Avalanche of Alzheimer's Cases: Are We Ready?

Is your doctor ready with EXACT PROTOCOLS to prevent your likely dementia? Or are you giving them a pass on their incompetency? 

Your chances of getting dementia.

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

5. Parkinson’s Disease May Have Link to Stroke March 2017 

The latest here:

Avalanche of Alzheimer's Cases: Are We Ready?

— Baby boomers turn 74 this year, and Alzheimer's prevalence keeps climbing

by Judy George, Senior Staff Writer, MedPage Today March 11, 2020

Nearly nine in 10 primary care physicians expect to see more patients with dementia in the next 5 years, and half say the medical profession is not prepared to meet this demand, new data from the Alzheimer's Association showed.
While 82% of primary care physicians said they're on the front lines of providing dementia care, not all are confident about caring for these patients, a survey commissioned by the association reported. Nearly 40% said they were never or sometimes comfortable making an Alzheimer's or dementia diagnosis and 27% said they were never or sometimes comfortable answering patients' questions about the disorders.
The survey findings were included as part of the annual facts and figures report published in Alzheimer's & Dementia, the journal of the Alzheimer's Association.
"Importantly, 50% of primary care physicians told us that the medical community as a whole is not ready to deal with the increase they're expected to see in people with dementia between now and 2050," said Keith Fargo, PhD, Alzheimer's Association director of scientific programs.
These perspectives raise an alarm about current and future dementia care, Fargo told MedPage Today. Currently, an estimated 5.8 million Americans age 65 or older have Alzheimer's dementia; 80% of these people are 75 and older. "The baby boom generation has already begun to reach age 65 and beyond; in fact, the oldest members of the baby boom generation turn age 74 in 2020," Fargo said.
In the next 5 years, the number of people 65 and older with Alzheimer's dementia is projected to reach 7.1 million, a 22% jump. Without breakthroughs to prevent or cure Alzheimer's, that figure is estimated to climb to 13.8 million by 2050.
Death certificates recorded 122,019 deaths from Alzheimer's disease in 2018, making it the sixth leading cause of death in the U.S. and the fifth leading cause of death among Americans 65 and older, Fargo noted. From 2000 through 2018, deaths resulting from stroke, HIV, and heart disease decreased, but reported deaths from Alzheimer's increased 146.2%.
The Alzheimer's Association survey, conducted by Versta Research in December 2019, included 1,000 primary care physicians balanced by age, gender, years in practice, type of practice, specialty, and region to match the total U.S. population. These doctors had been in practice for at least 2 years, spent at least 50% of their time in direct patient care, and had a practice in which at least 10% of their patients were 65 or older. In addition, the researchers surveyed 200 primary care doctors who had completed their residency in the past 2 years and 202 residents in general, family, or internal medicine.
About 32% of physicians said they referred dementia patients to specialists at least once a month, but 55% -- ranging from 44% of primary care doctors in large cities to 71% in rural areas -- said there were not enough dementia care specialists in their area to meet patient demand.
The report included a state-by-state analysis of geriatricians needed to meet future care needs for dementia patients and revealed severe shortages in some areas, including 14 states that need to increase the number of practicing geriatricians five-fold. As of 2016, there were 7,293 certified geriatricians in the U.S., placing an increasing burden on primary care physicians to provide dementia care, the report concluded.
Giving primary care doctors more training could help, but education needs to be accessible, Fargo pointed out: while 58% of primary care doctors said the quality of existing training options is either "good" or "excellent," 31% said training was difficult to access and 51% said there are too few options. Overall, 89% of primary care doctors reported staying current on medical developments, but 42% of those said "only a little."
"This is the voice of primary care physicians speaking," Fargo said. "It's them telling us 'We don't think the medical profession is ready.' It's a bit of a wake-up call to the medical community and people who can help them -- such as policymakers -- that there's a problem here and it's getting bigger."

Primary Source

Alzheimer's & Dementia: The Journal of the Alzheimer's Association

Source Reference: Alzheimer's Association "2020 Alzheimer's disease facts and figures" Alzheimer's & Dementia 2020; DOI: 10.1002/alz.12068.

5 Proven Ways to Boost Your Memory

Which of these does your doctor have EXACT PROTOCOLS FOR? Excuses are not allowed.

5 Proven Ways to Boost Your Memory

By Jonathan Ford Hughes on March 11, 2020

There are many things we’d like to forget. Our middle school fashion choices, our decision to invest in dot-com stocks, or that relationship we sunk a few miserable years into are some examples that come to mind. But with these few exceptions, memory is a precious resource on which we rely to navigate our careers, relationships, and day-to-day minutiae. If preserving your gray matter is something you care about, there are a few habits you can develop to help. Here are 5 scientifically validated ways to boost memory.

