Delaying Retirement May Reduce Risk for Dementia

dementiaAn older age at retirement may be associated with a significantly decreased risk of dementia, according to research presented at the 2013 Alzheimer’s Association International Conference. In a study of 429,803 retired French workers, Carole Dufouil, PhD, and colleagues found that the hazard ratio of dementia was 0.968 for each extra year of age at retirement.

“Our results highlight the importance of maintaining high levels of cognitive and social stimulation throughout work and retiree life and emphasize the need for interventions and policies to help older individuals achieve such cognitive and social engagement,” stated Dr. Dufouil, Director of Research in Neuroepidemiology at INSERM in Paris.

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Sleep Helps Our Memory

sleeping-womanEvery night, while we lie asleep, blind, dumb and almost paralyzed, our brains are hard at work. Neurons in the sleeping brain fire nearly as often as they do in a waking state, and they consume almost as much energy. What is the point of this unceasing activity at a time when we are supposedly resting? Why does the conscious mind disconnect so completely from the external environment while the brain keeps nattering on?

The brain’s activity during rest likely serves some essential function. The evidence for this importance starts with sleep’s ubiquity. All animals apparently sleep even though being unconscious and unresponsive greatly raises the risk of becoming another creature’s lunch. Birds do it, bees do it, iguanas and cockroaches do it, even fruit flies do it, as we and others demonstrated more than a decade ago.

Sleep must serve some vital function because all animals do it. Evidence suggests that sleep weakens the connections among nerve cells, which is a surprising effect, considering that strengthening of those connections during wakefulness supports learning and memory. But by weakening synapses, sleep may keep brain cells from becoming oversaturated with daily experience and from consuming too much energy.

The Lakes Surgical Center is one of the locations we perform surgeries

Lakes Surgical CenterThe Lakes Surgical Center in West Bloomfield is one of the locations that we perform spine and neuro surgeries.

The center includes four operating rooms, two procedure rooms, pre-operative and post-operative recovery areas and a large reception area. It is licensed by the State of Michigan and is fully accredited by the Joint Commission for Accreditation of Healthcare Organizations. Lakes Surgery Center is affiliated with National Surgical Hospitals.

New Headache Classification System

michigan-brainThe International Classification of Headache Disorders, Third Edition (ICHD-III beta version) is now complete and ready for field testing.

“It’s out, it’s published, you should start using it immediately because it’s much better than the second edition,” Jes Olesen, MD, PhD, professor of neurology, University of Copenhagen, Glostrup Hospital, Denmark, told delegates to the 2013 International Headache Congress (IHC).

Dr. Olesen, who chaired the working group on migraine, encouraged delegates to start citing this new classification system and to participate in field testing, which will take place during the next few years, before publication of the final version.

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Migraine: A Brain Disorder

headache-disordersPositron emission tomography of patients experiencing the premonitory phase of migraine, prior to the headache setting in, shows activation in several areas of the brain, indicating that migraine is a brain disorder and not a response to pain stimuli.

The results are significant in terms of understanding the neurobiology of migraine and could have future implications for drug treatment, said study author Peter James Goadsby, MD, PhD, professor, neurology, and director, Headache Program, University of California at San Francisco, and president, International Headache Society.

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Can we reduce the risk of recurrent event after a TIA or minor stroke? New study shows benefit of Clopidogrel with Aspirine

Transient Ischemic AttackStroke is common during the first few weeks after a transient ischemic attack (TIA) or minor ischemic stroke. Combination therapy with clopidogrel and aspirin may provide greater protection against subsequent stroke than aspirin alone.

In a randomized, double-blind, placebo-controlled trial conducted at 114 centers in China, we randomly assigned 5170 patients within 24 hours after the onset of minor ischemic stroke or high-risk TIA to combination therapy with clopidogrel and aspirin (clopidogrel at an initial dose of 300 mg, followed by 75 mg per day for 90 days, plus aspirin at a dose of 75 mg per day for the first 21 days) or to placebo plus aspirin (75 mg per day for 90 days). All participants received open-label aspirin at a clinician-determined dose of 75 to 300 mg on day 1. The primary outcome was stroke (ischemic or hemorrhagic) during 90 days of follow-up in an intention-totreat analysis. Treatment differences were assessed with the use of a Cox proportional- hazards model, with study center as a random effect.

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Stroke risk increases after TBI

medical-operating-roomThe risk of ischemic stroke increased modestly but significantly following traumatic brain injury (TBI), according to a review of more than 400,000 cases.

TBI was associated with a 31% greater risk of stroke compared with trauma patients whose injuries did not affect the brain. A significantly increased risk persisted after adjustment for potentially confounding factors.

Although the absolute increase in risk was 0.2%, the higher prevalence of TBI in trauma patients translated into a bigger contribution to ischemic stroke than hypertension, the leading risk stroke risk factor, James F. Burke, MD, of the University of Michigan in Ann Arbor, and co-authors reported in the July 2 issue of Neurology.

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FDA Approves Exelon Patch for Severe Alzheimer’s

alzheimersThe US Food and Drug Administration has approved an expanded indication for the rivastigmine transdermal system (Exelon Patch, Novartis Pharmaceuticals Corporation) to include patients with severe disease.

Approval of this new indication for the 13.3 mg/24h dose rivastigmine patch means it can be used across all stages of disease, making it the only transdermal therapy that can be used across all stages of disease, the company notes in a statement. The patch is already approved for patients with mild to moderate dementia of the Alzheimer’s type and for patients with mild to moderate dementia associated with Parkinson’s disease.

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Opioid Overdose: it can be lethal!

health-drug-overdoseOpioid analgesic overdose is a life-threatening condition, and the antidote naloxone may have limited effectiveness in patients with poisoning from long-acting agents. The unpredictable clinical course of intoxication demands empirical management of this potentially lethal condition.

Opioid analgesic overdose is a preventable and potentially lethal condition that results from prescribing practices, inadequate understanding on the patient’s part of the risks of medication misuse, errors in drug administration, and pharmaceutical abuse. Three features are key to an understanding of opioid analgesic toxicity. First, opioid analgesic overdose can have life-threatening toxic effects in multiple organ systems. Second, normal pharmacokinetic properties are often disrupted during an overdose and can prolong intoxication dramatically. Third, the duration of action varies among opioid formulations, and failure to recognize such variations can lead to inappropriate treatment decisions, sometimes with lethal results.

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Preoperative MRI predicts outcomes in cervical spondylosis with cord compression

Preoperative Magnetic Resonance Imaging Is Associated With Baseline Neurological Status and Can Predict Postoperative Recovery in Patients With Cervical Spondylotic Myelopathy.

preoperative-mri-mycelopathy

Types of MRI signal change in patients with CSM. (A) No signal change. (B) Diffuse T2 signal (open arrow). (C) Focal T2 signal (closed arrow). (D) Segmentation of T2 (double arrow). (E) Low T1 signal (arrow head). MRI indicates magnetic resonance imaging; CSM, cervical spondylotic myelopathy.

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