Can we and should we formally 'teach' humour to people diagnosed on the autism spectrum? Indeed, do we actually need to?Yes said the results of the study published by Ching-Lin Wu and colleagues  although I personally am not so impressed.Discussing how their results "supported the effectiveness of the 15-hour training" regime, Wu et al report that for a small group of adolescents diagnosed with an autism spectrum disorder (ASD) "and average intelligence" moves to implement "a humor-knowledge and humor-skill training workshop" seemed to impact on responses to a questionnaire covering joke appreciation and comprehension. They conclude by saying that "the appreciation of humor can be learned." This is not the first time that this group have looked at humour with autism in mind .I don't disagree with the idea that humour is at least in part, a learned concept. How else does one come to appreciate the blunders of Alan Partridge ('raining cows') or the delivery of the Two Ronnies ('folk handles or four candles')? But the suggestion that humour needs to be specifically taught to those on the autism spectrum makes a number of sweeping assumptions.First, it assumes that humour is 'missing' or somehow 'incomplete' when it comes to autism, all autism. As per historical sweeping generalisations on the now 'not typically discussed' issue of Theory of Mind (ToM), the 'mentalising' issues are for example, assumed to curb aspects of understanding behaviour including humour. As we've come to recognise however, issues with ToM are not universally present in autism and indeed, may not be specifically linked to the word 'autism' at all (see here). Insofar as the notion of 'missing humour' when it comes to autism, both peer-reviewed science  and quite a lot of anecdote suggest that this may not be typical. Indeed, even those who are quite profoundly autistic and with varying degrees of related learning disability, are not devoid of humour or an appreciation of humour (or mischief!). Second, can you teach humour? This is a rather nebulous question because humour comes in many different forms. Yes, you can teach someone about the use of words and how words can be humorous ('velcro: what a rip off'), you can even teach someone how to appreciate a particular joke or set of jokes. But can you actual teach someone to think/believe that something is humorous or not or is this just some sort of artificial learned response? I always thought humour was something fairly individual; one person's humour is another person's 'not so funny'. The added question of how one goes about measuring a person's 'humour rating' is something else that I might throw in the mix in these days of evidence-based practice (something that I doubt is going to measured just by a questionnaire).As you can see, I'm not overly impressed with the ideas that humour is missing or needs to be taught when it comes to autism. I'm not adverse the idea that teaching/training can help with some aspects of humour when it comes to language for example, but I'd like to think there are much easier and more 'natural' ways of picking up humour as per the focus on friendships and peer group involvement when it comes to autism. Indeed, in the age of the internet where humour/comedy is just a click away, the idea of spending 15 hours in 'humour-skill training' would probably be better spent scouring the internet comedy vaults for something a little more specific to the wants and wishes of that person...To close, I've already linked to one of my favourite comedians, Tim Vine, but here is a little more...---------- Wu C-L. et al. Effectiveness of humor training among adolescents with autism. Psychiatry Research. 2016. Sept 13. Wu C-L. et al. Do individuals with autism lack a sense of humor? A study of humor comprehension, appreciation, and styles among high school students with autism. Research in Autism Spectrum Disorders. 2014; 8: 1386-1393.----------Wu, C., Liu, Y., Kuo, C., Chen, H., & Chang, Y. (2016). Effectiveness of humor training among adolescents with autism Psychiatry Research DOI: 10.1016/j.psychres.2016.09.016... Read more »
Wu, C., Liu, Y., Kuo, C., Chen, H., & Chang, Y. (2016) Effectiveness of humor training among adolescents with autism. Psychiatry Research. DOI: 10.1016/j.psychres.2016.09.016
Among a group of older women, self-reported caffeine consumption of more than 261 mg per day was associated with a 36 percent reduction in the risk of incident dementia over 10 years of follow-up. This level is equivalent to two to three 8-oz cups of coffee per day, five to six 8-oz cups of black tea, or seven to eight 12-ounce cans of cola.
