mild-cognitive-impairment

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

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The FDA has approved Leqem­bi, the first dis­ease-mod­i­fy­ing treat­ment for ear­ly-stage Alzheimer’s and a pre­cur­sor con­di­tion, mild cog­ni­tive impair­ment. Medicare has said it will pay for the ther­a­py. Med­ical cen­ters across the coun­try are scram­bling to final­ize poli­cies and pro­ce­dures for pro­vid­ing the med­ica­tion to patients, pos­si­bly by summer’s end or ear­ly autumn.

It’s a fraught moment, with hope run­ning high for fam­i­lies and oth­er promis­ing ther­a­pies such as donanemab on the hori­zon. Still, med­ical providers are cau­tious. “This is an impor­tant first step in devel­op­ing treat­ments for com­plex neu­rode­gen­er­a­tive dis­eases, but it’s just a first step,” said Ronald Petersen, direc­tor of the Mayo Clinic’s Alzheimer’s Dis­ease Research Cen­ter in Rochester, Min­neso­ta. [Read more…] about Hopes and Ques­tions raised by Alzheimer’s drug Leqem­bi (lecanemab)

Taking your brain vitals: Stories from a techno-optimist inventing the future of human performance

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Dr. Cori Lath­an, author of Invent­ing the Future: Sto­ries from a Techno-Optimist

For as long as I can remem­ber, my father loved act­ing. Into his six­ties and ear­ly sev­en­ties, he was quite active in the the­ater. He played Tartuffe in Molière’s Tartuffe, Nick Bot­tom in Shakespeare’s A Mid­sum­mer Night’s Dream, and the Old Man in Steve Martin’s Picas­so at the Lapin Agile. When he won the role of Scrooge in a local pro­duc­tion of Dickens’s A Christ­mas Car­ol, I was so excit­ed for him that I bought tick­ets way before open­ing night. But he was hav­ing trou­ble remem­ber­ing his lines. Even­tu­al­ly, the direc­tor had to let him go.

To find out what was going on, my mom and dad went to his pri­ma­ry care physi­cian, who referred him to a neu­rol­o­gist. After wait­ing a month for that appoint­ment, the neu­rol­o­gist told Dad to see a neu­ropsy­chol­o­gist, who was booked anoth­er three months out. When that appoint­ment arrived, the neu­ropsy­chol­o­gist gave him a vari­ety of cog­ni­tive tests, includ­ing writ­ten, ver­bal, and com­put­er based. After anoth­er month, the neu­rol­o­gist called us back in and told my father, “You have mild cog­ni­tive impairment.”

“No shit, Sher­lock,” I thought. “That’s why we went to see his doc­tor six months ago.” The neu­rol­o­gist then dis­cussed my father’s oth­er health issues with us, which includ­ed car­dio­vas­cu­lar dis­ease, sleep apnea, type 2 dia­betes, and by that point, depres­sion. I then had an inspi­ra­tion. “Dad, when was the last time you used your CPAP machine?” He admit­ted sheep­ish­ly, “I don’t use it. I don’t like it.” [Read more…] about Tak­ing your brain vitals: Sto­ries from a tech­no-opti­mist invent­ing the future of human performance

Building cognitive reserve helps delay memory and thinking decline regardless of genetic or childhood markers

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Wel­come to a new edi­tion of Sharp­Brains’ e‑newsletter, fea­tur­ing time­ly brain news and a few fun brain teasers to test your per­cep­tu­al and cog­ni­tive skills.

