu has covered 23 villages and provided over 100 people with free treatment. The usual process of identifying a village is random; the team makes a prior visit and conducts a health awareness session among locals about the camp. During this process, topics like stroke risk factors, recognition of symptoms, and the use of medicines required for the treatment are discussed.

After the awareness session, the foundation provides free screening and detection of hypertension, diabetes, and stroke. It also provides medicines for treatment.

Speaking to The Logical Indian, Bindu said,

She added, One of the hurdles faced further by a patient includes what he should do after the medicines get over. We try to counsel patients about this. Undetected diseases and poor awareness about the risk of other major diseases was something we often observed during our camps. The situation is changing slowly, but not at the pace at which it should be.

Image: The Logical Indian

According to The News Minute, Bindu has worked as a neurologist in some hospitals in Andhra. She is also credited with setting up the Neurology Department at the Tirupati Medical College in 2008.

Bindu has also come up with a mobile application. She said, We also have an app called Epilepsy Help, where patients can get help in managing the problem, from timely alerts to take their medicines to help for checkups, The News Minute reported.

(Edited by Rekha Balakrishnan)

Do you have an interesting story to share? Please write to us at tci@yourstory.com. To stay updated with more positive news, please connect with us on Facebook and Twitter.

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To Your Good Health: Long-term hiccups have been a plague since youth – Arizona Daily Star

DEAR DR. ROACH: My friend has been struggling with almost never-ending hiccups since she was young. There seems to be no apparent trigger for them. They happen all hours of the day and even wake her up in the middle of the night. She will hiccup until it starts to become very painful for her, and she cannot make them stop. Shes tried every remedy she can find drinking water, holding her breath and slowly letting out, even doing handstands.

She lives in a rural community with no doctor who can figure it out. They also dont seem to take seriously how disruptive and painful it is. They tell her theres nothing they can do. Do you have any suggestions? What kind of specialist treats this problem? N.E.

ANSWER: Persistent hiccups can be a severe problem. The hiccup (singultus, in Latin) is a spasm of the diaphragm, the main muscle of breathing, and an ancient neurological reflex. There are numerous case reports of people having hiccups lasting for decades, despite exhaustive searches for cures. The effect on a persons quality of life can be devastating.

In a person with hiccups lasting more than 48 hours, its appropriate to look for one of the more common causes, but often, a cause is not found. This starts with a careful history and physical examination. A history of medication use is critical, since some medicines Aldomet, an old blood pressure medicine; diazepam (Valium); and dexamethasone, a steroid similar to prednisone are known causes.

Enlarged thyroid (goiter) and enlarged lymph nodes are causes of irritation to the phrenic nerve, which controls the diaphragm. Oddly, irritation in the external ear (such as by a hair) can stimulate the vagus nerve, which can affect the phrenic nerve via a neurological reflex. Gastroesophageal reflux disease may be the most common cause and it sometimes can be seen on exam, even if the person has no symptoms. A stroke is a known cause, but that does not seem likely for your friend.

If no cause is found, a doctor must make his or her best guess at treatment. The most common drugs tried are gabapentin, baclofen, metoclopramide and chlorpromazine, but only the last of these is indicated by the Food and Drug Administration for hiccups. None of these drugs is benign enough to use lightly. Because undiagnosed GERD can be a cause, it may be worth trying a proton pump inhibitor, such as omeprazole.

DEAR DR. ROACH: Im 61 years old and came down with facial shingles 11 months ago on my right side. The pain started in my ear, moved to my eye and then the entire side of my face and scalp. It was a severe case. I still suffer with post-herpetic neuralgia pain and itching. Just last month, I had a mild case (forehead and bridge of nose) on my left side, which I guess is rare but happens. Should I get the shingles vaccine to prevent more incidents in the future? My doctor and neurologist say it wont help, and two other doctors say it will but that I should let my immune system get stronger before getting it. S.R.

ANSWER: Another case of shingles is very unlikely; however, the downside of the vaccine, beyond a sore arm, is small. Vaccination will not help with the post-herpetic neuralgia, which is persistent nerve pain after shingles. Hopefully that will go away; it usually does.

You can get the shingles vaccine as long as the rash is gone.

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To Your Good Health: Long-term hiccups have been a plague since youth - Arizona Daily Star

Neurologists Anticipate Overall Expansion of the Fumarate Class Following the US Launch of Biogen’s Vumerity for Treatment in Multiple Sclerosis,…

While neurologists are eager to believe that Vumerity will provide a superior tolerability profile over Biogen's own Tecfidera, increasing first-line use of Genzyme's Aubagio, Novartis' Mayzent, and Genentech's Ocrevus could present additional competitive pressure in the crucial new start patient segment

EXTON, Pa., Dec. 10, 2019 /PRNewswire/ --Biogen's Vumerity (diroximel fumarate), a monomethyl fumarate prodrug, was approved by the FDA on October 30th for the treatment of relapsing forms of multiple sclerosis (MS). Fielded between November 1st and 18th, data from 99 neurologists surveyed for the Q4 wave of the ongoing quarterly report series included in Spherix's RealTime Dynamix: Multiple Sclerosis (US)service confirm robust opportunity for the newest disease-modifying therapy (DMT) in the relapsing-remitting MS (RRMS) segment. More than half of neurologists are aware that Vumerity demonstrated a significantly improved gastrointestinal (GI) tolerability profile compared to Biogen's own Tecfidera in the EVOLVE-MS-2 trial. While there has been some question about the relatively high adverse event rate for Tecfidera in EVOLVE-MS-2 compared to the brand's larger pivotal trials (DEFINE and CONFIRM), most neurologists believe that Vumerity will offer a clinically superior GI tolerability profile in clinical practice. Indeed, four out of five neurologists believe that Vumerity offers at least some advance over Tecfidera, as well as over future generic dimethyl fumarate agents.

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Not surprisingly, Vumerity is expected to compete most directly with Tecfidera once available, offering an alternative for patients at risk of side effects, especially GI issues, or as a switch for Tecfidera-treated patients. Neurologists estimate that, on average, more than one in ten patients discontinue Tecfidera within the first three months of treatment. GI tolerability is the primary driver for the majority of these early discontinuations. Whereas a minority of current Tecfidera-treated patients are expected to be switched to Vumerity, neurologists estimate that Vumerity will be selected over Tecfidera for about half of treatment-nave patients who are candidates for fumarate. As a viable option for first-line selection and tolerability-related switches among RRMS patients, Vumerity is also anticipated to compete with the other established oral DMTS, Genzyme's Aubagio and Novartis' Gilenya. Thus, a clear opportunity exists for Vumerity to not only improve fumarate persistency, but additionally grow the fumarate class share of DMT-treated patients over the six months post-Vumerity availability, suggesting slow erosion of Tecfidera share.

The greatest potential threats to a successful Vumerity launch will be the characterization of the brand as a "me-too" agent and the impact of pricing on neurologist and payer acceptance. Spherix's Q3 2019 data highlighted Vumerity as the DMT in development that neurologists were least interested in having available for prescribing. Concerns were related to the lack of differentiation with Tecfidera, as noted by neurologists: "Recycled Tecfidera," "Simply a second-generation Tecfidera," and "Too much like Tecfidera. GI side effects with Tecfidera are not that much of an issue." In the weeks following approval, surveyed neurologists encouraged Biogen to stress the clinically relevant benefits over other DMTs (i.e., Tecfidera) as part of a broad physician education and marketing strategy to help support the successful introduction of Vumerity.

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Neurologists also specifically advised pricing Vumerity substantially lower than Tecfidera. Announced by Biogen after fielding, Vumerity was instead priced just shy of the lowest cost oral DMT a strategy that was met with backlashfrom some in the MS community as a missed opportunity to provide an affordable option ahead of potential generic dimethyl fumarate challengers. At that time, with the list price still an unknown, the majority of neurologists already anticipated payers would be highly restrictive of Vumerity. Now, payers may be especially reluctant to provide favorable coverage of Vumerity, not only because of the looming potential of generics, but also as the high price of the first-gen fumarate, Tecfidera, was specifically called out recently by ICERas not supported by new clinical evidence. Luckily for Biogen's commercialization efforts, only one in four neurologists were aware of the ICER assessment.

Once commercially available, Spherix will be tracking the Vumerity launch metrics over the first 18 months as part of our quarterly report series. A key early launch indicator will be whether the brand has a greater impact among patients initiating their first DMT or among patients switching from an existing therapy. In the current survey, neurologists reported that fewer new start MS patients recently started a glatiramer acetate agent (i.e., Teva's Copaxone) or Gilenya compared to a year ago, with the bulk of share shifting to Aubagio, Novartis' Mayzent, and Roche's Ocrevus. Conversely, neurologist-reported recent switch shares have remained stable across brands, with use of the new high-efficacy DMTs, including EMD Serono's Mavenclad, pulling slightly from Gilenya and Ocrevus. In both patient segments, Tecfidera share has remained flat.

In 2020, Spherix will verify brand share trends, including the impact of Vumerity market entry, as well as drivers of (and obstacles to) brand selection, using our independent patient-level data collected annually on MS patients newly initiated on their first DMT [RealWorld Dynamix: DMT New Starts in Multiple Sclerosis (US)] and MS patients recently switched to a new DMT [RealWorld Dynamix: DMT Switching in Multiple Sclerosis (US)]. Of particular interest among patients switched to Vumerity will be the source of business, whether switches are predominantly coming at the expense of Tecfidera or have a broader footprint pulling from the injectable and other oral DMTs. In order to ensure continued growth of Biogen's MS franchise, a sustained synergistic Vumerity effect on fumarate class share within both patient segments will be essential.

