Memory and Brain Differences in Former NFL Players Who Lost Consciousness During Concussion

The hippocampus was found to be smaller in 28 former NFL players as compared with a control group of men of similar age and education, according to a new study published online in JAMA Neurology. The authors say this is the first study to compare the relationship between hippocampal volume, memory performance, and concussion severity.

Some of the retired NFL players also met criteria for Mild Cognitive Impairment (MCI), a condition that typically affects memory and may lead to dementia. The findings were more pronounced among those who experienced more severe concussions.

The former players ranged from 36 to 79 years old, with a mean age of 58. Twenty-one healthy men of similar age, educational level, and intelligence with no history of concussion or professional football experience served as control subjects.

The results do not explain why the hippocampus was smaller in the athletes who suffered more serious concussions. Some shrinkage is a part of the normal aging process but the reduction is accentuated in MCI and was even more notable in those MCI subjects with a history of concussion accompanied by loss of consciousness. Thus, there appears to be a cumulative effect of concussion history and MCI on hippocampal size and function.

Cognitive Impairment Predicts Worse Outcome in Heart Failure

Cognitive impairment predicts worse outcome in elderly heart failure patients, reveals research presented at Heart Failure 2015, the annual meeting of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Patients with cognitive impairment had a 7.5 times greater risk of call cause death and heart failure readmission.

Heart failure patients with cognitive impairment may get progressively worse at adhering to medications, leading to poorer prognosis.

Systematic reviews have shown that cognitive impairment is common in patients with chronic heart failure, said study author Hiroshi Saito, a physiotherapist at Kameda Medical Centre in Kamogawa, Japan. “However, the impact of cognitive impairment on the prognosis of heart failure patients is not known. Our study investigated whether cognitive impairment independently predicted the outcome of elderly patients with heart failure.”

The study retrospectively included 136 patients aged 65 years or over with heart failure who were admitted to Kameda Medical Centre. The MMSE was conducted to evaluate the presence of cognitive disorder in all patients before discharge. Patients were divided into two groups: those with cognitive disorder (score below 27 on the MMSE) and those without (score 27 or above).

Patients were 82 years old on average and 47 percent were men. According to the MMSE, 101 patients (74 percent) had cognitive disorder. After a follow up of 161 days, 33 patients (24 percent) were readmitted due to heart failure or died.

The researchers found that the prognosis of patients in the cognitive impairment group was significantly worse than the non-cognitive impairment group. They also showed that cognitive impairment predicted a 7.5 times greater risk of worse prognosis in elderly patients with heart failure. The risk remained even after adjusting for other prognostic factors.

Actavis Barred From Pulling Cheaper Alzheimer’s Drug

A federal appeals court ruled Actavis cannot pull its top-selling Alzheimer’s drug Namenda IR from the market in favor of a pricier extended-release version. New York State Attorney General Eric Schneiderman had sued to block the switch, arguing the move was intended to suppress competition from generic drugmakers.

MS May Double the Risk of Dying Early

People with MS may have double the risk of dying early compared to people without MS, with those younger than 59 at a three times higher risk, new research suggests. The study is published online May 27 in Neurology.

“Despite studies that show MS survival may be improving over time, the more than 2.3 million people affected worldwide by this disabling disease still face a risk of dying earlier, specifically those who are diagnosed younger,” said study author Ruth Ann Marrie, MD, PhD, of the University of Manitoba in Winnipeg, Canada.

For the study, researchers reviewed the health system use of 5,797 people diagnosed with MS and 28,807 healthy people of the same sex, born in the same year and from the same areas of the province. 

People with MS lived a median of 76 years, compared to 83 years for people who did not have the disease. 

A total of 44 percent of the people with MS were reported to have died from MS and related complications of the disease. After that, the most common causes of death were circulatory system disease, cancer and respiratory disease. 

