Four reasons to question “new generation” monoclonal antibody Alzheimer’s drugs such as aducanumab (Aduhelm), lecanemab (Leqembi), donanemab

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New Alzheimer’s Drugs Don’t Deserve the Hype (Being Patient):

A promi­nent child­hood mem­o­ry is of my grand­par­ents liv­ing with and then dying from demen­tia. As is uni­ver­sal with demen­tia, there was a dou­ble blow: watch­ing my grand­par­ents lose their iden­ti­ty and see­ing the suf­fer­ing of those clos­est to them. [Read more…] about Four rea­sons to ques­tion “new gen­er­a­tion” mon­o­clon­al anti­body Alzheimer’s drugs such as adu­canum­ab (Aduhelm), lecanemab (Leqem­bi), donanemab

Non-invasive Transcranial Electrical Stimulation (TES) shows early promise to treat ADHD symptoms in children

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While tDCS uses con­stant cur­rent inten­si­ty, tRNS and tACS use oscil­lat­ing cur­rent. The ver­ti­cal axis rep­re­sents the cur­rent inten­si­ty in mil­liamp (mA), while the hor­i­zon­tal axis illus­trates the time-course. Source: Wikipedia.

Many chil­dren with ADHD ben­e­fit from med­ica­tion treat­ment, behav­ioral treat­ment, or their com­bi­na­tion, but oth­ers do not. In addi­tion, par­ents are often reluc­tant to start their child on med­ica­tion and high qual­i­ty behav­ioral treat­ments are not read­i­ly acces­si­ble in many areas. The long-term effi­ca­cy of these treat­ments is also less than desir­able. Thus, despite these evi­dence-based ADHD treat­ments, there is a press­ing need to devel­op nov­el treat­ments with strong research support.

A study pub­lished recent­ly in Trans­la­tion­al Psy­chi­a­try [Dakawar-Kawar et al (2023). Tran­scra­nial ran­dom noise stim­u­la­tion com­bined with cog­ni­tive train­ing for treat­ing ADHD: a ran­dom­ized sham-con­trolled tri­al.] reports promis­ing results for a nov­el ADHD treat­ment approach.

The Study:

Study par­tic­i­pants were 24 6–12 year-old chil­dren recent­ly diag­nosed with ADHD fol­low­ing a com­pre­hen­sive eval­u­a­tion. They were ran­dom­ly assigned to receive either a) a type of Tran­scra­nial Elec­tri­cal Stim­u­la­tion (TES) called Tran­scra­nial Ran­dom Noise Stim­u­la­tion (TRNS) or b) sham stim­u­la­tion; chil­dren in both groups engaged in com­put­er­ized cog­ni­tive train­ing dur­ing the ses­sions. [Read more…] about Non-inva­sive Tran­scra­nial Elec­tri­cal Stim­u­la­tion (TES) shows ear­ly promise to treat ADHD symp­toms in children

“To do nothing is not an option”: The NHS Confederation releases digital mental health whitepaper

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The NHS Con­fed­er­a­tion–the mem­ber­ship organ­i­sa­tion for health­care providers in Eng­land, Wales and North­ern Ire­land– has just released a quite com­pre­hen­site 45-page whitepa­per titled Max­imis­ing the poten­tial of dig­i­tal in men­tal health.

Some of the highlights:

To do noth­ing is not an option. If we don’t make more progress we miss a key oppor­tu­ni­ty to make improve­ments to men­tal health ser­vices such as improv­ing access; pro­vid­ing ear­ly inter­ven­tion and pre­ven­tion at scale; imple­ment­ing new ways of reach­ing peo­ple; and help­ing to meet the demand sup­ply gap; and at the same time open­ing up access so that inequal­i­ties in access to health­care and sup­port for men­tal health are reduced.

