Brain Imaging: UK Biobank Epidemiology Study

I wanted to alert Brain Posts readers to a very important ongoing study out of the United Kingdom.

The UK Biobank prospective epidemiological study is a study designed to identify imaging markers for a wide variety of diseases. Additionally, a goal of the study is to better understand disease mechanisms.

Here is what is being collected on 100,000 healthy participants who will be tracked over decades:

• Brain structural and functional imaging (fMRI)
• Brain diffusion tensor imaging (DTI)
• Neuropsychological testing, i.e. cognition
• Body and cardiac imaging
• Genetics
• Lifestyle information
• Biomarker phenotyping
• Health records

This ambitious study reminds me of the Framingham study in the U.S. that helped identify a group of risk factors for cardiac and vascular disease.

Some early results from the UK Biobank study of early 5,000 subjects has been published in Nature Neuroscience.

The manuscript shows that the UK Biobank will be a powerful resource in replicating other studies. They reported a initial attempt to replicate an Austrian Stroke Prevention study (ASPS) finding. The UK Biobank data analysis demonstrated changes in brain gray matter on T2* imaging linked to older age, smoking and increased BMI. This finding is felt to demonstrate increased brain iron accumulation with aging and degeneration.

The UK Biobank data results were "highly concordant with the ASPS".

I highly recommend reviewing this early manuscript in the UK Biobank Epidemiological Study.  Readers can access the free full-text manuscript by clicking on the PMID link in the citation below. It features a review of the methodology of the study. Numerous important research findings will emerge from this study in the years and decades to come.

The Brits are to be congratulated on such an important and costly effort.

Image of brain is an iPad screen shot from the iPad app 3D Brain.

Follow me on Twitter WRY999

Miller KL, Alfaro-Almagro F, Bangerter NK, Thomas DL, Yacoub E, Xu J, Bartsch AJ, Jbabdi S, Sotiropoulos SN, Andersson JL, Griffanti L, Douaud G, Okell TW, Weale P, Dragonu I, Garratt S, Hudson S, Collins R, Jenkinson M, Matthews PM, & Smith SM (2016). Multimodal population brain imaging in the UK Biobank prospective epidemiological study. Nature neuroscience PMID: 27643430

Statin Therapy: Rethinking Benefits and Risks

A recent 30-page manuscript provides an exhaustive review of the evidence for the efficacy and safety of statin therapy.

The authors of this excellent review provide some context for the relative value of statins.

The note that putting 10000 individuals with a history of a vascular event on a statin drug for 5 years would prevent 1,000 subsequent events. This is an example of secondary prevention--preventing another adverse outcome in those already experiencing an adverse event.

But the statin drugs also appear very powerful in primary prevention-preventing a first event in those at high risk for vascular disease. They estimate putting 10,000 individuals at high risk for vascular events on statins would result in prevention of 500 vascular events over five years.

This review provides an up-to-date review of the safety of statins and generally supports the therapy as very low risk.

One proposed adverse event of statin therapy is concern about memory and cognition. However, the authors note that well-designed studies of statin therapy in older individuals find no evidence of adverse cognitive effects compared to placebo.

They argue that:

"..given the weight of evidence against adverse effects of statin therapy on memory or other adverse effects of cognition, it would now be appropriate for regulatory authorities to consider removal from the lists of potential adverse effects on the drug labels so that patients are not inappropriately deterred from using statin therapy." (emphasis mine).

The authors go on to emphasize the potential adverse public health consequences of misleading claims regarding the safety of the statin drug class.

This excellent review is likely to lead to further discussion about extending the indications for statin use in the general population.

This review also supports discussion between individuals and their physicans on the appropriateness of statin therapy as part of a disease prevention progra.

Readers with more interest in this topic can access the full free-text manuscript by clicking on the link in the citation below.

Follow me on Twitter by clicking HERE.

Photo of osprey in flight is from my photography files.

Collins R, Reith C, Emberson J et al.  (2016). Interpretation of the evidence for the efficacy and safety of statin therapy Lancet : http://dx.doi.org/10.1016/S0140-6736(16)31357-5

When Laughing Isn't Funny

Inappropriate uncontrollable laughing or crying is common in many neuroscience medicine disorders including after traumatic brain injury or stroke. It can be socially embarrassing and restrict opportunities for social interaction.

This loss of control over emotional responses is known by the term pseudobulbar affect or PBA. Until recently, few therapeutic options were available to treat this condition.