#1. Study: Build­ing cog­ni­tive reserve helps delay mem­o­ry and think­ing decline regard­less of genet­ic or child­hood markers

“While our child­hood can influ­ence our mem­o­ry and think­ing skills lat­er in life, this research under­lines the mes­sage that it’s nev­er too late to take action to sup­port cog­ni­tive health.” — Dr Sara Imari­sio, Head of Strate­gic Ini­tia­tives at Alzheimer’s Research UK

#2. Ful­ly-auto­mat­ed analy­sis of voice recordings–from neu­ropsy­cho­log­i­cal tests–found to help dif­fer­en­ti­ate nor­mal cog­ni­tion from demen­tia and mild cog­ni­tive impairment

As the researchers point out, “The pro­posed approach offers a ful­ly auto­mat­ed iden­ti­fi­ca­tion of MCI and demen­tia based on a record­ed neu­ropsy­cho­log­i­cal test, pro­vid­ing an oppor­tu­ni­ty to devel­op a remote screen­ing tool that could be adapt­ed eas­i­ly to any language”

#3. Debunk­ing the “chem­i­cal imbal­ance” the­o­ry yet not throw­ing out the anti­de­pres­sant baby with the bathwater

“Depres­sion is usu­al­ly man­aged effec­tive­ly with anti­de­pres­sants or by talk­ing treat­ments, such as cog­ni­tive behav­iour ther­a­py, despite an incom­plete under­stand­ing of the con­di­tion and how these treat­ments work. We can­not know if treat­ments address the under­ly­ing prob­lem because we haven’t yet iden­ti­fied what that is. To imply that SSRI anti­de­pres­sants may not be worth­while is to mis­un­der­stand an evi­dence base that says the very opposite.”

#4. Q&A with researcher Robb Rut­ledge on men­tal health, expec­ta­tions, deci­sion-mak­ing and hol­i­day planning

“Recent events have a big­ger impact on hap­pi­ness than ear­li­er events, so it can be a good strat­e­gy to save a cou­ple things that have a chance of a big pos­i­tive sur­prise for the last few days of your trip. It could be a nov­el expe­ri­ence that a lot of peo­ple like but you’re not sure what to expect … It prob­a­bly isn’t anoth­er muse­um. Just make sure it’s not some­thing that could get rained out”

#5. How much should you trust Bet­ter­Help, Talk­space, Cere­bral and oth­er men­tal health start-ups tout­ed by celebrities?

“Many U.S. adults aren’t able to find help because of a short­age of ther­a­pists. Near­ly 40% are strug­gling with men­tal health or sub­stance abuse issues, accord­ing to the Cen­ters for Dis­ease Con­trol and Prevention.
So mil­lions of peo­ple are turn­ing to online companies…”

#6. Dig­i­tal men­tal health inter­ven­tion by the World Health Orga­ni­za­tion (WHO) found to low­er anx­i­ety and depres­sion, with improve­ments main­tained at 3?month follow-up

As acknowl­edged “The main lim­i­ta­tion of the cur­rent tri­al is the high dropout rate”, but con­text is key: “Most dis­placed peo­ple with men­tal dis­or­ders in low- and mid­dle-income coun­tries do not receive effec­tive care, and their access to care has dete­ri­o­rat­ed dur­ing the Coro­n­avirus Dis­ease 2019 (COVID-19) pan­dem­ic”. — Inno­va­tion does­n’t need to be per­fect, just better/ cheaper/ more acces­si­ble than alternatives.

#7. Dig­i­tal ther­a­peu­tics pio­neer Akili Inter­ac­tive Labs goes pub­lic, rais­ing $150M+; trades down 49% first day

Quite dif­fi­cult mar­ket envi­ron­ment for an impor­tant evi­dence-based inno­va­tion — good news is they raised enough funds to test approach in the real world over the next 12–24 months. Let’s see!

#8. Arti­fi­cial Intel­li­gence (AI) meets Cog­ni­tive Behav­ioral Ther­a­py (CBT): Wysa rais­es $20M to scale up men­tal health chatbot

“Typ­i­cal­ly, access to a men­tal health ser­vice is gat­ed. It is restrict­ed by some kind of diag­no­sis — say­ing only if you are severe enough you will be able to get to speak to a ther­a­pist because obvi­ous­ly ther­a­py is expen­sive and somebody’s got to pay for it” … the app offers “ear­ly engage­ment and a safe space where peo­ple can come in and anony­mous­ly just talk about what’s both­er­ing them.”

Final­ly, here are three quick brain teas­er games to test your per­cep­tu­al and cog­ni­tive skills. Wish­ing you and yours a healthy and stim­u­lat­ing month of September!

