Discover and read the best of Twitter Threads about #dementia

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The largest underlying cause of recent non-COVID-19 excess deaths in Scotland has been “Other causes”

The “Other causes” category also includes deaths which
have an unascertained cause whilst being investigated by the Procurator Fiscal

From Humza Yousaf, Health Secretary ImageImage
Friend of mine wrote to his MP raising concerns with the high levels of #ExcessDeath in #Scotland🏴󠁧󠁢󠁳󠁣󠁴󠁿

MP then wrote to the then Health Secretary whom provided the response attached

We know where the excess deaths are, but they still won’t face what it is that’s causing the excess Image
1,520 excess deaths do far in 2023 (week 1-11)




#Other (ill defined condition)

‘Covid’ attributed to around 350 of those deaths

Source: #NRS
Read 4 tweets
Why do we need seniors to have access to a ketogenic diet to help ward off dementia? Because telling them to eat more fish and blueberries is woefully insufficient! Think I am making this up? I am not. It's time for a thread on a recent study. 🧵 (1/19)
The objective of this study was to examine the relationship between consumption frequency of meat, fish, fruits, and vegetables and long-term risk of dementia and Alzheimer’s disease while taking into account the possibility of protopathic bias (i.e., reverse causation). (2/19)
The researchers analyzed data from the Three-city study, which followed 5,934 volunteers aged 65 and over for 12 years. (3/19)
Read 19 tweets
Perceived stress increases the risk of cognitive decline and dementia

1. A recent study looked at the association of perceived stress and incidence of cognitive impairment in a long-term follow up study…
2. 24,448 people (median age 64 years) were followed up for >15 years. Elevated levels of perceived stress (dichotomized as low stress vs elevated stress) was associated with 1.37 times higher odds of poor cognition.
3. The association of the change in the Perceived Stress Scale score with incident cognitive impairment was significant in both the unadjusted model (OR, 1.62) and after adjustment for sociodemographic variables, cardiovascular risk factors, and depression (AOR, 1.39).
Read 6 tweets
1/To call it or not to call it? That is the question!

Do you feel a bit wacky & wobbly when it comes to calling normal pressure hydrocephalus on imaging?

Here’s a #tweetorial about imaging NPH!

#medtwitter #meded #neurotwitter #neurorad #radres #dementia #neurosurgery #FOAMed
2/First, you must understand the pathophysiology of “idiopathic” or iNPH. It was first described in 1965—but, of the original six in the 1965 cohort, 4 were found to have underlying causes for hydrocephalus.

This begs the question—when do you stop looking & call it idiopathic?
3/Thus, some don’t believe true idiopathic NPH exists. After all, it’s a syndrome defined essentially only by response to a treatment w/o ever a placebo-controlled trial.

However, most believe iNPH does exist--but its underlying etiology is controversial. Several theories exist
Read 19 tweets
Excess death in #England 🏴󠁧󠁢󠁥󠁮󠁧󠁿

🟧 50,000 excess deaths in England over the past 52 weeks

🟣4.2 Million doses of ‘Spring Booster’ given to over 75s

🟢 15.2 Million doses of ‘Autumn Booster’ given to over 50s

Followed by spikes in #ExcessDeaths

Does correlation = causation ?

Since the roll out of the first #COVID19 booster in September 2021, there has been 50,000 deaths attributed to ‘Covid’

6,000 #Unvaccinated
44,000 #Vaccinated
30,000 #Boosted

53 Million boosters - and STILL we had 44,000 Covid deaths in the vaccinated!

I see correlation

In January 2023, England suffered 6,632 excess deaths (+12% above average)




#Other (Ill defined conditions)


Note the increase in cardiac deaths & ‘Other’

Read 9 tweets
Any level of physical activity is associated with better later-life #cognition

1. The multiple benefits of #exercise on cognitive functions are well known. A recent research showed that it is never too late to start exercising, and any exercise is better than not exercising.
2. The investigators asked 1417 participants how much they had exercised at ages 36, 43, 60, and 69 years.
Activities included badminton, swimming, fitness exercises, yoga, dancing, football, mountain climbing, jogging, or brisk walks for 30 min or more.
#dementia #Alzheimers
3. They were also asked the number of times they had exercised in the previous month.
Most commonly reported activities at age 60 were walking (71%), swimming (33%), floor exercises (24%), and cycling (15%).…
Read 6 tweets
Regular laxative use is associated with a higher risk of dementia