Now a relatively new drug Nuedexta uses a combination of dextromethorphan and quinide to treat pseudobulbar affect. This drug combination has received FDA approval in the U.S.

A recent review article summarized what is known about the pharmacology of the drug dextromethorphan (DM). DM is found in over-the-counter cough medications, for example Robitussin DM.

The DM mechanism of action is felt to be due to the blocking of the NMDA receptor (N-methyl-D-aspartate). This results in a inhibition of the excitotoxic neurotransmitter glutamate. The effect of DM on neurotransmitter function is non-specific and effects on other neurotransmitter systems include:

• Inhibition of serotonin reuptake
• Inhibition of norepinephrine uptake
• Antagonism of the nicotinic acetylcholine receptors
• Agonism of sigma1-R gene

Quinidine inhibits CYP2D6 the cytochrome P450 liver enzyme involved in liver enzyme metabolism of DM. This results in much higher and prolonged blood levels of dextromethorphan.

The potential therapeutic targets for DM mentioned in the review include the following:

• Pseudobulbar affect
• Epilepsy
• Pain
• Peripheral neuropathy
• TBI
• Stroke
• Alzheimer’s disease (agitation)

I will take a look at some of the specific research studies in these additional targets over the next week or two.

Follow the author on Twitter WRY999

Figure of Advertising Card showing phases of laughter is from Wikipedia Creative Commons.
By not known, printed by Young's, The Hatter - eBay store Web page: http://ebay.to/29rwilh

Taylor CP, Traynelis SF, Siffert J, Pope LE, & Matsumoto RR (2016). Pharmacology of dextromethorphan: Relevance to dextromethorphan/quinidine (Nuedexta®) clinical use. Pharmacology & therapeutics PMID: 27139517

Complications and Prevention of stroke

Stroke is a life threatening condition that requires immediate medical attention. If the symptoms are recognized and treatment is administered immediately,damage can be limited. The severity of the complication of stroke can vary, depending on how long the brain was deprived of blood and the part of the brain that was affected. Stroke can cause temporal or permanent disabilities.

Some of the complications include:

• Paralysis
• Difficulty in walking
• Difficulty in talking or swallowing
• Loss of memory

Prevention of Stroke

Prevention is better than cure. All it takes is to know the risk factors and prevent them by living a healthy lifestyle. This lifestyle is also recommended for the prevention of heart diseases. They are:

1 Have a normal weight

Always Calculate your Body Mass Index (BMI) in order to help you determine if you are underweight, normal, overweight or obese. Overweight and obesity are risk factors for hypertension, heart diseases and obesity which in turn are risk factors for stroke. Learn how to control your weight in order to reduce your risk of developing stroke in the future.

2 Exercise regularly

Exercise is very important in life. It helps in keeping our weight under control, keeps us active and helps in bringing down high blood pressure. It has been recommended that we put in at least 150 minutes of exercise every week.

3 Do not drink alcohol in excess

Excessive consumption of alcohol is a risk factor for stroke. It is important to drink the recommended units of alcohol in order to stay healthy. what quantity of alcohol consumption is considered normal?

4 Eat less Junk food and more fruits and vegetables

The dietary approach to stop hypertension recommends that we eat more fruits and vegetables. This will help in preventing hypertension which is a risk factor for stroke.

5 control your high blood pressure

High blood pressure is the leading cause of ischaemic stroke. Reducing your blood pressure is the most important thing to do when preventing the occurrence of stroke. In order to reduce your blood pressure, you must make certain lifestyle changes such as eating more fruits and vegetables, exercising regularly, limiting your intake of foods that raise blood pressure, avoiding high amounts of sodium and limiting your intake of alcohol.

6 Control your diabetes

If you are a diabetic, learn to control your blood sugar level. You can control your diabetes by eating foods with a lower glycemic index, eat more fruits and vegetables, exercise regularly and take your medications as prescribed by your health care practitioner.

7 Consider quitting tobacco use

Those who smoke tobacco should consider quitting as this reduces the risk of developing stroke.

8 Reduce your consumption of bad cholesterol

You can reduce your consumption of bad cholesterol by eating healthy foods and limiting the intake of foods that contain saturated fats.

9 Treat sleep apnea if it is Present

your health care provider will guide you on the management and treatment of sleep apnea.

sources:

Mayo Clinic

Medical News Today

NHS Choices

Web MD

Health Pleromana

What is stroke? Know the symptoms and save a life by getting medical attention

Do you know you can have a silent stroke and not know it? You may only discover when damage has resulted.