About RealTime DynamixRealTime Dynamix: Multiple Sclerosis (US)is an independent service providing strategic guidance through rapid and comprehensive quarterly reports, which include market trending, launch tracking, and a fresh infusion of unique content with each wave. The 17th wave of research will publish in March 2020.

About RealWorld DynamixRealWorld Dynamix: DMT New Starts in Multiple Sclerosis (US)is an independent, data-driven service unmasking real patient management patterns through annual reports based on chart audits of ~1,000 patients started on their first DMT within the previous three months. The report uncovers the "why" behind treatment decisions, includes year over year trending to quantify key aspects of market evolution, and integrates specialists' attitudinal & demographic data to highlight differences between stated and actual treatment patterns. The fourth annual report will be publishing in February 2020.

Parallel US services include RealWorld Dynamix: Progressive Forms of Multiple Sclerosis (US), third annual report publishing in November 2020; RealWorld Dynamix: DMT Switching in Multiple Sclerosis (US), fifth annual report publishing in April 2020.

About Spherix Global InsightsSpherix Global Insights is a hyper-focused market intelligence firm that leverages our own independent data and expertise to provide strategic guidance, so biopharma stakeholders make decisions with confidence. We specialize in select immunology, nephrology, and neurology markets.

All company, brand or product names in this document are trademarks of their respective holders.

For more information contact:Virginia Schobel, Neurology Franchise HeadEmail:info@spherixglobalinsights.comwww.spherixglobalinsights.com

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Neurology – Children’s Health

Samu bravely manages seizures and reaches for the stars

In February 2017, Kata heard a strange sound on her monitor in the middle of the night. It sounded as if one of her children were drowning in their beds. She immediately went upstairs to check on her kids and saw that something was wrong with her son, Samu, then 7 years old.

Bella is the modern version of a Renaissance (wo)man. She's a high school junior who excels in academics and manages the school wrestling team. She has a close-knit group of friends and family, was recently promoted at her job and is a talented vocalist who is teaching herself to play guitar. She is also in the midst of a life-changing search for answers as she manages a chronic illness that has knocked her down several times in her life but Bella refuses to give up.

In December 2010, 4-year-old Aleah and her family were visiting her grandparents in Washington for the holidays when she started to feel sick. Aleah was lethargic, but her parents, Renee and Nathan, assumed she was just worn out from all the travel and festivities. But the next day, December 23rd, Aleah began having difficulties walking and was losing control of her other extremities.

Before starting kindergarten in August 2018, Molly spent the summer traveling with her family, swimming, spending time in the country with her grandparents and playing dress-up with her big sister. She loves her big sister, ice cream and dogs. Seeing her, you would never guess that her earliest days were spent at Children's Medical Center Dallas.

In the summer of 2015, Colin and his family were walking on a beach in Maine at the end of a college-tour-turned-family-vacation. Colin had just finished his junior year of high school and was preparing to pursue an education in circus performance, building upon his longtime passion for juggling.

A 10-year-old football fan from Lake Dallas and a 5-year-old farm boy from Oklahoma have matching scars and are the best of friends. "The boys relate to each other on a different level," says Shanna, Payton's mom.

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Neurology - Children's Health

Why Didnt She Get Alzheimers? The Answer Could Hold a Key to Fighting the Disease – The New York Times

The womans genetic profile showed she would develop Alzheimers by the time she turned 50.

A member of the worlds largest family to suffer from Alzheimers, she, like generations of her relatives, was born with a gene mutation that causes people to begin having memory and thinking problems in their 40s and deteriorate rapidly toward death around age 60.

But remarkably, she experienced no cognitive decline at all until her 70s, nearly three decades later than expected.

How did that happen? New research provides an answer, one that experts say could change the scientific understanding of Alzheimers disease and inspire new ideas about how to prevent and treat it.

In a study published Monday in the journal Nature Medicine, researchers say the woman, whose name they withheld to protect her privacy, has another mutation that has protected her from dementia even though her brain has developed a major neurological feature of Alzheimers disease.

This ultra rare mutation appears to help stave off the disease by minimizing the binding of a particular sugar compound to an important gene. That finding suggests that treatments could be developed to give other people that same protective mechanism.

Im very excited to see this new study come out the impact is dramatic, said Dr. Yadong Huang, a senior investigator at Gladstone Institutes, who was not involved in the research. For both research and therapeutic development, this new finding is very important.

A drug or gene therapy would not be available any time soon because scientists first need to replicate the protective mechanism found in this one patient by testing it in laboratory animals and human brain cells.

Still, this case comes at a time when the Alzheimers field is craving new approaches after billions of dollars has been spent on developing and testing treatments and some 200 drug trials have failed. It has been more than 15 years since the last treatment for dementia was approved, and the few drugs available do not work very well for very long.

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The woman is entering her late 70s now and lives in Medelln, the epicenter for an extended Colombian family of about 6,000 people whose members have been plagued with dementia for centuries, a condition they called La Bobera - the foolishness - and attributed to superstitious causes.

Decades ago, a Colombian neurologist, Dr. Francisco Lopera, began painstakingly collecting the familys birth and death records in Medelln and remote Andes mountain villages. He documented the sprawling family tree and took dangerous risks in guerrilla and drug-trafficking territory to cajole relatives of people who died with dementia into giving him their brains for analysis.

Through this work, Dr. Lopera, whose brain bank at the University of Antioquia now contains 300 brains, helped discover that their Alzheimers was caused by a mutation on a gene called Presenilin 1.

While this type of hereditary early-onset dementia accounts for only a small proportion of the roughly 30 million people worldwide with Alzheimers, it is important because unlike most forms of Alzheimers, the Colombian version has been traced to a specific cause and a consistent pattern. So Dr. Lopera and a team of American scientists have spent years studying the family, searching for answers both to help the Colombians and to address the mounting epidemic of the more typical old-age Alzheimers disease.

When they found that the woman had the Presenilin 1 mutation, but had not yet even developed a pre-Alzheimers condition called mild cognitive impairment, the scientists were mystified.

We have a single person who is resilient to Alzheimers disease when she should be at high risk, said Dr. Eric Reiman, executive director of the Banner Alzheimers Institute in Phoenix and a leader of the research team.

The woman was flown to Boston, where some of the researchers are based, for brain scans and other tests. Those results were puzzling, said Yakeel Quiroz, a Colombian neuropsychologist who directs the familial dementia neuroimaging lab at Massachusetts General Hospital.

The womans brain was laden with the foremost hallmark of Alzheimers: plaques of amyloid protein.

The highest levels of amyloid that we have seen so far, said Dr. Quiroz, adding that the excessive amyloid probably accumulated because the woman has lived much longer than other family members with the Alzheimers-causing mutation.

But the woman had few other neurological signs of the disease not much of a protein called tau, which forms tangles in Alzheimers brains, and little neurodegeneration or brain atrophy.

Her brain was functioning really well, said Dr. Quiroz, who, like Dr. Reiman, is a senior author of the study. Compared to people who are 45 or 50, shes actually better.

She said the woman, who raised four children, had only one year of formal education and could barely read or write, so it was unlikely her cognitive protection came from educational stimulation.

She has a secret in her biology, Dr. Lopera said. This case is a big window to discover new approaches.

Dr. Quiroz consulted Dr. Joseph Arboleda-Velasquez, who, like her, is an assistant professor at Harvard Medical School (he is also Dr. Quirozs husband). Dr. Arboleda-Velasquez, a cell biologist at Massachusetts Eye and Ear, conducted extensive genetic testing and sequencing, determining that the woman has an extremely rare mutation on a gene called APOE.

APOE is important in general-population Alzheimers. One variant, APOE4, present in about 14 percent of people, greatly increases risk and is present in 40 percent of people with Alzheimers. People with another variant, APOE2, occurring in about 7 percent of the population, are less likely to develop Alzheimers, while those with the most common variant, APOE3, are in the middle.

The Colombian woman has two copies of APOE3, but both copies have a mutation called Christchurch (for the New Zealand city where it was discovered). The Christchurch mutation is extremely rare, but several years ago, Dr. Reimans daughter Rebecca, a technologist, helped determine that a handful of Colombian family members have that mutation on one of their APOE genes. They developed Alzheimers as early as their relatives, though unlike the woman with mutations on both APOE genes.

The fact that she had two copies, not just one, really kind of sealed the deal, Dr. Arboleda-Velasquez said.

The womans mutation is in an area of the APOE gene that binds with a sugar-protein compound called heparan sulfate proteoglycans (HSPG), which is involved in spreading tau in Alzheimers disease.

In laboratory experiments, the researchers found that the less a variant of APOE binds to HSPG, the less it is linked to Alzheimers. With the Christchurch mutation, there was barely any binding.

That, said Dr. Arboleda-Velasquez, was the piece that completed the puzzle because, Oh, this is how the mutation has such a strong effect.

Researchers were also able to develop a compound that, in laboratory dish experiments, mimicked the action of the mutation, suggesting its possible to make drugs that prevent APOE from binding to HSPG.

Dr. Guojun Bu, who studies APOE, said that while the findings involved a single case and more research is needed, the implications could be profound.

When you have delayed onset of Alzheimers by three decades, you say wow, said Dr. Bu, chairman of the neuroscience department at the Mayo Clinic in Jacksonville, Fla., who was not involved in the study.

He said the research suggests that instead of drugs attacking amyloid or tau, which have failed in many clinical trials, a medication or gene therapy targeting APOE could be promising.

Dr. Reiman, who led another newly published study showing that APOE has a bigger effect on a persons risk of getting Alzheimers than previously thought, said potential treatments could try to reduce or even silence APOE activity in the brain. People born without APOE appear to have no cognitive problems, but they do have very high cholesterol that requires treatment.

