Saturday, November 18, 2017

Virtual reality training may be as effective as regular therapy after stroke

stroke
A blood clot forming in the carotid artery. 
Using virtual reality therapy to improve arm and hand movement after a stroke is equally as effective as regular therapy, according to a study published in the November 15, 2017, online issue of Neurology, the medical journal of the American Academy of Neurology.

18 nov 2017--"Virtual reality training may be a motivating alternative for people to use as a supplement to their standard therapy after a stroke," said study author Iris Brunner, PhD, of Aarhus University, Hammel Neurocenter in Denmark. "Future studies could also look at whether people could use virtual reality therapy remotely from their homes, which could lessen the burden and cost of traveling to a medical center for standard therapy."
The study involved 120 people with an average age of 62 who had suffered a stroke on average about a month before the study started. All of the participants had mild to severe muscle weakness or impairment in their wrists, hands or upper arms. The participants had four to five hour-long training sessions per week for four weeks. The participants' arm and hand functioning was tested at the beginning of the study, after the training ended and again three months after the start of the study.
Half of the participants had standard physical and occupational therapy. The other half had virtual reality training that was designed for rehabilitation and could be adapted to the person's abilities. The participants used a screen and gloves with sensors to play several games that incorporated arm, hand and finger movements.
"Both groups had substantial improvement in their functioning, but there was no difference between the two groups in the results," Brunner said. "These results suggest that either type of training could be used, depending on what the patient prefers."
Brunner noted that the virtual reality system was not an immersive experience. "We can only speculate whether using virtual reality goggles or other techniques to create a more immersive experience would increase the effect of the training," she said.


Provided by American Academy of Neurology

Friday, November 17, 2017

Memory complaints and cognitive decline: Data from the GuidAge study

A memory complaint, also called Subjective Cognitive Decline (SCD), is a subjective disorder that appears to be relatively common, especially in elderly persons.

17 nov 2017--The reports of its prevalence in various populations range from approximately 10% to as high as 88%, although it is generally thought that the prevalence of everyday memory problems lie within the range of 25% to 50%. It has been suggested that SCD may be an indication of cognitive decline at a very early stage of a neurodegenerative disease (i.e. preclinical stage of Alzheimer's disease) that is undetectable by standard testing instruments. SCD may represent the first symptomatic manifestation of Alzheimer's disease in individuals with unimpaired performance on cognitive tests.
The McNair and Kahn Scale or Cognitive Difficulties Scale was employed to define and characterize cognitive complaints in the GuidAge study, involving a population of more than 2800 individuals aged 70 years or older having voluntarily complained of memory problems to their general practitioner (GPs). It contains items that are related to difficulties in attention, concentration, orientation, memory, praxis, domestic activities and errands, facial recognition, task efficiency, and name finding.
The results of the GuidAge study suggest that the assessment of cognitive complaint voluntarily reported to primary-care physicians, by the McNair and Kahn scale can predict a decline in cognitive performance, as 5 items out of 20 were statistically significant.

These 5 items are:
  • item 1, "I hardly remember usual phone numbers",
  • item 5, "I forget appointment, dates, where I store things",
  • item 6, "I forget to call people back when they called me",
  • item 10, "I forget the day of the week",
  • item 13, "I need to have people repeat instructions several times".
Thanks to this short scale GPs, in clinical practice, can identify which patients with memory complaints should be referred to a memory center to assess cognitive functions.


Provided by IOS Press

Thursday, November 16, 2017

Landmark study may impact standard stroke treatment guidelines

stroke
A blood clot forming in the carotid artery. 
Standard guidelines for stroke treatment currently recommend clot removal only within six hours of stroke onset. But a milestone study with results published today in the New England Journal of Medicine shows that clot removal up to 24 hours after stroke led to significantly reduced disability for properly selected patients.

