How Long Does a Concussion Last?

Contributed by: Dennis Fortier, President, Medical Care Corporation

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How long does a concussion last? This is a common question.

Historically, science has tried to answer this question by measuring the duration of concussion symptoms. Often, depending on the severity of the concussing event, symptom such as dizziness, blurred vision, and interrupted sleep are completely resolved within a few days or a couple of weeks.

However, we also know that many injuries, to various tissues in the body, are not completely healed until long after clinical symptoms have faded. This may also be true of injuries to the brain.

In fact, new research from the Mind Research Network in Albuquerque, N.M. supports such thinking. In a paper published in the online edition of Neurology, researchers showed that physical changes to concussed brains persisted for many months after symptoms had resolved.

One implication is that the brain needs longer to heal than the period demarcated by clear symptoms.

A second, and perhaps more important implication, is that brain injury and symptoms of brain injury may not be always correlated. In that regard, the constant, low-impact collisions of many sports may be injuring the brain in ways that are not obvious in terms of symptoms, but are injurious just the same.

No symptom of brain injury doesn't necessarily mean no brain injury.

Memory Loss More Common in Men?

Contributed by: Dennis Fortier, President, Medical Care Corporation

There is much press this week about a study published in Neurology that measured the incidence of mild cognitive impairment (MCI) in an aging population.

MCI is a subtle loss of thinking ability, such as impaired memory or judgment, that is not severe enough to interfere with the person's normal activities of living.  The study showed about a 20% incidence rate which is squarely in line with previous estimates.

The press has been largely focused on the fact that, in this study, men between the ages of 70 and 89 years had a higher incidence of MCI than women of the same age.  This is probably true.  It is also probably easy to explain.

MCI is not a disease, it is merely a descriptor term for a certain level of cognitive impairment.  It refers to the degree of impairment that falls between normal cognition and the severe loss of function that we call dementia.  Asking "why" a person has MCI is a whole different question with a host of common answers including depression, thyroid disease, stroke, sleep disorder, Alzheimer's disease, and anxiety, to name just a few.  

The question of "why" a person has MCI was not adressed in this study, but may shed some important light on the observed gender differences.  For example, sleep disorders and certain cardiovascular conditions, like hypertension and stroke, are common causes of MCI and are somewhat more prevalent among men than women.  Clearly, conditions that impair memory and are also more common in men, could fully explain the observed gender differences in this study.  In that respect, these results are hardly surprising and, in fact, make perfect sense.

It would be truly worthy of a media frenzy if researchers controlled for each cause of MCI and still found that one gender was more susceptible than the other.  But despite many misleading headlines, that was not the case in this study.

Can B-12 Vitamins Prevent Memory Loss?

Contributed by: Dennis Fortier, President, Medical Care Corporation

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Can B-12 vitamines prevent memory loss?  As with so many questions, the answer to this one is "it depends".

Remember, there are many causes of memory loss, including depression, anxiety, diabetes, medications, thyroid disorders, head injuries, strokes, Alzheimer's disease, Parkinson's disease, tumors, sleep disorders, and drug use, just to name the most common. Vitamin deficiency is also on the list of common causes, especially for older adults who become less proficient at absorbing B vitamins from the foods they eat.

According to a recent study conducted at Rush University Medical Center and published in Neurology, research subjects who had markers for vitamin B deficiency, such as brain shrinkage and high homocysteine levels, also performed worse on cognitive tests compared to subjects without vitamin B deficiency.  These findings are consistent with other studies linking vitamin B deficiency to poor cognition.

So, it would be a stretch to conclude that taking a B-12 supplement will protect a person from all causes of memory loss or cognitive decline.  However, the evidence suggesting that proper intake of B-12 is important to ongoing brain health is quite strong.  In that regard, think about including fish, meat, poultry, eggs, milk, and cheese in your diet as good sources of B vitamins.

Can Vitamin B Reduce Risk for AD?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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A short time ago, we reviewed the promising evidence that Vitamin B levels are negatively correlated with brain atrophy. That is, higher levels of Vitamin B were correlated to less brain shrinkage. This spawned hope that these vitamins might be somehow preventative of diseases that result in brain atrophy.

Today, there is more news about B Vitamins and brain health.

The Karolinska Institute in Stockholm, has published in Neurology, a study showing that elevated levels of homocysteine, an amino acid related to Vitamin B12, seemed to increase risk for developing Alzheimer's disease. However, high levels of the biologically active portion of Vitamin B12 (holoTC) was correlated with reduced risk. The results make sweeping conclusions difficult to draw.

At this point, the strongest conclusions that should be drawn from these studies of Vitamin B are that, (1) Vitamin B seems to pay some important role in brain biology, an (2) no one really knows for sure what that role is.

I have already seen several headlines suggesting that Vitamin B prevents Alzheimer's. That might someday prove to be the case, but it is far too early and too many questions remain for anyone to defend such a position.

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Memory Loss: Men vs. Women

Contributed by: Dennis Fortier, President, Medical Care Corporation
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A new study published in Neurology is driving lots of press coverage about gender differences as they pertain to subtle memory loss.

In the past, studies on the prevalence of dementia, a much more severe condition than subtle memory loss, have shown that incidence increases with age. Given the relatively longer life span of women, there has been no surprise that a higher percentage of women eventually become demented compared to men. This knowledge contributed nothing to the question about whether or not there is a gender difference at earlier symptomatic stages of decline.