1. A recently reported study looked at association between #laxative use and new-onset #dementia in >5,00,000 UK Biobank participants.
2. Regular use of laxative was associated with 51% higher risk of all-cause dementia and 65% higher risk of vascular dementia. There was no significant association with risk of #Alzheimers disease.
3. The risk of dementia increased by 28% in people using one type of laxative, as compared to 90% in people using two or more types of laxatives.
Only osmotic type of laxative use was associated with higher risk of dementia.
Read 7 tweets
1/Having trouble remembering how to differentiate dementias on imaging?

Here’s a #tweetorial to show you how to remember the imaging findings in dementia & never forget!

#medtwitter #meded #neurorad #radres #dementia #alzheimers #neurotwitter #neurology #FOAMed #FOAMrad #PET
2/The most common functional imaging used in dementia is FDG PET. And the most common dementia is Alzheimer’s disease (AD).

On PET, AD demonstrates a typical Nike swoosh pattern—with decreased metabolism in the parietal & temporal regions
3/The swoosh rapidly tapers anteriorly—& so does hypometabolism in AD in the temporal lobe. It usually spares the anterior temporal poles.

So in AD look for a rapidly tapering Nike swoosh, w/hypometabolism in the parietal/temporal regions—sparing the anterior temporal pole
Read 16 tweets
Insulin receptors and IGF-1 receptors, along with their signaling partners, are found throughout the brain. I think this needs a thread. 🧵(1/13)
IGF-1 receptors are involved in important #brain processes, including neuronal growth and survival, regulation of synaptic plasticity, and modulation of #neurotransmitter release. They are implicated in neuroprotection and #cognitive function. (2/13) #science #neuroscience
Many of you are familiar with insulin, but maybe you don't know well enough what its important roles are in the brain. Insulin affects neurotransmitter channel activity, brain cholesterol synthesis, and mitochondrial function. (3/13) #mitochondria
Read 13 tweets
Dementia is a major public health challenge, affecting around 55 million people worldwide. Unfortunately, it's expected that the number of people living with dementia will increase by 50% over the next decade. (1/10)
Dementia doesn't just appear suddenly one day. It sneaks up on you. There are symptoms of brain fog in the form of mood disturbance and reduced cognitive function years before a diagnosis of dementia is provided. (2/10)
Alzheimer's disease is the most common type of dementia, characterized by memory loss, impaired judgment, and other cognitive difficulties. (3/10)
Read 10 tweets
Family: Bruce #Willis' condition has progressed to #dementia | Feb 17
- his family said on Thursday, nearly a year after the "#DieHard" franchise star retired from acting due to #aphasia that hampered his #cognitive abilities. Image
#Biden's physician says he remains "fit for duty" after routine physical | Feb 16
- On Nov-21 O'Connor noted the pres had more stiffness and less fluidity in his gait, which he attributed to the "wear and tear" of #osteoarthritic changes to the spine.…
What is frontotemporal #dementia? Bruce #Willis endures "cruel disease" | Feb 16
- "While this is painful, it is a relief to finally have a clear diagnosis. #FTD is a cruel disease that many of us have never heard…
Read 4 tweets
There are positive effects of the #ketone body beta hydroxy-butyrate (BHB) on vascular function. Why? Very likely, the following things that we already know BHB does. And quite frankly, there are likely additional mechanisms that haven't even been discovered yet. 🧵(1/10)
BHB lowers high blood sugar, and that reduces the production of reactive oxygen species #ROS and #inflammation mediators. In other words, BHB reduces Oxidative Stress (2/10)
BHB increases endogenous #antioxidant production by upregulating gene expression in those pathways. So yes, #BHB reduces Oxidative Stress from that mechanism as well. (3/10)
Read 10 tweets
1. Replacing just 9 minutes (per day) of sedentary behavior (SB) by moderate-vigorous #PhysicalActivity (MVPA) results in better #cognition scores over long-term in middle aged people.
MVPA time was derived using a step cadence of ≥100
#exercise #dementia…
2. Possible physiological explanations underlying a direct role for MVPA in supporting cognition include *Acute increases in cerebral perfusion,
*Growth factor release such as brain-derived neurotrophic factor,
*Hippocampal neurogenesis.
3. Lastly, MVPA, when attained by structured exercise, involves some degree of self-motivation, planning and social interaction, which are all factors considered to be cognitively stimulating.
Read 5 tweets
1/🧵 Real-World Long COVID
🔹She got COVID Oct 2020
🔹59 y/o walked 5mi 4x /wk
w no prior cognitive problems
🔹“I got better but 4 mo later my memory faded. I struggled.
🔹HR came after me, ‘You can’t do your job.’”
Husband: “I want my wife back!”