16 nov 2017--The international multi-center clinical study, known as the DAWN trial, randomly assigned 206 stroke victims who arrived at the hospital within six to 24 hours to either endovascular clot removal therapy, known as thrombectomy, or to standard medical therapy.
Thrombectomy involves a catheter placed in the femoral artery and snaked up the aorta and into the cerebral arteries where the clot that is blocking the artery, and causing the neurological symptoms, is retrieved.
Almost half of the patients (48.6 percent) who had clot removal showed a considerable decrease in disability, meaning they were independent in activities of daily living 90 days after treatment. Only 13.1 percent of the medication group had a similar decrease. There was no difference in mortality or other safety end-points between the two groups.
"These findings could impact countless stroke patients all over the world who often arrive at the hospital after the current six-hour treatment window has closed," says co-principal investigator Raul Nogueira, MD, professor of neurology, neurosurgery and radiology at Emory University School of Medicine and director of neuroendovascular service at the Marcus Stroke & Neuroscience Center at Grady Memorial Hospital.
"When the irreversibly damaged brain area affected by the stroke is small, we see that clot removal can make a significant positive difference, even if performed outside the six-hour window," says co-principal investigator Tudor Jovin, MD, director of the University of Pittsburgh Medical Center Stroke Institute. "However, this does not diminish urgency with which patients must be rushed to the ER in the event of a stroke. The mantra 'time is brain' still holds true."
To select patients for the trial, the researchers used a new approach which used brain imaging and clinical criteria as opposed to just time alone.
"Looking at the physiological state of the brain and evaluating the extent of tissue damage and other clinical factors seems to be a better way to decide if thrombectomy will benefit patients as opposed to adhering to a rigid time window," says Nogueira.
The researchers planned to enroll a maximum of 500 patients over the course of the study period. However, a pre-planned interim review of the treatment effectiveness after 200 patients were enrolled in the trial led the independent Data Safety Monitoring Board overseeing the study to recommend early termination of the trial, based on pre-defined criteria demonstrating that clot removal provided significant clinical benefit in the studied patients.
"Our research and clinical teams are immensely proud of these breakthrough findings, which are so profound they will likely result in a paradigm shift that will not be seen again for many years in the field of stroke therapeutics," says Michael Frankel, MD, professor of neurology, Emory University School of Medicine, chief of neurology and director of the Marcus Stroke and Neuroscience Center for the Grady Health System.
According to Frankel, the Emory neuroscience team was a major contributor to the DAWN trial, working at Grady Memorial Hospital, the second leading site of the trial's enrollment.
The DAWN trial included trial locations in the United States, Spain, France, Australia and Canada. The trial was sponsored by Stryker Corporation, a medical technology company that manufactures the clot removal devices used in the study.
The DAWN trial results were presented at the European Stroke Organization Conference in May.


Provided by Emory University

Wednesday, November 15, 2017

US regulators approve first digital pill to track patients

US regulators approve first digital pill to track patients

FDA approved the first drug in the United States with a digital ingestion tracking system, in an unprecedented move to ensure that patients with mental illness take the medicine prescribed for them. The drug Abilify MyCite was developed by Otsuka Pharmaceutical
15 nov 2017--U.S. regulators have approved the first drug with a sensor that alerts doctors when the medication has been taken, offering a new way of monitoring patients but also raising privacy concerns.
The digital pill approved Monday combines two existing products: the former blockbuster psychiatric medication Abilify—long used to treat schizophrenia and bipolar disorder—with a sensor tracking system first approved in 2012.
The technology is intended to help prevent dangerous emergencies that can occur when patients skip their medication, such as manic episodes experienced by those suffering from bipolar disorder.
But developers Otsuka Pharmaceutical Co. and Proteus Digital Health are likely to face hurdles. The pill has not yet been shown to actually improve patients' medication compliance, a feature insurers are likely to insist on before paying for the pill. Additionally, patients must be willing to allow their doctors and caregivers to access the digital information.
These privacy issues are likely to crop up more often as drugmakers and medical device companies combine their products with technologies developed by Silicon Valley.
Experts say the technology could be a useful tool, but it will also change how doctors relate to their patients as they're able to see whether they are following instructions.
"It's truth serum time," said Arthur Caplan, a medical ethicist at NYU's Langone Medical Center. "Is the doctor going to start yelling at me? Am I going to get a big accusatory speech? How will that interaction be handled?"
The technology carries risks for patient privacy too if there are breaches of medical data or unauthorized use as a surveillance tool, said James Giordano, a professor of neurology at Georgetown University Medical Center.
"Could this type of device be used for real-time surveillance? The answer is of course it could," said Giordano.
The new pill, Abilify MyCite, is embedded with a digital sensor that is activated by stomach fluids, sending a signal to a patch worn by the patient and notifying a digital smartphone app that the medication has been taken.
The FDA stressed however that there are limitations to monitoring patients.
"Abilify MyCite should not be used to track drug ingestion in 'real-time' or during an emergency," the statement said, "because detection may be delayed or may not occur."
Patients can track their dosage on their smartphone and allow their doctors, family or caregivers to access the information through a website.
In a statement issued last May at the time the FDA accepted submission of the product for review, the companies said "with the patient's consent, this information could be shared with their health care professional team and selected family and friends, with the goal of allowing physicians to be more informed in making treatment decisions that are specific to the patient's needs."
While it's the first time the FDA has approved such a pill, various specialty pharmacies and hospitals in the U.S. have previously "packaged" various drugs and sensors. But the federal endorsement increases the likelihood that insurers will eventually pay for the technology.
Drugmakers frequently reformulate their drugs to extend their patent life and to justify raising prices. For instance, Otsuka already sells a long-acting injectable version of Abilify intended to last for one month. The patent on the original Abilify pill expired in 2015.
The Japanese drugmaker has not said how it will price the digital pill. Proteus Digital Health, based in Redwood City California, makes the sensor.

