Managing Children’s Weight, Blood Pressure & Cholesterol Protects Brain Function Mid-life

Managing weight, blood pressure and cholesterol in children may help protect brain function in later life, according to new research published in the American Heart Association’s flagship journal Circulation. This is the first study to highlight that cardiovascular risk factors accumulated from childhood through mid-life may influence poor cognitive performance at midlife.

Previous research has indicated that nearly 1 in 5 people older than 60 have at least mild loss of brain function. Cognitive deficits are known to be linked with cardiovascular risk factors, such as high blood pressure, obesity, type 2 diabetes, smoking, physical inactivity and poor diet, as well as depression and low education level.

Many diseases that cause neurological deficits, such as Alzheimer’s, have a long preclinical phase before noticeable symptoms begin, so finding links between childhood obesity and other cardiovascular risk factors is important for cognitive health. The researchers noted that there are currently no cures for major causes of dementia, so it is important to learn how early in life cardiovascular risk factors may affect the brain.

“We can use these results to turn the focus of brain health from old age and midlife to people in younger age groups,” said the study’s first author Juuso O. Hakala, M.D., a Ph.D. student at the Research Centre of Applied and Prevention Cardiovascular Medicine at the University of Turku, in Turku, Finland. ”Our results show active monitoring and prevention of heart disease and stroke risk factors, beginning from early childhood, can also matter greatly when it comes to brain health. Children who have adverse cardiovascular risk factors might benefit from early intervention and lifestyle modifications.”

The Cardiovascular Risk in Young Finns Study is a national, longitudinal study on cardiovascular risk from childhood to adulthood in Finland. Researchers followed the participants’ cardiovascular risk factor profiles for 31 years from childhood to adulthood. Baseline clinical examinations were conducted in 1980 on approximately 3,600 randomly selected boys and girls, ranging in ages from 3 to 18, all of whom were white. More than 2,000 of the participants, ranging in ages from 34 to 49, underwent a computerized cognitive function test in 2011. The test measured four different cognitive domains: episodic memory and associative learning; short-term working memory; reaction and movement time; and visual processing and sustained attention.

Researchers found:

  • Systolic blood pressure, total blood cholesterol and low-density lipoprotein (LDL) cholesterol, as well as body mass index, from childhood to midlife are associated with brain function in middle age.
  • Consistently high systolic blood pressure or high blood total cholesterol and LDL cholesterol were linked to worse memory and learning by midlife when compared with lower measures.
  • Obesity from childhood to adulthood was associated with lower visual information processing speed and maintaining attention.
  • Having all three cardiovascular risk factors was linked to poorer memory and associative learning, worse visual processing, decreased attention span, and slower reaction and movement time.

These results are from observational findings, so more studies are needed to learn whether there are specific ages in childhood and/or adolescence when cardiovascular risk factors are particularly important to brain health in adulthood. Study limitations include that a definite cause-and-effect link between cardiovascular risk factors and cognitive performance cannot be determined in this type of population-based study; cognition was measured at a single point in time; and because all study participants are white, the results may not be generalizable to people from other racial or ethnic groups.

Source: American Heart Association

How Oral Health May Affect Your Heart, Brain and Risk of Death

Thor Christensen wrote . . . . . . . . .

Dental cavities could significantly increase the risk of a life-threatening stroke from bleeding in the brain, according to new research.

Past studies have shown a link between gum infection and stroke, but few studies have looked into what role dental cavities might play. In the new study, researchers looked specifically at cavities and intracerebral stroke, which occur when an artery in the brain bursts and floods surrounding tissue with blood.

Researchers looked at data from 6,506 people without stroke, and then followed them for 30 years. For the first 15 years, those who developed cavities had a slightly higher risk for stroke from brain bleed, but their risk shot up dramatically in the next 15 years.

In the second half of the study period, people with cavities had 4.5 times higher risk of a stroke from brain bleed than those without cavities, after adjusting for age, gender, race and high blood pressure.

Dr. Souvik Sen, co-author of the study, said it was one of the first times cavities and intracerebral stroke had been studied in people. While brain bleeds, also called as intracerebral hemorrhages, account for only 10% to 20% of all strokes, they’re more deadly than the more common ischemic strokes, which occur when blood flow through an artery is blocked.

While doctors can manage the risk for ischemic stroke in several ways, options are limited for brain bleeds, he said.

“This study throws more light on how we can address and prevent this more devastating form of stroke,” said Sen, professor and chair of the department of neurology at University of South Carolina School of Medicine.

South Carolina medical student Elizabeth LaValley presented the research this week at the American Stroke Association’s virtual International Stroke Conference. It was one of two studies Sen and his colleagues offered for the conference on the topic of oral disease and stroke. The second study showed gum disease is associated with damage to the brain’s tiny blood vessels. Study findings are considered preliminary until published in a peer-reviewed journal.