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Driscoll, I., Shumaker, S., Snively, B., Margolis, K., Manson, J., Vitolins, M., Rossom, R., & Espeland, M. (2016) Relationships Between Caffeine Intake and Risk for Probable Dementia or Global Cognitive Impairment: The Women’s Health Initiative Memory Study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. DOI: 10.1093/gerona/glw078
In a post last week, I highlighted a recent study examining clinical issues in the diagnosis of Lewy body dementia (LBD).This study examined differentiating clinical and neuropsychological factors between LBD, Alzheimer's dementia and Parkinson's disease.You can access this post by clicking HERE.This topic received significant attention following the description of comedian Robin Williams' last years by his wife in the journal Neurology.Robin Williams suffered from LBD and like many, his diagnosis was not made until autopsy.I want to review some of the key clinical features shown by Robin Williams described by his widow's in his last few years.Psychological symptoms/signsAnxietyFear Panic attacksDepressionParanoiaDelusionsSuicideCognitive symptoms/signsMemory impairmentFluctuating levels of memory/orientationPhysical symptoms/signsConstipationUrinary problemsHeartburnInsomniaPoor sense of smellSensitivity to anti-psychotic medicationsTremor left handFreezing of gaitLab/ImagingElevated serum cortisol levelsNormal brain imaging (CT or MRI?)Neuropathology40% loss of dopamine neuronsLewy bodies throughout brainHigh concentration of Lewy bodies in brain amygdalaA clinical diagnosis of Parkinson's disease had been made for Robin and he had been placed on anti-Parkinson's medication. Signs and symptoms of LBD as outlined by Mayo Clinic staff include:Visual and other hallucinationsMovement disorder (signs of Parkinson's disease)Autonomic nervous system dysregulation (tachycardia, sweating, constipation, dizziness, falls)Cognitive problems (confusion, visuospatial problems, memory loss, fluctuating levels of attention)Sleep problems (REM sleep behavior problems)Depression/ApathyAs noted in Mrs. Williams' description, Robin Williams never reported visual hallucinations, a key symptom in LBD. However, his clinical team felt is was quite possible visual hallucinations could have been present and simply not disclosed due to fear of how others would perceive the hallucinations.The high concentration of Lewy bodies in the brain amygdala could explain some of the panic, fear and depression noted in the case history.Suicide is not commonly noted in LBD although it has not been studied in great detail. I will examine this issue in a separate post.Mrs. Williams has done a great service in writing this clinical history. She urges increased research into the causes and treatment for LBD. Additionally, her report again underscores the need for clinicians to be vigilant for the signs and symptoms of LBD.I highly recommend reading about the clinical history of Robin Williams. You can access the free full-text report by clicking HERE.Access the Mayo Clinic description of Lewy body dementia by clicking HERE.Follow me on Twitter @WRY999Photo of Robin William's Hollywood star is from a Creative Commons Wikipedia file authored by: CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=2710421Williams SS (2016). The terrorist inside my husband's brain Neurology, 87 (13), 1308-1311... Read more »
Williams SS. (2016) The terrorist inside my husband's brain. Neurology, 87(13), 1308-1311. info:/
Another short post today opening with the conclusion reached in the paper by Andrew Cashin and colleagues : "From the findings, it can be stated with confidence that people with ASD [autism spectrum disorder] have a high rate of comorbidity and increased risk for chronic disease."Yes, not new news to many that physical health is generally 'under-rated' when it comes to adult autism (see here and see here for examples). The question remains however: what are we all going to do about it?Following continued acceptance that a diagnosis of autism might go WELL beyond the presented core behavioural features, how about a few more discussions about the healthcare experiences of those on the spectrum  (see here too) as a start and taking things from there, save ending up where another label has (see here) with regards to physical health?---------- Cashin A. et al. A scoping review of what is known of the physical health of adults with autism spectrum disorder. J Intellect Disabil. 2016 Sep 13. pii: 1744629516665242. Raymaker DM. et al. Barriers to healthcare: Instrument development and comparison between autistic adults and adults with and without other disabilities. Autism. 2016 Sep 22. pii: 1362361316661261.----------Cashin A, Buckley T, Trollor JN, & Lennox N (2016). A scoping review of what is known of the physical health of adults with autism spectrum disorder. Journal of intellectual disabilities : JOID PMID: 27623754... Read more »
Cashin A, Buckley T, Trollor JN, & Lennox N. (2016) A scoping review of what is known of the physical health of adults with autism spectrum disorder. Journal of intellectual disabilities : JOID. PMID: 27623754
I'm cheating a little bit today as minus too much critical commentary or discussion, I'm drawing your attention to the paper by Tony Salvatore and colleagues  (open-access) on a most important topic: suicide risk and autism.Written by authors who between them seem to know quite a bit about autism and also managing suicide prevention particularly under crisis conditions, I reckon this review article is one of the best we have so far in this area. I say that on the basis that not only are estimated prevalence figures included in the text but two very important discussion points on the key risk factors and also what might be protective against suicide behaviours are included. Importantly, the authors suggest that "suicide risk factors are similar for adults with and without ASD [autism spectrum disorder]". So rather than seeing suicide in relation to autism as something detached from suicidal behaviour on other occasions in other groups, they suggest common risk factors including comorbid mental illness as potentially 'precipitating suicidal ideation' or