Do you know if you get angry a lot, your blood pressure may rise and this may put you at risk for a stroke?

A stroke, is a medical condition which occurs when blood flow is prevented from reaching your brain. The cells of your brain are therefore cut off from oxygen and nutrients. If the blockage is not removed, damage could result.

According to the  National Institute of Neurological Disorders and Stroke, 8 out of every 10 strokes can be prevented.

Types of stroke

1 Ischaemic stroke
This is the most common type of stroke. This occurs when the blood vessels carrying blood to your brain get blocked by blood clots or fatty deposits from your arteries. Atrial fibrillation, which is an irregular heartbeat can cause poor blood flow resulting in blood clots which can cause a stroke if it occludes a blood vessel carrying blood to the brain.

2 Hemorrhagic stroke

The most common cause of a hemorrhagic stroke is high blood pressure (hypertension). If a hemorrhage occurs along the blood vessels in the brain, a hemorrhagic stroke will result. Those who have extremely high blood pressure can suffer from this type of stroke. Those who have high blood pressure should:
know some foods that help in lowering high blood pressure 
know what foods to avoid and 
make lifestyle changes that will generally prevent high blood pressure and other non communicable diseases.

Factors that put you at risk for developing stroke

This factors that increase your risk of developing stroke can be controlled. They are:

• Hypertension

• Heart Disease

• Atherosclerosis (hardened arteries)

• Diabetes

• High cholesterol

• Overweight and Obesity

• Sickle cell disease

• Smoking

• Excessive alcohol intake

• Increase in age

• Family history

• Sleep apnea

Symptoms of stroke

If anyone around you is having stroke, it is a medical emergency and the person needs medical care as soon as possible. The most important symptoms to watch out for are:

1 slurred speech

Someone experiencing stroke will have a slurred speech even when the person is awake. Sometimes, the person may not be able to talk at all.

2 Numbness/weakness of the arms and legs

Someone who is experiencing a stroke may experience weakness in the arms or worst still the arms may be numb. The person may not be able to lift  the arm and suspend it for a while because it is weak. This numbness/weakness may also cause problems in walking.

3 paralysis of the face

Paralysis of the face is one of the symptoms of stroke. You may notice that the person’s face has dropped to one side and he or she may not be able to smile. 

other symptoms include

• headache

• unable to see clearly in one or both eyes

• confusion and not being able to understand clearly

Sources:
Web MD

NHS Choices
Mayo Clinic

Quick Aspirin Use Reduces Stroke Risk in TIA

A free full-text commentary in the Lancet summarizes recent evidence of the benefit of aspirin in stroke prevention.

This commentary focused on what is called secondary prevention. Secondary prevention is defined as prevention following events related to the disease in question.

So secondary prevention in stroke would be reduction in stroke risk in those who have had a stroke or pre-stroke syndromes such as transient ischemic attacks (TIA).

The key take-home message from the commentary by Graeme Hankey includes:

• Aspirin following mild stroke reduced risk of recurrent ischemic stroke by 49%
• In a summary of 12 trials in those with TIA or ischemic stroke, aspirin reduced risk of any further stroke by 51%, reduced risk of fatal or disabiling stroke by 66% and reduced risk of myocardial infarction by 70%
• Adding another agent (dipyridamole) to aspirin did not reduce stroke risk any further in 12 weeks of follow-up but did appear to add some benefit long-term

Active trials of new drugs for stroke prevention are ongoing and will become available in the next several years. These interventions may provide additional secondary prevention options for clinicians and patients. 

Readers with more interest in this topic can access the free-full text manuscript by clicking on the citation link below.

Follow me on Twitter @WRY999:  HERE.

Image is an iPad screenshot from the app 3D Brain.

Hankey, G. (2016). The benefits of aspirin in early secondary stroke prevention The Lancet DOI: 10.1016/S0140-6736(16)30511-6

25 Foods that contain potassium

Some potassium rich foods

Foods that are rich in potassium can reduce blood pressure and prevent heart attack and stroke. The American Heart Association encourages the consumption of a diet that includes natural sources of potassium. This is because potassium helps in reducing blood pressure by lowering the effects of sodium.  Here are some foods that contain potassium:

[next]
1 Fresh tomatoes

[next]

2 Banana

[next]

3 Sweet potato

[next]

4 Mushroom

[next]

5 Grapefruit

[next]
6 Spinach

[next]

7 Orange

[next]

8 Cantaloupe

[next]

9 Molasses

[next]

10 Apricots

[next]

11 Prunes

[next]

