Autistic Spectrum Disorders (ASDs) are neurodevelopmental disorders that have much better outcomes the earlier they are diagnosed.and the sooner children are enrolled in appropriate intervention programs. To help disseminate information to more effectively avoid a delayed diagnosis it important to make available some of the earliest signs and symptoms to watch for.

The Child Neurology Service "red flags" screening parameters include the following as absolute indications for immediate evaluation for autism:

1) no babbling or pointing or other gesturing by 12 months of age

2) no single words by 16 months

3) no spontaneous 2-word phrases by 24 months

4) loss of language or social skills at any age

Speech delays usually prompt parents to raise concerns with their child's pediatrician at 16 to 19 months. However, certain social deficits occur earlier and may be more specific but more difficult to recognize. Presenting symptoms can vary widely from one child to the next. Some may be perceived by parents as just "being different" during the first few months of life. Inability to manifest social relatedness by developing connections with others and sharing complementary states is common. These children are content being alone, ignore their parents bids for attention, and seldom make eye contact or bid for other's attention with gestures or vocalizations.

Difficulty with skills such as joint activity is a distinguishing characteristic of very young children with autism. Joint activity refers to the behavior whereby the infant shows enjoyment in sharing an object or an experience with another person by looking back and forth between the two. Early in life it frequently appears as joyous smiling in recognition of a parent's attention or vocalization. At about 8 months of age, an infant starts to follow a parent's gaze and look in the same direction. At 10-12 months children begin to look in the same direction when a parent points at an interesting object. This is usually accompanied by the child looking back at the parent as if to acknowledge a shared appreciation. At 12 to 14 months children typically begin to initiate pointing themselves usually to request a desired object and then to draw the parent's attention to share an interesting object. These pointing episodes are frequently accompanied with a back and forth gaze of the child between the object and the parent in effect to "share" the experience. Orienting to social stimuli such as turning consistently to respond to one's name is an early (8-10 months) trait that is often deficient.

Most children later diagnosed with autism are sent to their doctor for "speech delay." Most parents sense that something is wrong by 18-20 months. Earlier pre-speech deficits often exist and should be looked for. These traits include:

1) lack of appropriate gaze

2) lack of warm, joyful expressions

3) lack of the alternating to-and-fro pattern of vocalizations between infant and parent that usually occurs at approximately 6 months of age (ie, infants with autistic tendencies usually continue vocalizing without regard for the parent's speech)

4) lack of recognition of parent's voice

5) disregard for vocalizations such as calling of the child's name but with preserved awareness of environmental sounds

6) delayed onset of babbling past 9 months

7) decreased use of pre-speech gestures such as  waving or pointing

8) lack of expressions such as "oh oh" or "huh"

9) Lack of interest or response of any kind to neutral statements such as "Oh no, it's raining again!"

If you see these changes, please suggest that the child be evaluated as soon as possible because an early, proper diagnosis means starting treatment at a time when the intervention is likely to result in a better outcome for the child.

 

 

The association between smoking and cognitive function (thinking, learning and memory) has been discussed extensively in recent years. The consensus has been that smoking negatively impacts brain function. However, evaluating this effect in older persons is problematic because old smokers frequently die or don't return for follow-up assessments. One way to avoid some of these problems in clinical study design is to explore the association between smoking and cognitive function before dementia develops.

The link between mild cognitive impairment and dementia is well established. Therefore, it is logical to determine whether there is an association between smoking  and cognitive impairment in midlife. Evidence of a link at younger ages would bolster the contention that smoking is involved in the production of cognitive decline.

Data in a recent study were drawn from 10,308 civil servants in the UK who were followed for an average of 17 years. The relationship between smoking history and multiple domains of cognition was investigated sequentially in middle-aged individuals aged 35-55 at baseline. They included memory, reasoning, vocabulary, and semantic and phonemic fluency.

Compared to those who had never smoked, middle-aged smokers experienced memory deficits and declines in reasoning abilities. Compared with smokers, long-term ex-smokers were less likely to have cognitive problems in memory, vocabulary and verbal fluency. The study also documented that those who gave up smoking in midlife manifested improvements in other health related behaviors such as diet and activity.

These results are significant because individuals with cognitive impairment in midlife due to smoking may progress to dementia at a more rapid rate.

 

 

ScienceDaily (June 11, 2008) — A 115-year-old woman who remained mentally alert throughout her life had an essentially normal brain, with little or no evidence of Alzheimer's disease, according to a study in the August issue of Neurobiology of Aging.

The findings question the assumption that Alzheimer's disease or other forms of dementia will inevitably develop, if people live long enough. "Our observations suggest that, in contrast to general belief, the limits of human cognitive function may extend far beyond the range that is currently enjoyed by most individuals, and that improvements in preventing brain disorders of aging may yield substantial long-term benefits," according to a study led by Prof. dr. Gert Holstege of University Medical Centre Groningen, The Netherlands.

Dr. Holstege and colleagues had a unique chance to test the mental functioning of one of the world's oldest humans, and then to compare their findings with the condition of the subject's brain after death. The patient was a Dutch woman who, at age 82, made arrangements to donate her body to science after death. At age 111, she contacted the researchers to ask whether her body would still be useful for research or teaching purposes. They assured her that, contrary to what she thought, they were especially interested because of her age: "She was very enthusiastic about her being important for science," Dr. Gert Holstege and colleagues write.

The researchers found the patient to be "an alert and assertive lady, full of interest in the world around her, including national and international politics and sports." She had lived independently until moving to a residential care home at age 105, mainly because of poor eyesight. Ironically, she had been very small at birth and was not expected to survive.