Tuesday, November 14, 2017

Doctors and patients make more decisions together

doctor

In a shift away from the more patriarchal/matriarchal relationship between doctor and patient, patients report an increased partnership with their physicians in making medical decisions, reports a new study from Northwestern Medicine and Harvard University.

14 nov 2017--Shared decision-making between patients and their clinicians increased 14 percent from 2002 to 2014, the study reports. According to the study, patients generally felt their physicians more commonly:
  • Asked them to help make medical decisions
  • Listened carefully to them
  • Explained things in a way that was easy to understand
  • Showed respect for what they had to say
  • Spent enough time with them
The paper will be published Monday in the Annals of Family Medicine.
"There has been increased attention among clinicians and health systems to involve patients in decision-making," said co-lead author Dr. Jeffrey Linder, chief of general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine and a Northwestern Medicine internist. "Patients who have engaged in shared decision-making understand their condition and options better. They feel less uncertain about a chosen course of action."
Shared decision-making generally results in better-informed patients, who then decide not to use treatments or interventions that have marginal or no benefit, Linder said.
"Finally clinicians are realizing that just because we say, 'You should do that,' a patient will not necessarily comply with our recommendation," said co-lead author Dr. David Levine, an instructor in medicine at Harvard Medical School and an associate physician at Brigham and Women's Hospital in Boston. "Moving the conversation to a space where it is a shared decision likely improves adherence."
Although there was a significant increase in shared decision-making, there is still much room for improvement, the authors said. More than 30 percent of Americans felt their clinician did not always listen to them, and more than 40 percent felt their clinician did not always spend enough time with them.
The study also highlighted a few areas where shared decision-making is lacking. Shared decision-making scores were lower for patients in poor health and for patients who were of a different race/ethnicity than their clinician. Focusing on patients with poor health or of a different race/ethnicity than the doctor or clinician could increase shared decision-making in these groups.
The study was an analysis of a nationally representative survey of Americans. It involved about 10,000 people per year from 2002 to 2014.


Provided by Northwestern University

Monday, November 13, 2017

Research shows low chance of sudden cardiac arrest after sex

sex

A small percentage of sudden cardiac arrest events are related to sexual activity, but survival rates in those cases remain low, according to a research letter published today in the Journal of the American College of Cardiology and presented at the American Heart Association's Scientific Sessions 2017. Despite these sexual activity related SCA events being witnessed by a partner, bystander CPR was performed in only one-third of cases.

13 nov 2017--Sudden cardiac arrest (SCA) is when the heart suddenly stops beating; it usually occurs without warning. If not treated immediately it can lead to sudden cardiac death, which results in around 350,000 deaths annually in the United States. It is known that sexual activity may trigger non-fatal cardiac events such as myocardial infarction, but researchers in this study sought to determine if sexual activity is a potential trigger for SCA in the general population.
The researchers looked at the community-based Oregon Sudden Unexpected Death Study (Oregon SUDS) database from 2002 to 2015 to discover the frequency to which SCA occurred during or within one hour after sexual activity for all persons over the age of 18. All reported cases of SCA were based on emergency medical service reports containing detailed information regarding cause of the cardiac arrest event.
In total, the researchers identified 4,557 SCAs in Portland during the 13-year study period. Of these, 34 (0.7 percent) of SCAs were linked to sexual activity. On average, these patients were more likely to be male, middle-aged, African-American and have a history of cardiovascular disease, with a majority taking cardiovascular medication. Patients who experienced SCA related to sexual activity also had a higher rate of ventricular fibrillation/tachycardia than those who did not.
Only one-third of these SCA cases received bystander CPR. The researchers determined that the low bystander CPR rate accounted for the less than 20 percent of patients who survived to hospital discharge.
"Even though SCA during sexual activity was witnessed by a partner, bystander CPR was performed in only one-third of the cases," said Sumeet Chugh, MD, senior study author and associate director of the Cedars-Sinai Heart Institute. "These findings highlight the importance of continued efforts to educate the public on the importance of bystander CPR for SCA, irrespective of the circumstance."
Limitations to the study included unknown information surrounding the frequency of sexual activity, so researchers could not determine relative risk compared to rest and physical activity.
Overall, the study authors said they found a relatively low burden of SCA in relation to sexual activity. The majority of cases were men with a previous history of cardiovascular disease. The researchers also noted that some cases of SCA after sexual activity may also involve medications, stimulants and alcohol use.