Meditate

Is there anything that doesn’t benefit from a mindfulness practice? You can add memory to the list. Though spending some time focusing on the present moment daily will help boost memory, meditation does so in an interesting, indirect way.
Psychologists and psychiatrists among you will likely be familiar with the term proactive interference. You can think of this as a glitch between short term and long term memory. Let’s say you’re trying to learn a new approach to something you already know how to do, like suturing a wound. Proactive interference might inhibit learning the new skill, because there’s a memory conflict between the new information (the new suturing method) and the information that was once relevant (your old approach to suturing).
A 2019 study published in Brain Imaging and Behavior showed that a 4-week mindfulness training program guarded against proactive interference. The thinking here is that mindfulness training may keep the mind focused on the present moment (in this case, learning the new task), filtering out competing theories and/or memories. Additionally, researchers said, the training resulted in an increase in size of the hippocampus, one of the brain’s key memory systems.

Focus on key information

Think back to the last serious conversation you had with your boss — one that contained things you had to remember or act on. You probably can’t replay the entire conversation from memory, like a video, right? Most of us remember the finer points, or the most important facts that we’ll need in the future. This is a function of episodic memory. Episodic memories are unique to you. Likely, your boss won’t have the same memory of the event and that’s because they had different priorities during the conversation.
There are specific ways to enhance episodic memory, according to this Harvard Men’s Health Watch post. Once again, a mindfulness practice will help you here, enabling you to focus all of your attention on key details, like a name, while tuning out distractions. Another useful technique is relying on mental cues. Using the name as an example, if you’re having trouble recalling it, try recalling other facts about the person — where they live, their hobbies, if they have children. This will often shake loose the information you’re searching for.

Play brain games

Spend some time perusing the app store on your phone, and you’ll find a few of these. But do they actually work? Research suggests that while brain games won’t reduce the risk of dementia alone, they may boost specific memory-related skills.
You also don’t need to shell out for any specific brain-boosting games or services. Any game that’s mentally stimulating, such as chess, seems to help. For example, a 2017 University of Exeter study showed that participants who did daily crossword puzzles performed better on reasoning, attention, and memory tests. The researchers clarified that while they can’t say that word puzzles will give you a sharper brain, they may stave off mental decline.
Their findings were echoed in a 2014 Journal of Aging Health literature review. Researchers concluded that in people ages 65 and over, word puzzles, memory games, and visual recognition tasks boosted memory.
“This finding supports the theory that keeping the mind active, in addition to regular physical exercise, may help slow the onset of dementia,” researchers wrote.

Exercise

Speaking of exercise, there are 2 categories of exercise that provide some benefit for memory, according to a 2013 Neuroscience & Behavioral Reviews study. But if you want to reap the benefit, you’re going to have to do some cardio (sorry!).
Category 1 is acute exercise. In the immediate aftermath of intense cardio, you’ll likely see a short-term memory boost. Researchers say this is because the vigorous activity juices the molecular processes of memory.
Category 2 is long-term exercise. Think of this as repeating your chosen form of cardio over an extended period of time — preferably your lifetime. “Long-term exercise optimizes the molecular machinery responsible for memory processing,” researchers wrote. Essentially, the chemical functions of memory become more efficient over time. So, for the maximum memory benefit, according to the research, do cardio, and do it regularly.

Diet

The effects of diet on memory, though well-researched, aren’t exactly slam dunks. That’s because the most prevalent studies are rat-based. While most of us aren’t rats, perhaps our rodent friends can give us some insights as to how diet affects our gray matter.
A 2008 study published in the Journal of Alzheimer’s Disease looked at how saturated fat and a high cholesterol diet affect hippocampal morphology in middle-aged rats. Researchers concluded that diets high in saturated fat hurt memory and hippocampal morphology. The rats that they pumped full of saturated fat made more errors navigating mazes, compared to the control group. The sat-fat-fed rats also showed decreased dendritic integrity in their brains, correlating to memory errors.

TL;DR

Want to sharpen your memory?

• Meditate: It minimizes proactive interference.
• Focus on key facts: Harness episodic memory. Don’t go for a full recall of an event or conversation.
• Play brain games: No need to shell out for an app. Play chess or do a crossword puzzle.
• Exercise: Looks like cardio is best. You’ll get an immediate memory boost, and sustained memory function if you keep doing cardio throughout your life.
• Diet: Rat studies show diets high in saturated fat may harm memory.

Caffeine boosts problem-solving ability but not creativity, study indicates

YOU have a massive problem to solve. How to get 100% recovered. Since your doctor knows absolutely nothing about that, you are completely on your own, including how much caffeine to consume to solve that problem. My 12 cups of daily coffee is not enough for me, still haven't even got anywhere close to 100% recovery. 

Caffeine boosts problem-solving ability but not creativity, study indicates

MedicalXpress Breaking News-and-Events | March 05, 2020

Caffeine increases the ability to focus and problem solve, but a new study by a University of Arkansas researcher indicates it doesn't stimulate creativity.

"In Western cultures, caffeine is stereotypically associated with creative occupations and lifestyles, from writers and their coffee to programmers and their energy drinks, and there's more than a kernel of truth to these stereotypes," wrote Darya Zabelina, assistant professor of psychology and first author of the study recently published in the journal Consciousness and Cognition.