Dr. Huang, who wrote a commentary about the study and is affiliated with two companies focusing on potential APOE-related treatments, said the findings also challenge a leading Alzheimers theory about the role of amyloid.

Since the woman had huge amounts of amyloid but few other Alzheimers indicators, it actually illustrates, to my knowledge for the first time, a very clear dissociation of amyloid accumulation from tau pathology, neurodegeneration and even cognitive decline, he said.

Dr. Lopera said the woman is just beginning to develop dementia, and he recently disclosed her genetic profile to her four adult children, who each have only one copy of the Christchurch mutation.

The researchers are also evaluating a few other members of the Colombian family, who appear to also have some resistance to Alzheimers. They are not as old as the woman, and they do not have the Christchurch mutation, but the team hopes to find other genetic factors from studying them and examine whether those factors operate along the same or different biological pathways, Dr. Reiman said.

Weve learned that at least one individual can live for very long having the cause of Alzheimers, and shes resistant to it, Dr. Arboleda-Velasquez said. What this patient is teaching is there could be a pathway for correcting the disease.

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Why Didnt She Get Alzheimers? The Answer Could Hold a Key to Fighting the Disease - The New York Times

Police meet Department of Health chiefs over Dr Watt neurology scandal – The Irish News

POLICE have confirmed they met with Department of Health officials to discuss the neurology recall scandal.

Around 3,000 patients of consultant Dr Michael Watt were recalled in May last year after safety concerns were raised about his work.

Earlier this week, BBC's Spotlight programme claimed that a procedure known as an epidural blood patch was carried out on many of former patients who didn't require it.

Last week The Irish News reported that than than 600 patients caught up in the recall were given an unreliable diagnosis or received the wrong drug treatment.

It also emerged that uncertainty exists around a further 300 cases, who "may" have been given inappropriate care or an incorrect diagnosis.

The figures are detailed in an 'outcomes' report, which was due to be published by the department in June but was cancelled due to "unforeseen circumstances".

Read More:30 per cent of Dr Watt recall patients may have received unreliable diagnosis or drugs

In a statement, the PSNI said: "We are aware of the recall of neurology patients by the Belfast Health and Social Care Trust and have met with senior officials within the Department of Health to discuss the issue.

"The department has agreed to provide us with further information so that we can assess how best to move forward and to enable us to determine if any potential criminal offences can be identified."

Dr Watt remains suspended from his employer, the Belfast health trust, but applied to retire on medical grounds in August. He remains on full pay.

Read More:Belfast health trust boss issues first letter of apology to Dr Watt patients

Last June, The Irish News revealed that the consultant neurologist did not receive an annual appraisal by his medical bosses in the trust for two years prior to a whistleblower raising the alarm.

Appraisals for his work in 2014, 2015 and 2016 did not take place - but these were instead "completed" in late 2017, five months after he was stopped from seeing his patients.

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Police meet Department of Health chiefs over Dr Watt neurology scandal - The Irish News

Explore the Neurological Biomarkers Market analysis and forecast to 2025 – WhaTech Technology and Markets News

Neurological Biomarkers Market Outlook and Global Insights 2019-2025. It provides the market report in overview with growth analysis, market status, future trends, current market trends, opportunities, and challenges

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The report offers detailed coverage of Neurological Biomarkers industry and main market trends. The market research includes historical and forecast market data, demand, application details, price trends, and company shares of the leading Neurological Biomarkers by geography.

The report splits the market size, by volume and value, on the basis of application type and geography.

At the same time, we classify Neurological Biomarkers according to the type, application by geography. More importantly, the report includes major countries market based on the type and application.

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Market by Type- Proteomics- Genomics- Imaging- Bioinformatics- Others

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This report presents the worldwide Neurological Biomarkers Market size (value, production and consumption), splits the breakdown (data status 2015-2020 and forecast to 2025), by manufacturers, region, type and application. This study also analyzes the market status, market share, growth rate, future trends, market drivers, opportunities and challenges, risks and entry barriers, sales channels, distributors and Porters Five Forces Analysis.

Major Points from Table of Contents

Table Type of Neurological BiomarkersTable Application of Neurological BiomarkersTable Region of Neurological BiomarkersTable Global Neurological Biomarkers Market by Region, 2015-2019 (Million USD)Table Global Neurological Biomarkers Market by Region, 2015-2019 (Volume)Table Price List by Region, 2015-2019Table Global Neurological Biomarkers Market by Company, 2015-2019 (Million USD)Table Global Neurological Biomarkers Market by Company, 2015-2019 (Volume)Table Price List by Company, 2015-2019Table Global Neurological Biomarkers Market by Type, 2015-2019 (Million USD)Table Global Neurological Biomarkers Market by Type, 2015-2019 (Volume)Table Price List by Type, 2015-2019Table Global Neurological Biomarkers Market by Application, 2015-2019 (Million USD)Table Global Neurological Biomarkers Market by Application, 2015-2019 (Volume)Table Price List by Application, 2015-2019Table Asia-Pacific Neurological Biomarkers Market by Company, 2015-2019 (Million USD)Table Asia-Pacific Neurological Biomarkers Market by Company, 2015-2019 (Volume)Table Price List by Company, 2015-2019Table Asia-Pacific Neurological Biomarkers Market by Type, 2015-2019 (Million USD)Table Asia-Pacific Neurological Biomarkers Market by Type, 2015-2019 (Volume)Table Price List by Type, 2015-2019Table Asia-Pacific Neurological Biomarkers Market by Application, 2015-2019 (Million USD)Table Asia-Pacific Neurological Biomarkers Market by Application, 2015-2019 (Volume)Table Price List by Application, 2015-2019Table China Neurological Biomarkers Market by Type, 2015-2019 (Million USD)Table China Neurological Biomarkers Market by Type, 2015-2019 (Volume)Table Price List by Type, 2015-2019Table China Neurological Biomarkers Market by Application, 2015-2019 (Million USD)Table China Neurological Biomarkers Market by Application, 2015-2019 (Volume)Table Price List by Application, 2015-2019Table Southeast Asia Neurological Biomarkers Market by Type, 2015-2019 (Million USD)Table Southeast Asia Neurological Biomarkers Market by Type, 2015-2019 (Volume)Table Price List by Type, 2015-2019Table Southeast Asia Neurological Biomarkers Market by Application, 2015-2019 (Million USD)Table Southeast Asia Neurological Biomarkers Market by Application, 2015-2019 (Volume)Table Price List by Application, 2015-2019Table India Neurological Biomarkers Market by Type, 2015-2019 (Million USD)Table India Neurological Biomarkers Market by Type, 2015-2019 (Volume)Table Price List by Type, 2015-2019Table India Neurological Biomarkers Market by Application, 2015-2019 (Million USD)Table India Neurological Biomarkers Market by Application, 2015-2019 (Volume)Table Price List by Application, 2015-2019Table Japan Neurological Biomarkers Market by Type, 2015-2019 (Million USD)Table Japan Neurological Biomarkers Market by Type, 2015-2019 (Volume)Table Price List by Type, 2015-2019Table Japan Neurological Biomarkers Market by Application, 2015-2019 (Million USD)Table Japan Neurological Biomarkers Market by Application, 2015-2019 (Volume)Table Price List by Application, 2015-2019Table Korea Neurological Biomarkers Market by Type, 2015-2019 (Million USD)Table Korea Neurological Biomarkers Market by Type, 2015-2019 (Volume)Table Price List by Type, 2015-2019Table Korea Neurological Biomarkers Market by Application, 2015-2019 (Million USD)Table Korea Neurological Biomarkers Market by Application, 2015-2019 (Volume)Table Price List by Application, 2015-2019Table Oceania Neurological Biomarkers Market by Type, 2015-2019 (Million USD)Table Oceania Neurological Biomarkers Market by Type, 2015-2019 (Volume)

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Neurology | Hendricks Regional Health

Serviceid = 28CareworksPageId= 26

The neurodiagnostic services offered at Hendricks Regional Health assist physicians in diagnosing and treating neurological disorders and diseases.

Neurologists are medical specialists that focus on diagnosing and treating disorders of the nervous system. Some of the common conditions they treat include headaches or migraines, stroke, dementia, epilepsy, muscular dystrophy and Parkinson's disease. They help manage chronic pain, as well as carpal tunnel syndrome and sleep disorders.

Your physician may order an electroencephalogram (EEG) to record electrical activity of the brain, a brainstem auditory evoked response (BAER) study to evaluate how the brainstem responds to specific sounds, or other tests, such as PET/CT imaging. Other common tests ordered are a transcranial doppler (TCD), electronystagmograms (ENG) and 24-hour ambulatory electrocardiogram.

Your primary care or family doctor may refer you to a neurologist for evaluation if you are experiencing symptoms such as memory loss, tingling or weakness in your arms or legs, frequent headaches that do not respond to recommended treatments, and other concerns.

Hendricks Regional Health Medical Group includes neurologists who can work with your primary doctor to help you manage your health.

Hendricks Regional Health includes a multi-specialty hospital in Danville, Indiana with services in neurodiagnostic testing and treatment of neurological disorders and diseases.

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Neurology | Hendricks Regional Health

Predicting Amyloid Accumulation in Patients With Objective Subtle Cognitive Difficulties – Neurology Advisor

The presence of objective subtle cognitive difficulties (Obj-SCD) on neuropsychological measures may predict faster amyloid accumulation and neurogenerative changes prior to mild cognitive impairment (MCI), according to study results published in Neurology.

Previously, the researchers showed an association between Obj-SCD with cerebrospinal fluid Alzheimer disease markers and reported that Obj-SCD was associated with faster progression to MCI and dementia compared with patients with normal cognitive function. The goal of the study was to assess whether Obj-SCD predicts future amyloid accumulation and medical temporal lobe neurodegeneration.