More information: Aapo L. Aro et al, Sexual Activity as a Trigger for Sudden Cardiac Arrest, Journal of the American College of Cardiology (2017). DOI: 10.1016/j.jacc.2017.09.025 , dx.doi.org/10.1016/j.jacc.2017.09.025


Provided by American College of Cardiology

Sunday, November 12, 2017

Online therapy proves effective for treating depression and anxiety

anxiety

Providing an online computerized cognitive behavioral therapy (CCBT) program, both alone and in combination with an Internet Support Group (ISG), is a more effective treatment for anxiety and depression than a doctor's usual primary care, researchers from the University of Pittsburgh found. Results were published today in JAMA Psychiatry.

12 nov 2017--Bruce Rollman, M.D., M.P.H., professor of medicine and director of the Pitt Center for Behavioral Health and Smart Technology, led the National Institutes of Mental Health-funded Online Treatment for Mood and Anxiety Disorders Trial, which enrolled 704 depressed and anxious patients from 26 UPMC-affiliated primary care offices across western Pennsylvania.
UPMC primary care physicians referred patients ages 18 to 75 to the trial between August 2012 and September 2014 using an electronic health record prompt. Eligible and consenting patients were then randomized to one of three groups: care manager-guided access to the eight-session Beating the Blues CCBT program (CCBT-alone); care manager-guided access to both the CCBT program and a password-protected, moderated ISG that patients could access at any time via their smartphone or desktop computer (CCBT+ISG); or to their primary care physician's usual care.
Over the six-month intervention, 86 percent of patients randomized to CCBT started the program and completed an average of 5.4 sessions. Seventy-five percent of patients assigned to the ISG logged into the site at least once, and 62 percent made one or more posts or comments, with an average of 10.5 posts and comments per person. The maximum number of posts and comments from one participant was 306.
Six months later, patients randomized to the CCBT+ISG and CCBT-alone groups both reported significant improvements in their mood and anxiety symptoms versus patients receiving usual care, and these improvements lasted for six months after the end of the intervention. However, the addition of the moderated ISG provided no additional benefit over guided access to CCBT only. Additionally, the more CCBT sessions patients completed, the greater the improvement in their symptoms, highlighting the critical importance of patient engagement with online interventions.
Despite proven effectiveness at treating mood and anxiety disorders and use by many patients abroad, CCBT remains largely unknown and underutilized within the U.S., Rollman said. ISGs that enable individuals with similar conditions to access and exchange self-help information and emotional support have thrived in recent years, but benefits have yet to be established in randomized trials. This trial was the first to examine the effectiveness of incorporating either a CCBT program or an ISG into a collaborative care program for treating depression or anxiety in primary care.
"Providing access to these effective emerging technologies may be an ideal method to deliver mental health treatment to depressed and anxious patients at scale, especially to those who live in areas with limited access to care or personal obligations that make in-person counseling difficult to obtain," Rollman said. "Our study findings have important implications for transforming the way mental health care is delivered in primary care and focus further attention on the emerging field of e-mental health in the United States."

More information: Bruce L. Rollman et al. Effectiveness of Online Collaborative Care for Treating Mood and Anxiety Disorders in Primary Care, JAMA Psychiatry (2017). DOI: 10.1001/jamapsychiatry.2017.3379


Provided by University of Pittsburgh

Tuesday, November 07, 2017

More physical activity, higher intensity may significantly reduce risk of death in older women in the short term


old person

More physical activity and at higher intensities could lead to a big drop in the risk of death in older women from any cause, according to new research in the American Heart Association's journal Circulation.

