Fatty Liver Alliance’s Post

How will dementia be treated in the future? What happens if a person develops dementia? Let's say you live in Silicon Valley and go to see the best doctor, an MD/PhD professor at Stanford University. You'll get a recommendation to use purely symptomatic treatment, like memantine and a cholinesterase inhibitor (for newcomers, I'll hint that this is just a symptomatic remedy that only slightly smooths out dementia but doesn't really affect the rate of progression. Even if you give the most powerful cholinesterase inhibitor in the world - a novichok (newcomer) - the brain won't recover). At the same time, if you have hypertension and atherosclerosis, you'll get a prescription for boring stuff like blood pressure medication and statins. And after some rounds the doctor will finally say: “it’s Joever” Even if Grandpa Joe himself comes to you, your output (prescriptions) will differ only with a greater emphasis on security. That is, despite all your regalia and million-dollar salary, your recommendations won't differ from those of a doctor in an ordinary district clinic in the middle of nowhere. Let's say you're asked VERY INSISTENTLY to do something else. You'll start frantically recalling your experience in medical school, conferences, clinical studies you've read, and you'll end up prescribing experimental aducanumab to the old man (it will remove some amyloids from the brain, effectiveness slightly better than placebo, lots of side effects), anticoagulants, antiplatelet agents, metformin, testosterone, selegiline for depression, and modafinil so that the old man doesn't mess up in debates. As a result, you'll get a crazy old man, frantically saying something irrelevant, with a high anxious pace of speech and aggressive pressure. What if we try something more cutting-edge and don't care about proof? No red tape, no responsibility, a billion for expenses... Then, of course, we'll bring out the big guns: Intranasal insulin Intranasal senolytics Plasmapheresis with albumin Blood transfusion from an ApoE 2/2 gene carrier More radical atherosclerosis therapy (praluent + IL-1 antibodies) 5HT2A receptor agonists Interval hypoxia-hyperoxia Aggressive microflora modification Bredesen protocol Tadalafil Will this help? Who knows, I think the chances are about 40-60%, there's partial impact right on the pathogenesis, and a number of therapies have shown promise in studies. But even in the worst case, there will be a complete feeling that we really did everything we could; in the best case, it will be a very joyful case. So, the problem is that something experimental is very reluctantly penetrating into generally accepted recommendations, partly due to laziness, partly due to overload, partly due to insufficient large-scale research (for financial reasons). Therefore, it's very important to understand this topic deeply yourself, because if the rooster crows (fried is harmful), few will be able to help you. “God save the queen-man” (c), Grandpa Joe

I just came across a very interesting study examining the relationship between dementia and liver cirrhosis. In a retrospective cohort study of 177,422 US veterans diagnosed with dementia, 5.3% had a Fibrosis-4 (FIB-4) score greater than 3.25, suggesting liver cirrhosis, while a total of 10.3% had a score greater than 2.67, indicating advanced fibrosis. It is important to note that FIB-4 is not a perfect test for liver fibrosis, and the veteran population may not be representative of the general population. Furthermore, it is impossible to determine how many patients had dementia symptoms at least partly caused by hepatic encephalopathy. However, it is crucial to remember the wide spectrum of symptoms associated with hepatic encephalopathy and to consider excluding liver cirrhosis when evaluating a patient with symptoms of dementia. This might already be a routine practice in neurology clinics, but I am not aware of that. https://lnkd.in/e7AgbBzF

Impact on risk for dementia and haemorrhagic stroke of aggressive LDL-C lowering therapy A long read but very nice piece of prebunking/debunking to fight misinformation. The available data consistently show that lowering LDL-C reduces the risk of adverse ASCD-related events in high-risk populations. Although some older studies suggest that statins are associated with cognitive impairment or dementia, the preponderance of observational studies and data from randomized trials do not support this conclusion. Contemporary guidelines recommending the risk-stratified attainment of lipid-lowering goals are reasonable. It is clear that lower LDL-C correlates with lower risk of overall stroke and stroke recurrence. Data reflecting the risk of haemorrhagic stroke with statin treatment among patients with a history of haemorrhagic stroke are not robust. PCSK9 inhibitors have not been adequately tested in patients with prior ICH. Lipid lowering in this populations requires more focused study. https://lnkd.in/eVe_aPR2

Another great article from the Frontiers in Aging Neuroscience special article series on Hospitalization and Parkinson’s Disease titled "Complications and outcomes of hospitalizations for patients with and without Parkinson disease" From my perspective, the main takeaway is that patients with Parkinson's had statistically significant increased odds of 2 complications: Aspiration Pneumonia (17% increase in odds) and Delirium (11% increase in odds). Seeing this with such a large cohort (over 35k patients with PD) highlights what we were pretty sure we knew - these hospital complications are more common in Parkinson's! Clear data like this helps us continue to build the case for improving hospital care at the systems level!