at least, increasing vulnerability to such behaviour are important.Yes, I know we still have quite a way to go before any road maps or definitive protocols/toolkits are available to manage suicide risk in autism. But the Salvatore paper is as good a document as any to read on this important topic and potentially making moves to off-set at least some of the risk of this devastating behaviour. I might also add that other texts including talk of an 'acquired capability for suicide' among some groups might also offer some important links between something like self-harm and suicide risk which could also be relevant to [some] autism . More investigations are very much needed including on the topic of suicide prevention .And when it comes to biological risk factors also potentially associated with / linked to suicidal behaviour, the meta-analysis from Chang and colleagues  (open-access) initially highlighting fish oils and cytokines (inflammation?) as potentially being important might similarly prove applicable in the context of autism (minus any sweeping generalisations)...---------- Salvatore T. et al. Suicide Risk in Adults with Autism Spectrum Disorder: An Exploratory Discussion. The Journal of Special Populations. 2016; 1: 1. Paula-Perez I. & Artigas-Pallares J. Vulnerability to self-harm in autism. Rev Neurol. 2016;62 Suppl 1:S27-32. Zalsman G. et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry. 2016 Jul;3(7):646-59. Chang BP. et al. Biological risk factors for suicidal behaviors: a meta-analysis. Translational Psychiatry. 2016. Sept 13.----------Chang, B., Franklin, J., Ribeiro, J., Fox, K., Bentley, K., Kleiman, E., & Nock, M. (2016). Biological risk factors for suicidal behaviors: a meta-analysis Translational Psychiatry, 6 (9) DOI: 10.1038/tp.2016.165... Read more »
Chang, B., Franklin, J., Ribeiro, J., Fox, K., Bentley, K., Kleiman, E., & Nock, M. (2016) Biological risk factors for suicidal behaviors: a meta-analysis. Translational Psychiatry, 6(9). DOI: 10.1038/tp.2016.165
A team of researchers has found that consuming an omega-3 fatty acid called DHA, or docosahexaenoic acid, can stop a known trigger of lupus and potentially other autoimmune disorders. DHA can be found in fatty, cold-water fish and is produced by the algae that fish eat and store in their bodies. It can be found in fish oil supplements as well, used by more than 30 million Americans.
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Bates, M., Brandenberger, C., Langohr, I., Kumagai, K., Lock, A., Harkema, J., Holian, A., & Pestka, J. (2016) Silica-Triggered Autoimmunity in Lupus-Prone Mice Blocked by Docosahexaenoic Acid Consumption. PLOS ONE, 11(8). DOI: 10.1371/journal.pone.0160622
The International Rare Lung Diseases Research Conference (RLDC) and LAM symposium were held last week over four days. They brought together clinicians, scientists, patients and families to Cincinnati to review research developments in rare lung disease and to promote dialogue between the research community and patients. Next week’s blog will focus on the highlights of the entire conference. This week the blog is focused on the BHD syndrome specific talk and poster.... Read more »
Toro JR, Pautler SE, Stewart L, Glenn GM, Weinreich M, Toure O, Wei MH, Schmidt LS, Davis L, Zbar B.... (2007) Lung cysts, spontaneous pneumothorax, and genetic associations in 89 families with Birt-Hogg-Dubé syndrome. American journal of respiratory and critical care medicine, 175(10), 1044-53. PMID: 17322109
"The results indicate that there is an elevated injury risk among Swedish schoolchildren with ADHD [attention-deficit hyperactivity disorder] but not for children with ASD [autism spectrum disorder]."So went the findings reported by Carl Bonander and colleagues  providing yet more important data on how a diagnosis of ADHD might be something that confers quite a bit of additional risk for all-manner of different negative outcomes.I've hinted at this important topic before as per some discussion a few years back on how road crossing behaviour might be 'affected' by a diagnosis of ADHD (see here). This time around Swedish researchers compared the risk of injury for those diagnosed with autism vs. risk of injury for those diagnosed with ADHD based on school nurse collected- and school-based data (survey A and B respectively). "After adjusting for confounders, ADHD was associated with a 65% increased risk of injury... in Survey A, and a 57% increased risk of injury... in Survey B" relative to data derived from "unaffected controls."A quick look through the other peer-reviewed material on this topic reveals the extent to which a diagnosis of ADHD might increase the risk of various injuries. Take the paper by Silva and colleagues  who noted that in "young children who are subsequently diagnosed with attention deficit hyperactivity disorder (ADHD)" there was an increased risk of hospitalisation for all manner of different things: "head injuries, burns, poisons, all other injuries." Other studies have reported similar findings  including that relying on 'big data' from the big data capital that is Taiwan  (see here for more chatter on Taiwan).Whilst no-one is suggesting that every visit to accident and emergency (the emergency room) is somehow the product of ADHD, there are some potentially important lessons to learn from such collected data. Timely diagnosis and appropriate management of ADHD symptoms when they affect quality of life are two points raised, bearing in mind 'management' might include several strategies (see here and see here and see here). Where also hospitals or other medical professionals are presented with children or young people who are 'regular visitors', one might also look to the possibility of preferential screening for something like ADHD too as part of additional enquiries. I might add that whilst Bonander and colleagues looked at ADHD vs. autism when it comes to injury risk, one must not forget that ADHD and autism occurring together is not an uncommon finding (see here) and accident and emergency is not necessarily an unfamiliar place to some of those on the autism spectrum (see here). There is more to do in this important area of research.Finally, I'm also minded to reiterate that hosptial admissions for certain chronic somatic issues might also flag up preferential ADHD screening as well (see here)...