07 nov 2017--Researchers found the volume of light intensity physical activity or sedentary behavior was not associated with death rate. However, light intensity activity may be beneficial for other health outcomes not studied in this research.
Previous studies, which used self-reports, showed that active people have about 20 percent to 30 percent lower death rates compared to their least active counterparts.
This research, conducted from 2011 to 2015, is among the first to investigate physical activity, measured using a wearable device called a triaxial accelerometer, and a clinical outcome. The device is capable of measuring activity along three planes: up and down, front to back and side to side. These capabilities increase sensitivity to detect physical activity and allow for more precise measurements.
"We used devices to better measure not only higher intensity physical activities, but also lower intensity activities and sedentary behavior, which has become of great interest in the last few years," said I-Min Lee, M.B.B.S., Sc.D., the study's first author and professor of medicine and epidemiology at Harvard University's medical and public health schools in Boston, Massachusetts.
More than 17,700 women (average age 72) who were asked to wear the device for seven days, when awake, returned their devices. Data were analyzed from 16,741 compliant participants (i.e., their devices showed it was worn for at least 10 hours a day, on at least four days). During an average follow-up of approximately two-and-a-half years, 207 women died.
Researchers found:
  • More moderate to vigorous intensity physical activity (such as brisk walking) was associated with roughly a 60 percent to 70 percent lower risk of death at the end of the study among the most active women, compared to the least active.
  • More light intensity activity (such as housework and slow walking - e.g., window shopping in a mall), or more sedentary behavior was not independently associated with death risk at the study's end. Researchers stressed this finding does not mean light activity isn't beneficial for other health outcomes not studied here.
Researchers chose this study population to begin addressing knowledge gaps, said Lee who is also an associate epidemiologist at Brigham and Women's Hospital in Boston. "Younger people in their 20s and 30s generally can participate in vigorous intensity activities, such as running or playing basketball. But for older people, vigorous intensity activity may be impossible, and moderate intensity activity may not even be achievable. So, we were interested in studying potential health benefits associated with light intensity activities that most older people can do."
The study's participants, selected from the Women's Health Study, were relatively healthy, and mostly white women, therefore the findings may have limited generalizability to other groups of people.
The findings support 2008 federal guidelines and American Heart Association that suggest at least 150 minutes a week of moderate intensity or 75 minutes a week of vigorous-intensity aerobic physical activity (or a combination of the two) and muscle-strengthening exercises two or more days a week.
"We hope to continue this study in the future to examine other health outcomes, and particularly to investigate the details of how much and what kinds of activity are healthful. What is irrefutable is the fact that physical activity is good for your health," Lee said.

More information: Circulation (2017). DOI: 10.1161/CIRCULATIONAHA.117.031300


Provided by American Heart Association

Thursday, November 02, 2017

Colorectal cancer screening should start at 45, new research shows

Colorectal cancer screening should start at 45, new research shows
Infographic on CRC. 
Screening for colorectal cancer (CRC) should begin at 45 years of age to match rising mortality rates in young adults, research presented today at the 25th UEG Week Barcelona reveals.