【 Understanding the Risks: How Brain Vessel Health Influences Bleeding in Patients on Blood Thinners 】 Researchers at the National Cerebral and Cardiovascular Center in Suita, Japan, conducted a study published in 'Ann Neurol. 2023 Dec 25,' aimed to understand how cerebral small vessel disease (SVD) affects the risk of bleeding in patients taking blood-thinning medications. Over 5,000 patients with heart or brain vessel diseases from various hospitals in Japan were followed, tracking their health and treatment with drugs that prevent blood clots. Using MRI scans, the team calculated each patient's total SVD score, a measure of the disease's severity in the brain's small vessels. They then observed these patients over time to see how often major bleeding or clot-related problems (ischemic events) occurred. The findings revealed a clear pattern: as the SVD score increased, so did the rate of major bleeding and stroke-like events. Particularly, patients with the highest SVD score (4) were significantly more likely to experience severe bleeding within the brain and other parts of the body compared to those with a score of 0. In summary, the study suggests that the severity of cerebral SVD is a helpful indicator for doctors to consider when prescribing blood-thinning medications. A higher SVD score means a higher risk of bleeding, which can guide safer treatment decisions. This information is crucial for balancing the benefits of preventing clots with the risks of bleeding, especially in patients with underlying vascular conditions. https://lnkd.in/gw4HzDgW

There are approximately 476,000 people diagnosed with Lyme disease annually in the US. Of these, an estimated 10-20% suffer from impairing symptoms well beyond the acute phase of infection. Persistent symptoms include severe fatigue, pain, and cognitive problems. Vexingly, these symptoms can be difficult to validate using current diagnostic tests. Patients are often told by their health practitioners: “your tests are normal, it’s in your head” (aka psychosomatic). Researchers have discovered, however, that by using more advanced imaging modalities, brain changes can be objectively detected in Lyme disease patients. For example, clinical researchers at Johns Hopkins University School of Medicine have used novel PET imaging, functional MRI (fMRI), and diffusion tensor imaging (DTI) to identify inflammatory, functional, and structural abnormalities in the brains of Lyme disease patients as compared to healthy controls. Their findings indicate that Lyme-disease-associated brain alterations are biologic and measurable, not psychosomatic. These discoveries are significant but not yet well known by the physician community or broadly available to clinicians. What does “brain fog” mean? Brain fog is a term used to describe difficulties with cognitive functions such as working memory, focusing, concentrating, planning, organizing, word recall, processing speed, and mental fatigue. Working memory enables one to do tasks quickly or easily solve a problem without looking up information. This includes quickly learning a new computer program or using names or numbers for a routine task. Mental fatigue is akin to how one feels after taking a long test that requires remembering detailed information or doing a complicated mental task when short on sleep. https://lnkd.in/edQGkCuE

This is an extremely important paper about misdiagnosis of dimentia Undiagnosied Cirrhosis with Hepatic Encephalopathy can present with "dementia" It is estimated that up to 13 % of patients are misdiagnosed. Why is this important? Because it is reversible So if you have a loved one who has been diagnosed with Dementia Ask for theFibrosis-4 (FIB-4) index, which helps identify liver disease. Liver disease can be cause by several factors Causes include: Viral infections. ...  Alcohol-induced hepatitis. ...  Toxic hepatitis. ...  Non-alcohol related fatty liver disease. ...  Biliary stasis. ...  Autoimmune diseases. ...  Inherited metabolic disorders. ...  Cardiovascular diseases. These findings were reported in the JAMA medical journal. It can be difficult for physicians to differentiate dementia from hepatic encephalopathy, which is the cognitive decline caused by cirrhosis. If it is undetected, patients may not receive treatment that can reverse or halt the impairment.

