Archives for January 2020

New Dementia Research: Anti-Inflammation Drugs May Reverse Dementia

Jan 30, 2020 by United Brain Association Leave a Comment

The mental decline that, in extreme cases leads to dementia, might be a natural part of aging, doesn’t mean that it’s inevitable or irreversible. At least that’s what a team of researchers at the University of California, Berkeley, and Ben-Gurion University think. A new study published by the team suggests that age-related cognitive decline may actually be a non-permanent result of inflammation in the brain, and drugs designed to treat inflammation may be able to reverse the decline.

An Ineffective Wall

The theory pursued by the team’s study is based on the idea that the blood-brain barrier, a biochemical wall that prevents harmful chemicals and infectious agents from traveling from the bloodstream into the brain, gets less effective as we age. Studies have indicated that as many as 60% of people over the age of 70 have leaky blood-brain barriers.

The team’s study produced data that seems to show that when certain chemicals are able to leak into the brain, they produce an inflammatory response. And that, the researchers think, is what causes confusion, memory problems, and other symptoms of age-related cognitive decline and dementia.

“We tend to think about the aged brain in the same way we think about neurodegeneration: Age involves loss of function and dead cells. But our new data tell a different story about why the aged brain is not functioning well: It is because of this ‘fog’ of inflammatory load,” says Daniela Kaufer, PhD, one of the study’s senior authors. “But when you remove that inflammatory fog, within days the aged brain acts like a young brain. It is a really, really optimistic finding, in terms of the capacity for plasticity that exists in the brain. We can reverse brain aging.”

Building the Case Against Inflammation

An earlier study by two of the team’s scientists showed that when a protein called albumin is able to make it through the blood-brain barrier, it sparks an inflammatory response that damages nerve cells and makes them function abnormally. The current study showed that, at least in mice, the introduction of albumin into the brain produces effects that look much like the negative effects of aging. Among other things, the albumin-affected mice were not able to find their way through a maze as well as young, healthy mice could.

Even more hopeful is the study’s finding that when the mice were given a drug that blocked the effects of albumin, their brains began to look young again. They were less prone to seizures, and they were able to navigate a maze as well as a young mouse.

The team was not, at first, trying to find a way to turn back the clock on the brain’s aging process. But their investigation into problems with the blood-brain barrier may have inadvertently uncovered a new hope for dementia patients.

“We got to this through this back door; we started with questions about plasticity having to do with the blood-brain barrier, traumatic brain injury and how epilepsy develops,” Kaufer said. “But after we’d learned a lot about the mechanisms, we started thinking that maybe in aging it is the same story. This is new biology, a completely new angle on why neurological function deteriorates as the brain ages.”

Sources
UC Berkeley, Drugs that quell brain inflammation reverse dementia
Science Translational Medicine, Blood-brain barrier dysfunction in aging induces hyperactivation of TGFβ signaling and chronic yet reversible neural dysfunction

Study Found Limitations on Cognitive Behavioral Therapy’s Effect on Patients with Contamination OCD

Jan 28, 2020 by United Brain Association Leave a Comment

Cognitive-behavioral therapy (CBT) is a proven and effective treatment for obsessive-compulsive disorder (OCD). Studies have found that many OCD patients see a marked improvement in their symptoms after completing a Cognitive-behavioral therapy program. A new study has found, however, that a specific subset of OCD sufferers may not respond as well to CBT.

Most Obsessive-Compulsive Disorder Responds to Cognitive Behavioral Therapy

The study, conducted by researchers at Aarhus University in Denmark, followed 269 children between the ages of 7 and 17 who had been diagnosed with OCD. All of the participants received a 14-week course of cognitive-behavioral therapy. Those participants who still exhibited OCD symptoms after the 14 weeks were treated either with more CBT or with antidepressant medications (SSRIs). All participants were evaluated after 6 months, 1 year, 2 years, and 3 years.

After three years, the study found that most of the participants had seen significant improvement in their OCD symptoms.

“Part of the overall picture is that almost eighty percent of those we studied were so well-functioning following the cognitive behavioral therapy that after three years they no longer had OCD to a degree that required treatment,” says Per Hove Thomsen, the study’s lead investigator.

An Unusual Exception

One of the study’s results stood out, however. Among the 59 participants who seemed in danger of an OCD relapse after three years, a significant number exhibited a specific kind of symptom. They suffered from the “contamination and washing variant” of OCD, and they were limited in their insight into their condition. That is, they are compelled to act out behaviors revolving around cleanliness, and they are not especially aware of how the behaviors affected them.

