The workshop discussed topics including Food and health; and nutrition and neurological and metabolic disorders in Oman.

In addition to researchers from different colleges at SQU, three international [...]]]>

The Food Science and Nutrition Department of the College of Agricultural & Marine Sciences at Sultan Qaboos University organized a workshop on ‘Food and Nutrition in Health and Disease’.

The workshop discussed topics including Food and health; and nutrition and neurological and metabolic disorders in Oman.

In addition to researchers from different colleges at SQU, three international speakers presented papers in the workshop. In his paper, Dr G. J. Guillemin from the Dept of Pharmacology at the University of New South Wales in Australia, said mammalian longevity could be potentially increased by two mechanisms, namely, caloric restriction and ingestion of natural neuroprotective compounds.

Dr Samir Al Adawi, Associate Professor in the Department of Behavioural Medicine at SQU said that rising tide of obesity among population is a real challenge for the Sultanate. He said that three per cent to nine per cent of pre-school children, 12 to 25 per cent of school children, 15 per cent to 45 per cent of adolescents and 30 per cent to 75 per cent of adult male are obese in Oman.

Dr Samir highlighted some of emerging psychosocial issues relevant for understanding and coming to grip with this emerging public health problem.

According to findings, walnut diets (six per cent and nine per cent) improved spatial learning and memory.

The walnut diet also improved motor coordination reduced anxiety in elevated plus maze. These findings suggest that dietary supplementation of walnut improves behavioural abnormalities in Alzheimer’s disease mouse model, Dr Essa said.

Dr Karin Petrini from the Department of Psychology at the University of Glasgow gave a presentation on the link between dietary patterns and risk of Alzheimer’s and Parkinson’s diseases.

Presenting a paper titled Omega 3 DHA in Pregnancy and Neurocognitive Development, Prof Mary Harris from the Department of Food Science and Human Nutrition, at Colorado State University in USA said that DHA (docosahexaenoic acid) is key to the developing brain, accumulating in vast amounts during infant development and during the first years of your baby’s life.

Share/Save

History of Present Illness

Mr. X is a 53-year-old male who presents to you with memory loss and blackouts. His wife thinks he has Alzheimer’s disease. She states that over the last year, Mr. X has become more and more forgetful. He used to take care of the family finances and run his own business [...]]]>

Patient Presents

History of Present Illness

Mr. X is a 53-year-old male who presents to you with memory loss and blackouts. His wife thinks he has Alzheimer’s disease. She states that over the last year, Mr. X has become more and more forgetful. He used to take care of the family finances and run his own business out of his home until his memory loss forced him to turn the finances over to his wife and quit his business. Mrs. X also states that he forgets appointments and phone calls, sometimes just after he hangs up the phone.

His wife states that last week he blacked out while driving home from the grocery store, ran a stop sign and hit a parked car. No one was injured, but the episode scared them both.

Mrs. X states that over the last year, her husband has had problems walking. Although he was never very active prior to this, he has become more sedentary and prefers to sit in his recliner all day. Over the last 6 months, he has used a walker to get around the house.

He also reports urinary incontinence over the last 6 months. Mr. X describes it as “not being able to control it.”
Past Medical History

Unremarkable except for the report of a prior head injury with no loss of consciousness occurring last year.

Social History

He reports a 60 pack year smoking history, starting when he was 23. His alcohol consumption consists of about a case of beer a week.
Family History

Mr. X’s father died at the age of 49 from a heart attack. His mother is still alive and is in a nursing home. She moved there after having a stroke 3 years ago. His brother and sister are in good health.

Physical Examination

Temp: 98°F
BP: 170/110
Pulse: 95
Resp: 19/min
Height: 5’11″ Weight 293
HEENT: Within normal limits
Motor:

Biceps: 5/5 bilaterally
Triceps: 5/5 bilaterally
Quadriceps: 3/5 bilaterally
Hamstrings: 3/5 bilaterally
Sensory:

Pin-prick and temperature sensation and simple touch are intact. Vibration is normal in upper extremities, but diminished in lower extremities bilaterally.
Neurological
Reflexes:

Biceps: 2+ bilaterally
Brachioradial: 2+ bilaterally
Patellar: 3+ bilaterally
Ankle: 4+ bilaterally
Plantar Response: Extensor bilaterally
Proprioception and Cerebellar Function:

Finger to finger: normal
Heel to shin: normal
Rapid alternating movements: normal
Romberg: negative
Joint position: normal
Gait:

Mr. X’s gait is abnormal, walking in a shuffling manner. He is mildly ataxic.
Cranial Nerves:

II-XII are intact.

Mental Status:

Patient seems confused. He is oriented to person, but not place or time. He exhibits dyscalculia. Remote memory is intact, yet immediate recall is impaired. When asked to act out combing his hair or shaving, the patient could not do so. Complex commands were difficult for the patient to follow. Judgment was impaired as was the ability to describe simple analogies.

What is your Differential Diagnosis?

Reflect on the information you have gathered thus far.

* Chief complaint: memory loss and black outs
* Other major symptoms: urinary incontinence, trouble walking
* Items noted from history: 60 pack-year smoking history, alcohol abuse issues, head injury within the last year
* Abnormalities noted from the physical and neurological exam:

• decreased strength bilaterally in lower extremities,
• diminished vibratory sensation bilaterally in lower extremities,
• increased reflexes bilaterally on patellar and ankle reflexes,
• plantar reflex was extensor bilaterally,
• mild ataxia,
• shuffling gait,
• patient is confused and not oriented to place or time,
• dyscalculia,
• impaired immediate recall,
• task apraxia,
• impaired judgment,
• could not follow simple commands.