---------- Bonander C. et al. Injury risks in schoolchildren with attention-deficit/hyperactivity or autism spectrum disorder: Results from two school-based health surveys of 6- to 17-year-old children in Sweden. J Safety Res. 2016 Sep;58:49-56. Silva D. et al. Children diagnosed with attention deficit disorder and their hospitalisations: population data linkage study. Eur Child Adolesc Psychiatry. 2014 Nov;23(11):1043-50. Hurtig T. et al. The Association Between Hospital-Treated Injuries and ADHD Symptoms in Childhood and Adolescence: A Follow-Up Study in the Northern Finland Birth Cohort 1986. J Atten Disord. 2016 Jan;20(1):3-10. Kang JH. et al. Attention-deficit/hyperactivity disorder increased the risk of injury: a population-based follow-up study. Acta Paediatr. 2013 Jun;102(6):640-3.----------Bonander C, Beckman L, Janson S, & Jernbro C (2016). Injury risks in schoolchildren with attention-deficit/hyperactivity or autism spectrum disorder: Results from two school-based health surveys of 6- to 17-year-old children in Sweden. Journal of safety research, 58, 49-56 PMID: 27620934... Read more »
Bonander C, Beckman L, Janson S, & Jernbro C. (2016) Injury risks in schoolchildren with attention-deficit/hyperactivity or autism spectrum disorder: Results from two school-based health surveys of 6- to 17-year-old children in Sweden. Journal of safety research, 49-56. PMID: 27620934
Children with HIV who can resist the disease progressing could point the way to new treatments for HIV infection that are more widely applicable to infected adults and children alike, an international team of researchers has found.
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Muenchhoff, M., Adland, E., Karimanzira, O., Crowther, C., Pace, M., Csala, A., Leitman, E., Moonsamy, A., McGregor, C., Hurst, J.... (2016) Nonprogressing HIV-infected children share fundamental immunological features of nonpathogenic SIV infection. Science Translational Medicine, 8(358), 358-358. DOI: 10.1126/scitranslmed.aag1048
The journal Neurology published a unique and touching paper today: it's by artist Susan Schneider Williams, the widow of actor Robin Williams, who died by suicide in August 2014. It's titled The terrorist inside my husband's brain, the 'terrorist' being Lewy Body disease (LBD), the neurodegenerative disorder that, as Schneider Williams recounts, destroyed his life.
Here's how she describes the first signs of her husbands' illness:
The colors were changing and the air was crisp; it wa... Read more »
They've finally arrived. The results of the English Adult Psychiatric Morbidity Survey 2014 have been published by NHS Digital (yes, our Nation's healthcare services has a digital arm) and when it comes to autism (adult autism 18 years+), some rather peculiar statistics have been produced.OK, for those who want/need a quick heads-up on all-things Adult Psychiatric Morbidity Survey (APMS), I'll refer you to a previous post I wrote covering this prevalence survey with autism in mind (see here). APMS provides estimates of the numbers of various mental health diagnoses among adults living in private households in England.The 2014 data report some key facts, not least that: "One in three adults aged 16-74 (37 per cent) with conditions such as anxiety or depression, surveyed in England, were accessing mental health treatment, in 2014." This figure is an increase on the 2007 APMS data (24%). There are also some other important data derived from the 2014 survey too with regards to sex differences in relation to "common mental disorder (CMD)" in diagnosis and in symptoms. Lessons need to be learned.It is however with autism in mind (see here for the section covering autism), that I'm concentrating on in this post and the observation that: "The estimated prevalence of autism in 2014, using the threshold of a score of 10 on the ADOS [autism diagnostic observation schedule] to indicate a positive case, was 0.7% of the adult population in England (equivalent to a rate of 7 per thousand). The estimated prevalence of autism in the 2007 data (1.0%) was similar to the 2014 estimate; with largely overlapping confidence intervals." A separate 'additional notes' document accompanies the APMS 2014 autism findings (see here).1% in 2007 and 0.7% in 2014? Accepting that when it comes to prevalence estimates there is always a degree of 'error' expected (as per the comment on 'overlapping confidence intervals') I'm a little bit puzzled by this latest data and the idea that the figures are described as 'similar'. Puzzled because as well as suggesting that adult autism prevalence estimates might have actually dipped between the years, the authors note that their search of 3 quite populous areas of England ("Leicestershire, Lambeth and Sheffield") across both the 2007 and 2014 data combined only found "31 participants identified with autism."So what's going on with the APMS and autism?A question indeed and I assume that the 'combining' of the 2007 and 2014 datasets reveals quite a bit more than just the very small number of participants identified in the studies. I have to say that my brow is furrowing a little at the sight of the Autism Spectrum Quotient (AQ) as retaining an 'autism screener' role in the APMS 2014. If I've learned anything about the AQ in recent times it is that whilst measuring something, it may not be a particularly great exclusive screen for autism (see here). Even the authors attached to the APMS 2014 autism data have said so : "The AQ-20 was only a weak predictor of ADOS-4 cases." I've also mentioned about the ADOS module situation and the whys and wherefores with APMS in mind in that previous post on the topic (see here again).So we're left with a quandary. The much heralded '1% of adults may have autism' statistic is replaced by a lower value (with appropriate caveats on confidence intervals) of 0.8% when the APMS 2007 and 2014 data are combined. Is this a true reflection of adult autism in England in recent times? How does this tally with the suggestion that child and adolescent rates of autism are on the increase as per that seen in other parts of the UK (see here)?Or, are the processes pertinent to estimating adult autism used by the APMS not really cutting the statistical/methodological mustard?Which one is it?---------- Brugha TS. et al. Validating two survey methods for identifying cases of autism spectrum disorder among adults in the community. Psychol Med. 2012 Mar;42(3):647-56.----------Brugha TS, McManus S, Smith J, Scott FJ, Meltzer H, Purdon S, Berney T, Tantam D, Robinson J, Radley J, & Bankart J (2012). Validating two survey methods for identifying cases of autism spectrum disorder among adults in the community. Psychological medicine, 42 (3), 647-56 PMID: 21798110... Read more »