The researchers also looked at whether participants had several other conditions, such as diabetes, depression and epilepsy. Overall, they found that having other conditions did not shorten the lifespan of people with MS any more than it did for the people without MS. However, people with MS who had other conditions had a shorter life span than those who did not have conditions such as diabetes. 

Delusions and Hallucinations Occur More Commonly Than Thought

About five percent of the general population will at some point in their lives hear voices or see things others cannot, new research suggests. The study was led by the University of Queensland and Harvard Medical School.

Published online in JAMA Psychiatry, the study looked at six types of psychotic experiences (PE) (two hallucinatory experiences and four delusional experiences) among more than 31,000 adults from 19 countries. Researchers examined lifetime and 12-month prevalence and frequency.

The mean lifetime prevalence of ever having a PE was 5.8 percent, with hallucinatory experiences much more common than delusional experiences. More than two-thirds of respondents with lifetime PEs also reported experiencing only one type. Psychotic experiences were typically infrequent, with 32.2 percent of respondents with lifetime PEs reporting only one occurrence and 31.8 percent reporting only two to five occurrences. The team found a significant relationship between having more than one type of PE and having more frequent PE episodes. Lifetime prevalence estimates were significantly higher among respondents in middle- and high-income countries than among those in low-income countries, and among women than among men.

Researchers also found significant associations with lifetime prevalence of PEs in the multivariate model among non-married compared with married respondents and among respondents who were not employed and who had low family incomes.

 

Rheumatoid Arthritis Drug Meets Phase III Endpoints

Regeneron Pharmaceuticals and Sanofi said its Phase III study of sarilumab, an investigational, fully human IL-6 receptor antibody, met its co-primary efficacy endpoints to treat rheumatoid arthritis (RA). The companies plan to submit their Biologics License Application to FDA by the end of 2015.

The study, called SARIL-RA-TARGET, evaluated the efficacy and safety of two subcutaneous sarilumab doses versus placebo, added to non-biologic disease modifying anti-rheumatic drugs (DMARD) therapy in RA patients who were inadequate responders to or intolerant of TNF-alpha inhibitors (TNF-IR).

The SARIL-RA-TARGET trial enrolled 546 TNF-IR patients who were randomized to one of three treatment groups self-administered subcutaneously every other week: sarilumab 200mg, sarilumab 150mg, or placebo, in addition to DMARD therapy. Both sarilumab groups showed clinically relevant and statistically significant improvements compared to the placebo group in both co-primary endpoints: 1) improvement in signs and symptoms of RA at 24 weeks, as measured by the American College of Rheumatology score of 20 percent improvement (ACR20), and 2) improvement in physical function, as measured by change from baseline in the Health Assessment Question-Disability Index (HAQ-DI) at week 12. 

The improvements on ACR20 were 61 percent in the sarilumab 200mg; group; 56 percent in the sarilumab 150mg group; and 34 percent in the placebo group, all in combination with DMARD therapy.

 

Shift Work Can Cause Sleep Problems, Weight Gain

Employees who work shifts outside of a 9-to-5 schedule are more likely to be overweight and experience sleep problems, and possibly more likely to develop metabolic disorders, such as diabetes, compared to workers following traditional work schedules, a study shows. The study was published online May 18 in Sleep Health.

The investigators used cross-sectional data from a population-based health examination survey that includes home- and clinic-based interviews and physical examinations. In the analysis, 1593 participants were assessed using measures from the physical examination to calculate body mass index and determine obesity or overweight status.

Shift-workers were significantly more likely than traditional schedule workers to be overweight (47.9 percent vs. 34.7 percent). They also experienced more sleep problems such as insomnia (23.6 percent vs. 16.3 percent), insufficient sleep (53.0% vs. 42.9%), or excessive wake-time sleepiness (31.8 percent vs. 24.4 percent). Since shiftwork and sleep problems have both been implicated in poor metabolic health, this study asked whether sleep problems may play a role in shift-worker health disparities. Researchers found that experiencing sleep problems was positively associated with being overweight/obese or diabetic.