12 Beetroot

[next]

13 Lima beans

[next]

14 Avocado (pear)

[next]
15 Soy beans

[next]

16 Potatoes

[next]

17 Broccoli

[next]
18 Carrot

[next]

19 Cabbage

[next]

20 Celery

21 Bell pepper

[next]

22 Paw-paw (papaya)

[next]

23 Onions

[next]

24 Water melon

[next]

25 Cucumber

[next]

 Also Read:  How To Get Rid Of Pimples and Acne at Home

How to get rid of pimples and acne at home

How to get rid of pimples and acne at home

How to get rid of pimples and acne at home

Resources

World’s Healthiest Foods. Potassium

American Heart Association. Potassium and High Blood Pressure

Consuming dietary potassium can bring down high blood pressure (hypertension)

Hypertension is the leading cause of cardiovascular diseases worldwide.  In addition to consuming dietary potassium, eating less sodium, eating healthy food and doing exercise regularly also helps in reducing high blood pressure. The recommended daily intake of potassium for an average adult is about 4,700 milligrams per day except for those who have hyperkalemia. Hyperkalemia means you have too much potassium in your blood. It is very important to seek medical advice before embarking on the use of dietary potassium or potassium supplements if you have been diagnosed with hyperkalemia or kidney problems.

Numerous studies have confirmed the role potassium plays in bringing down hypertension. A study conducted by Houston MC on The importance of potassium in managing hypertension confirmed the role of potassium in lowering blood pressure in both hypertensive and non-hypertensive individuals.
The American Heart Association describes potassium as the only one component of a well-rounded plan for blood pressure health.

To see the list of some foods that contain potassium, click here.

7 HEALTH BENEFITS OF PEAR (AVOCADO

Avocados are fruits that are creamy and buttery in nature. It is found in Cameroon, Nigeria, Ghana, other African countries, America and in almost all parts of the world. It is commonly called pear in African countries.  It is a good source of healthy fats (unsaturated fats) and contains many vitamins and minerals.

1 Healthy heart

Studies have showed that Avocado contains a compound called beta-sitosterol. Beta-sterol is able to reduce bad cholesterol levels in our system and thus prevents bad cholesterol from destroying our heart.

2 Regulates Blood Pressure

Pear is significantly high in potassium. Potassium helps to regulate the effects of sodium. This is because an increase in the intake of sodium is responsible for an increase in blood pressure.

3 Vision

Avocado contains chemicals that promote good vision and enhance the overall health of the eye. These chemicals (zeaxanthin and lutein) help in reducing our risk of developing macular degeneration due to ageing.

4 Beautiful skin

Pear contains Vitamin C and E which helps in the growth of the cells of our skin. Pear has also been used in facial products to treat skin conditions such as acne. 

5 Digestion and constipation

Pear contains a significant amount of dietary fiber that encourages regular bowel movements. These are very essential for digestion and prevention of constipation.

6 Cancer

Some studies have established a link between consumption of pears and a decreased incidence of certain types of cancers such as breast, mouth, cervical, stomach and prostate cancer. Researchers have attributed this to the presence of dietary folates which helps in DNA and RNA production.

7 Prevention of birth defects in infants

In order to prevent neural tube defects in babies when they are born, it is recommended that pregnant women consume Folate. Studies also show that folate can prevent miscarriages.

Resources:

MNT: Avocados, Health Benefits, Nutritional Information

The World’s Healthiest Foods: Avocados

A heart age predictor to determine if you are at risk of developing heart attack and stroke

Recent studies on cardiovascular diseases has showed that we may have a heart age that is older than our actual age. The difference in age was accounted for by our unhealthy habits and lifestyle.

The Center for Disease control and prevention stated that 3 out of every 4 Americans have a heart age that is older than their actual age. This puts them at risk of developing heart attack and stroke.

Calculating the heart age involves the use of an online calculator which uses our age, BMI, sex, systolic blood pressure and other risk factors for heart disease such as the presence of diabetes or smoking.

Decreasing our heart's age to our normal age involves working on the risk factors that put us at risk for developing a heart attack or stroke such as watching our weight , reducing our blood pressure and making healthy choices.

In order to calculate your age using the online calculator, click here . More research is still being conducted on the use of this calculator to predict the risk of developing heart attack and stroke. 

The best way to avoid heart diseases is to eat Foods that prevent heart disease, do exercise regularly and avoid junk/processed foods. 

Resources:

Framingham Heart study: Heart Age predictor using BMI
CBS News: Is your heart older than you are?