The study was based on data from the Alzheimers Disease Neuroimaging Initiative (ADNI) database. The study cohort included 747 older adults without dementia, including 305 patients with normal cognitive function, 153 with Obj-SCD, and 289 with MCI. All patients had baseline florbetapir amyloid PET imaging and underwent neuropsychological testing and structural magnetic resonance imaging examinations.

Cognitive group status was used to estimate changes in amyloid positron emission tomography over 48 months. Relative to patients with normal cognitive function, patients with Obj-SCD had a faster increase in amyloid PET standardized uptake value ratio (SUVR) (P =.010). There was no statistically significant difference in the rate of amyloid accumulation between patients with MCI and patients with normal cognitive function or Obj-SCD.

Cognitive group also predicted entorhinal cortex thinning and hippocampal volume loss in the same period. Compared with patients with normal cognitive function, patients with Obj-SCD (P =.003) and MCI (P <.001) had faster entorhinal cortex thinning over 48 months. Relative to patients with normal cognitive function, patients with MCI had a faster rate of hippocampal volume loss over 48 months (P <.001), but there was no statistically significant difference between patients with Obj-SCD and patients with normal cognitive function or MCI.

The researchers noted several study limitations, including a cohort that is highly educated, mostly white, and generally healthy. The relatively short period of follow-up is another possible limitation.

The investigators concluded that while the operational definition of Obj-SCD, which incorporates neuropsychological process scores, has previously predicted progression to MCI and Alzheimer disease, these findings also suggest that Obj-SCD is a sensitive and noninvasive predictor of future amyloid accumulation and early neurodegenerative changes, prior to frank cognitive impairment consistent with MCI.

Reference

Thomas KR, Bangen KJ, Weigand AJ, et al. Objective subtle cognitive difficulties predict future amyloid accumulation and neurodegeneration [published online December 30, 2019]. Neurology. doi:10.1212/WNL.0000000000008838

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Predicting Amyloid Accumulation in Patients With Objective Subtle Cognitive Difficulties - Neurology Advisor

The GutBrain Connection: – Thrive Global

What Is the GutBrain Axis?

Intestinal health is quickly becoming one of the most critical components in maintaining optimal well-being, including mental/emotional as well as physical. In recent years, it has become more common to refer to the gut as our second brain, meaning it can engage in neurological activity independently from the central nervous system. At any given moment, the brain and the gut are in complex, essential communication, giving rise to a two-way flow of information called the gutbrain axis.

The second brainin technical parlance, the enteric nervous system (ENS)controls the gastrointestinal (GI) system and is linked to the brain by millions of neurons. While our ENS is in constant contact with the central nervous system, it can also act independently, performing the important role of monitoring the entire digestive tract without direct supervision from the brain.

The ENS is made up of two thin layers with more than 100 million neurons in themmore than the spinal cord. These cells line the gastrointestinal tract, controlling blood flow and secretions to help the GI tract digest food. They also help us feel whats happening inside the gut, since this second brain is behind the mechanics of food digestion.

While the second brain doesnt get involved in thought processes like political debates or theological reflection, it does control behavior on its own. Researchers believe this came about to make digestion more efficient in the body; instead of having to direct digestion through the spinal cord and into the brain and back, we developed an on-site brain that could handle things closer to the source.

The gut and brain are also connected through chemicals called neurotransmitters. Those produced in the brain control feelings and emotions. The best known of these is serotonin, which contributes to feelings of well-being. Another very important one is gamma-aminobutyric acid (GABA), which helps control feelings of fear and anxiety and helps with sleep regulation. A large proportion of serotonin, GABA, and other neurotransmitters are produced by gut cells and the trillions of microbes living in the GI tract.

It used to be thought that neurological disorders such as depression and anxiety trigger autoimmune conditions such as irritable bowel syndrome or other digestive-related issues. However, the opposite is likely truein other words, dysfunction in the gut may in fact cause changes in mood and behavior, triggered by the enteric nervous system. An estimated 30 to 40 percent of the population suffers from digestive-related illness, which helps explain why a higher-than-normal percentage of people with a compromised gut suffer from mood-related challenges such as depression and anxiety.

As our understanding of the gutbrain axis deepens, we are gaining a better appreciation for why taking good care of our gastrointestinal health can lead to significant improvements in our mental and emotional well-being.

What Can Disrupt the GutBrain Connection?

Stress has very deleterious effects on health, including the gutbrain axis. Our bodys immediate reaction to stress, whether physical or mental, is to release the hormone adrenaline and other stress hormones to help us survive. For instance, if youre hiking and encounter a mountain lion, your body goes into survival mode. Your heart beats faster, your eyes widen, and even your blood platelets become sticky in case the dangerous encounter leaves you bleeding; your blood will clot more quickly. Once the stressful situation is over, your body stands down from the fight-or-flight response and returns to normal.

This is perfectly healthy. The problem arises when youre living in a chronic state of stressworking in a stressful environment, for example. Since your body cannot differentiate between a physical stressor, like being pursued by a mountain lion, versus a mental stressor, like an unpleasant job, it reacts the same way and keeps on reacting. The prolonged presence of adrenaline and other stress-related hormones generates inflammation throughout your body.

Inflammation is the immune systems natural response to toxins, infection, and stress. If inflammation is experienced over a prolonged period of time, the immune system weakens, leading to neurodegenerative diseases such as Alzheimers and Parkinsons, as well as neurological disorders such as ADHD, autism, anxiety, and depression. Roughly 80 percent of the immune system is located in the gut, which makes gut health a primary concern to achieve optimal health.

Environmental toxins are substances that work in direct opposition to natural healing and can have a very negative effect on the gutbrain connection; they are numerous and include lead, mercury, cadmium, and arsenic. Environmental toxins can create a negative and potentially life-altering pattern in the brain and body (the brainbody) or worsen a negative pattern. They tell your brain to stop healing the body, and they can make you jittery and reactive.

We carry these toxins in our fat tissues and release them with fat loss. Most of us also carry the most common environmental toxins in our bones, and every daythrough our diet, the water we drink, the products we usewe take in a little more. Around age thirty-five, as bone buildup slows down and bone breakdown begins, the body slowly releases these substances into the bloodstream. The brainbody can become a little more poisoned each day from this internal storehouse of toxic substances, as well as new exposures, including in the food we eatespecially foods with pesticides, herbicides, genetically engineered ingredients, and hormonesthe water we drink, the products we use, and the air we breathe.

Glyphosate is a weapon of mass destruction in our food supply that is ruining the gutbrain connection. It disrupts the integrity of the gut barrier and may then disrupt the integrity of the bloodbrain barrier, leading to inflammation. Glyphosate is associated with increased anxiety, attention deficit, depression, weight gain, cancer, memory impairment, and other brainbody problems. Its residues are commonly found in GMO foods and conventional wine.

The Role of Microbes in the GutBrain Axis

Gut health is determined by the collection of bacteria that resides in the GI tract, commonly referred to as the microbiome. The key to optimal gut health is maintaining a healthy diversity and balance of good and bad bacteria in the microbiome.

The microbiome plays a crucial role in the immune system and in brain function. The overgrowth of bad bacteria can cause many complications, such as dysbiosis (microbial imbalance) and bacterial overgrowth in the gut. These eventually lead to more serious conditions, including inflammatory bowel diseases such as Crohns disease and ulcerative colitis, as well as neurological issues such as depression and anxiety.

The trillions of microbes in the gut make numerous chemicals that affect the brain. Certain gut bacteria make a compound called brain-derived neurotropic factor, which helps the brain stay young and build new pathways. A healthy brain requires the right level of hormones to stay sharp, and the right neurotransmitters to focus, and the microbiome makes vital contributions in both respects. Gut microbes also produce abundant short-chain fatty acids (SCFAs), such as butyrate, propionate, and acetate, by digesting fiber. SCFAs affect brain function in a number of ways, such as by reducing appetite. Finally, gut microbes metabolize bile acids and amino acids to produce other chemicals that affect the brain.

As such a large proportion of the immune system is located in the gut, the microbiome plays a key role in that systems functioning by controlling what is passed into the body and what is excreted. When the microbiome isnt healthy, inflammation results, which is associated with a number of brain disorders, including depression, anxiety, Alzheimers, dementia, and schizophrenia.

Clearly, if we want to repair breakdowns in the gutbrain axis, we need to focus on the microbiome. There is now extensive research being executed to explore how the microbiome can be utilized to fight illness and disease.

Ways to Repair the GutBrain Connection

Probioticsare supplements containing specific strains of bacteria that contribute to maintaining a healthy microbiome in the gut. Studies show that taking probiotics can reduce feelings of depression and anxiety and improved overall well-being.

A recent study looked at how the gut and brain are connected by examining the effects of probiotics on patients with irritable bowel syndrome and depression. The researchers found that twice as many patients saw improvements from depression when they took the probiotic Bifidobacterium longum NCC3001 daily compared with patients who took a placebo. Studies in laboratory mice have shown that certain probiotics can increase the production of GABA and reduce anxiety and depression-like behavior.

Fermented foods contain various species of Lactobacillus and Bifidobacterium bacteria that can contribute positively to the microbiome. Examples include sauerkraut, kimchi, and kefir.

The good bacteria in the guts microbiome require appropriate food materials, and these are known asprebiotics. The best sources for prebiotics are: asparagus, bananas, carrots, chicory root, coconut meat & flour, dandelion greens, flax and chia seeds, garlic, Jerusalem artichoke, jicama, leeks, onions, radishes, tomatoes, yams.