In other studies, it has been clearly established that cardiovascular health is closely linked to cognition. Higher rates of hypertension in men suggested that direct gender comparisons would need to adjust for this confounding information before drawing conclusions. However, it is difficult to quantify the specific cognitive impact across a range of vascular factors and other demographic variables, so little could be concluded about absolute gender differences.

Now, in a study of 2000 seniors, researchers at the Mayo Clinic have made a puzzling discovery. Men seem to be about 50% more likely than women to suffer from mild cognitive impairment, even when accounting for age, education, and cardiovascular health factors.

This surprising finding cannot be attributed to differences in longevity or incomparable levels of vascular risk. If these findings are duplicated and substantiated, they may suggest important, gender-based differences in cognitive health. Ultimately, this could point the way to promising new avenues of research in the quest to understand and treat degenerative disorders like Alzheimer's disease.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

Does Mental Activity Accelerate Cogntive Decline?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Does mental activity accelerate cognitive decline for people with Alzheimer's disease? Of course not. But to read the headlines over the past two days, one could be excused for wondering.

Contradictory Study?
A study published yesterday in Neurology noted that, among demented subjects with AD, those who had a history of high cognitive activity like reading, doing crosswords, and visiting museums, declined at an accelerated pace. On the surface, this seems contradictory to the notion that exercising your brain preserves mental function. A closer look, however, reveals an obvious and consistent conclusion.

This study demonstrates that, most probably, maintaining a high level of mental activity allows subjects with progressing Alzheimer's pathology, to continue functioning at a high cognitive level, even as the lesions accumulate in their brains. This means that those who remain mentally active may not manifest symptoms until they have very extensive damage in their brains. If so, symptoms will first appear in these subjects at a later, more pathologically severe stage. As such, there is little wonder that the decline seems more rapid for these subjects.

Delay and Compression of Symptoms
A good way to look at it is this: We don't see an acceleration of decline, but rather, a delay and compression of decline, into the final stages of the disease.

To illustrate this point, consider a typical course of decline between a mentally active person and a mentally inactive person. The inactive person may show subtle symptoms for 5 years, moderate symptoms for five years, and severe symptoms for five years, across a 15-year disease course. The mentally active person might show no symptoms for the first ten years of disease and then degrade quickly to severe symptoms during the final five years. Both had a 15 year disease course but the mentally active person showed no symptoms for the first ten. That person appeared to decline more rapidly, but actually declined much slower (perhaps not at all) during ten of the 15 years. In the broad context, the active person was certainly far better off across the full course of decline.

Many of the headlines on this study are sensationalistic and misleading. I thought this coverage from Bloomberg/Business Week was well done and represented the facts quite fairly.

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A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Many Strokes Preceded by a "Warning"

Contributed by: Dennis Fortier, President, Medical Care Corporation
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According to a recent publication in Neurology, about one in eight strokes is preceded by a transient ischemic attack, known as a TIA, which is very mild stroke that usually produces only subtle and short lasting symptoms. The research suggests that noting and reacting to this warning can reduce the likelihood of a more serious stroke later.

Th importance of this study is highlighted by the fact that up to 80% of strokes that follow a TIA might be preventable with intensive management of risk factors. Risk factors that should be managed include hypertension, high cholesterol, smoking, diabetes, and obesity. Also important is expert evaluation (and intervention if necessary) following any symptoms of stroke, even mild symptoms from a TIA.

Please consider sharing this short posting (share button below) with any of your contacts who may be at risk for stroke.

Infection, Inflammation, and Memory Loss

Contributed by: Dennis Fortier, President, Medical Care Corporation
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A study out of the University of Southampton and published this month in Neurology is generating lots of coverage in the popular press. Most of the headlines indicate that infection accelerates memory loss but the story must be considered a bit more carefully.

First of all, it must be considered that the participants in this study all had Alzheimer's disease. Although it is important to understand the health factors that might exacerbate cognitive decline due to Alzheimer's disease, it is also important not to generalize these findings too broadly beyond the scope of the research. Importantly, this study did not conclude, as some headlines suggest, that every common cold will reduce your ability to store and retrieve information from memory.

Secondly, the study focused on the presence of inflammation (as a surrogate marker for infection) and its relationship to cognitive decline. Researchers have known for some time that there is a relationship, albeit a poorly understood relationship, between inflammation and memory loss. This study suggests that there may be a connection between infection and memory loss but makes no bold conclusions about what that connection entails.

Bottom line: many of the headlines I have seen on this study have overstated the strength of any proven relationship between infection (which can cause inflammation) and memory loss.

A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share button below to spread this educational message as widely as possible.

More News on the Relationship Between Alzheimer's and Depression

Contributed by: Dennis Fortier, President, Medical Care Corporation
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A study published in the June 16 issue of Neurology, the journal of the National Academy of Neurology, suggests that people with memory loss who are also depressed have a greater likelihood of getting Alzheimer's disease (AD).

In a three year study of 756 subjects aged 55 to 91, those diagnosed with depression and memory loss developed AD at a higher rate than those with memory loss and no depression.

The study also had some good news about Aricept, a cholinesterase inhibitor commonly used to treat AD. Among a group of subjects with both memory loss and depression, 11% of those given Aricept developed AD during the study while 25% of those not given Aricept developed AD.

This finding suggests that Aricept may have slowed the progression of Alzheimer's pathology and prolonged high quality of life. This bodes well for our ongoing ability to treat AD in a more effective manner.