[Read more…] about “To do noth­ing is not an option”: The NHS Con­fed­er­a­tion releas­es dig­i­tal men­tal health whitepaper

Next: Harnessing Neuroplasticity, Medication AND Psychotherapy to treat mental health conditions

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There is mount­ing recog­ni­tion in the sci­en­tif­ic com­mu­ni­ty that com­bin­ing dif­fer­ent treat­ment approach­es for men­tal health con­di­tions can cre­ate a ben­e­fit greater than the sum of its parts.

As a clin­i­cal psy­chol­o­gist and neu­ro­science researcher, I have been work­ing to inte­grate insights from both fields to expand treat­ment options for those suf­fer­ing from depres­sion, anx­i­ety and relat­ed con­di­tions. Design­ing a treat­ment plan that pays care­ful atten­tion to the sequence and dose of both bio­log­i­cal and behav­ioral ther­a­pies might ben­e­fit peo­ple in new ways that nei­ther approach can achieve on its own. [Read more…] about Next: Har­ness­ing Neu­ro­plas­tic­i­ty, Med­ica­tion AND Psy­chother­a­py to treat men­tal health conditions

Time for a universal “exercise prescription” for kids and adults to boost cognition and mental health?

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Wel­come to a new edi­tion of Sharp­Brains e‑newsletter, fea­tur­ing this time a range of brain research find­ings, tools and con­tro­ver­sies plus some brain teasers to chal­lenge your (and our) work­ing memory.

#1. Major evi­dence review sup­ports an “exer­cise pre­scrip­tion” for most adults to boost men­tal health

“High­er inten­si­ty phys­i­cal activ­i­ty was asso­ci­at­ed with greater improve­ments” and “Effec­tive­ness of phys­i­cal activ­i­ty inter­ven­tions dimin­ished with longer dura­tion interventions.”
The sweet spot was four or five half-hour effort­ful ses­sions per week. Are you hit­ting it?

#2. (Sep­a­rate) Evi­dence review: Phys­i­cal exer­cise helps boost atten­tion, cog­ni­tive flex­i­bil­i­ty and inhibito­ry con­trol in chil­dren and ado­les­cents with ADHD

Not sur­pris­ing but impor­tant find­ings. Next to research: the type, inten­si­ty, and dura­tion that may help the most.

#3. Read­ing for plea­sure dur­ing child­hood may lead to high­er brain/ cog­ni­tive devel­op­ment and men­tal well-being dur­ing adolescence

Cru­cial­ly, “… read­ing for plea­sure in ear­ly child­hood was linked with bet­ter scores on com­pre­hen­sive cog­ni­tion assess­ments and bet­ter edu­ca­tion­al attain­ment in young ado­les­cence. It was also asso­ci­at­ed with few­er men­tal health prob­lems and less time spent on elec­tron­ic devices … can be ben­e­fi­cial regard­less of socioe­co­nom­ic sta­tus. It may also be help­ful regard­less of the children’s ini­tial intel­li­gence lev­el.” — Long Live Books and Read­ing (and, yes, Exercise)!

#4. Vir­tu­al cog­ni­tive behav­iour­al ther­a­py (CBT) accounts for over 30% of NHS men­tal health treat­ments — up from 10% in 2017

“Ear­ly inter­ven­tion is crit­i­cal in pre­vent­ing a patient’s mild to mod­er­ate symp­toms from wors­en­ing” … (but) online ther­a­py may not suit every­one and that it was still up to health­care pro­fes­sion­als to iden­ti­fy “who may and may not benefit”

#6. Neu­rotech and brain data in con­text: Are “neu­ror­ights” the way to men­tal privacy?

Impor­tant point: “The poten­tial to col­lect brain data more direct­ly, with high­er res­o­lu­tion, and in greater amounts has height­ened wor­ries about men­tal and brain pri­va­cy …(but) We argue that by empha­siz­ing what is dis­tinct about brain pri­va­cy issues, rather than what they share with oth­er data pri­va­cy con­cerns, risks weak­en­ing broad­er efforts to enact more robust pri­va­cy law and policy.”