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While the cognitive benefits of caffeine—increased alertness, improved vigilance, enhanced focus, and improved motor performance—are well established, she said, the stimulant's affect on creativity is less known.
In the paper, Zabelina differentiates "convergent" from "divergent" thinking. The former is defined as seeking a specific solution to a problem, for example, the "correct" answer. The latter is characterized by idea generation where a large set of apt, novel or interesting responses would be suitable. Caffeine was shown to improve convergent thinking in the study, while consuming it had no significant impact on divergent thinking.
For the study, 80 volunteers were randomly given either a 200mg caffeine pill, equivalent to one strong cup of coffee, or a placebo. They were then tested on standard measures of convergent and divergent thinking, working memory and mood. In addition to the results on creativity, caffeine did not significantly affect working memory, but test subjects who took it did report feeling less sad.
"The 200mg enhanced problem solving significantly, but had no effect on creative thinking," said Zabelina. "It also didn't make it worse, so keep drinking your coffee; it won't interfere with these abilities."

To read more, click here.

Iron in brain shows cognitive decline in people with Parkinson's

Useless, NOTHING on how to reduce such iron accumulation.  You do need to worry about this. 

Parkinson’s Disease May Have Link to Stroke March 2017

Iron in brain shows cognitive decline in people with Parkinson's

MedicalXpress Breaking News-and-Events | February 21, 2020

A cutting-edge MRI technique to detect iron deposits in different brain regions can track declines in thinking, memory and movement in people with Parkinson's disease, finds a new UCL-led study.

The findings, published in the Journal of Neurology, Neurosurgery, and Psychiatry, suggest that measures of brain iron might eventually help predict which people with Parkinson will develop dementia.

"Iron in the brain is of growing interest to people researching neurodegenerative diseases such as Parkinson and dementias. As you get older, iron accumulates in the brain, but it's also linked to the build-up of harmful brain proteins, so we're starting to find evidence that it could be useful in monitoring disease progression, and potentially even in diagnostics," said the study's lead author, Dr. Rimona Weil (UCL Queen Square Institute of Neurology).
The study involved 97 people with Parkinson disease, who had been diagnosed within the last 10 years, along with 37 people without the condition, as a control (comparison) group. They were tested for their thinking and memory as well as for their motor function.
Parkinson disease is a progressive condition of brain degeneration resulting in tremors, stiffness and slowness of movement. Close to 50% of people with the condition end up developing dementia, but the timing and severity vary substantially.
Currently there are no reliable measures to track Parkinson progression in the brain, so clinicians rely on monitoring symptoms. Conventional brain imaging fails to track progression until quite a late stage, when large-scale brain volume loss can be detected.
Iron accumulates in people's brains as part of the normal aging process, partly due to increased permeability in the blood-brain barrier. Excess iron can have toxic effects leading to proteins being irreversibly modified. Recent studies have found that when proteins linked to Alzheimer disease (amyloid and tau, which are also linked to Parkinson dementia) build up, iron also accumulates in the affected brain areas.
In the current study, researchers used a new technique, called quantitative susceptibility mapping, to map iron levels in the brain based on MRI (magnetic resonance imaging) scans. They found that iron accumulation in the hippocampus and thalamus brain regions was associated with poor memory and thinking scores. Iron in the putamen brain region was associated with poor movement scores, suggesting a more advanced stage of the disease.
In Parkinson disease, the hippocampus and thalamus are known to be associated with thinking and memory, and the putamen with movement scores, so the researchers say it's very promising that iron deposition was specifically detected in those areas.
The findings suggest that iron deposition could be valuable to track if a treatment is working in a clinical trial, and might eventually be helpful for early diagnosis of Parkinson or other neurodegenerative diseases.
Dr. Weil has previously found in a 2019 study that a suite of vision tests may be helpful to predict cognitive decline in Parkinson. She and her colleagues hope that further research will determine if the vision tests and iron measures could be helpful to predict which people with dementia are likely to develop dementia.
First author, PhD student George Thomas (UCL Queen Square Institute of Neurology), said: "It's really promising to see measures like this which can potentially track the varying progression of Parkinson disease, as it could help clinicians devise better treatment plans for people based on how their condition manifests."
Co-author Dr. Julio Acosta-Cabronero (Tenoke Ltd. and Wellcome Centre for Human Neuroimaging, UCL) added: "We were surprised at how well the iron levels measured in different regions of the brain with MRI were correlated with cognitive and motor skills. We hope that brain iron measurement could be useful for a wide range of conditions, such as to gauge dementia severity or to see which brain regions are affected by other movement, neuromuscular and neuroinflammatory disorders, stroke, traumatic brain injury and drug abuse."
The researchers are now following up the same study participants to see how their disease is progressing, whether they develop dementia, and how such measures correlate with changes in iron levels over time.

To read more, click here.

Could your personality influence your risk of Alzheimer's disease?

Does your doctor even know that you should be informed on this and have ways to change since you have an an extremely likely chance of getting dementia? 

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

5. Parkinson’s Disease May Have Link to Stroke March 2017 

The latest here:

Could your personality influence your risk of Alzheimer's disease?