These participants responded well to CBT during the 14-week treatment period, but when they were evaluated after three years, they were not doing as well.

“The tricky thing is that they initially react positively to the cognitive behavioral therapy, and they, therefore, leave the mental health services again after the 14-week period of treatment,” says Sanne Jensen, another of the study’s authors. “But when we contact them again after three years, we can see they demonstrate a worrying development – they have gotten worse.”

The authors don’t draw any conclusions about why this particular type of OCD might be resistant to cognitive behavioral therapy. They do, though, see the need for mental healthcare providers to be aware of the limitations of CBT in these cases, especially since the therapy may seem at first to be delivering good results.

“The conclusion isn’t that you’re doomed to a life-long disabling OCD if you’re a teenager with cleanliness rituals and poor insights into your condition,” says Thomsen. “There are also young people from this patient group who don’t suffer a relapse. On the contrary, the conclusion is that we need to become better at following up on precisely these patients because otherwise, we risk leaving them in the lurch.”

Sources
Aarhus University, Standard treatment programs for OCD are not always enough
The Journal of Child Psychology and Psychiatry, Distinct trajectories of long‐term symptom severity in pediatric obsessive-compulsive disorder during and after stepped‐care treatment

New Study Suggests Money Affects Your Risks of Binge Eating

Jan 23, 2020 by United Brain Association Leave a Comment

Binge eating disorder strikes across cultural boundaries, affecting people regardless of their economic status or educational level. But a new study suggests that the triggers that set the disorder in motion might be different depending on how much money your family has.

Researchers at the University of Minnesota conducted the first study that specifically looks at the impact of socioeconomic status on binge eating. The study looked at the eating behaviors of 2,179 young people at two points: first, during their adolescence, and then five years later, as they entered adulthood.

The study found, unsurprisingly, that some risk factors were common across both groups. Those children with higher body weight were more likely to binge eat, as were those who reported going on diets to lose weight. Children who were teased about their weight were also more likely to binge eat.

The Economics of Binge Eating

But when the researchers compared the two groups, they found that some risk factors had a significantly bigger impact on one group than on the other.

Children from more well-off families were more likely to binge eat when they were dissatisfied with their bodies. They were more affected by being overweight and by dieting, and they were more susceptible to binge eating when they were teased about their weight by their families.

Children from low-income families, on the other hand, were more affected by food insecurity. That is, they were more likely to binge eat if they went through periods in which they didn’t have access to enough food.

Different Communities, Different Risks

The researchers concluded that children from high-income families might be more vulnerable to social pressure to be thin. They suggested that because obesity is less common among people with high socioeconomic status, overweight kids in these communities might be more conspicuous and be subject to more teasing from their peers and their families. The pressure could cause more dieting and restrictive eating behaviors that are key risk factors for binge eating.

Children from low-income families, however, are more likely to experience times when they can’t get enough to eat. Although high-income kids don’t share that experience, food insecurity could mimic the restrictive eating patterns motivated by social pressure in high-income communities. High-income children limit their eating because of social pressure, while low-income children limit their eating because they have no other choice.

In both cases, restrictive eating increases the risk of binge eating, but the source of the risk is very different. That’s an important difference to be aware of for healthcare providers who are looking out for the kids.

“There are a lot of implications for providers who might see adolescents from lower-income communities,” says Caroline West, a Kent State University PhD student who led the study. “While it’s still important to provide them with typical care and resources for treating binge eating, it’s also important to address issues, such as food insecurity, that might be salient in that population by connecting patients with food assistance programs, such as SNAP or WIC.”

Sources
University of Minnesota, Research Brief: Risk factors for adolescent binge eating vary by family socioeconomic status
International Journal of Eating Disorders, Differences in risk factors for binge eating by socioeconomic status in a community‐based sample of adolescents: Findings from Project EAT

Ketamine Shows Potential as a Treatment for Alcoholism

Jan 21, 2020 by United Brain Association Leave a Comment

Ketamine, a hallucinogenic drug that has already shown promise as a treatment for brain disorders such as depression, may also be effective at treating alcoholism, according to researchers at Columbia University. In combination with psychotherapy, the drug appears to help patients control their problem drinking behavior for weeks at a time. It may also help patients to recover when they experience a relapse of their problem drinking behavior.

One Dose at a Time

In the study, the researchers administered a single dose of ketamine to participants under controlled circumstances. Afterward, the participants also received motivational therapy on an outpatient basis. A control group of participants received a dose of midazolam, a drug used to treat alcohol withdrawal symptoms, rather than ketamine.

