Spot the Lesion

Movin’ Meat: Case of the day

Spot the Lesion – MedPage Today Blogs – 27989

While the NEJM Image Challenge is challenging, the blog I’ve linked to is much more informative and educational.  Click the first link for the patient pictures and problem description.  The second link provides the answer and the physician’s deductive reasoning.

This post is dedicated to the medical student in my life who starts his Neurology block later this year.

NEJM Teaching Topic – MCI

The NEJM Resident e-Bulletin is one of the ways I keep up with medical information.  While it will not be possible for me to reproduce every email that comes from this service, on occasion I will post topics of interest.  Copyright remains vested with the NEJM so don’t try and steal this to make money.

Teaching Topic

Mild Cognitive Impairment

Clinical Practice

Mild Cognitive Impairment

R.C. Petersen

CME Exam   Full Text Audio  Comments

MCI represents an intermediate state of cognitive function between the changes seen in aging and those fulfilling criteria for dementia, often Alzheimer’s disease (AD).

Clinical Pearls

Clinical Pearl  What is the estimated prevalence of MCI?

The estimated prevalence of MCI in population-based studies ranges from 10 to 20%. In the Mayo Clinic Study of Aging, a prospective, population-based study of non-demented persons ages 70 to 89 years at enrollment, the prevalence of amnestic MCI was 11.1% and of nonamnestic MCI, 4.9%.

Clinical Pearl  How can the “worried well” be differentiated from patients with MCI?

Neuropsychological testing may be necessary to corroborate a history of decline in cognition, usually memory. At times, the “worried well” can give a convincing history for memory loss, but neuropsychological testing reveals normal performance.

Figure 1. Diagnostic Algorithm for Amnestic and Nonamnestic Mild Cognitive Impairment.

Morning Report Questions

Q. What factors predict a more rapid progression of cognitive impairment among patients with MCI?

A. As compared with the incidence rate for dementia in the general population of 1 to 2% per year, the incidence of dementia in patients with MCI is significantly increased, with an annual rate of 5 to 10% in community-based populations and 10 to 15% in clinic-based populations. The degree of cognitive impairment at presentation is a clinical predictor of progression; those with greater baseline impairment appear more likely to progress more rapidly. The presence of the apolipoprotein E ε4 allele is also predictive of progression rate. Several MRI measures have also been reported to predict a faster rate of progression, including atrophic hippocampi, dilated ventricles, reduced total brain volume, and the presence of white matter hyperintensities.

Q. How can patients with MCI be managed?

A. Limited data support the potential benefit of cognitive rehabilitation approaches. Several clinical trials that treated persons with MCI with cholinesterase inhibitors used for AD (donepezil, galantamine, and rivastigmine) at standard AD treatment doses for 2 to 4 years have shown no significant reduction in the rates of progression to dementia.

Be Still…(it may help your brain)

Mindfulness Meditation Is Associated With Structural Changes in the Brain [NCCAM Research Results]

Brain images in the meditation group revealed increases in gray matter concentration in the left hippocampus. The hippocampus is an area of the brain involved in learning, memory, and emotional control, and is suspected of playing a role in producing some of the positive effects of meditation. Gray matter also increased in four other brain regions (though not in the insula, a region that has shown changes in other meditation studies) in the meditation group. Responses to the questionnaire indicated improvements in three of the five aspects of mindfulness in the mediators, but not the control group. 

The researchers concluded that these findings may represent an underlying brain mechanism associated with mindfulness-based improvements in mental health. Additional studies are needed to determine the associations between specific types of brain change and behavioral mechanisms thought to improve a variety of disorders.

Memantine for PDD or DLB

Underwriting Quick Notes:

  • PDD = Parkinson’s Disease Dementia
  • DLB = Dementia with Lewy Bodies
  • Memantine = Namenda

Memantine for patients with Parkinson’s disease dementia or dementia with Lewy bodies: a randomised, double-blind, placebo-controlled trial : The Lancet Neurology

Memantine seems to improve global clinical status and behavioural symptoms of patients with mild to moderate DLB, and might be an option for treatment of these patients.

Train Your Brain

Underwriters love stuff like this!

How Your Brain Connects the Future to the Past – Jeff Brown and Mark Fenske – Your Health at Work – Harvard Business Review

In the business world, it’s a distinct advantage to have a brain that anticipates future demands and negotiates them well. Accurate predictions typically translate to success. Being able to envision future scenarios helps foster strategic planning and resist immediate rewards in favor of longer-term gains. The proactive brain flexibly recombines details from past experiences that, by analogy with your current surroundings, help you make sense of where you are, anticipate what will come next, and successfully navigate the transition.