Brugha TS, McManus S, Smith J, Scott FJ, Meltzer H, Purdon S, Berney T, Tantam D, Robinson J, Radley J.... (2012) Validating two survey methods for identifying cases of autism spectrum disorder among adults in the community. Psychological medicine, 42(3), 647-56. PMID: 21798110
"School-based interventions should address malleable factors such as the number of peer connections and received friendships that predict the best social outcomes for children with ASD [autism spectrum disorder]."So said the study findings reported by Jill Locke and colleagues  looking at "the stable (unlikely to change) and malleable (changeable) characteristics of socially successful children with ASD."Mindful that the phrase 'socially successful children' is perhaps not one that I'm particularly enamoured with, and certainly not one that necessarily opens the doors to 'successful' academic outcomes in childhood for example (see here), the Locke paper makes for interesting reading.Looking at nearly 150 "elementary-aged children with ASD" authors listed a number of factors linked to 'playground peer engagement' and 'social network salience ' a.k.a playing with other children in the school yard and "inclusion in informal peer groups." The severity of autistic symptoms was unsurprisingly a key feature as was those numbers of 'peer connections' and 'received friendships'.What do these results mean? Well, minus sweeping generalisations, there may be some pretty easy ways that 'social outcomes' can be positively influenced for at least some children on the autism spectrum; not least one important variable: friends. Yes, a shocker I know.I've used the term 'easy ways' and 'friends' in that previous sentence to denote how [sometimes] complicated and expensive/resource intensive interventions to 'increase social outcomes' when it comes to the label of autism really might not be the most effective use of resources. I however understand that friends, real friends, are not just something that can be magically produced on demand and that also friendships, whilst in the end generally worthwhile, are not without their own stresses and strains (some of which might be even more stressful and strainful(!) for a child on the autism spectrum).One approach that does seem to be finding some favour in the peer-reviewed domain at least is that of employing a buddy system. The findings reported by Laushey & Heflin  whilst not without their methodological issues, provide some important assertions that a peer buddy approach might be something for schools to consider for some pupils with autism. I know some people might argue that a buddy is not the same as a friend but I'm not one of the them: opportunity (not necessity) is the mother of invention. Visit most schools (at least in here in the UK) and you will see similar arrangements being made for pupils whether diagnosed with autism or not. That and use of 'buddy/friendship stops' in certain parts of the playground and you'll see how important socialisation is viewed for all school pupils.I'm also a greater believer that sport and exercise can be an important part of inclusion practices when it comes to autism - something equally applicable to school. Y'know, those team games that help build and forge important bonds between children particularly when it comes to competitive team games, also introducing the important concept of 'belonging'. I appreciate that finding the right sport is important in terms of likes/dislikes and ability but there are quite a few options out there. Indeed, drilling further down into the concept of 'belonging', one can perhaps see how even at elementary school age, finding your social niche can open up a whole world of new friends/associates thus implying that school clubs (e.g. Lego club, ICT club) might also be an important intervention tool too.I don't want to come across too formulaic or mechanical when it comes to how to improve social outcomes for children on the autism spectrum because there is not one-size-fits-all 'flowchart' to this issue. Appreciating also that some children on the autism spectrum might not necessarily want to be 'social butterflies' there has to be some indication from the child as to the extent of their wants and wishes when it comes to social interaction also taken into account.I should also remind readers that when it comes to friendships, children can be a rather fickle bunch...---------- Locke J. et al. Characteristics of socially successful elementary school-aged children with autism. J Child Psychol Psychiatry. 2016 Sep 13. Laushey KM. & Heflin LJ. Enhancing social skills of kindergarten children with autism through the training of multiple peers as tutors. J Autism Dev Disord. 2000 Jun;30(3):183-93.----------Locke J, Williams J, Shih W, & Kasari C (2016). Characteristics of socially successful elementary school-aged children with autism. Journal of child psychology and psychiatry, and allied disciplines PMID: 27620949... Read more »
Locke J, Williams J, Shih W, & Kasari C. (2016) Characteristics of socially successful elementary school-aged children with autism. Journal of child psychology and psychiatry, and allied disciplines. PMID: 27620949
A team of researchers has observed what they believe are the building blocks of memories in a mouse brain. In their paper, the researchers describe how they caused certain neurons to become illuminated when they fired, allowing them to watch in real time as memories were made and then later as they were replayed while the mouse was sitting idle.