New European research has found that certain personality traits may influence an individual's risk of Alzheimer's disease.
Carried out by scientists from the University of Geneva (UNIGE) and the University Hospitals of Geneva (HUG), Switzerland, the new study looked at 65 participants over the age of 65 and followed them for a period of five years.
During this time, the participants underwent tests such as neurocognitive assessments, functional and structural brain imaging to assess amyloid accumulation in the brain and brain volume, and personality tests.
The findings, published in the journal Neurobiology of Aging, showed perhaps surprisingly, that people who score lower for agreeableness -- in short people who are more unpleasant -- appeared to have a brain that is better protected against Alzheimer's disease. The same was also true for people who are not afraid of conflicts and who show characteristics of anti-conformity.
Participants with these three personality traits tended to lose less volume in the brain regions which typically shrink in both normal aging and in Alzheimer's disease.
The researchers explain that atrophy, or shrinking, of certain brain regions is one of the major features that comes before memory loss and Alzheimer's disease.
"A high level of agreeableness characterizes highly adaptive personalities, who want above all to be in line with the wishes of others, to avoid conflict, and to seek cooperation," explains Professor Panteleimon Giannakopoulos, who directed the research. "This differs from extraversion. You can be very extroverted and not very pleasant, as are narcissistic personalities, for example. The important determinant is the relationship to the other: do we adapt to others at our own expenses?"
In addition, the team also found that another personality trait that seems to have a protective effect is being curious and open to experience. "This is less surprising, as we already knew that the desire to learn and interest in the world around us protects against cerebral ageing," said Professor Giannakopoulos.
Alzheimer's is the main cause of dementia in the elderly. Some risk factors for the disease have already been established, such as high blood pressure or diabetes, but the how non-biological factors may play a role is still unclear.
"If it seems difficult to profoundly change one's personality, especially at an advanced age, taking this into account in a personalized medicine perspective is essential in order to weigh up all the protective and risk factors of Alzheimer's disease. It is an important part of a complex puzzle," the authors conclude.

1. Agreableness: Yep, good on this except for my ex.
2. Being curious: Open to experience: I want to know about everything. 
   Why do you think I went to Madagascar?
3. Not afraid of conflicts, anti-conformity: Seems to conflict with number 1. 

So demand your doctor figure out the EXACT protocols you need to accomplish to reduce your Alzheimer's risk.

Repeated morphine exposure activates synaptogenesis and other neuroplasticity-related gene networks in the prefrontal cortex of male and female rats

Don't do this. This will never have followup research in humans. 

Repeated morphine exposure activates synaptogenesis and other neuroplasticity-related gene networks in the prefrontal cortex of male and female rats

View ORCID ProfileShirelle X. Liu, Mari S. Gades, Andrew H. Harris, Phu V. Tran, Jonathan C. Gewirtz

doi: https://doi.org/10.1101/2020.02.26.966416

This article is a preprint and has not been certified by peer review [what does this mean?].

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Abstract

Background Opioid abuse is a chronic disorder likely involving stable neuroplastic modifications. While a number of molecules contributing to these changes have been identified, the broader spectrum of genes and gene networks that are affected by repeated opioid administration remain understudied.

Methods We employed Next-Generation RNA-sequencing (RNA-seq) to investigate changes in gene expression in adult male and female rats’ prefrontal cortex (PFC) following daily injection of morphine (5.0 mg/kg) for 10 days. Ingenuity Pathway Analysis (IPA) was used to analyze affected molecular pathways, gene networks, and associated regulatory factors.

Results 90% of differentially expressed genes (DEGs) were upregulated in both males and females, with a 35% overlap between sexes. A substantial number of DEGs play roles in synaptic signaling and neuroplasticity. Although broadly similar, some differences were revealed in the gene ontology networks enriched in females and males (e.g., the endocannabinoid pathway in females and neuroinflammation in males).

Conclusions Our results cohere with findings from previous studies based on a priori gene selection, while identifying broader gene networks activated by repeated opioid exposure. Our results also reveal novel genes and molecular pathways that are upregulated by repeated morphine exposure.

Footnotes

• Role of Funding Source: This work was supported by grants from the Engdahl Family Research Fund and the Office of the Vice President for Research, University of Minnesota, and by T32 DA007097.

Copyright 

The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. All rights reserved. No reuse allowed without permission.

Our Turn: Teresa Paiva Weed and Scott Fraser: New rehab hospital is not needed, Rhode Island

Well, but are your existing hospitals good enough for stroke rehab? These statistics are available? 

1. tPA full recovery? Better than 12%?
2. 30 day deaths? Better than competitors?
3. rehab full recovery? Better than 10%?