🔬💡 Unveiling the Clinical Significance of the Ammonia Test: Insights into Liver Health 🌟💉 Today, let’s uncover the significance of the Ammonia Test in assessing liver function and guiding patient care. Understanding the Ammonia Test: The Ammonia Test is a biochemical assay utilized to measure the concentration of ammonia in the bloodstream. Ammonia, a byproduct of protein metabolism, is primarily detoxified in the liver through the urea cycle. Elevated ammonia levels in the blood can indicate impaired liver function or metabolic disorders. Clinical Significance: 1. Assessment of Liver Function: The Ammonia Test serves as a valuable tool for evaluating liver function, particularly in conditions such as cirrhosis, hepatitis, and liver failure, where impaired detoxification capacity leads to ammonia accumulation. 2. Diagnosis of Hepatic Encephalopathy: Elevated ammonia levels are implicated in the pathogenesis of hepatic encephalopathy, a neuropsychiatric syndrome characterized by cognitive impairment and altered consciousness in patients with liver dysfunction. Monitoring ammonia levels aids in diagnosing and managing this condition. Patient Impact and Clinical Considerations: 1. Early Detection of Liver Dysfunction: Timely assessment of serum ammonia levels enables early detection of liver dysfunction, facilitating prompt intervention and management to prevent disease progression and complications. 2. Monitoring Treatment Response: Serial monitoring of ammonia levels allows healthcare providers to assess the effectiveness of therapeutic interventions, such as pharmacological therapy or liver support measures, in reducing ammonia accumulation and improving liver function. Community Awareness: 1. Promoting Liver Health: Raising awareness about the importance of liver health and regular screening for liver function parameters, including the Ammonia Test, encourages individuals to adopt lifestyle modifications and seek medical attention for early detection and management of liver disorders. 2. Educating Healthcare Professionals: Providing healthcare professionals with comprehensive knowledge about the clinical significance of the Ammonia Test enhances their ability to interpret results accurately and formulate evidence-based treatment plans for patients with liver-related conditions. The Ammonia Test plays a crucial role in assessing liver function and diagnosing hepatic encephalopathy, contributing to the early detection and management of liver disorders. ⚕️I’m Dennis Odoi empowering you to seize control of your health. ⚕️Follow along to join a community of like-minded commanders. ♻️ Repost to save a life #LiverFunction #HepaticEncephalopathy #AmmoniaTest #ClinicalBiochemistry Day 140/366 Days

🔍 Exploring Pulmonary Rehabilitation in Interstitial Lung Diseases (ILDs) 🌬️ 🔬 Background: ILDs lead to lung parenchyma fibrosis, impacting quality of life and causing dyspnea. Anxiety and depression are prevalent among ILD patients. Recent findings highlight how Pulmonary Rehabilitation (PR) aids COPD patients. ❓ Research Question: What's PR's impact on anxiety and depression in ILD patients? 📊 Study Design: We conducted a PRISMA-2020-compliant systematic review of RCTs exploring PR's effects on anxiety and depression in ILD patients. Databases searched: MEDLINE, EMBASE, Cochrane, and PsycINFO until April 3, 2023. 🔍 Results: Five RCTs (n = 281) were analyzed, with IPF being the most common ILD (k = 3). Significant anxiety improvements in IPF and depression improvements in sarcoidosis were observed. Dropout rates were similar across groups, yet all studies bore a high risk of bias. 💡 Interpretation: PR doesn't worsen anxiety or depression in ILD patients. It may even alleviate anxiety in IPF and depression in sarcoidosis. Yet, conclusive evidence is lacking due to diverse populations and small sample sizes. More RCTs focusing on anxiety and depression are necessary. 🔑 Keywords: Anxiety, Depression, Interstitial lung disease, Pulmonary rehabilitation, Randomized controlled trial. Let's advance ILD management and mental well-being together! 🌟 #ILD #PulmonaryRehabilitation #MentalHealth #ResearchInsights https://lnkd.in/gmf9sitq #scienceslab #evidencebasedmedicine #mentalhealth University of Ottawa, Department of Psychiatry University of Ottawa Nicholas Fabiano

🩸 A new blood test was found to be 91% effective at diagnosing Alzheimer’s disease. Here's what you should know about it 👇 Published in JAMA, the new study involved over 1,200 patients currently undergoing cognitive evaluation for mild symptoms of dementia in Sweden. The blood test measured their levels of p-tau217 and amyloid beta, two biomarkers for #Alzheimers disease. While the new blood test marks a major advancement, it is not yet a replacement for the current diagnostic process for #dementia, which includes medical history, review of medications, neurologic exams, neuropsychological testing, and brain scans. As our Chief Medical Officer Joel Salinas, MD, MBA, MSc, FAAN explained in an interview with Health, "While the blood test could serve as a helpful tool in conjunction with other diagnostic methods, further research is needed to establish clear guidelines for its use and to determine its role in improving treatment outcomes." Learn more about the new #bloodtest in our latest blog post 👉 https://lnkd.in/eVqpt_Gu Read the full Health article about the research findings 👉 https://lnkd.in/gXbq6na5 If you are experiencing problems with memory or thinking, it is important to seek a thorough medical evaluation as early as possible. Early diagnosis of Alzheimer’s disease and related dementias can be crucial for planning and managing the condition. Isaac Health's clinicians are here to help you get the answers and support you need. We offer specialist diagnosis and treatment for individuals experiencing symptoms of dementia. You can book a free consultation here: https://lnkd.in/euGFX29P