#7. Hopes and Ques­tions raised by Alzheimer’s drug Leqem­bi (lecanemab)

“Will Leqembi’s pri­ma­ry ben­e­fit — a slight slow­ing of decline in cog­ni­tion and func­tion­ing — make a sig­nif­i­cant dif­fer­ence to patients and fam­i­ly mem­bers or will it be dif­fi­cult to dis­cern? … How many old­er adults in their 70s and 80s will be able and will­ing to trav­el to med­ical cen­ters for infu­sions twice a month and have reg­u­lar MRI scans and physi­cian vis­its to mon­i­tor for poten­tial side effects such as brain bleeds or swelling? Even with Medicare cov­er­age, how many peo­ple will be able to afford the suite of med­ical ser­vices required?”

#8. Its mas­sive price tag: $109,000 per patient, per year

“To qual­i­fy for Leqem­bi, patients must under­go a PET scan that looks for amy­loid plaques, the pro­tein clumps that clog the brains of many Alzheimer’s patients. About 1 in 5 patients who took Leqem­bi in the major clin­i­cal test of the drug devel­oped brain hem­or­rhag­ing or swelling, a risk that requires those tak­ing the drug to under­go fre­quent med­ical check­ups and brain scans called MRIs … Out­stand­ing doubts about Leqem­bi and relat­ed drugs have giv­en urgency to efforts to mon­i­tor patient experiences.”
#9. Final­ly, let’s piv­ot into some­thing more fun. Here are a few brain teasers aimed at chal­leng­ing your work­ing mem­o­ry and help­ing get that brain and mind in great shape for the new academic/ life­long learn­ing year. Please give them a try … they are not as easy as they may sound:

 

Say the days of the week in alpha­bet­i­cal order, then back­wards. If too hard, try the 5 work days first.

If you speak a lan­guage oth­er than Eng­lish, do the same in said language.

Say the months of the year in alpha­bet­i­cal order. Too easy? Well, try doing so back­wards, in reverse alpha­bet­i­cal order. (You will prob­a­bly need some pen and paper for this one.)

Find the sum of your date of birth, mm/dd/yyyy. For a tougher brain teas­er, do the same with your best friend’s date of birth (with­out look­ing it up…)

Look around you and, with­in a minute, find three green things that may fit in your pock­ets, and three red objects that are clear­ly too big to fit.

(more brain teasers here, for teens and adults of every age)
Have a great month of September!

Evidence review: Physical exercise helps boost attention, cognitive flexibility and inhibitory control in children and adolescents with ADHD

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The impact of phys­i­cal exer­cise on ADHD has been exam­ined in a large num­ber of stud­ies. Col­lec­tive­ly, these stud­ies have exam­ined whether exer­cise reduces on core ADHD symp­toms, e.g., inat­ten­tion and hyperactivity/impulsivity, and strength­ens exec­u­tive func­tions, e.g., inhibito­ry con­trol, work­ing mem­o­ry, and men­tal health, e.g., emo­tion­al and social func­tion­ing. Over­all, results across mul­ti­ple stud­ies sug­gest a pos­i­tive impact of phys­i­cal activ­i­ty (PA) on sev­er­al of these out­comes in youth with ADHD.

Con­clu­sions based on a sin­gle study –no mat­ter how strong the study design and exe­cu­tion may be– are nec­es­sar­i­ly lim­it­ed, how­ev­er. This has led researchers to com­bine results from mul­ti­ple stud­ies using a sta­tis­ti­cal tech­nique called meta-analy­sis so that more robust and reli­able esti­mates of a treat­men­t’s impact can be deter­mined. [Read more…] about Evi­dence review: Phys­i­cal exer­cise helps boost atten­tion, cog­ni­tive flex­i­bil­i­ty and inhibito­ry con­trol in chil­dren and ado­les­cents with ADHD

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