Three weeks after the administration of the drugs, 82% of the participants who received ketamine were still abstaining from drinking, as compared to only 65% of the midazolam group. Overall, those in the ketamine group were less likely to experience a relapse, less likely to have heavy-drinking days, and more likely to return to abstinence after a relapse.

The reason for ketamine’s effectiveness is not clear. One theory is that it helps patients to respond to motivational therapy, a therapeutic approach that is not typically effective in treating alcoholism.

“One possibility is that ketamine addresses addiction-related vulnerabilities, like low motivation and low resilience, that contribute to problematic use. This may create a window where they can benefit more from behavioral treatment and lay the groundwork to meet their goals,” says Elias Dakwar, MD, the study’s lead author.

A striking effect of ketamine is that it seems to have made participants better able to handle the inevitable setbacks in their quest for improvement.

“In our participants, ketamine appears to have increased resilience and reduced demoralization after a lapse,” says Dakwar. “Participants may have been better able to bounce back after slipping, and they may have been more motivated to resume the work of recovery. In the midazolam group, on the other hand, there was a higher likelihood of escalating use after slipping and either relapsing or dropping out.”

A New Class of Treatments

The possibility of ketamine as a treatment for alcoholism fits into a body of recent research that is revealing the therapeutic effects of psychoactive drugs. This class of drugs, which also includes MDMA and psilocybin, may be able to significantly alter behavior in patients with a wide range of brain disorders, particularly when combined with psychotherapy. The Columbia team undertook the study on alcoholism after conducting a similar study that showed ketamine to be effective at treating cocaine addiction.

The scientists at Columbia are continuing to research ketamine’s use as a treatment for alcoholism. Further research will attempt to determine if multiple doses of the drug will produce even better results than a single dose.

Sources
Columbia University, Single Dose of Ketamine Plus Talk Therapy May Reduce Alcohol Use
The American Journal of Psychiatry, A Single Ketamine Infusion Combined With Motivational Enhancement Therapy for Alcohol Use Disorder: A Randomized Midazolam-Controlled Pilot Trial

Can Opioid Use Cause PTSD?

Jan 16, 2020 by United Brain Association Leave a Comment

The link between post-traumatic stress disorder (PTSD) and opioids is well established. About 40% of people with PTSD also have a drug-use disorder, and many people suffering from PTSD use opioid painkillers to self-medicate their PTSD symptoms. The connection could be even more insidious, though, according to a new study that suggests opioid use might actually cause PTSD.

Opioids as a PTSD Trigger

To test the effect of opioids on the development of PTSD, researchers at UCLA gave morphine, an opioid painkiller, to mice for a week. Following the doses of morphine, the researchers administered an electric shock to the mice. When the effects of the morphine had worn off, they gave the mice a second, milder shock.

The shocks triggered a fear response in the mice, but the morphine-treated mice were fearful for longer than a control group of mice that had not received an opioid. The prolonged fear response mimics PTSD in human patients, who suffer from physical fear responses even when there is no threat present.

Significantly, the prolonged fear response was triggered in the mice long after the morphine was gone from their systems. It appeared that the drug had caused a lasting change in their brains that was triggering PTSD.

“The ability of opioids to increase PTSD-like symptoms far outlasted the direct effects of the drug or withdrawal from the drug, suggesting the effect may continue even after opioid treatment has stopped,” says Michael Fanselow, PhD, the study’s senior author.

Fanselow and his team concluded that the mice’s prolonged opioid use made them more vulnerable to the stress caused by the initial electric shocks. That vulnerability translated into the PTSD symptoms the mice exhibited later.

The researchers also administered morphine to mice after the initial shock, but the later opioid dose didn’t increase the risk of PTSD. It appears that the timing of the opioid use is important. If the drugs are used before the traumatic event, the risk of PTSD is higher.

Risk Down the Road

The study’s implications are important for situations in which repeated trauma and stress are likely.

“As opioids are often prescribed to treat symptoms such as pain that may accompany trauma, caution may be needed because this may lead to a greater risk of developing PTSD, if exposed to further traumatic events, such as an accident, later on,” says Fanselow.

That means, for example, that treating soldiers with opioids following an injury might put them at risk for PTSD if they are sent back into combat after using the drugs. Further exposure to trauma could be much more likely to lead to PTSD.

Awareness of the link could also be important for healthcare providers caring for patients with a history of opioid abuse. Those patients might be especially in danger of developing PTSD if they encounter traumatic events later, and providers should be aware of the risks.

Sources
UCLA, Chronic opioid treatment may raise risk of post-traumatic stress disorder, study finds