Bone broth is one of the most healing and nourishing foods for the gut. It aids in reducing inflammation and helps provide the gut with the necessary nutrients for healing. Bone broth also contains collagen and cartilage, two proteins that help rebuild the gut lining, as well as glycine, proline, and l-glutamineamino acids that are essential for repairing and rebuilding the body. L-glutamine promotes digestive health, brain function, and muscle integrity. It is an important nutrient in relation to the gut, because it helps repair and rebuild intestines and strengthen the gut lining.

You can also use your beliefs along with the basics of neuroscience to improve spiritual neuroplasticity and build a better, healthier brain-body connection. Something as simple as awalking meditation on a daily basis can lead to important changes. A daily practice can increase blood flow to the brain, grow the grey matter and create a connection to something greater. This has measurable effects on the brain that improve brain-body physiology and provide a shield against the normal stress of daily life.

Although the brain represents only 23 percent of the bodys total weight, it consumes 25 percent of the bodys glucose supply and 20 percent of its oxygen and cardiac output. The brain is the single biggest consumer of what we put into our bodies, yet most of us dont consider our brains when making food choices, focusing instead on calories. We rarely think of how our brain is going to benefit or suffer from our food choices.

In reality, the food you consume has the potential to help or hurt your gut first, then your brain, and finally the rest of your body. Food is information not only for the DNA of your cells but also for the DNA of the microbes in your gut. The food on your fork determines your gene expression, hormone levels, immune activityeven the stress levels in your gut, your brain, and the rest of your body. A change in the food you eat rapidly alters the activity of the gut microbiotatypically within one to four days, and in some cases, within just six hours.

A healthy brainbody connection exists when your brain and your body are fully in sync and congruent in their mission and goals. Healing conversations are occurring. Your gut is having a healing conversation with your brain, and your heart is telling your brains overactive stress-response system that it can calm down. In short, having a healthy brainbody connection means that you dont have the high levels of inflammation that cause brainbody breakdown.

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The GutBrain Connection: - Thrive Global

New study uncovers the neurology behind how kind and generous you are – Ladders

Virtually every society rests its principles on the basic constructs of good and evil. The tendency presumes that one denotes the absence of the other when the reality actually exists in a clinical gray area.

As concluded by a pioneering new paper published in the February edition ofNature Neuroscience, human ecology is informed by physiological signatures. When the amygdala and the medial prefrontal cortex fail to communicate in sync, instances of anti-social behavior increases.

Social behaviors recruit multiple cognitive operations that require interactions between cortical and subcortical brain regions. Interareal synchrony may facilitate such interactions between cortical and subcortical neural populations, the authors write. These findings suggest that specialized coordination in the medial prefrontalamygdala network underlies social-decision preferences.

The new study was co-authored byOlga Dal Monte,Cheng C. J. Chu,Nicholas A. FaganandSteve W. C. Chang ofYale Universitys department of psychology.

This neurological correlation observed by Dal Monte and her team not only determined the presence of prosocial and antisocial traits, but it also allowed the experts to gauge the extent to which they were present.

The first leg of the research employed non-human primate models. Monkeys were encouraged to choose between sharing fruit juice with another monkey and keeping the sample for themselves over the course of multiple trials. During each scenario, the psychologists would monitor neural activity.

In every trial, a monkeys decision to act benevolently was preluded by the basolateral amygdala and the rostral anterior cingulate gyrus region of their medial prefrontal cortex expressing high synchronization. The exact inverse was evident when the subjects decided to act selfishly.

By merely analyzing the degree of neural suppression andsynchronicitythe authors were able to reliably predict which outcome each primate was about to realize.

We found aunique signature of neural synchrony that reflects whether a prosocial or an antisocial decision was made, senior authorChang, who is an assistant professor of psychology and neuroscience at Yale, said in anews release. We all know there are individual differences in levels ofgenerosity. Maybe Scrooge did not havehigh levels of synchronyafter all.

While lesser primates may not evidence as many genetic similarities to us as the great apes, the researchers suspect their finds to be translatable to human subjects saying nothing of the previously published literature bridging the gap between aggression and neurological deficiencies.

Not unlike the thesis recently motioned by the journal Scientific Reportsback in January the core elements of empathetic behaviors are authored by biological predispositions as opposed to someconditioned moral avatar.

Synchronization between the two nodes was enhanced for a positive other-regarding preference but suppressed for a negative ORP, the authors write. These interactions occurred in beta and gamma frequency bands depending on the area contributing the spikes, exhibited a specific directionality of information flow associated with a positive ORP and could be used to decode social decisions.

The new study, published on February 24th, 2020, is titled Specialized Medial PrefrontalAmygdala Coordination in Other-Regarding Decision Preference.

The report can be read in full in the Journal of Nature Neuroscience.

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New study uncovers the neurology behind how kind and generous you are - Ladders

Statin Therapy and Cognitive Function in Elderly Patients – Neurology Advisor

Treatment with statins in the elderly population is not associated with accelerated memory dysfunction, greater decline in global cognitive function, or brain volume changes over 2 years, according to study results published in The Journal of the American College of Cardiology.

While many guidelines recommend statin treatment to prevent cardiovascular and cerebrovascular morbidity and mortality, there are consumer concerns regarding the possible effect of this treatment on cognitive function, because memory and/or cognitive changes are the second most common reported adverse event with statins.

The goal of the study, the Sydney Memory and Ageing Study (MAS), was to investigate the changes in memory and global cognition associated with statin therapy over 6 years and changes in brain volume over 2 years.

The MAS was a longitudinal, prospective, observational, population-derived cohort of non-demented Australians aged 70 to 90 years at baseline. Data were collected every 2 years over a 6-year period.

The study cohort included 1037 patients: 395 were statin nave and 642 had ever used statins. The mean duration of statin use at baseline was 9.1 years. At baseline, patients who had reported ever using statins were slightly younger, had higher body mass index, and had lower diastolic blood pressure than did never users. Over the observation period, 68% of patients who had used statin were continuous users.

The primary outcome measures included 2 end points: memory and global cognition, as assessed by neuropsychologic testing every 2 years. In a subgroup of 526 patients, magnetic resonance imaging was used to assess changes in total brain, hippocampal, and parahippocampal volume.

Over 6 years of observation, there was no significant difference in the rate of decline in memory and global function between patients who had ever used statins and patients who had never used statins. The trend was similar between continuous statin users and never users. Furthermore, there was no difference in rates of decline in memory and global cognition over 6 years between each statin subgroup (atorvastatin, simvastatin, and pravastatin) and the group of patients who never used statins.

Statin initiation was not associated with a change in global cognition performance or rate of decline, but was associated with an attenuation in the rate of decline of memory (P =.038).

Analyses to examine the possibility that statins may unmask memory difficulties in patients predisposed to cognitive impairment revealed no interaction between statins, risk factors for dementia, and changes over 6 years in memory and global cognition.

The researchers noted protective associations were found for some aspects of memory testing. Exploratory analyses of specific memory tests revealed a significant interaction between statin ever use and heart disease on decline in total learning. There was also evidence that supported apolipoprotein E4 carriage and slower decline in long-delayed recall in men who reported statin use compared with men who never used statins.

No difference in brain volume changes was found between statin users and never users.

The researchers acknowledged several study limitations, including its observational design, potential selection bias and survivor bias, as well as baseline differences between the groups for dementia risk factors. In addition, patients with advanced cognitive impairment were excluded from the study.

This study offers reassurance to consumers who hold concerns about harmful statin effects on memory and cognition, concluded the researchers.

Reference

Samaras K, Makkar SR, Crawford JD, et al. Effects of statins on memory, cognition, and brain volume in the elderly. J Am Coll Cardiol. 2019;74(21):2554-2568. doi:10.1016/j.jacc.2019.09.041

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Statin Therapy and Cognitive Function in Elderly Patients - Neurology Advisor

Antioxidant in Fruits, Vegetables, Tea Linked to Lower Risk of Alzheimer’s – PsychCentral.com

A new study has found that people who eat more foods with the antioxidant flavonol, which is found in nearly all fruits and vegetables, as well as tea, may be less likely to develop Alzheimers years later.

Flavonols are a type of flavonoid, a group of phytochemicals found in plant pigments known for its beneficial effects on health, researchers explained.

More research is needed to confirm these results, but these are promising findings, said study author Thomas M. Holland, M.D., of Rush University in Chicago. Eating more fruits and vegetables and drinking more tea could be a fairly inexpensive and easy way for people to help stave off Alzheimers dementia.

With the elderly population increasing worldwide, any decrease in the number of people with this devastating disease, or even delaying it for a few years, could have an enormous benefit on public health.

The study included 921 people with an average age of 81 who did not have Alzheimers dementia. They filled out a questionnaire each year on how often they ate certain foods. They were also asked about other factors, such as their level of education, how much time they spent doing physical activities, and how much time they spent doing mentally engaging activities, such as reading and playing games.

The group was followed for an average of six years, with yearly tests to see if they had developed Alzheimers dementia.

The researchers reported they used various tests to determine that 220 people developed Alzheimers dementia during the study.

The researchers found that the average amount of flavonol intake in U.S. adults is about 16 to 20 milligrams per day. In the study, people in the lowest group had an intake of about 5.3 mg per day, while the highest group consumed an average of 15.3 mg per day.

The studys findings showed that people who consumed the highest amount of flavonols were 48 percent less likely to later develop Alzheimers dementia than the people in the lowest group, after adjusting for genetic predisposition and demographic and lifestyle factors.

Of the 186 people in the highest group, 28 people, or 15 percent, developed Alzheimers dementia, compared to 54 people, or 30 percent, of the 182 people in the lowest group, according to the researchers.

The results were the same after researchers adjusted for other factors that could affect the risk of Alzheimers, such as diabetes, previous heart attack, stroke, and high blood pressure.