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Malvache, A., Reichinnek, S., Villette, V., Haimerl, C., & Cossart, R. (2016) Awake hippocampal reactivations project onto orthogonal neuronal assemblies. Science, 353(6305), 1280-1283. DOI: 10.1126/science.aaf3319
One clinical challenge is making an accurate diagnosis in patients with dementia.Alzheimer's disease is typically the predominant diagnosis in dementia. However a significant number of patients will present with dementia due to Lewy Body disease, Parkinson's dementia, frontotemporal dementia or vascular dementia.A recent study helps clinicians to distinguish Lewy Body from Alzheimer's dementia and Parkinson's disease.Douglas Scharre and collegues from Ohio State University conducted a matched pair analysis of 21 patients with Lewy Body dementia with 21 patients with Alzheimer's disease and 21 patients with Parkinson's disease.Parkinson's disease subjects in this study had higher cognitive function scores than the Lewy Body disease subjects but were matched on level of motor impairment.Subject groups were assessed on a variety of motor, cognitive and neuropsychological domains. Lewy Body dementia subjects differed from the Alzheimer's group in the following areas:Higher impairment scores on executive function and visuospatial functionLower impairment on memory and orientationHigher scores on measures of sleepinessHigher scores on fluctuation of cognitive and behavior deficitsMore hallucinationsMore sleep apneaLewy body dementia subjects differed from the Parkinson's disease group in the following areas:More impairment in axial motor functionMore impairment in gait and balance functionHigher scores on measures of sleepinessHigher scores on fluctuation of cognitive and behavior deficitsMore hallucinationsMore sleep apneaThe authors noted that measures of axial motor, gait and balance impairment correlated higher with level of executive function impairment, visuomotor function impairment and global cognitive impairment.This is an important study and highlights the need for specific neuropsychological testing along with assessment of motor, gait and balance domains dementia evaluations.Readers with more interest in this study can access the author's uncorrected proofs by clicking on the DOI link in the citation below.Follow me on Twitter WRY999Photo of brown thrasher from my back yard is from my files.Scharre, D., Chang, S., Nagaraja, H., Park, A., Adeli, A., Agrawal, P., Kloos, A., Kegelmeyer, D., Linder, S., Fritz, N., Kostyk, S., & Kataki, M. (2016). Paired Studies Comparing Clinical Profiles of Lewy Body Dementia with Alzheimer’s and Parkinson’s Diseases Journal of Alzheimer's Disease, 1-10 DOI: 10.3233/JAD-160384... Read more »
Scharre, D., Chang, S., Nagaraja, H., Park, A., Adeli, A., Agrawal, P., Kloos, A., Kegelmeyer, D., Linder, S., Fritz, N.... (2016) Paired Studies Comparing Clinical Profiles of Lewy Body Dementia with Alzheimer’s and Parkinson’s Diseases. Journal of Alzheimer's Disease, 1-10. DOI: 10.3233/JAD-160384
For the first time, an antibody was able to target and disrupt the Aβ plaques in the brain.... Read more »
Sevigny, J., Chiao, P., Bussière, T., Weinreb, P., Williams, L., Maier, M., Dunstan, R., Salloway, S., Chen, T., Ling, Y.... (2016) The antibody aducanumab reduces Aβ plaques in Alzheimer’s disease. Nature, 537(7618), 50-56. DOI: 10.1038/nature19323
Dietary intake in young athletes seem to meet most recommendations, therefore supplementing may only be necessary for a few select micronutrients based on age and gender. ... Read more »
Parnell, J., Wiens, K., & Erdman, K. (2016) Dietary Intakes and Supplement Use in Pre-Adolescent and Adolescent Canadian Athletes. Nutrients, 8(9), 526. DOI: 10.3390/nu8090526
Please use your full stops wisely.I believe that this is the first time that I've talked about postural tachycardia syndrome (PoTS) on this blog as I bring to your attention some rather intriguing findings reported by Hugo Penny and colleagues  on how PoTS and gluten-related disorders might not be unstrange diagnostic bedfellows.PoTS by the way, describes symptoms where standing upright / sitting down induces dizziness, fainting and other symptoms. As well as being quite prevalent in a certain condition called Ehlers-Danlos syndrome (see here), PoTS is also described fairly frequently in cases of chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME) too.Describing how "patients with postural tachycardia syndrome (PoTS) were placing themselves on a gluten-free diet without medical consultation" the authorship team (mentioned previously on this blog) residing in the great city of Sheffield