Fully-automated analysis of voice recordings–from neuropsychological tests–found to help differentiate normal cognition from dementia and mild cognitive impairment

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Cred­it: James Byrne

Voice Record­ings Spot Cog­ni­tive Impair­ment (Med­Page Today):

A machine-learn­ing mod­el iden­ti­fied mild cog­ni­tive impair­ment and demen­tia from dig­i­tal voice record­ings of neu­ropsy­cho­log­i­cal tests, an ear­ly study showed.

Among 1,084 peo­ple in the Fram­ing­ham Heart Study whose tests were record­ed, the aver­age area under the curve (AUC) reached 92.6% for dif­fer­en­ti­at­ing nor­mal cog­ni­tion from demen­tia, 88.0% for dis­cern­ing nor­mal cog­ni­tion or mild cog­ni­tive impair­ment from demen­tia, and 74.4% for dis­tin­guish­ing nor­mal cog­ni­tion from mild cog­ni­tive impair­ment. [Read more…] about Ful­ly-auto­mat­ed analy­sis of voice recordings–from neu­ropsy­cho­log­i­cal tests–found to help dif­fer­en­ti­ate nor­mal cog­ni­tion from demen­tia and mild cog­ni­tive impairment

Deep learning model built on neuroimaging data identifies “Brain Age Gaps” as markers of Alzheimer’s disease (AD)

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Brain Age Gap is a Com­pos­ite Bio­mark­er for Demen­tia Pathol­o­gy or Sever­i­ty (GEN):

Mayo Clin­ic sci­en­tists have devel­oped a com­pu­ta­tion­al mod­el that pre­dicts brain age using a large col­lec­tion of neu­roimag­ing data obtained using FDG-PET (flu­o­rodeoxyglu­cose positron emis­sion tomog­ra­phy) and struc­tur­al MRI (mag­net­ic res­o­nance imag­ing). The deep learn­ing-based mod­el tests the rela­tion­ship between brain age gaps in var­i­ous forms of demen­tia, includ­ing mild cog­ni­tive impair­ment (MCI), Alzheimer’s dis­ease (AD), fron­totem­po­ral demen­tia (FTD), and Lewy body demen­tia (LBD), as well as in nor­mal brains.

[Read more…] about Deep learn­ing mod­el built on neu­roimag­ing data iden­ti­fies “Brain Age Gaps” as mark­ers of Alzheimer’s dis­ease (AD)

On physical activity, neuroplasticity, depression, screen time, neuromodulation and more

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Wel­come to a new edi­tion of Sharp­Brains’ e‑newsletter, fea­tur­ing this time eight sci­en­tif­ic reports and indus­try resources plus a few fun brain teasers.

#1. Study finds ulti­mate hack to pro­tect teen brains from harm­ful screen time: Exer­cise (and good role-mod­el­ing):

“Girls who spent less than an hour on screens and boys who spent less than 90 min­utes on screens were not neg­a­tive­ly impact­ed by it. But at high­er amounts of screen time, their life sat­is­fac­tion dropped significantly—they were less hap­py with their lives, and it got worse the more time they spent … (the) study also found that teens who got more reg­u­lar exer­cise had greater life sat­is­fac­tion and few­er phys­i­cal com­plaints for both gen­ders. Not only that, the effects were large­ly unre­lat­ed to how much time a teen spent on screens, so that if teens exer­cised more, it could poten­tial­ly undo the dam­age to their well-being that went along with even six or eight hours of screen time.”

#2. Stud­ies find grow­ing evi­dence link­ing weight, phys­i­cal activ­i­ty, neu­ro­plas­tic­i­ty and depres­sion:

‘Obe­si­ty and depres­sion are both major glob­al health chal­lenges, and our study pro­vides the most robust evi­dence to date that high­er BMI caus­es depres­sion,’ said lead author Jess O’Loughlin. ‘Under­stand­ing whether phys­i­cal or social fac­tors are respon­si­ble for this rela­tion­ship can help inform effec­tive strate­gies to improve men­tal health and wellbeing.’