Sen said gum disease can be caused by 20 to 30 different types of bacteria, but cavities are predominantly caused by one: Streptococcus mutans, which has been shown in animal studies to be linked with brain bleeds.

While Streptococcus mutans was the most likely “culprit” in the study’s results, Sen said, a limitation of the research is that it didn’t pinpoint the type of bacteria responsible for the dental cavities. He’s currently researching that question in another study, and he’d like to see future work done on whether antibiotics or other treatments for dental cavities that may lower the risk of intracerebral stroke.

Today, the only real preventive strategy for cavities is to seek dental care regularly, Sen said. “Maybe we need to start thinking about how we can treat people with Streptococcus mutans aggressively in the early stages.”

Dr. Robert P. Friedland, who has researched the link between oral bacteria and stroke, said the new study underscores the need for medical professionals to take the topic seriously.

“I’ve been disturbed that many stroke doctors don’t counsel patients about it. It’s just not something in their toolbox,” said Friedland, the Mason C. and Mary D. Rudd Endowed Chair and a professor of neurology at the University of Louisville School of Medicine. He was not involved in the current research.

“I discuss it with every patient I see, regardless of what they’re seeing me for,” he said. “I tell them ‘Take care of your teeth: It’s important for the health of your teeth, but more so, it’s good for the health of your brain and your heart.'”

Source: American Heart Association

What is Alien Hand Syndrome?

Susan Fitsgerald wrote . . . . . . . . .

Four months after experiencing flulike symptoms, Dona Kim Murphey, MD, PhD, a neurophysiologist in Pearland, TX, was still feeling less than 100 percent when something strange happened. While out walking one evening, she felt short of breath and sat down to rest. As she tried to send a text, she suddenly became obsessed with her left hand. “My brain was acutely attuned to my left hand—its position, orientation, and activity,” she recalls. “I was able to use both hands to send the text, but I was unnaturally and exquisitely aware of the left one.”

When the fixation persisted for a week, Murphey was reminded of a neurologic phenomenon she had learned about in medical training and witnessed in one of her patients: alien hand syndrome. She looked it up online and felt that the definition—feeling estranged from, or having a tenuous relationship with, a hand—described her sensations. She remembered that her patient had a far more pronounced experience. “Her left hand kept unhooking her bra and she couldn’t control it,” says Murphey.

To understand the problem better and rule out a more serious condition, Murphey saw a neurologist, who ordered a brain MRI to see if a stroke might have caused the problem. Testing turned up nothing, but in the weeks that followed, Murphey would experience the strange sensation periodically, especially when she was sleep- deprived or overly stressed.

First described in 1908, alien hand syndrome can result from brain damage due to surgery, brain tumors, aneurysms, stroke, neurodegenerative disease, or trauma. Sometimes, as with Dr. Murphey, a specific cause is not identified. Variations of it involve different regions of the brain, but it generally stems from disruptions in brain networks involved in movement and control. It is also called alien limb syndrome because it can occur in the legs as well.

Strange Phenomenon

Film buffs may remember that the title character of the classic 1964 dark comedy Dr. Strangelove, or: How I Learned to Stop Worrying and Love the Bomb had what looked like alien hand syndrome. Dr. Strangelove’s hand would perform what appeared to be purposeful acts but were in fact unintentional. This quirk was used for comic effect in the movie, but in real life the condition can be distressing—and can present in varying ways. One hand may swat at the other involuntarily, or an arm may inexplicably shoot into the air.

In a report documented in the medical literature, a man’s alien hand started undoing the buttons on his shirt as his other hand buttoned them. In other case reports, patients have said they awoke from sleep to find their hands choking them.

In another case, a 56-year-old patient recovering from a stroke reported that his right hand was behaving of its own accord—flipping light switches, grabbing papers, and batting away his left hand. “He walked around with a rolled-up magazine in his right hand so it wouldn’t get in the way of things,” says the patient’s doctor, Anjan Chatterjee, MD, FAAN, professor of neurology at the University of Pennsylvania’s Perelman School of Medicine.

The man would wake up because the hand was grabbing at his body. He pushed his bed against the wall to trap the hand and keep it still, says Dr. Chatterjee. At other times, the man’s alien hand untucked his shirt from his pants and snatched a knife from his left hand as he cut food.

Brain imaging showed that the stroke had caused a lesion in the man’s left medial frontal lobe that extended into the corpus callosum (a nerve tract connecting the brain’s right and left hemispheres), which likely was the root of the problem, Dr. Chatterjee says. The patient’s involuntary hand movements became less frequent and less severe over time.