(Pics & story w perm)
2/ Could her new #dementia be unrelated to COVID?

Maybe, but…
Her excellent neurologist feels her negative work-up, young age, speed of demise, temporal onset in relation to COVID all fit LongCOVID-related brain dysfunction & not a pattern of Alzheimers.
They want to share
3/ Husband through tears: “I want my wife back.”
Her Description – “I walk down the hall & see pictures of family & trips. I feel like a ghost because I don’t remember. My husband cries because I seem gone to him.”
“I’m trying to figure out who Barbara 2.0 is going to be.”
Read 10 tweets
#PhysicalActivity and #brain health in patients with atrial fibrillation

1. Vascular brain lesions, such as ischemic infarcts, are common among patients with atrial fibrillation (AF) and are associated with impaired cognitive function.
#MedTwitter #neurotwitter #dementia
2. In a recent study, effects of physical activity and regular exercise on brain infarcts, brain volume and cognition were looked at.
3. In AF patients, regular exercise was associated with a lower prevalence of ischemic infarcts and of moderate to severe white matter disease, with larger brain volume, and with better cognitive performance.
Read 4 tweets
#music improves quality of life for people with #Dementia

1. Dementia caused by #Alzheimers disease is a relentlessly progressive #brain disease. Sufferers have #memory loss and impaired cognitive functions. Many require assistance for carrying out daily living activities.
2. People with dementia are often depressed and have poor quality of life.
Immediate recall and recent memory are the most affected in dementia, whereas remote memory is preserved until later stages.
Memory of music (especially their favorite ones) is also retained in many.
3. In a study, effects of music on #mood and quality of life of seniors suffering from dementia were assessed.
Over a period of 6 weeks, the seniors listened to their favorite music via headphones and an MP3 player for 20 minutes at a time three or four times a week.
Read 6 tweets
Resources to study #Neurology

Adams and Victor’s. By far my favourite textbook.
The book is more clinically oriented, coloured with anecdotes and mental models. Reading it feels like seeing a pt in the ward/OPD

#MedTwitter #neurotwitter
It has elements of philosophy, history and is written eloquently.
Whimsical, yet profound, it’s teachings stay with me. Added bonus, my Guru in Neurology finds mention in the text 🙃 I’d recommend this for #mbbs #md and #dm students
Bradley is the standard #textbook in #neurology. A great book, it’s more like #Harrison. Great for information, latest research and management. Essential for the DM #neurology candidate, but also useful for MD #internalmedicine
Read 11 tweets
A fascinating symptom in #neurology is #Alien Hand syndrome
If anyone has seen @StanleyKubrick ‘s great film Dr. Strangelove, you might have wondered what’s wrong with the titular character

His hand has a #mind of its own!!!