Treatment

Once the diagnosis of NPH was made, a neurosurgical consult was obtained and placement of a shunt was recommended. After discussing the risks and benefits with Mr. X and his wife, they agreed to the placement of a ventriculoperitoneal shunt.
Two Weeks Later

Mr. X returns 2 weeks after surgery during a follow-up appointment. He reports that his walking has become much easier since the his operation. This is evident on observation of the patient’s gait. He also notes that his incontinence has resolved. Mrs. X states that his memory is a little better but not back to normal.

Share/Save

In a study of patients with mild to severe Alzheimer’s disease, they found that people who suffered acute or chronic infections, or even bumps and bruises from a fall, were much more likely to have high blood levels of a protein involved in inflammation and also experienced faster memory loss than people who did not [...]]]>

In a study of patients with mild to severe Alzheimer’s disease, they found that people who suffered acute or chronic infections, or even bumps and bruises from a fall, were much more likely to have high blood levels of a protein involved in inflammation and also experienced faster memory loss than people who did not have infections and who had low levels of this protein.

It’s possible that finding a way to reduce inflammation in the body “could be beneficial for people with Alzheimer’s disease,” study chief Dr. Clive Holmes, from the University of Southampton, UK, said in a prepared statement.

Over about 6 months, Holmes and colleagues measured the cognitive abilities and blood levels the inflammatory protein TNF-alpha of 222 people with Alzheimer’s disease. They also interviewed each subject’s main caregiver several times during the study.

During follow up, roughly half of the study subjects experienced a sudden infection or injury that led to inflammation, and a spike in TNF-alpha levels. These people, the researchers found, experienced memory loss that was at twice the rate of those who did not have infections or injuries.

People who had high levels of TNF-alpha in their blood at the beginning of the study, a sign of chronic, ongoing inflammation, had memory loss at four times the rate of those with low levels of the protein at the start of the study.

By contrast, subjects with low levels of TNF-alpha throughout the study showed no decline in brain function, the report indicates.

“One might guess that people with a more rapid rate of cognitive decline are more susceptible to infections or injury, but we found no evidence to suggest that people with more severe dementia were more likely to have infections or injuries at the beginning of the study,” Holmes noted in a prepared statement.

Share/Save

Two large studies found that the three new genes join the better-known APOE4 gene as significant risk factors for the most [...]]]>

Scientists have found three new major genetic links to Alzheimer’s, affecting up to 20 percent of people with the brain-wasting disease, and said on Sunday it was the most significant such discovery in 15 years.

Two large studies found that the three new genes join the better-known APOE4 gene as significant risk factors for the most common cause of dementia.

“If we were able to remove the detrimental effects of these genes through treatments, we could reduce the proportion of people developing Alzheimer’s by 20 percent,” Julie Williams, a professor of Neuropsychological Genetics at Britain’s Cardiff University, told a news conference in London.

Alzheimer’s disease affects more than 26 million people globally, has no cure and no good treatment. The need for effective remedies is pressing, with the number of cases forecast to go beyond 100 million by 2050.

Current drugs can only delay the symptoms endured by patients, who lose their memories, the ability to find their way around and to care for themselves.

Williams, who led one of the two studies published in Nature Genetics, said that in Britain alone, eradicating the effects of the three new genes would mean almost 100,000 people could avoid the disease.

She said the findings were the most significant genetic discoveries for Alzheimer’s in the 15 years since APOE4 was found to be linked, and said drug companies had shown a keen interest in their research.

More genes out there to catch

Williams and colleagues at Cardiff’s Medical Research Council Center for Neuropsychiatric Genetics and Genomics carried out a genome-wide association study — a scan of the entire genetic map — involving more than 16,000 people from eight countries. They identified two new genes — called Clusterin and PICALM — that increase the risk of developing Alzheimer’s.

A second genome-wide study conducted by Philippe Amouyel and colleagues at the Institut Pasteur de Lille in France, studied more than 6,000 people with Alzheimer’s and nearly 9,000 healthy people in France, Belgium, Finland, Italy and Spain. They identified Clusterin and a third gene called CR1.

Amouyel said the disease risks associated with each gene were difficult to quantify, and said all three genes were relatively common. The scientists also stressed that an as yet unknown combination of many genetic and other environmental factors cause Alzheimer’s.

The researchers said Clusterin may explain 10 percent of Alzheimer’s cases, PICALM around 9 percent and CR1 4 percent. By comparison, 20 to 25 percent of Alzheimer’s cases are linked to APOE.

Three gene variations have also been associated with rare, early-onset forms of Alzheimer’s that run in families. Identifying the genes can help researchers understand the underlying causes of a disease and design drugs to fight them.

Michael Owen, director of the Cardiff center, said their study also found evidence that other genes could play a role in the risk of developing Alzheimer’s.

“It’s a bit like we have been fishing with a fishing net and we’ve pulled out some fish. We know there are more fish there, and with a finer mesh net we can catch them,” he said.

The Cardiff team now plans a further study involving 60,000 participants to look deeper into genetic causes of Alzheimer’s.

Share/Save