 

Our Turn: Teresa Paiva Weed and Scott Fraser: New rehab hospital is not needed, Rhode Island

We write today with good news. Rhode Islanders in need of inpatient rehabilitation services can be sure our five existing licensed providers and skilled nursing facilities are meeting the needs of patients(Really? You get stroke patients 100% recovered?) in quality and capacity. As a result of our readiness, a new additional facility in Johnston, proposed by the out-of-state company Encompass Health, is clearly not needed.
On the surface, some may believe this is a simple economic development equation: more investment plus more jobs equals a good idea. But, a deeper look at the facts shows the addition of Encompass Health would instead be an economic drain on our health-care system and state economy.
Thanks to existing law, there is a clear path to showing the potential benefits and the potential damage.
In Rhode Island, any health-care facility hoping to enter the state must apply to the Health Services Council for a Certificate of Need. The prospective facility must prove a need or gap in health services in order to establish themselves here.
So, let’s consider a couple of issues: First, to the question of need. Our rehabilitation centers have 109 available beds to care for those who have suffered injuries (stroke, brain injury or other debilitating health issue) and whom a doctor determines requires more than three hours of daily inpatient intensive therapy for five days a week.
A 2018 audit revealed a 54% daily use rate of the inpatient rehabilitation beds, meaning nearly half the 109 beds remain available each day. This leaves us with the capacity to nearly double the amount of patients, if needed. Our skilled nursing facilities provide rehabilitative care for hundreds more. In other words, we have an over-supply.(But are you any good at all?)
So why would Encompass try to build a facility knowing these facts? Encompass has a business model including marketing their facility with the result of cannibalizing the existing facilities. In other words, they would be taking patients from Rhode Island’s hospitals and nursing homes. Encompass would create a duplication of services and the potential decimation of existing providers. This would result in closures and the loss of many jobs.
The best and most efficient use of state and federal health-care dollars and the overall impact on providers and their employees must be considered. Economic development is not replacing an existing facility with a new one just for sake of creating something new.
As inpatient rehabilitation and skilled nursing facilities, together we employ thousands of people and serve as economic drivers in our community.

Minnesota Launches New Policy For Car Used Less Than 50 Miles/Day

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The case is clear. Rhode Island has high-quality, nationally recognized rehabilitation resources in place. We have more than enough capacity to meet current and future needs.
The addition of a large, new facility would duplicate existing resources and likely degrade the ability of existing programs to maintain themselves. The state’s own consultant, The Faulkner Consulting Group, has validated these conclusions.
We urge the Health Services Council and the Department of Health to deny this petition.
Teresa Paiva Weed is the president of the Hospital Association of Rhode Island. Scott Fraser is the president of the Rhode Island Health Care Association.

Associations of Widowhood and β-Amyloid With Cognitive Decline in Cognitively Unimpaired Older Adults

Does this mean I shouldn't get married again? Even though this is widows not widowers?

Associations of Widowhood and β-Amyloid With Cognitive Decline in Cognitively Unimpaired Older Adults

Kelsey D. Biddle, BA¹; Heidi I. L. Jacobs, PhD^2,3; Federico d’Oleire Uquillas, BA^4,5; et al Benjamin S. Zide¹; Dylan R. Kirn, MPH⁵; Michael R. Properzi, BEng⁵; Dorene M. Rentz, PsyD^5,6; Keith A. Johnson, MD^3,6; Reisa A. Sperling, MD^5,6; Nancy J. Donovan, MD^1,6,7

Author Affiliations Article Information

JAMA Netw Open. 2020;3(2):e200121. doi:10.1001/jamanetworkopen.2020.0121

Key Points español 中文 (chinese) Question  Is widowhood a specific risk factor associated with more rapid cognitive decline among cognitively unimpaired older adults with higher levels of brain β-amyloid, the Alzheimer disease biomarker?
Findings  In this cohort study of 257 community-dwelling cognitively unimpaired older adults, widowhood and β-amyloid were additively and interactively associated with cognitive decline. These results were independent of demographic factors, cardiovascular disease risk, depression, health-related behaviors, and social support factors.
Meaning  These findings suggest that widowhood may be an understudied risk factor for cognitive decline associated with Alzheimer disease and highlight the need for increased research and clinical attention to this high-risk group.

Abstract

Importance  To reduce the rising incidence of clinical impairment due to Alzheimer disease, it is essential to define older adults at highest risk. Widowhood may be an unrecognized factor contributing to accelerated clinical progression along the Alzheimer disease pathway among cognitively unimpaired older adults.
Objective  To determine whether widowhood status and level of brain β-amyloid (ie, the Alzheimer disease pathologic protein) are additively or interactively associated with cognitive decline among cognitively unimpaired older adults.
Design, Setting, and Participants  In this cohort study, 257 married, widowed, and unmarried (ie, never married, divorced, or separated) participants from the Harvard Aging Brain Study longitudinal cohort underwent baseline evaluation of neocortical β-amyloid levels using Pittsburgh compound B positron emission tomography and 4 annual cognitive assessments. Data were collected from September 2010 to February 2017 and analyzed from July 2018 to July 2019.
Main Outcomes and Measures  Cognitive performance was measured using the Preclinical Alzheimer Cognitive Composite.
Results  Of the 257 participants, 153 (59.5%) were women, and the mean (SD) age was 73.5 (6.1) years; 145 participants (56.4%) were married (66 [45.5%] women), 77 (30.0%) were unmarried (56 [72.7%] women), and 35 (13.6%) were widowed (31 [88.6%] women). Compared with married participants, widowed participants demonstrated worsening cognitive performance after adjusting for age, sex, socioeconomic status, depression, and β-amyloid levels (β = −0.11; 95% CI, −0.19 to −0.04; P = .002) with no difference observed between married and unmarried participants. Furthermore, widowed participants with higher baseline β-amyloid levels exhibited steeper cognitive decline (β = −0.22; 95% CI, −0.42 to −0.03; P = .02), indicating both independent and interactive associations of β-amyloid levels and widowhood with cognition. In a secondary model using dichotomous β-amyloid–marital status groupings, the rate of cognitive decline among widowed participants with high β-amyloid was nearly 3 times faster than among married participants with high β-amyloid (widowed, high β-amyloid: β, −0.33; 95% CI, −0.46 to −0.19; P < .001; married, high β-amyloid: β, −0.12; 95% CI, −0.18 to −0.01; P < .001).
Conclusions and Relevance  In a sample of cognitively unimpaired older adults, being widowed was associated with accelerated β-amyloid–related cognitive decline during 3 years. Cognitively unimpaired, widowed older adults were particularly susceptible to Alzheimer disease clinical progression, emphasizing the need for increased research attention and evidenced-based interventions for this high-risk group.