In a 2014 case study, a 77-year- old woman was watching television when her left hand began stroking her face and hair of its own accord. She was terrified when she couldn’t control the left hand with her right. The movements stopped after half an hour, but the woman’s upper left arm was numb and slightly weak and her left hand dragged, according to the report. At the hospital, brain scans revealed that the woman had sustained a stroke, probably because she had stopped taking anticoagulants for atrial fibrillation in preparation for spine surgery. The report noted that 30 minutes was the shortest case of alien hand syndrome ever documented.

Another case study involved an 84-year-old woman who went to the emergency room because she had episodes during sleep in which her left arm moved as if it were groping around trying to grab at her body. The bizarre movements also happened while she ate, watched TV, and went to the bathroom. She found herself talking to her hand or yelling at it to get it to stop making embarrassing movements, and she even worried that she might be “possessed by the devil,” according to the report. A CT scan showed that the woman had sustained a stroke. By the time of her one-month checkup, the woman’s alien hand had quieted down.

Some people refer to their alien hands in the third person, as if the limbs were distinct entities from their bodies; they may even scold them as if they were naughty children. “It’s as if something else is controlling their hands,” Dr. Chatterjee says. “Part of your body is doing something you don’t want it to do and getting in the way of doing something you do want to do.”

Different Manifestations

There are several variations of alien hand syndrome. The most common involves the brain’s frontal lobe, which usually affects the right hand, and is characterized by impulsive groping, manipulation of objects, and difficulty releasing things after grasping them, says Anhar Hassan, MD, FAAN, associate professor of neurology at Mayo Clinic, who co-wrote a review on the disorder in Current Neurology and Neuroscience in 2016.

Another variation, callosal, is caused by an injury to the corpus callosum and results in conflicting movements between the two hands during two-handed tasks such as tying shoelaces, says Dr. Hassan.

The posterior version of the syndrome—involving the parietal lobe of the brain—usually produces less purposeful movements, such as the hand raising involuntarily. People with this variant may not recognize the limbs as their own, says Dr. Hassan.

A Cause for Study

Doctors diagnose based on patient history and a clinical exam. They may also order brain scans to look for lesions, says Dr. Hassan. While there is no direct treatment, supportive care, including occupational and physical therapy, can help patients develop strategies to minimize interference from the hand. Cases caused by stroke may improve weeks or months later as patients recover, says Dr. Hassan.

Researchers continue to study alien hand syndrome to determine the underlying pathophysiology and connections involved. As brain imaging technology evolves and reveals more about the organization and function of the brain, it may help us understand what causes the involuntary movements and may lead to better treatments, says Dr. Hassan.

While not painful, alien hand syndrome can be frustrating and embarrassing for patients and their families. “Our hands explore the space around us and provide information about the physical world and how we interact with it,” says Steven Frucht, MD, professor of neurology at NYU Langone Health. “It’s bizarre to have a body part move around and do things you aren’t asking it to do.”

Dr. Chatterjee says alien hand syndrome is intriguing both medically and psychologically because having a sense of agency and control over our actions is essential to interacting in the world. Alien hand syndrome challenges the notion of “what it means to feel ownership of your body,” he says.

Source: Brain&Life

Study: Midday Nap Could Leave You Smarter

“You snooze, you lose” may not be true when it comes to your brain: A new study finds that napping in the afternoon may actually boost mental agility.

The study couldn’t prove cause and effect, but a midday nap was associated with a rise in “locational awareness,” verbal fluency and working memory, the Chinese researchers reported Jan. 25 in the journal General Psychiatry.

“Among the things that are good for you and fun, you can now count daytime naps,” said Dr. Gayatri Devi, a neurologist specializing in memory disorders at Lenox Hill Hospital in New York City.

“We know that healthy sleep habits are protective for dementia and this study suggests that at least for some, midday naps may be of benefit in keeping the brain healthy,” said Devi, who wasn’t involved in the new research. He stressed, however, that “more studies are needed to confirm this preliminary finding.”

The new study was led by Dr Lin Sun, of the Alzheimer’s Disease and Related Disorders Center at the Shanghai Mental Health Center, in Shanghai. Sun’s team collected data on more than 2,200 people at least age 60 who lived in Chinese cities including Beijing, Shanghai and Xian.

In all, more than 1,500 took regular afternoon naps, which were no more than two hours long, and 680 did not.

Study participants were given tests that judge several aspects of mental ability including visuospatial skills, working memory, attention span, problem-solving, locational awareness and verbal fluency.

Those who took afternoon naps scored higher than those who didn’t, and there were significant differences in locational awareness, verbal fluency and memory.

According to the study team, there are theories why naps may be beneficial. One is that naps help ease inflammation, which plays a role in sleep disorders and overall health.