Though sleep problems did not fully explain the relation between shiftwork and overweight or diabetes, “these association appear to be stronger among shift-workers who were not able to obtain sufficient sleep (less than seven hours per day), suggesting that the adverse metabolic consequences of shiftwork could be partially alleviated by sufficient sleep,” according to the study.

AMA Medical Education Initiatives Update

The American Medical Association (AMA) adopted a policy to ensure medical students receive necessary hands-on clinical experience using electronic health records (EHR). The new policy calls on the AMA to work with medical school accrediting bodies to encourage medical schools and residency and fellowship training programs to teach students how to use electronic devices in the exam room and at the bedside in an effort to improve patient care as well as increase the accuracy of communications. The policy also encourages the AMA to support medical student acquisition of hands-on experience in documenting patient encounters and entering clinical orders into patients’ EHRs, with appropriate supervision. As part of the AMA’s Accelerating Change in Medical Education initiative aimed at reshaping medical education in the US, AMA work currently is underway with a consortium of 11 leading medical schools to develop innovative models that incorporate EHR training into undergraduate medical education. Based on research and the future outcomes of this strategic work, the new policy also calls for determining the characteristics of an ideal software system that should be used at medical schools and teaching hospitals that offer teaching EHRs.

FDA ACTIONS

FDA Approves Migraine Drug For Pediatric Patients

FDA approved Treximet (sumatriptan and naproxen sodium) for use in pediatric patients 12 years of age and older for the acute treatment of migraine with or without aura.

It is the first approved combination prescription medicine, and the first to contain sumatriptan, for the treatment of acute migraine attacks in pediatric patients. The two medicines—sumatriptan and naproxen sodium—in combination provide more effective, sustained control of the pain and associated symptoms of migraine compared to either medicine taken alone, according to the drug’s maker. Approval came after the FDA’s review of pivotal Phase III safety and efficacy clinical trial, plus long-term safety and pharmacokinetic data, demonstrating that Treximet is significantly more effective than placebo in treating migraine in pediatric patients and has a favorable safety profile similar to that of Treximet for adults.

Treximet carries a boxed warning noting cardiovascular and gastrointestinal risks.

The recommended dose for pediatric patients 12 years of age and older is a single tablet of Treximet 10/60mg (sumatriptan 10mg and naproxen sodium 60mg) per 24-hour period and the maximum recommended dose is 85/500mg per 24-hour period. The recommended dose for adults is a single tablet of Treximet 85/500mg.

The AMA also adopted policy reaffirming the need for increasing medical residency slots and expanding funding sources for graduate medical education (GME) to improve access to health care. The new policy addresses the many valuable ways that physicians-in-training contribute to the health and well-being of the general public in both the US and around the world during their residency, including providing care to underserved areas and at-risk populations. Through the new policy, the AMA will advocate for continued and expanded GME funding from federal, state, local and private sources. Specifically, the AMA will advocate for federal funding for the National Healthcare Workforce Commission, established under the Affordable Care Act, to provide the nation with data and health care workforce policy that supports the value of GME to the nation as a whole.

Over the last year, the AMA has adopted numerous policies calling for the modernization of GME, including increased funding for medical residency slots, development of innovative practice models and residency positions that reflect societal needs. Most recently, the AMA has urged support of two federal bills—the Creating Access to Residency Education (CARE) Act, which would expand funding for graduate medical education and improve access to health care for patients in underserved areas, and the recently introduced Resident Physician Shortage Reduction Act of 2015, which would also help increase the number of residency slots and address physician shortages.