Two studies in Nature Medicine showed a blood test could detect abnormal accumulation of phosphorylated-tau-181 and differentiate between Alzheimer's and other neurodegenerative diseases.

What are the chances your doctors knows of all these and has protocols to ensure stroke survivors get these tests?

Didn't this from November 2019 already prove this?

Blood test may find early signs of Alzheimer's - harvard health November 2019

 

Two studies in Nature Medicine showed a blood test could detect abnormal accumulation of phosphorylated-tau-181 and differentiate between Alzheimer's and other neurodegenerative diseases.

You probably want this one also.

Simple blood test could help predict progression of Parkinson disease February 2020

You'll want this one also:

Blood test may predict cardiovascular disease

July 2019 

Maybe this one also:

Needle in a haystack: Two days after stroke, a handful of blood cells reveal risk of dementia a year later April 2019

 

 

 

Cognitive Reserve as an Emerging Concept in Stroke Recovery

You mean YOU, YOUR MENTORS AND SENIOR RESEARCHERS ARE THAT FUCKING OUT-OF-DATE? No wonder stroke never gets closer to a solution, no one in stroke knows a damn thing from the past and builds on it.

• brain reserve (29 posts to September 2010)

• cognitive reserve (17 posts to November 2014)

 

Cognitive Reserve as an Emerging Concept in Stroke Recovery 

Show all authors

Emily Rosenich, Brenton Hordacre, PhD, Catherine Paquet, PhD, ...

First Published February 24, 2020 Research Article

https://doi.org/10.1177/1545968320907071

Article information

Abstract

Stroke is a leading cause of death and disability. It is a complex and largely heterogeneous condition. Prognosis for variations in impairment and recovery following stroke continues to be challenging and inaccurate, highlighting the need to examine the influence of other currently unknown variables to better predict and understand interindividual differences in stroke impairment and recovery. The concept of “cognitive reserve,” a feature of brain function said to moderate the relationship between brain pathology and clinical outcomes, might provide a partial explanation. This review discusses the potential significance of cognitive reserve in the context of stroke, with reference to reduced burden of disability post stroke, health promotion, intervention and secondary prevention of cognitive impairment, ease and challenges of translation into clinical practice, prognosis and prediction of recovery, and clinical decisions and trial stratification. Discussions from the review aim to encourage stroke clinicians and researchers to better consider the role of premorbid, lifestyle-related variables, such as cognitive reserve, in facilitating successful neurological outcomes and recovery following stroke.

Keywords cognitive reserve, reserve, stroke, stroke recovery, stroke outcomes, cognition

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Motor Imagery Training After Stroke Increases Slow-5 Oscillations and Functional Connectivity in the Ipsilesional Inferior Parietal Lobule

So fucking what? Did it improve recovery? Are you that stupid that you don't know what stroke research is for? 100% recovery, not some intermediate measurement.  

Motor Imagery Training After Stroke Increases Slow-5 Oscillations and Functional Connectivity in the Ipsilesional Inferior Parietal Lobule 

Show all authors

Xu Wang, PhD*, Hewei Wang, PhD*, Xin Xiong, ...

First Published February 26, 2020 Research Article

https://doi.org/10.1177/1545968319899919

Article information

Abstract

Background. 
Reorganization in motor areas have been suggested after motor imagery training (MIT). However, motor imagery involves a large-scale brain network, in which many regions, and not only the motor areas, potentially constitute the neural substrate for MIT.  
Objective.
This study aimed to identify the targets for MIT in stroke rehabilitation from a voxel-based whole brain analysis of resting-state functional magnetic resonance imaging (fMRI).  
Methods.
Thirty-four chronic stroke patients were recruited and randomly assigned to either an MIT group or a control group. The MIT group received a 4-week treatment of MIT plus conventional rehabilitation therapy (CRT), whereas the control group only received CRT. Before and after intervention, the Fugl-Meyer Assessment Upper Limb subscale (FM-UL) and resting-state fMRI were collected. The fractional amplitude of low-frequency fluctuations (fALFF) in the slow-5 band (0.01-0.027 Hz) was calculated across the whole brain to identify brain areas with distinct changes between 2 groups. These brain areas were then targeted as seeds to perform seed-based functional connectivity (FC) analysis.  
Results.
In comparison with the control group, the MIT group exhibited more improvements in FM-UL and increased slow-5 fALFF in the ipsilesional inferior parietal lobule (IPL). The change of the slow-5 oscillations in the ipsilesional IPL was positively correlated with the improvement of FM-UL. The MIT group also showed distinct alternations in FCs of the ipsilesional IPL, which were correlated with the improvement of FM-UL.  
Conclusions.
The rehabilitation efficiency of MIT was associated with increased slow-5 oscillations and altered FC in the ipsilesional IPL. Clinical Trial Registration. http://www.chictr.org.cn. Unique Identifier. ChiCTR-TRC-08003005.