#3. Dr. Judith Beck on the future of cog­ni­tive ther­a­py and psy­chother­a­py:

Let’s hope! — “I think Cog­ni­tive Behav­ioral Ther­a­py (CBT) will con­tin­ue to be adapt­ed for more prob­lems, diag­noses, and con­di­tions. We will train many kinds of care­givers, teach­ers, front-line work­ers, police, and even politicians.”

#4. Ratio­nal­i­ty doesn’t equal effi­cien­cy: Cell­phone data shows how we nav­i­gate cities:

“We dis­cov­ered that the most pre­dic­tive mod­el – rep­re­sent­ing the most com­mon mode of city nav­i­ga­tion – was not the quick­est path, but instead one that tried to min­i­mize the angle between the direc­tion a per­son is mov­ing and the line from the per­son to their des­ti­na­tion … Evo­lu­tion is a sto­ry of trade-offs, not opti­miza­tions, and the cog­ni­tive load of cal­cu­lat­ing a per­fect path rather than rely­ing on the sim­pler point­ing method might not be worth a few saved min­utes. After all, ear­ly humans had to pre­serve brain pow­er for dodg­ing stam­ped­ing ele­phants, just like peo­ple today might need to focus on avoid­ing aggres­sive SUVs.”

#5. Trend: Har­ness­ing dig­i­tal tech to improve men­tal health and well­ness:

“Designed with the help of Dutch aca­d­e­m­ic Isabela Granic … the game is cen­tred around an avatar who stays in bed for the day and aims to relax play­ers by using sooth­ing music, mut­ed colours and self-care prac­tices. Think med­i­ta­tive tasks such as word games and guid­ed breath­ing exer­cis­es. There’s no way to win, com­pete or binge – in fact, it delib­er­ate­ly starts to feel bor­ing after a few min­utes of play, which dis­in­cen­tivizes mind­less scrolling. #Self­Care was an instant hit, gar­ner­ing half a mil­lion down­loads in its first six weeks with­out any advertising…”

#6. Study: Per­son­al­ized, closed-loop neu­ro­mod­u­la­tion can (one day) become a “pace­mak­er for the brain”:

“What made this proof-of-prin­ci­ple tri­al suc­cess­ful was the dis­cov­ery of a neur­al bio­mark­er – a spe­cif­ic pat­tern of brain activ­i­ty that indi­cates the onset of symp­toms – and the team’s abil­i­ty to cus­tomize a new DBS device to respond only when it rec­og­nizes that pat­tern. The device then stim­u­lates a dif­fer­ent area of the brain cir­cuit, cre­at­ing on-demand, imme­di­ate ther­a­py that is unique to both the patient’s brain and the neur­al cir­cuit caus­ing her illness.”

#7. Six guide­lines to nav­i­gate the Aduhelm con­tro­ver­sy and (hope­ful­ly) help patients with Mild Cog­ni­tive Impair­ment and ear­ly-stage Alzheimer’s Dis­ease:

“After ini­tial­ly indi­cat­ing that Aduhelm could be pre­scribed to any­one with demen­tia, the Food and Drug Admin­is­tra­tion now spec­i­fies that the pre­scrip­tion drug be giv­en to indi­vid­u­als with mild cog­ni­tive impair­ment or ear­ly-stage Alzheimer’s, the groups in which the med­ica­tion was studied.
Yet this nar­row­er rec­om­men­da­tion rais­es ques­tions. What does a diag­no­sis of mild cog­ni­tive impair­ment mean? Is Aduhelm appro­pri­ate for all peo­ple with mild cog­ni­tive impair­ment, or only some? And who should decide which patients qual­i­fy for treat­ment: demen­tia spe­cial­ists or pri­ma­ry care physicians?”

#8. The Fed­er­al Trade Com­mis­sion (FTC) hard­ens data secu­ri­ty rules for health apps and devices:

“With data breach­es on the rise, the FTC is look­ing to make health apps more account­able for telling patients when their data has been exposed.”

 

Wish­ing you and yours a sweet Hal­loween and a healthy month of November,

The Sharp­Brains Team