decided to look-see whether there may be underlying medical reasons why such gluten-free moves seemed to be used in cases of PoTS. They screened their 100 participants with PoTS "for gluten sensitivity, related symptoms and dietary habits" as well as assessing for coeliac disease, the archetypal gluten-related autoimmune condition.Results: compared with a couple of control groups numbering in total above 1500 local participants, coeliac disease (CD) seemed to be more common in the PoTS groups - "serology and biopsy-proven coeliac disease." Alongside: "PoTS patients also had a higher prevalence of self-reported gluten sensitivity... compared with age-matched and sex-matched controls." The authors conclude that there may be more to see when it comes to the presence of classical and non-classical gluten-related disorders in relation to PoTS.This is potentially important stuff. Accepting that outside of the immediate dizziness and fainting symptoms associated with PoTS there may be other 'gastrointestinal' involvement  the intriguing idea that [certain] symptoms might be to some degree alleviated by use of a dietary change is worthy of greater inspection. Indeed, set within the context of an associated diagnostic label, orthostatic intolerance, where an upright posture provokes related symptoms, also being potentially linked to gastrointestinal issues  one has an interesting template as to how gut and brain might show some important links. That a gluten-free diet will most likely target both gut and brain (yes, it might) provides plenty of food for thought as to possible mechanisms.I'm also pretty interested in the growing research base looking at a possible autoimmune component to at least some cases of PoTS . I know this takes us into some 'brow-furrowing' areas of peer-reviewed science  (indeed, complicated science) but the potential importance of cases of autoimmune PoTS intersecting with cases of autoimmune coeliac disease provides yet another example of how birds of an autoimmune feather tend to flock together (see here). The implication being that cases of PoTS should perhaps be screened for CD and other autoimmune disease/features and perhaps treated accordingly, offers some new directions for research and clinical practice.And just in case you are still convinced that use of a gluten-free diet outside of CD is all bunk, the worm still continues to turn...To close, 'Shatner's Bassoon'. That is all.---------- Penny HA. et al. Is there a relationship between gluten sensitivity and postural tachycardia syndrome? Eur J Gastroenterol Hepatol. 2016 Sep 7. Wang LB. et al. Gastrointestinal dysfunction in postural tachycardia syndrome. J Neurol Sci. 2015 Dec 15;359(1-2):193-6. Sullivan SD. et al. Gastrointestinal symptoms associated with orthostatic intolerance. J Pediatr Gastroenterol Nutr. 2005 Apr;40(4):425-8. Thieben MJ. et al. Postural orthostatic tachycardia syndrome: the Mayo clinic experience. Mayo Clin Proc. 2007 Mar;82(3):308-13. Blitshteyn S. & Brook J. Postural tachycardia syndrome (POTS) with anti-NMDA receptor antibodies after human papillomavirus vaccination. Immunol Res. 2016 Aug 25.----------Penny, H., Aziz, I., Ferrar, M., Atkinson, J., Hoggard, N., Hadjivassiliou, M., West, J., & Sanders, D. (2016). Is there a relationship between gluten sensitivity and postural tachycardia syndrome? European Journal of Gastroenterology & Hepatology DOI: 10.1097/MEG.0000000000000740... Read more »
Penny, H., Aziz, I., Ferrar, M., Atkinson, J., Hoggard, N., Hadjivassiliou, M., West, J., & Sanders, D. (2016) Is there a relationship between gluten sensitivity and postural tachycardia syndrome?. European Journal of Gastroenterology , 1. DOI: 10.1097/MEG.0000000000000740
‘Overpronation’ and achilles tendon blood flow... Read more »
Karzis, K., Kalogeris, M., Mandalidis, D., Geladas, N., Karteroliotis, K., & Athanasopoulos, S. (2016) The effect of foot overpronation on Achilles tendon blood supply in healthy male subjects. Scandinavian Journal of Medicine . DOI: 10.1111/sms.12722