Keywords motor imagery training, inferior parietal lobule, resting-state fMRI, fractional amplitude of low frequency fluctuations, functional connectivity, rehabilitation

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Efficacy of Controlled Whole-Body Vibration Training on Improving Fall Risk Factors in Stroke Survivors: A Meta-analysis

So I guess this wasn't a high quality study, since they recommend more high quality studies.  Why do this particular study since this one from Jan. 2018 seems to have already come to the same conclusion. Did your mentors and senior researchers even know about this earlier study?  It is so fucking obvious that stroke has NO STRATEGY AND NO LEADERSHIP.  Your children and grandchildren are screwed if they have strokes unless YOU effect stroke leadership change.

Effect of whole-body vibration exercise in preventing falls and fractures: a systematic review and meta-analysis Jan. 2018

 

Efficacy of Controlled Whole-Body Vibration Training on Improving Fall Risk Factors in Stroke Survivors: A Meta-analysis

Feng Yang PhD, Andrew J. Butler, PhD

First Published February 28, 2020 Review Article

https://doi.org/10.1177/1545968320907073

Article information

Abstract

Background.
Controlled whole-body vibration (CWBV) training has been applied to people with stroke. However, it remains inconclusive if CWBV reduces fall risk in this population.  
Objective.
To (1) assess the immediate and retention effects of CWBV training on fall risk factors in people at postacute and chronic stages of stroke and (2) examine if CWBV dosage is correlated with the effect size (ES) for 3 fall risk factors: body balance, functional mobility, and knee strength.  
Methods.
 Twelve randomized controlled trials were included. ES was calculated as the standardized mean difference, and meta-analyses were completed using a random-effects model.  
Results.
CWBV training may lead to improved balance and mobility immediately after training (ES = 0.27, P = .03 for balance; ES = 0.34, P = .02 for mobility) but not at the 3-month follow-up test (ES = 0.02, P = .89 for balance; ES = 0.70, P = .11 for mobility). CWBV affects knee strength capacity with mild ES (ES = 0.08 and 0.11, respectively, for immediate and retention effect; P ≥ .68 for both). Meta regression indicated that the immediate ES is strongly correlated with training dosage for balance (r = 0.649; P = .029) and mobility (r = 0.785; P = .036).  
Conclusions. CWBV training may benefit balance and mobility immediately, but the training effect may not persist among people with stroke. Additionally, the CWBV dosage correlates with the ES for body balance and mobility. More high-quality studies are needed to determine the retention effects of CWBV training.

Keywords systematic review, falls prevention, body balance, functional mobility, muscle strength, retention, dose-response

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Robotic-Assisted Gait Training Effect on Function and Gait Speed in Subacute and Chronic Stroke Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Oh well, more useless crapola, a review NOT A PROTOCOL. Good luck getting these robotic helpers. And when you do have them, WHAT THE HELL DO YOU DO WITH THEM?

Robotic-Assisted Gait Training Effect on Function and Gait Speed in Subacute and Chronic Stroke Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

 Jaya Shanker Tedla

a
 Snehil Dixit

a
 Kumar Gular

a
 Mohammed Abohashrh

b

a

Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia;
b

Department of Basic Medical Science, College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
Received: March 25, 2019Accepted after revision: May 1, 2019Published online

 Abstract

Background:
 The review is intended to provide the effectiveness of robotic-assisted gait training (RAGT) for function-al gait recovery in post stroke survivors through a systematic review and to provide evidence for gait speed improvements through the meta-analysis of randomized controlled trials (RCTs).
Summary:
 In this systematic review, PubMed, Web of Science, Wiley Online Library, Science Direct, Science Robotics, Scopus, UpToDate, MEDLINE, Google Scholar, CINHAL, EMBASE, and EBSCO were reviewed to identify relevant RCTs. Articles included in the study were thoroughly examined by 2 independent reviewers. The included RCTs were having a PEDro score between 6 and 8 points. The initial database review yielded 1,371 studies and, following further screening; 9 studies finally were selected for systematic review and meta-analysis. Out of the 9 studies, 4 were on chronic stroke and 5 were on subacute stroke. The meta-analysis of gait speed showed an effect size value ranging between –0.91 and 0.64, with the total effect size of all the studies being –0.12. During subgroup analysis, the subacute stroke total effect size was identified as –0.48, and the chron-ic stroke total effect size was noted as 0.04. Meta-analysis revealed no significant differences between RAGT and con-ventional gait training (CGT).
Key Messages:
 Our systematic review revealed that the RAGT application demonstrated a better or similar effect to that of CGT in a post stroke population. A meta-analysis of gait speed involving all the studies identified here indicated no significant differences between RAGT and CGT. However, the subanalysis of chronic stroke survivors showed a slight positive effect of RAGT on gait speed.
© 2019 S. Karger AG, Basel

How do you thoroughly wash your hands one-handed to prevent coronavirus transmission?