The study also broke the flavonols down into four types: isorhamnetin, kaempferol, myricetin and quercetin. The top food contributors for each category were: Pears, olive oil, wine, and tomato sauce for isorhamnetin; kale, beans, tea, spinach, and broccoli for kaempferol; tea, wine, kale, oranges, and tomatoes for myricetin; and tomatoes, kale, apples, and tea for quercetin.

According to the researchers, people who had a high intake of isorhamnetin were 38 percent less likely to develop Alzheimers, as well as those with a high intake of myricetin. Those with a high intake of kaempferol were 51 percent less likely to develop dementia. However, quercetin was not tied to a lower risk of Alzheimers dementia.

Holland noted that the study shows an association between dietary flavonols and Alzheimers risk, but does not prove that flavonols directly cause a reduction in disease risk.

Other limitations of the study are that the food frequency questionnaire, although valid, was self-reported, so people may not accurately remember what they eat. The majority of participants in the study were white people, so the results may not reflect the general population, the researcher added.

The study was published in Neurology, the medical journal of the American Academy of Neurology.

Source: The American Academy of Neurology

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Antioxidant in Fruits, Vegetables, Tea Linked to Lower Risk of Alzheimer's - PsychCentral.com

For APPs, Now There Are More Training Opportunities in… : Neurology Today – LWW Journals

Article In Brief

With the right training, advanced practice providers (APPs) can obtain the knowledge needed to be effective team members in inpatient or outpatient neurology. APPs and neurologists discuss the opportunities for greater training and collaboration.

When they start their first job in neurology, advanced practice providers (APP) may not know how to perform the detailed examination needed to localize the neurological lesion and make a diagnosis. The nuances of headache, spine disorders, multiple sclerosis, and other common neurological conditions may be unfamiliar to them, let alone the treatment options and how to create a specific neurology treatment plan.

Their graduate education trains them well to be generalists in medicine, several physician assistants (PAs) and nurse practitioners (NPs) told Neurology Today in interviews, but that does not necessarily include a focus on neurology.

With the right training, however, they can obtain the knowledge needed to be effective team members in the settinginpatient or outpatient, general neurology or subspecialtyin which they are working, said Robert D. Brown, Jr., MD, MPH, FAAN, chair of the Division of Stroke and Cerebrovascular Disease and professor of neurology at Mayo Clinic College of Medicine.

APP staff members are integral to the care of neurology patients, and that is increasingly the case at small and large neurology practices, he said.

But the right training is key. An AAN survey of APPs practicing in neurology completed in 2018 found that, during their formal APP schooling, 87 percent attended neurology lectures but only 30 percent had a neurology course and just 25 percent had a clinical rotation in neurology.

It's apparent that on-the-job training is essential, Dr. Brown said.

That is the basic approach used for most advanced APPsnurse practitioners and PAsworking in neurology. But every APP's training needs are different, said Jessica Erfan, MPAS, PA-C, APP manager at Ascension Seton. Their graduate education prepares them to be generalists, so their neurology-specific training is limited to what they learned in their previous work experiences.

I think some neurologists have trouble understanding the different backgrounds and that every advanced practice nurse is not the same, every PA is not [the] same, said Erfan, a PA at Seton Brain & Spine Institute in Austin, TX. That can make it difficult when a neurologist wants to hire an APP. They have to factor in the training time [in neurology] to make APPs successful so that ultimately they can become [productive] members of the practice.

That is why training in neurology is a critical need. This past October, the AAN stepped in to help address that need by sponsoring the Academy's first APP conferencea one-day education event that preceded the AAN Fall Conference in October. Approximately 175 PAs, NPs, and clinical nurse specialists attended the conferencefar surpassing the goal of 100 APPs, said Calli Cook, DNP, APRN, FNP-C, chair of the Academy's Consortium of Neurology APPs. Because of the participants' enthusiasm, a multi-day standalone conference for APPs will take place in 2020.

Most attendees at the initial event had been practicing in neurology for three years or less.

APPs who are practicing in neurology are really hungry for information and education, said Bryan Walker, PA-C, associate director for the APP residency program in neurology at Duke University School of Medicine. These are folks who are now coming into the specialty or have been in practice for just a little while they are figuring out what they know and what they need to know.

APPs make up the fastest-growing membership category for the AAN, said Cook, a NP at Emory Brain Health and co-director of the October pre-conference. As of last month, the consortium included more than 1,400 members, up from about 350 when Cook joined just four years ago.

That growth reflects the increasing role that APPs are playing in the delivery of neurological care in both private and academic practices. By working together to deliver team-based care, APPs and neurologists can shorten the waits for patients seeking appointments and make sure all patients get the high-quality care they need, she said.

I see a lot of my physician colleagues really embracing this concept, valuing the APP's role and understanding the positive effect it has on their practice and on their patient population, she said.

When fully trained, APPs and neurologists often work in teams, although there is no standard model for team-based care, Cook said. In some practices, the neurologist sees a patient in the first few visits to establish the diagnosis and create the treatment plan; the APP provides follow-up care, adjusting the treatment plan as needed; the patient is scheduled with the neurologist perhaps once a year or at another routine interval.

Another approach is for the APP to evaluate a patient on their first visit and order the appropriate tests needed for diagnosis. Armed with that information, the neurologist sees the patient on a second visit to establish the diagnosis and treatment plan. In another model, patients are scheduled so that both the neurologist and APP, operating in tag-team fashion, will see each patient during each visit, sharing responsibilities so that high-quality care is delivered in an efficient fashion.

All of these models can be successfulit depends on what works best for the culture that these two people are going to be practicing in together, Cook said.

But attracting APPs to neurology, equipping them with the clinical knowledge they need to succeed and retaining them in the specialty can be a challenge.

AAN President James C. Stevens, MD, FAAN, said neurology education to support APP careers is an essential component to overcoming that challenge.

The need is there, and I think it's our responsibility as an organization to meet these education needs and to show examples of how this team concept of neurologist and APP working together can be done in a successful manner, Dr. Stevens said.

The importance of APPs became clear to AAN leaders when its Workforce Task Force Report, published in 2013, revealed that demand for neurologic services exceeded the supply of neurologists and projected that the shortfall will increase substantially by 2025, Dr. Stevens said.

With too few neurology residency slots available to meet demand, the focus turned to another way to increase patients' access to care.

Many neurologists, who for decades have been utilizing advanced practice providers to help shorten waiting lists, found that it was very successful in doing so and could be done with excellent patient satisfaction concerning their care, Dr. Stevens said.

He was one of them. Since the 1990s, NPs and PAs have worked in his practice, learning their neurologic clinical skills by shadowing him for at least six months before seeing patients on their own.

On-the-job training is common for APPs working in neurology because graduate education programs for NPs and PAs typically provide little or no education specific to the specialty, said Walker, a PA at Duke Neurology.

PA programs are standardized because there is a single accrediting body nationally, he said. During the first year, students take didactic courses which will include, at most, four weeks of neurology content. During the second year, students do clinical rotations and while a neurology rotation may be an option, it is not required. NP programs vary in content because there are multiple accrediting bodies, he said. In general, neurology content is not included in the required curriculum.

In PA programs, neurology education is minimal; in NP programs, it's variable from none to minimal, he said. So we find that folks coming out of either PA school or NP school really have to rely on on-the-job training.

While that worked well for Walker and many APPs, that training model has its limits. For one thing, the variability of on-the-job training may worry inexperienced APPs, who know that neurology is a particularly complex field.

It's challenging, Erfan said. There are a lot of things you have to put together compared to other specialties.

And, unlike physicians, who are tied to the specialty in which they completed a residency, APPs are trained as generalists and can easily move to a different field if they are unsatisfied with their on-the-job training or other aspects of the work, she said.

The AAN wants to address that stickiness issue by increasing the likelihood that APPs working in neurology are pleased with their choice of specialty, Dr. Stevens said.

Many of our members have observed over the years that APPs have a tendency to rotate out of neurology and go to some other specialty or back to primary care, he said. We really want to create a home for them where they can get their academic needs met and be successful in a rewarding career.

Joel C. Morgenlander, MD, FAAN, chief of general and community neurology at Duke University School of Medicine, became interested in creating a formal one-year training program after seeing his fellow neurologists and APPs get frustrated with each other because of unrealistic expectations about what the APPs should be able to do.

An in-depth training program, he believed, would help APPs have greater job satisfactionand longer tenuresbecause they would be able to think like a neurologist.

The hope was that they would feel more comfortable and be a bigger part of the team, working on many aspects of what we do, including patient care, education and research, Dr. Morgenlander said. And that would give our faculty better job satisfaction because they would have valuable partners in practice that they can share patients with as a team.

That has proven to be the case, he said. Now in its fifth year, Duke's Neurology APP Residency program has trained two to three APPs in each class. The program works because our neurology faculty has bought into the concept and is a critical part of the APP resident education, he said.

The APP residents receive a salary but do not bill for any patients.

We see them and treat them as true residents because I felt that to do anything less was doing them a disservice, he said. To keep them in the learner mindset was really important to me.

The residents, who take an online neuroscience course before they join the program, do clinical rotations through the neurology subspecialties and attend the same lectures that neurology residents do. Because their training overlaps, APP and physician residents form relationships that make it easy for them to work together after their training programs end.

This, to me has been a great plus because these are the kind of teams that we need in the future to be successful, Dr. Morgenlander said.

Several APP residents have taken positions in Duke Neurology subspecialty clinics after completing the program. The Duke residency is one of only a handful of APP neurology post-graduate training programs in the country, each of which varies in content and training approach. Dr. Morgenlander is working to encourage other neurology departments at other academic medical centers to establish APP residencies of their own.