Dr. Melissa Bernbaum directs epilepsy and ambulatory sleep medicine at Huntington Hospital in Huntington, N.Y. Reading over the Chinese findings, she said they “seem to indicate a cognitive benefit for napping.”

But Bernbaum added that the “duration and frequency of naps may also be important.”

For example, “individuals who fall asleep unintentionally during the day — potentially due to underlying medical or sleep disorders — may not perform as well as individuals who take planned naps,” Bernbaum said. Future studies might tease out whether the type of midday snooze taken matters when it comes to brain health,” she said.

Source: HealthDay

Keeping Your Brain Sharp isn’t About Working More Puzzles

Laura Williamson wrote . . . . . . . . .

Mental decline is one of the most feared aspects of growing older. People will do just about anything to prevent it, from swallowing supplements touted as memory boosters to spending hours solving Sudoku and crossword puzzles.

But do these things really keep the aging brain sharp? The short answer is, not really.

“It can certainly help you concentrate if you spend an hour or two doing puzzles,” said Dr. Vladimir Hachinski, a Canadian neurologist and global expert in the field of brain health. “It’s good because you’re exercising your brain. But don’t expect too much from it.”

One in 8 Americans age 60 or older report having at least some memory loss and roughly 35% of them report problems with brain function, according to the Centers for Disease Control and Prevention. While this doesn’t always lead to full-blown dementia, the number of older people in the United States struggling with cognitive issues is growing: The CDC predicts the number of people in the U.S. with dementia – including its most common form, Alzheimer’s disease – will nearly triple to roughly 14 million people by 2060.

Research suggests there are indeed ways to prevent or delay many types of cognitive loss, but they don’t involve fish oil supplements or brain teasers. Instead, Hachinski and others in the field agree, people who want to preserve good brain function should take the same steps they would to protect their hearts.

“If you have a good heart, you have a good brain,” said Dr. Rong Zhang, professor of neurology at UT Southwestern Medical Center in Dallas. “Whatever risk factors that are bad for your heart, such as high blood pressure, smoking, obesity or a lack of physical activity, these things are also bad for your brain.”

The link between heart health and brain health is well established.

The American Heart Association and an expert-led Lancet Commission advise people to focus on their risk factors for heart disease and stroke. These include lowering blood pressure, blood sugar and cholesterol levels; getting enough sleep; not smoking; limiting alcohol intake; eating a healthy diet; exercising at least 150 minutes per week; maintaining a healthy weight; and staying socially active. The Lancet Commission recently expanded its list of dementia risk factors to also include head injuries in mid-life and exposure to air pollution.

Researchers believe at least 40% of dementias can be prevented or delayed by modifying these risk factors. Hachinski said the percentage could well be higher if more strokes were prevented. He was the lead author of a 2019 paper published by the World Stroke Organization calling for the joint prevention of stroke and dementia.

Stroke doubles the chance of developing dementia and high blood pressure is a powerful predictor of stroke, Hachinski said, adding that an estimated 90% of strokes are preventable.

“All major dementias have a vascular (blood vessel) component,” he said, because the brain needs good blood flow to provide it with sufficient nutrients and oxygen to work properly. “If you control the vascular component, you can diminish or prevent dementia.”

While major strokes cause an obvious and sudden decline in cognitive function, it’s more common for people to have smaller, silent strokes they don’t even realize are happening, Hachinski said. These “mini-strokes” have been shown to accelerate mental decline, as does uncontrolled blood pressure at any age.

Type 2 diabetes, which often can be prevented or delayed by losing weight and increasing physical activity, also increases the risk of dementia by 60%.

“By and large, the onset of dementia is gradual,” Hachinski said, likening the process to “descending into an abyss. It can happen in different ways, at different rates and to different depths.”

The best way to slow that decline, he said, is to identify your personal risk factors and then tackle the biggest ones. Do you need to lose weight? Exercise more? Eat a healthier diet? Lower your blood sugar?

“Know your family history. Have some idea of what you’re facing,” he said. “Get your blood pressure taken. Risk factors love company. If you have high blood pressure, you undoubtedly have other things going on.”

During the day, the brain uses a lot of energy, in the process discarding excess proteins that build up like junk in a teenager’s room. “The brain needs a way to get rid of these bad proteins,” Zhang said, “to clear away the waste. When there is a lot of garbage in the environment, it hurts the brain.”

Exercise helps with this clearance, and so does sleep, he said.

Building good brain health habits should start long before cognition starts to decline, experts advise.

“In middle age, the risk begins to climb rather rapidly,” Hachinski said. “It’s never too late, but the earlier, the better. I think the most important thing is to begin.”

Source: American Heart Association