Scientists in France analysed 6,027 colonoscopies and found a 400% increase in the detection of neoplasia (the new, uncontrolled growth of abnormal tissue) in patients aged between 45-49 in comparison to patients aged 40-44. The neoplasia detection rate was also 8% higher in people aged between 45-49 than it was between 50-54, leading to calls for CRC screening programmes to begin at 45 years of age.
The mean number of polyps (growths on the inner lining of the colon that can turn cancerous if left untreated) and the adenoma detection rate (proportion of individuals undergoing a colonoscopy who have one or more adenomas detected) also increased by 95.8% and 95.4% respectively between the 40-44 and 45-49 age groups. This was far more substantial than the increase between the 45-49 and 50-54 age groups, which was 19.1% and 11.5% respectively.
Lead researcher, Dr David Karsenti, who will present the findings for the first time today at UEG Week, explains; "These findings demonstrate that it is at 45 years old that a remarkable increase in the colorectal lesions frequency is shown, especially in the detection rate of early neoplasia. Even when patients with a familial and personal history of polyps or cancer are excluded from the findings, there is still a noticeable increase in detection rates in patients from the age of 45."
Colorectal cancer screening should start at 45, new research shows
The mean number of polyps, adenoma detection rate and neoplasia detection rate by age. Credit: UEG
CRC is the second most common cause of cancer-related death in Europe, killing 215,000 Europeans every year, with research recently revealing that three in ten CRC diagnoses are now among people younger than 55. There is strong evidence to demonstrate that screening for CRC reduces incidence and mortality rates, yet there are vast inequalities in CRC screening across Europe with both organised and opportunistic schemes, different types of tests and varying participation and detection rates. Despite the dramatic rise of CRC in young adults, the vast majority of screening programmes throughout Europe commence between the ages of 50 and 55, with some not beginning until the age of 60.
Dr Karsenti adds "Regardless of the type of screening that is in place, the results of our research strongly indicate that screening for colorectal cancer should begin at the age of 45. This will this help us to increase the early detection of colorectal cancer in young adults and also enable the identification and safe removal of polyps that may become cancerous at a later date."
Colorectal cancer screening should start at 45, new research shows
The neoplasia detection rate by age. Credit: UEG
More information: 1. Karsenti, D. et al (2017), Adenoma detection rate according to age: colonoscopy screening should start at 45 years old, Presented at the 25th UEG Week Barcelona, October 30, 2017.
2. Epidemiology of colorectal cancer: international comparison, 4th European Colorectal Cancer Days 2015. Available at: www.crcprevention.eu/index.php … -cancer-epidemiology
3. Dramatic rise in colorectal cancer in younger adults (2017), Medscape. Available at: www.medscape.com/viewarticle/876409


Provided by United European Gastroenterology

Wednesday, November 01, 2017

Research lays groundwork for promising Alzheimer's-fighting drink

Research lays groundwork for promising Alzheimer’s-fighting drink
A nutrient mix based in part on research from the lab of MIT Professor Emeritus Richard Wurtman has shown promise in treating the early stages of Alzheimer’s disease. 
Much of Professor Emeritus Richard Wurtman's career in MIT's Department of Brain and Cognitive Sciences revolved around developing new treatments for diseases and conditions by modifying chemicals produced in the brain.

01 nov 2017--Since coming to MIT in 1970, Wurtman and his research group have generated more than 1,000 research articles and 200 patents, laying the groundwork for numerous successful medical products.
 "I'm very interested in using basic knowledge to ameliorate the human condition, to make living better," says Wurtman, who is also a medical doctor.
Now a nutrient mix based on essential research contributions by Wurtman has shown promise in treating the early stages of Alzheimer's disease, according to a new clinical trial funded by the European Union.
In the mid-2000s, Wurtman developed a nutrient cocktail aimed at treating what he considers "the root cause" of Alzheimer's: loss of brain synapses. The mixture increases production of new synapses and restores connectivity between brain regions, improving memory and other cognitive functions. A French company then combined this research with a multinutrient it was developing along with the LipiDiDiet consortium—a European collaboration of 16 universities and research centers—to create a drink, called Souvenaid, for Alzheimer's patients.
Over the years, Souvenaid has been the focus on several clinical trials to validate its efficacy. The mixture is not yet available in the United States, but it is being sold as a "medical food"—a category of regulated and safe foods that are designed for dietary management of diseases—in a number of countries across the globe.
In the new clinical trial, published in today's issue of Lancet Neurology, patients with prodromal Alzheimer's—the predementia stage of Alzheimer's with mild symptoms—were given either Souvenaid or a placebo. Compared to people who drank the placebo, patients who drank Souvenaid throughout the trial showed less worsening in everyday cognitive and functional performance and significantly less atrophy of the hippocampus, which is caused early in Alzheimer's by brain tissue loss.
"It feels like science-fiction, where you can take a drink of Souvenaid and you get more synapses … for improved cognitive function," Wurtman says. "But it works."
The co-authors of the study are from the University of Eastern Finland, Kuopio University Hospital, Karolinska Institutet and Karolinska University Hospital, the University of Masstricht, the VU University Medical Centre, Pentara Corporation, the University of Gothenburg, Sahlgrenska University Hospital, and Saarland University and the LipiDiDiet study group.