The Medical College of South Carolina (MUSC) takes a different approach in its one-year fellowship program for neurology APPs. That program, now in its second year, trains APPs to do outpatient general neurology, said Kimberly Robeson, MD, the program's faculty director.

The program was started to address two challenges: the difficulty of recruiting enough general neurologists to MUSC and the difficulty of onboarding APPs with no experience in neurology.

We don't necessarily have people who have the time to train them, she said.

Dr. Robeson, who also serves as associate program director for MUSC's neurology residency program, said the APP curriculum includes hands-on training and didactic learning. The APP fellows see new patients in mentored clinicsthe APP examines the patient alone, then with the attendingand sees follow-up patients on their own. They shadow APPs working in subspecialty clinics, attend lectures with neurology residents, and have two half-days a week dedicated for studying. Each APP in the first class received AAN membership as part of the fellowship, providing access to online education materials offered by the Academy.

The APP trainees in the MUSC program bill for patient visits, so the program pays for itself, she said.

Meanwhile, the AAN intends to provide increased short-term opportunities for APPs, starting with next year's conference. The standalone conference will be relevant for all APPs, whether they are new as a neurology APP or have been in practice for many years, Dr. Brown said.

Presentations will include neurology fundamentals, including localizing the lesion, anatomical and clinical correlations, and the basics of the neurologic history and exam. Attendees will learn also diagnostic fundamentals, including the appropriate use of neuroimaging studies, EMG, EEG, and other exams, as well as how to read test results and key findings that might be detected.

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Novel peripherally acting opioid eases pain in mice without related side effects – Duke Department of Neurology

A peripherally acting opioid with multifunctional agonistic properties has shown to provide peripheral pain relief in morphine-tolerant mice with minimal side effects associated with classic opioids. The drug could serve as a potential candidate for treating pain disorders in humans, according to a study in the August 2019 issue of the British Journal of Pharmacology.

Wolfgang B. Liedtke,MD, PhD, a Duke neurologist and pain medicine specialist, senior co-author and co-corresponding author of the study, explains that the subcutaneous dose of DN-9, a multifunctional agonist for opioid and neuropeptide FF receptors, produced potent antinociceptive effects via peripheral opioid receptors. The study was a collaboration between Duke University (including Liedtke and Yong Chen, PhD, from the Liedtke Lab in the Duke Department of Neurology) and a group of investigators at Lanzhou University and the Shanghai Jiao Tong University School of Medicine in China.

We are lookingperhaps more urgently than beforefor what could at least partially replace opioids, and this collaboration is a highly welcome opportunity to do so because the approach is based on peptides that naturally occur, Liedtke says. The ingenuity of the process is to engineer a new peptide out of two naturally occurring ones by fusing them together, tweaking the way the opioid is signaling in the organism and defusing the toxicity while still providing anti-pain effects.

Results from the study also indicated that the DN-9 administration via peripheral opioid receptors shows less antinociceptive tolerance, constipation, motor impairment, and reward/abuse liability compared with morphine.

The continuous development of this multifunctional opioid peptide has significantly added to the research in that the molecule is applied subcutaneously peripherally and has no apparent direct effects on microglial activation of the brain or spinal cord. Via peripheral site of action, this approach is similar to new self-injectable treatments for migraines, Liedtke says.

This novel peripherally acting opioid with multifunctional agonistic properties has significant potential for translational medical development in the near future, Liedtke says. This study is the result of a longer-term, dedicated effort, that is bearing fruition, and it indicates that this is a result of a research pipeline that could very well lead to the opioid 2.0 of the 21st century, he adds.

(This article originally appeared in Clinical Practice Today. Read it in its original context, or other CPT articles, here.)

While a future therapy for pain that relies only on non-opioids is desirable, Liedtke says that the opioid system should still be considered as an ally in the battle against chronic pain. Chronic pain is an epic, large-scale, high prevalence disorder that is unresolved for too many patients, so the mandate to come up with more safe and effective treatments also stems from that. We are moving forward toward new practical solutions.

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Brain Tumors l Neurology l University Hospitals l …

For any type of brain tumor, our neurological specialists at University Hospitals provide the expert diagnosis and specialized treatments you or a loved one may need. Brain tumors include a wide range of types of tumors and can be cancerous or non-cancerous. If a tumor originates in the brain, its called a primary brain tumor. If a tumor travels to the brain from another location, like the lungs, its called a metastatic brain tumor.

Regardless of the type of tumor, our multidisciplinary team at University Hospitals leads the way in offering our patients comprehensive care with the latest surgical and non-surgical interventions to stop tumor growth and maintain brain health.

For any suspected neurological issue, including potential brain tumors, it is important to see a neurological specialist as quickly as possible for an accurate diagnosis to begin treatment toward recovery. Brain tumor symptoms may easily be confused with less serious conditions, so you want to be sure of the diagnosis as soon as possible.

Our neurologists and neurosurgeons are integral members ofUH Seidman Cancer Centerfor comprehensive brain tumor care. We are available to see potential patients within 24 hours to conduct a full examination. During this visit, you will meet with several specialists who are experts in their fields, including:

Once we determine if you have a brain tumor and identify the specific type, our team will work together to develop a personalized treatment plan based on our latest research and innovative technology available.

Our nationally recognized cancer specialists offer a range of brain tumor treatment options when designing your personalized treatment plan:

University Hospitals has access to groundbreaking brain and nervous system specific clinical trials which offer new and emerging therapies. But rest assured that once a brain tumor treatment path is chosen, our team meets every week to share information about your specific case, discuss progress and collaborate on next steps. This lets us view your care from various clinical perspectives - which means you have the experience and expertise of an entire team working toward an optimal recovery.

Throughout the care experience, our patients have access to comprehensive UH services to help navigate the physical, emotional and financial consequences of a serious illness such as a brain tumor. Our neurology team closely partners with all of the clinical services and resources throughout the UH system to ensure we fully meet all your needs.

Some of our patients have been told that their brain tumor is inoperable. We offer a fresh look at the diagnosis and treatment plan. In many cases, we have found ways to help patients who thought they were out of options, extending their quality of life for many years.

For more information about University Hospitals neurology, neurosurgery and oncology services at a range of convenient locations across the region, contact one of our team members.

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Exploring the Link Between Atrial Fibrillation and Dementia – Neurology Advisor

Both atrial fibrillation (AF) and dementia are highly prevalent pathologies, with reported rates of approximately 33.5 million and 40 million worldwide.1,2 Experts anticipate that the prevalence of both conditions will continue to increase along with the growing elderly population, and accumulating research suggests that AF may increase the risk for cognitive decline and dementia.2,3

Thereare many studies showing an increased rate of all types of dementia in patientswith [AF], said Hugh Calkins, MD, FHRS, FACC, FAHA, FESC, the Catherine Ellen Poindexter Professor of Cardiology and director ofthe electrophysiology laboratory and arrhythmia service at Johns Hopkins University.New data [have] also shown thattreatment of AF lowers the risk of cognitive dysfunction, he told NeurologyAdvisor.

However,findings on the topic have been mixed overall, which may be the result of methodologicdifferences such as variation in age ranges and methods used to assess AF and dementia.2In addition, most of these studies focused on prevalent AF rather than incidentAF, as noted by the authors of a study published in the July 2019 issue of the EuropeanHeart Journal.2

To addressthis gap, these researchers conducted a longitudinal, community-based study in SouthKorea to examine associations between incident AF and the risk for dementia, aswell as the influence of stroke and the administration of oral anticoagulants on theseassociations. The sample consistedof 262,611 participants aged 60years who did not have AF, dementia, valvular heartdisease, or stroke at the time of enrollment.

The following results were observed:

Based on these findings, clinicians should be vigilant for clinical manifestations implying any cognitive decline and functional impairment in [patients with AF], especially those with a high CHA2DS2-VASc score,the authors wrote.2

These results alignwith those of a 2018 population-based cohort study (n=2685) which found an associationbetween AF and rapid decline on the Mini-Mental State Examination (, 0.24; 95% CI, 0.31 to 0.16) and an increasedrisk for all-cause dementia (HR,1.40; 95% CI, 1.11-1.77) and vascular and mixed dementia (HR, 1.88; 95% CI, 1.09-3.23).4Findings further revealed that the use of anticoagulants was associated with a 60%reduction in dementia risk among patients with both prevalent and incident AF (HR,0.40; 95% CI, 0.18-0.92).

Similarly, resultsof an epidemiologic review published in 2018 reinforced these findings, with investigatorsreporting that the available evidence largely suggests that AF contributes to cognitivedecline and dementia, independent of a history of stroke.3

According to Paul JWang, MD, professor of medicine in the division of cardiology at Stanford UniversityMedical Center and director of the Stanford Cardiac Arrythmia Service, theproposed mechanisms underlying the AF-dementia link include ischemic stroke, chronic inflammation, andhypoperfusion of the brain.

Despite these findings, however, there is currently not enoughevidence to treat AF purely with a goal of reducing or preventing dementia, DrCalkin noted. It is important to follow anticoagulation guidelines in all [peoplewith] AF, and if a patient with AF has symptoms, then a rhythm control strategywith medications or catheter ablation is warranted.

Thisis an important topic, but needs to be further elucidated. Prospective trials areneeded and underway, Dr Wang told Neurology Advisor.

Dr Calkinsechoed this notion and added that additional large-scale randomized trials areneeded to confirm that treatment of AF prevents or slows the development of dementia.

To gain furtherinsight into this topic and its related clinical implications, Neurology Advisorinterviewed Rebecca Gottesman, MD, PhD, professor of neurology and epidemiologyin the division of cerebrovascular neurology at Johns Hopkins University and director of research at Johns Hopkins Bayview Neurology.

Neurology Advisor: What isknown thus far about associations between AF and dementia, including proposed mechanismsby which AF might influence the development of cognitive dysfunction and dementia?