New Study Maps the Types of Physical Activity Associated with Better Sleep Habits

Physical activities, such as walking, as well as aerobics/calisthenics, biking, gardening, golfing, running, weight-lifting, and yoga/Pilates are associated with better sleep habits, compared to no activity, according to a new study from researchers at the Perelman School of Medicine at the University of Pennsylvania. In contrast, the study shows that other types of physical activity – such as household and childcare -- work are associated with increased cases of poor sleep habits. The full results of the study (Abstract #0246) will be presented during the poster session June 8, at SLEEP 2015, the 29th annual meeting of the Associated Professional Sleep Societies.

Physical activity is already well associated with healthy sleep, but the new study, led by Michael Grandner, PhD, instructor in Psychiatry and member of the Center for Sleep and Circadian Neurobiology at Penn, yields insight into whether specific types of physical activities may impact sleep quality.

Using data on sleep and physical activities of 429,110 adults from the 2013 Behavioral Risk Factor Surveillance System, the Penn researchers measured whether each of 10 types of activities was associated with typical amount of sleep, relative to both no activity and to walking. Survey respondents were asked what type of physical activity they spent the most time doing in the past month, and also asked how much sleep they got in a typical 24-hour period. Since previous studies showed that people who get less than 7 hours are at greater risk for poor health and functioning, the study evaluated whether people who reported specific activities were more likely to also report sufficient sleep.

Compared to those who reported that they did not get physical activity in the past month, all types of activity except for household/childcare were associated with a lower likelihood of insufficient sleep. To assess whether these effects are just a result of any activity, results were compared to those who reported walking as their main source of activity. Compared to just walking, aerobics/calisthenics, biking, gardening, golf, running, weight-lifting and yoga/Pilates were each associated with fewer cases of insufficient sleep, and household/childcare activity was associated with higher cases of insufficient sleep. These results were adjusted for age, sex, education level, and body mass index.

“Although previous research has shown that lack of exercise is associated with poor sleep, the results of this study were surprising,” said Grandner. “Not only does this study show that those who get exercise simply by walking are more likely to have better sleep habits, but these effects are even stronger for more purposeful activities, such as running and yoga, and even gardening and golf. It was also interesting that people who receive most of their activity from housework and childcare were more likely to experience insufficient sleep – we know that home and work demands are some of the main reasons people lose sleep.”

“These results are consistent with the growing scientific literature on the role of sleep in human performance,” said Grandner. “Lab studies show that lack of sleep is associated with poor physical and mental performance, and this study shows us that this is consistent with real-world data as well. Since these results are correlational, more studies are needed to help us understand whether certain kinds of physical activity can actually improve or worsen sleep, and how sleep habits help or hurt a person’s ability to engage in specific types of activity.”

AMA Addresses Risk of Concussion in Youth Sports

The American Medical Association (AMA) has adopted a new policy it says addresses the need for prompt diagnosis and appropriate concussion management plans in treating sports-related concussions.

The AMA’s adopted policy calls for youth athletes suspected of having sustained a concussion to be removed immediately from the activity. They should be allowed to return only with a physician’s written consent, the AMA says.

“The new policy also encourages the adoption of evidence-based, age-specific guidelines for physicians, other health care professionals and athletic organizations to use in evaluating and managing concussion in all athletes as well as the development and evaluation of effective risk reduction measures to prevent or reduce sports-related injuries and concussions,” the AMA said.

Most concussions at the high school and college levels occurred during practice, according to an article published online last month in JAMA Pediatrics. Analysis indicates that 53.9 percent of concussions occurred during youth football games, but in high school and college most concussions (57.7 percent and 57.6 percent, respectively) happened during practice. No concussions were reported in youth football players who were five to seven years old, although the young players accounted for more than 7,000 athlete exposures (AEs, one player participating in one game or one practice).

In games, the college concussion rate (3.74 per 1,000 AEs) was higher than that reported in high school (2.01 per 1,000 AEs) and youth athletes (2.38 per 1,000 AEs). In practice, the college concussion rate (0.53 per 1,000 AEs) was lower than that in high school (0.66 per 1,000 AEs), according to the study.