Making Souvenaid

Souvenaid's popularity may be on the rise today, but the product would not be possible without years of MIT research, Wurtman says.
In the mid-2000s, Wurtman's research led him to seek the mechanisms behind the body's production of phosphatides, a class of lipids that, along with proteins, form biological membranes. Production of these phosphatides, Wurtman discovered, depends on a set of nutrient precursors.
Specifically, Wurtman homed in on three naturally occurring dietary compounds: choline, uridine, and the omega-3 fatty acid DHA. Choline is found in meats, nuts, and eggs. Fish, flaxseeds, and certain meats contain omega-3 fatty acids. Uridine is mostly produced in the liver.
All those compounds taken simultaneously boost production of phosphatides, encouraging membrane development, which is critical in creating new synapses. Knowing that Alzheimer's-affected brains continuously lose synapses, Wurtman patented the work through MIT's Technology Licensing Office in hopes of using some version of the cocktail to treat Alzheimer's and any disease that leads to loss of synapses.
Then, in 2003, Wurtman presented the work at a meeting in Europe. Attending the event was a representative from Nutricia—a unit of Danone, a French company known as Dannon in the United States—which was experienced in making medical foods. Wurtman was invited to the company's headquarters, where a deal was hashed out to combine Wurtman's findings with a multinutrient the company was working on to create a new treatment for Alzheimer's.
By 2008, Danone had licensed the patent and Souvenaid was already a product. But Wurtman and several graduate students continued basic research behind Souvenaid, which gave the product a boost. "We were much more able to do the basic research at MIT," Wurtman says. "As soon as we found something in the research, we'd patent it. We never had the lag time. If you work in entrepreneurship and innovation that lag time could be the downfall of a prospective product."
Among the group's key discoveries was the finding that Souvenaid boosted the number of structures called dendritic spines, found in brain cells. When spines from one neuron contact another, a synapse is formed.
A 2010 study detailing those findings in Alzheimer's and Dementia indicated that Souvenaid improved verbal memory in patients with mild Alzheimer's. A 2012 study published in the Journal of Alzheimer's Disease confirmed and expanded these findings. Over six months, patients with mild Alzheimer's were given Souvenaid or a placebo. Patients taking the placebo deteriorated in their verbal-memory performance in the final three months of the study, while the Souvenaid patients continued to improve. Both trials were conducted by Philip Scheltens of the Alzheimer Center of the VU University Medical Centre in Amsterdam.

Future of Souvenaid

In the new clinical trial by the LipiDiDiet consortium, researchers conducted a 24-month trial, where more than 300 patients with prodromal Alzheimer's were randomly assigned Souvenaid or a placebo. The patients taking Souvenaid showed about 45 percent less cognitive decline than people taking the placebo, according to a measure known as the clinical dementia rating sum of boxes.
But the surprising finding, Wurtman says, is that the patients taking Souvenaid showed a substantial reduction is the loss of hippocampal volume. In early stages of Alzheimer's, the hippocampus—which plays an important role in memory—shrinks as tissue is destroyed. But rates of deterioration for those taking Souvenaid were about 26 percent lower than the control group.
"That's remarkable," Wurtman says. "I never would have guessed that something like that could happen. But if you suppress the loss of the hippocampus, it makes sense that you'd have better retention of cognitive function."
The results indicate that Souvenaid may be able to slow or stop full progression of very early Alzheimer's into full-blown Alzheimer's, Wurtman says.
With this new study, Wurtman has high hopes for Souvenaid. First, he says the findings could encourage more researchers to view synapse restoration as a treatment for Alzheimer's, which isn't a popular area of study. Most research today, he says, focuses on reducing the accumulation of amyloid plaques or minimizing damage caused by toxic metabolites in Alzheimer's-affected brains.
"Everyone who writes about Alzheimer's knows there's a synapse deficiency, and this impairs connections between brain regions," he says. "Even if the amyloid or another problem gets solved, one way or another, you'll have to replace these synapses."
Wurtman also hopes the study will "catalyze the rapid appearance of Souvenaid in the American market" and become a very early treatment for suspected Alzheimer's patients. Several potential biomarkers are being studied as indicators of early Alzheimer's. But it's somewhat useless to detect these biomarkers if nothing can be done about the disease at that point, Wurtman says. With Souvenaid, he says, that can change.
"Most people don't do a biomarker test, because … there's been nowhere to go from there. Now, it will be possible, I believe, for a doctor to tell a patient that, even though they have early Alzheimer's, they can take Souvenaid chronically to suppress the development of the disease."

This story is republished courtesy of MIT News (web.mit.edu/newsoffice/), a popular site that covers news about MIT research, innovation and teaching.

Provided by Massachusetts Institute of Technology