Dr Gottesman: A number of studieshave shown that AF is an independent risk factor for cognitive decline and perhapseven dementia. The association appears to extend beyond just having shared riskfactors for both AF and cognitive decline.

The most well-documented mechanism is through strokes, which canlead to cognitive problems and even dementia. It is also probable that many patientswith AF have silent infarcts, which similarly adversely affect cognition. But theremay be other mechanisms that dont involve these structural changes, perhaps relatedto hypoperfusion in patients with AF.

Neurology Advisor: What arethe relevant screening and treatment recommendations that clinicians shouldfollow?

Dr Gottesman: The steps thatclinicians take to reduce stroke risk are likely the most important things thatcan be done to reduce dementia risk. Anticoagulation to reduce stroke risk willprobably also reduce silent infarction risk, so it is likely to help preserve cognitivefunction in patients with AF. There is no evidence that rate control makes a differencein either stroke risk or dementia risk, however.

The American Heart Associations recommendation for screeningin primary stroke prevention consists of pulsepalpation in older adults, with an electrocardiogram in the event of an irregularpulse, but with no other recommendations for active AF screening needed.5For dementia and cognitive impairment, its likely that a similar screening approachis best.

Neurology Advisor: What areremaining research needs pertaining to the link between AF and cognitive declineand dementia?

Dr Gottesman: We still verymuch need to understand the underlying mechanisms. Furthermore, I mentioned thattheres no evidence that rate control reduces cognitive impairment or dementia frequency,yet if episodes of rapid ventricular response contribute to hypoperfusion, for example,perhaps there are meaningful sequelae of alterations in rate.

Finally, although it is likely that reducing stroke risk withanticoagulation will also reduce cognitive impairment and dementia, there isntevidence specifically proving this. It is also important to study whether differentcriteria differentially identify the level of risk for cognitive decline and dementia.For example, a CHA2DS2-VASc score is definedbased on stroke risk and informs the clinician about risk for stroke, thus informingdecisions about anticoagulation, but a lower threshold might need to be consideredfor risk for dementia, which might warrant initiation of anticoagulation at a differentrisk level, at least theoretically.

In addition, there is increasing interest inatrial structural changes that can have an impact on stroke risk. As more researchis done about these changes as a cause of embolic stroke of undetermined source,it will be important to consider whether there is also an increased risk for cognitivedecline and dementia with these cardiac non-AF structural changes.

References

1. Patel NJ, Atti V, Mitrani RD, Viles-Gonzalez JF, Goldberger AJ. Global rising trends of atrial fibrillation: a major public health concern. Heart. 2018;104(24):1989-1990.

2. Kim D, Yang PS, Yu HT, et al. Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a population-based cohort. Eur Heart J. 2019;40(28):2313-2323.

3. Ding M, Qiu C. Atrial fibrillation, cognitive decline, and dementia: an epidemiologic review. Curr Epidemiol Rep. 2018;5(3):252-261.

4. Ding M, Fratiglioni L, Johnell K, et al. Atrial fibrillation, antithrombotic treatment, and cognitive aging: a population-based study. Neurology. 2018;91(19):e1732-e1740.

5. Meschia JF, Bushnell C, Boden-Albala B, et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(12):3754-3832.

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Meet the Wellness OfficersWhat They’re Doing About Burnout : Neurology Today – LWW Journals

Article In Brief

Wellness officersa new executive position established by many health systems to address the burnout epidemicshare the initiatives they've taken their institutions.

Many health systems across the country are establishing a new executive positionchief wellness officeras a strategy to address the burnout epidemic among physicians and other clinicians.

Jonathan Ripp MD, MPH, chief wellness officer at the Icahn School of Medicine at Mount Sinai, said there were only a handful of chief wellness officer positions when he was appointed to the role in May 2018.

There have been at least a dozen more who have been named in the past year, and several more places that are looking to create the position, said Dr. Ripp, professor of medicine, medical education and geriatrics and palliative medicine. I would not be surprised if, 10 years from now, it's commonplace for most large organizations to have a chief wellness officer or equivalent, taking this challenge on, and doing so in a way that is effective.

Dr. Ripp was a co-author, along with Neil Busis, MD, FAAN, director of community neurology at the University of Pittsburgh Physicians, and others in a 2018 Health Affairs blog post that issued a call for action for executive leadership to address clinician burnout.

Working on behalf of the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-being and Resilience, the authors encouraged health systems to create the position of chief wellness officer to give wellness the attention it needs.

This individual should facilitate system-wide changes, including the implementation of evidence-based interventions that enable clinicians to effectively practice in a culture that prioritizes and promotes their well-being, the blog post said. This leadera Chief Wellness Officer (CWO)would have the authority, budget, staff, and mandate to implement an ambitious agenda.

Dr. Busis said the chief wellness officer position is analogous to the positions of chief patient-safety officer, chief quality officer, and chief medical informatics officer.

It's not that the person in that position does everything, but they lead a team responsible for wellness, he said. And by being in the C suite, it makes a statement that the organization takes this seriously and is willing to devote resources.

Children's Mercy Hospital in Kansas City does not currently have a chief wellness officer position, but neurologist Jennifer Bickel, MD, FAAN, serves as medical director of the hospital's Center for Professional Well-Being. That position reports directly to the executive leadership and serves on the hospital's Physician Administration Council and Quality and Safety Council.

The fact that this role was going to be inserted into the fabric of administration in order to have an influence was really important to me, said Dr. Bickel, chief of the headache section at Children's Mercy and professor of pediatrics at the University of Missouri-Kansas City.

One of her first priorities after assuming the job in January 2019 was formalizing the hospital's commitment to the NAM Action Collaborative. Like the other institutions that have made formal commitments, Children's Mercy identified specific tactics it is undertaking. They include reducing non-meaningful work for clinicians, evaluating policies and procedures that decrease clinician autonomy and professionalism, and coaching leaders on how to identify and reduce burnout.

Dr. Bickel is working to understand the specific causes of burnout among her colleagues and identify mitigation strategies that target them.

While there are, of course, national drivers of burnout-the way we are reimbursed, prior authorizations, regulatory hasslesall of which are major issues, I am a big believer that we should focus on what we can do within our sphere of influence as a hospital or as department leaders or as individual physicians, she said.

For example, Children's Mercy Hospital is making some improvements to the medical staff lounge at the main facility and creating lounge spaces in other locations to make it easier for physicians to build a sense of community with their colleagues.

A hospital-wide survey for physicians, advanced practice providers, psychologists, and trainees to measure burnout rates and perceived causes was underway before Dr. Bickel stepped into the new position. She met with every physician leader to discuss the results for his or her work unit and identify hospital-level issues that might contribute to clinician burnout.

She also blocks time in her schedule each week for appointments with physicians to discuss any concerns and issues, and she has already met with about 10 percent of the faculty one-on-one.

Most of these situations are people telling me about different system-level problems that they see contributing to burnout, she said. The vast majority of people are coming not just to complain; they are there because they want to be better doctors, they love their work, they want to be able to be connected with their patients more.

To help prepare for her new role, Dr. Bickel participated in a weeklong chief wellness officer workshop at Stanford Medicine WellMD Center, which brought together a wide range of individuals interested in becoming wellness leaders.

It was incredibly eye-opening to see the wide variety of titles and responsibilities and degrees of influences within the room, she said. Some people were truly just starting to learn about wellness; some people were already in a wellness leadership role, perhaps for their department but not for their hospital. And there were others who are system-level leaders in their organizations.

Cormac O'Donovan, MD, associate professor of neurology in the department of neurology and internal medicine at Wake Forest University Baptist Medical Center, attended the chief wellness officer training to advance his own knowledge of wellness leadership and to expand his network of clinicians working to address clinician burnout.

Dr. O'Donovan, director of the Peer Support Program at Wake Forest Baptist, started educating himself about physician wellness after his own experience with burnout. One takeaway from the Stanford course was that health systems are addressing the burnout epidemic in a variety of ways.

There is no one-size-fits-all, he said. The way each organization tackles this is very different and based on the strengths that their institution brings to the task.

Organizations also have different structureshospitals with nurse unions, for example, have a different culture than those that do notand different dynamics that may contribute to burnout, Dr. Bickel said. Thus, wellness leaders need expertise in change management, strategic planning, and leadership development.

I appreciated that the workshop was not about providing a bunch of patches for solving burnout because the solution is going to be different in each hospital or even each department, she said.

At Mount Sinai, for example, Dr. Ripp is focused on workplace efficiencymaking the electronic health record system less cumbersome and limiting physicians' administrative burdenand workplace culture. Each of 24 departments, including neurology, has a wellness champion that works on department-level issues and serves as an information conduit with the Office of Well-being and Resilience, which Dr. Ripp leads.

At Ohio State University, the chief wellness officer co-chairs a university-wide health and well-being council that is in the fourth year of a multifaceted wellness plan.

According to a case study written by Dr. Busis and co-authors, the plan tracks outcomes in three categories: the culture and environment of health and wellness; population health; and fiscal health/value of investment in wellness.

Since starting the wellness plan, the university has seen increased productivity and its cost for health insurance is actually decreasing; indeed, for every dollar invested in wellness, the university is seeing a $3.65 return on investment.

At Children's Mercy, a second survey to measure burnout rates was sent out this fall, and Dr. Bickel hopes to continue surveying clinicians every year. She does not expect dramatic or quick changes from one year to the next, but each survey is an opportunity to get feedback from staff and ideas for new programs or initiatives.

Of course, I hope to see the numbers start to trend down over the next few years, but that's going to take some time, she said. More than anything, I hope people know we are sincerely working on making the system better and providing support services for those who need it. This is a long game.

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