A series of neurological and psychological examinations were performed when the patient was 112 and 113 years old. The results were essentially normal, with no signs of dementia or problems with memory or attention. In general, her mental performance was above average for adults aged 60 to 75.

As planned, her body was donated to science when she died at age 115. At the time, she was the world's oldest woman. Examination after death found almost no evidence of atherosclerosis (narrowing of the arteries) anywhere in her body. The brain also showed very few abnormalities--the number of brain cells was similar to that expected in healthy people between 60 and 80 years old.

A key finding was the absence of brain abnormalities typical of Alzheimer's disease. There were almost no deposits of a substance called beta-amyloid, which are characteristic of Alzheimer's patients. The other abnormalities present, including "neurofibrillary tangles," were very mild--too early to cause significant mental impairment.

The unique case lends new insights into the potential for preserving brain function in very elderly patients. Previous studies have found at least mild abnormalities in the brains of nearly all "cognitively normal" elderly people. As the number of people living to age 100 and beyond continues to increase, the findings suggest that deterioration of the brain is not inevitable.

 

 

Increasing rates of obesity have led to concerns about an epidemic of adverse health consequences. Obesity is most simply characterized by measuring waist circumference or waist to hip ratio (WHR). The frequent association of abdominal obesity, as determined by the WHR, with elevation of serum triglycerides, decline in HDL (the "good cholesterol"), hypertension and diabetes constitute a metabolic constellation often referred to as Syndrome X, or the Metabolic Syndrome. It is an important risk factor for cardiovascular disease and stroke.

Obesity has been linked to the development of Alzheimer disease and specific changes in brain structure. Based on the correlation between obesity, dementia and cardio-metabolic factors, investigations have focused on defining potential alterations in brain anatomy seen in this context. Magnetic Resonance Imaging (MRI) was chosen as the desired imaging modality because of its capacity for high spatial resolution and quantitative assessment.

MRI measures that have been previously linked to cognitive impairment and dementia include  hippocampal volume (HV) and white matter hyperintensities (WMH). The hippocampus is a region of the brain essential for memory processing and retrieval. Cerebral white matter consists of nerve cell processes that serve to connect distant clusters of neurons into functional networks. Decreases in HV and and increases in WMH have been shown to contribute independently to the risk of dementia. Because WHR is a component of the Metabolic Syndrome, associations between it and these structural brain changes were investigated.

A recent study was conducted in the Central Valley of California including 112 individuals in the Latino community. WHR determinations, MRI scans and metabolic assessments were performed.  In this cross-sectional analysis greater WHR was associated with a fall in HV and an increase in WMH. A one standard deviation increase in WHR was associated with a 27% increase in WMH. It is important to note that these relationships were not affected by adjustment for body mass index (BMI) (a measure of generalized obesity), total cholesterol level, fasting blood glucose, serum insulin levels or systolic blood pressure.

Although prior studies have shown correlations between HV and WMH with various metabolic and cardiovascular factors, in this study they did not explain the entire association. The authors suggested other potential etiologies such as inflammatory mechanisms linked to the central fat depots, stress and elevation of the stress hormone cortisol as additional factors.

These findings complement a large body of data that demonstrate the negative effects of obesity on cognitive function. They are also consistent with the emerging reports of the beneficial effects of exercise on cognition. One result of exercise may be improved weight regulation. Taken together, these findings provide further support for the suggestion that structural brain changes might be at least partially modifiable by lifestyle alterations.

The only drug approved by the FDA for the acute treatment of strokes is tPA. tPA is the "clot busting" drug that must be given very shortly after a stroke has started. It's major side effect is bleeding which may occur in the brain. If this happens, additional damage to the brain can occur. Because of the short time window during which it may be administered, many people don't get to the hospital soon enough to qualify for use of tPA.

A novel new function may breathe new life into an old drug. Minocycline, an antibiotic used to treat acne, may be an alternative treatment for stroke. It is a semisynthetic cousin of tetracycline. It has been shown to have neuroprotective effects in animal models of multiple sclerosis (MS), Parkinson disease, Huntington disease and ALS (Lou Gehrig's disease). The mechanisms responsible for the death of nerve cells in these diseases share many similarities with cell death pathways in stroke. This prompted investigators to evaluate minocycline in a rodent stroke model. Pyramidal neuron (a type of nerve cell) survival increased from 10 to 77% after administration of minocycline. In another animal stroke model, even when administered 48 hours after a stroke developed, minocycline reduced the size of the stroke.

The proposed mechanisms of minocycline's actions appear to have nothing to do with its antibiotic effects. It seems to have significant anti-inflammatory activities as well as a novel ability to inhibit what are referred to as cell death cascades (that cause nerve cells to essentially self destruct under adverse circumstances) triggered by stroke-like events.

In an open-label, evaluator-blinded study done at Edith Wolfson Hospital in Holon, Israel, minocycline was given to stroke patients for five days. It was started between 6 and 24 hours after onset of a stroke. One hundred fifty-one patients were enrolled in the study. They were followed for 90 days. Recovery rate and final neurological status were evaluated. Improvement was noted as early as day 7. No evidence of recurrent stroke or hemorrhage was noted during the follow-up period. Patients had significantly improved outcome with minocycline treatment in this open label study.

It appears that the beneficial actions of minocycline, especially its antagonism of cell death pathways, which are not engaged acutely during a stroke, make it a potentially useful candidate for stroke therapy with a wider therapeutic time window. Based on these promising preliminary findings, Dr. David Hess at the Medical College of Georgia will further study the efficacy of minocycline in acute stroke in a prospective double-blinded human trial. The current focus of the study is to determine drug safety, optimal dosing regimens and during of therapy.

If previous findings are upheld, minocycline may become a new "standard" therapy for patients experiencing symptoms of acute stroke.