#cinema #neurotwitter #MedTwitter
Simplifying , for carrying out bimanual planned movements, we need a Supplementary Motor Cortex (SMA) (left frontal lobe). This communicates to the opposite side via the corpus callosum. Lesions in any will impair proper bimanual function and cause an “alien limb”#neuroanatomy
Frontal variant (left sma lesion) : Patient will have impulsive groping and difficulty releasing objects
Affects the dominant hand
Can be due to a #stroke, #degeneration

My patient impulsively grabs my hand (with his right hand) despite me telling him not to!
Read 7 tweets
Dementia with Lewy Bodies:

Part 2️⃣ Biomarkers

#Neuro #Neurotwitter #Teaching #Education




What is a biomarker? 🏷🧪️

"A characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention." 🩸🧠


What is the use of biomarkers? 🧠

Diagnostic tool🪓

Tool for staging the disease 🥼

Indicator of prognosis📡

Predic or monitor of clinical response to an intervention🚨

Remember: "tools"should aid clinicians, not be the source of all truth.

Read 14 tweets
1/🧵 Micro Clots & Endothelial Dysfunction in Long COVID

Plus new Epidemiology in @JAMA_current some say proves #LongCOVID is a hoax⁉️
Truth is…endothelial dysfunction plus inflammation can lead to life-altering brain & body dz.
Let’s explore data

Pic H/T @VirusesImmunity
2/ Remember that Vascular flow problems don’t occur in isolation from inflammation.

This new piece by @Jamie_Ducharme balances the discussion well.
It’s time for great studies & NOT immediate widespread treatment with blood thinners that might harm.
3/ The urgency is that people are living w what amounts to newly acquired #dementia.
This WaPo piece starts w “Haze. Slow. Drunk. Lost.”
Our patients are adamant that descriptors like #fatigue & #brainfog don’t do justice to what makes them suicidal.
Read 22 tweets
#hearingaids reduce the risk of #Dementia in people with #hearingloss

1. Age-related hearing loss is the most common sensory deficit in the elderly and has been identified as the highest modifiable risk factor for dementia (Livingston et al., 2020).
#MedTwitter #NeuroTwitter
2. In a recent meta-analysis, the usage of hearing restorative devices (hearing aids or cochlear implants) by participants with hearing loss was associated with a 19% decrease in hazards of long-term cognitive decline.
3. Furthermore, usage of these devices was significantly associated with a 3% improvement in cognitive test scores that assessed general #cognition in the short term.
To be beneficial, hearing aids should be worn for a minimum 4 hours per day.
Read 5 tweets
Dementia with Lewy Bodies:

Part 1️⃣ Clinical features and Probable Diagnosis

#Neuro #Neurotwitter #Teaching #Education



Introduction 🥇

DLB belongs to a family of disorders typically known as "synucleinopathies" 🔬

Other members are:

- PD

All of them have abnormal inclusions of α-Synuclein at a pathological level.

"Pathology is not pathogenesis", therefore we shouldn't assume that the presence of these pathological changes are a synonym of "protein toxicity".

Suggested reading ⬇️…

Read 24 tweets
"Retirement" from work as a risk factor for #Dementia: experience of 5 recent patients

1. I saw 5 new cases of dementia last month, which apparently started within 6 to 18 months after retirement from work. All were cognitively normal until retirement.

#MedTwitter #Alzheimer
2. Memory impairment was the most prominent symptom. Over a period of time, other symptoms such as impaired calculation, speech impairment, losing sense of direction, poor judgement and inability to do daily activities without assistance, also started. Symptoms were progressive.
3. A diagnosis of Alzheimer's disease was made on the basis of detailed neuro-psychological assessment, brain scans and other appropriate investigations.
Two patients had comorbid #depression. Three patients had #sleep disorders- two had #insomnia and one had excessive sleep.
Read 10 tweets
Calcium supplements increase the risk of dementia inn older people

1. #Calcium tablets are commonly prescribed to older people to lower the risk of #osteoporosis and #fractures. However, calcium tablets may increase the risk of #Dementia.
#neurotwitter #MedTwitter
2. Women (aged 70 or more) taking calcium supplements had a higher risk of all type dementia, vascular and mixed dementia at 5-year follow up.
The risk of dementia was higher in women with previous history of #stroke and those with white matter lesions (WML) on #MRI brain.
3. In another study, higher serum calcium status (even if not hypercalcemia) was associated with increased risk of #Alzheimers disease in elders. Serum calcium is a useful biomarker in predicting clinical progression in nondemented elders.
Read 6 tweets

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