There is no point in looking for your fucking failures of stroke associations to provide this. It is obvious the response is likely; 'Just fuck off and die'. Your doctor will be no help.  I need to know, going to Madagascar this week and Vienna and northern Italy in April if Italy borders aren't completely closed. We were planning on visiting Balzano, the area between the Lombardy and Veneto regions that are hard hit. I'm healthy and not concerned.

How to prevent coronavirus infection: Wash your hands - Vox

Mayo Clinic Minute: How to properly wash your hands

Damn, I had an excellent comment from Jo, but managed to delete it.  

High-tech C-Mill rehab treadmill at Northridge Hospital Medical Center is first in L.A. County

Do you really think your stroke hospital will buy this and your doctors prescribe it? My doctor pooh-poohed the usefulness of the Lokomat. I considered it the only thing that could suppress my spasticity and make walking almost normal. This wouldn't have been useful for me at all. 

Or maybe this might be better: Does your stroke hospital even know about this one, only 7 years old?

Smart Floor Hopes to Help Improve Walking Skills June 2013

 

 High-tech C-Mill rehab treadmill at Northridge Hospital Medical Center is first in L.A. County

Tina Orkin, a stroke survivor, utilizes the new C-Mill at Northridge Hospital Medical Center. The C-Mill provides safe therapy to improve balance by simulating real-life experiences.(photo by Andy Holzman).

 

 

 

The Motek C-Mill, a trend-setting motivational and therapeutic tool for patients, made its debut last week at the Center for Rehabilitative Medicine at Dignity Health-Northridge Hospital.
It’s the first of its kind in Los Angeles County, hospital officials said.

Physical Therapist Megan Grady helps stroke survivor Tina Orkin with safety equipment before she uses the the new C-Mill at Northridge Hospital Medical Center. The C-Mill provides safe therapy to improve balance by simulating real-life experiences. (Photo by Andy Holzman).

The high-tech treadmill helps patients train for everyday life’s shifting environments and changing circumstances, such as walking in a crowded room or avoiding obstacles on the sidewalk.
The C-Mill is for people who need to improve or regain balance, build a steadier gait or restore the ability to manage dual tasking — such as clearing dishes from a table and walking over to a kitchen counter at the same time.
The C-Mill, which uses a body-weight support system to keep patients from losing balance or falling, analyzes a person’s stride pattern as they walk and helps them adjust their gait.
It then uses virtual and augmented reality — adding digital images — to help the person adjust their walking to avoid obstacles in a fun and interactive rehabilitation exercise.

Patients who may benefit from the virtual treadmill include people who have:

• Suffered a brain injury
• Endured a spinal cord injury
• Been diagnosed with multiple sclerosis
• Faced orthopedic challenges
• Been diagnosed with Parkinson’s disease
• Experienced a stroke.

In the end, the most important goal of the treadmill and accompanying therapy is to help people regain the ability to live independently.
More information on the Center for Rehabilitative Medicine at Northridge Hospital is available at  dignityhlth.org/3a8ke32
 

Chronic stroke survivors experience continued impairment of dexterity but not strength in the nonparetic upper limb

Just what the fuck was the point of this research? Because absolutely nothing here will get survivors recovered.  But there is the absolutely wonderful weasel word of imply. Nothing here solves the only goal in stroke of 100% recovery. Just maybe you would like stroke researchers to solve stroke, that will take strong stroke leadership of which there is none today.

Chronic stroke survivors experience continued impairment of dexterity but not strength in the nonparetic upper limb

Archives of Physical Medicine and Rehabilitation — Barry AJ, et al. | March 02, 2020

This study was undertaken to evaluate the performance of the less affected upper limb in people with stroke, compared with normative values and to explore less affected upper limb function in those whose pre-stroke dominant limb became paretic and those whose pre-stroke non-dominant limb became paretic. Researchers designed a cohort study including chronic stroke survivors (7.2±6.7 years post-incident). The research was conducted at a freestanding academic rehabilitation hospital. A total of 40 chronic stroke survivors with severe hand impairment (Chedoke-McMaster Stroke Assessment rating of 2-3 on Stage of Hand) were included in this study. This study compared data from stroke survivors and normative age- and gender-matched data from neurologically intact individuals. The results showed that stroke survivors with severe impairment of the paretic limb continue to exhibit significant upper extremity impairment in their nominally nonparetic limb even years after stroke. This appearance was witnessed regardless of whether the DH or NH hand was primarily influenced. The outcomes imply that the nonparetic upper limb should be targeted for rehabilitation as this group of stroke survivors is particularly dependent on the nonparetic limb for performing functional tasks.

• See Also: Stroke prevention in elderly patients with non-valvular atrial fibrillation in the BALKAN-AF survey

Read the full article on Archives of Physical Medicine and Rehabilitation