"Elevated peripheral pro-NT [neurotensin] levels reflect more severe forms of active celiac disease, indicating a potential role of NT in intestinal inflammation."The suggestion, from Caroline Montén and colleagues , that the neuropeptide called neurotensin might play a role in paediatric coeliac disease is an interesting one that caught my eye recently. Interesting not only because of the potential implications for the archetypal 'gluten-causing' autoimmune condition called coeliac disease, but also because neurotensin might have some rather important links to [some] autism too .OK, a quick recap is perhaps useful. Neurotensin when it comes to autism typically means one name, Theoharis Theoharides, he of mast cells fame (see here). The idea is that neurotensin (NT) is, among other things, quite a 'potent trigger' of mast cells and when activated these mast cells can release their inner contents that include quite a few substances linked to allergic inflammation. At least some of the talk linking 'inflammation' and autism might include a role for mast cells  and so hey presto, a potentially important chain of biological events might therefore be linked.Going back to the original Montén paper on NT and coeliac (celiac) disease, researchers set about investigating "if plasma pro-NT levels correlated with the degree of intestinal mucosal damage and tissue transglutaminase autoantibody (tTGA) levels in children with celiac disease." They did find elevated levels of one of the NT precursor fragments in a coeliac disease group (n=96) compared with controls (n=89) and there did seem to be something of a possible connection between pro-NT levels and tTGA. On these basis, they concluded that NT might indeed be linked to the intestinal inflammation noted in cases of coeliac disease. Mast cells might also be important to coeliac disease too according to recent findings.Accepting that coeliac disease is not autism (even though in some individual cases they may be linked ), there are a few further studies that might be required on this topic with autism in mind. As I've already mentioned, inflammation - particularly inflammation of the gastrointestinal (GI) tract - is not something unheard of in autism research/practice circles (see here). I know furrowed brows can be associated with this area of discussion but I'm talking about peer-reviewed science not anecdote and speculation. One might for example, see an investigation whereby those with autism and GI-related issues (including an inflammatory component) might be more closely inspected for something like NT to see if it is something important. You could even include those potentially falling into the grey area of non-coeliac gluten sensitivity (NCGS) if you so wished (see here). Given also related findings for some on the autism spectrum in relation to tTGA too (see here) and the possibility of another link there with NT, some brave research team might also wish to inspect this parameter. I might also suggest that looking at gut motility patterns in relation to NT levels could be another area ripe for further investigation with autism in mind (see here) given some previous discussions on the effects of NT.Just a few suggestions for how a little more work in this area might prove illuminating.Insofar as what to do about a possible link between NT and autism, well someone it seems has already started that conversation  and discussions are seemingly continuing in the peer-reviewed domain ...---------- Montén C. et al. Role of pro-neurotensin as marker of paediatric celiac disease. Clin Exp Immunol. 2016 Sep 10. Angelidou A. et al. Neurotensin is increased in serum of young children with autistic disorder. J Neuroinflammation. 2010 Aug 23;7:48. Theoharides TC. et al. Atopic diseases and inflammation of the brain in the pathogenesis of autism spectrum disorders. Transl Psychiatry. 2016 Jun 28;6(6):e844. Genuis SJ. & Bouchard TP. Celiac disease presenting as autism. J Child Neurol. 2010 Jan;25(1):114-9. Ghanizadeh A. Targeting neurotensin as a potential novel approach for the treatment of autism. Journal of Neuroinflammation. 2010; 7:58. Patel AB. et al. Neurotensin stimulates sortilin and mTOR in human microglia inhibitable by methoxyluteolin, a potential therapeutic target for autism. Proc Natl Acad Sci U S A. 2016 Sep 23. pii: 201604992.----------Montén C, Torinsson Naluai Å, & Agardh D (2016). Role of pro-neurotensin as marker of paediatric celiac disease. Clinical and experimental immunology PMID: 27612962... Read more »
Montén C, Torinsson Naluai Å, & Agardh D. (2016) Role of pro-neurotensin as marker of paediatric celiac disease. Clinical and experimental immunology. PMID: 27612962
Why do more men die when they attempt suicide than women? The answer could lie in four traits, finds scientists. There are over 6,000 British lives lost to suicide each year, and nearly 75 per cent of those are male. However, research has found women are more likely to suffer from depression, and to attempt to take their own life.
... Read more »
Deshpande, G., Baxi, M., Witte, T., & Robinson, J. (2016) A Neural Basis for the Acquired Capability for Suicide. Frontiers in Psychiatry. DOI: 10.3389/fpsyt.2016.00125
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