The Bench. The Bedside
Date: December 16, 2013
Could deep brain stimulation reverse resistant, chronic anorexia nervosa? This spring, a pilot trial whose team included neuroscientist Gwenn Smith tested that idea in six patients. It’s the same collaboration with a Toronto neurosurgeon that earlier saw positive results with DBS for resistant depression. In this work, three of six severely anorexic patients gained weight and had far less anxiety. The trial is small, the procedure isn’t trivial. Still, Smith says, it warrants further research.
The online interview that Jason Brandt is refining for people concerned about dementia “isn’t a definitive diagnostic,” he says. “Its goal is to teach the public about dementia risk factors. It also is meant to encourage clinical follow up when it’s warranted.” So far, he says, it looks promising.
Recently, Brandt’s team reviewed data from several thousand Internet users who clicked onto the Dementia Risk Assessment (DRA). Comparing results of older peoples’ responses with their in-person exams by geriatric neuropsychiatrists showed that the DRA flags those with probable dementia at least 80 percent of the time, reliably enough to suggest medical follow-up. And a look at proxy reports, where healthy people filled out the DRA on someone they were concerned about, showed online reports are in sync with a patient’s actual memory test performance.
“We’re readying additional studies,” says Brandt, “but are convinced of the DRA’s promise for wide-scale screening for dementia risk.”
The Johns Hopkins-associated MMSE—the mini-mental state examination—set a standard for quickly checking a patient’s state of mind. Now psychologist David Schretlen’s team is pooling international MMSE data and that of other cognitive tests to solve the huge problem of not being able to compare people of different countries and cultures.
The norms his group will publish, Schretlen says, “should let examiners anywhere be able to tell, for example, if an MMSE score of 24/30 is abnormal for a 53-year-old French man with 18 years of education but normal for an under-schooled elderly Brazilian woman.”
So far, they have data on a quarter million people from 49 countries and have launched the web site www.inndi.org to explain the initiative. Response at worldwide conferences, Schretlen says, “has been phenomenal.”