Joel Salinas

Sex differences in parietal lobe structure and development.

Structural magnetic resonance imaging studies provide evidence for sex differences in the human brain. Differences in surface area and the proportion of gray to white matter volume are observed, in particular in the parietal lobe. To our knowledge, no studies have examined sex differences in parietal lobe structure in younger populations or in the context of development. The present study evaluated sex differences in the structure of the parietal lobe in children aged 7 to 17 years. In addition, by adding a cohort of previously studied adults aged 18 to 50 years, sex differences in parietal lobe structure were examined across the age span of 7 to 50 years. Compared with the adult sample, the younger sample showed that the ratio of parietal lobe cortex to white matter was greater in female brains, but no sex differences in surface area. When examining the effects of age, surface area exhibited a significant sex-age interaction. In male brains, there was essentially no decrease in surfaces area over time, whereas in female brains, there was a significant decrease in surface area over time. These findings support the notion of structural sex differences in the parietal lobe, not only in the context of cross-sectional assessment but also in terms of differences in developmental trajectories.

Associations between social relationship measures, serum brain-derived neurotrophic factor, and risk of stroke and dementia

Mechanisms underlying social determinants of stroke and dementia are unclear and brain‐derived neurotrophic factor (BDNF) may contribute as a molecular link.

Behavioral Interventions for Stroke Prevention: The Need for a New Conceptual Model

Social and behavioral factors, also termed social determinants of health, are increasingly established risk factors for incident and recurrent stroke, both ischemic and hemorrhagic stroke, yet improvement in addressing these factors remains insufficient.1 There is a lack of clarity on who should share in accountability for reducing risk (eg, patients, providers, or health systems) and what interventions are practical, cost-effective, and scalable.2 For the purpose of this review, we will use the definition of an intervention as a set of actions with a coherent objective to bring about change or produce identifiable outcomes.3 We first review the published literature to summarize the relevant research on previous behavioral interventions for prevention of stroke and other related conditions, the theoretical frameworks underpinning these behavioral interventions, and then propose a new conceptual model for more effective implementation of social and behavioral interventions for stroke prevention. Successful implementation will require adequately addressing the known inherent barriers to behavioral interventions and the ambiguity of financial responsibility and accountability among the various stakeholders. Because new tools, such as digital phenotyping, social network analysis, machine learning, and gamification, have emerged for facilitating, measuring, and improving existing behavioral interventions, a promising new paradigm in behavioral change has emerged. Table 1 categorizes the various behavioral interventions by operational level, risk factor targets, and tactics that range from the simple (eg, provider referral for behavior change program) to the complex (eg, multifaceted, multidomain intervention).4 Table 2 summarizes the prior interventions specific to stroke prevention covered in 3 major systematic Cochrane reviews. Because the evidence suggests that modifiable risk factors are often not effectively managed after a stroke or transient ischemic attack, the first review sought to identify interventions for improving control of 6 major modifiable risk factors5 of blood pressure, lipids, atrial fibrillation, diabetes mellitus, …

Factors Associated With New-Onset Depression After Stroke

To better identify stroke survivors at risk for depression who may benefit from early prevention through targeted strategies in the acute-subacute poststroke period, we examined 118 Framingham Heart Study stroke survivors with longitudinal prestroke depression assessments. Among those who developed poststroke depression, most lacked a history of depressive symptoms 5 years prior to their stroke. Sex (female), advanced age, and prestroke factors (smoking and functional dependence) were associated with new-onset depression poststroke. These findings suggest fully characterizing and accounting for prestroke factors, including psychosocial and behavioral determinants, may inform the predictive modeling needed to determine whether targeted preventive trials early in stroke recovery will improve stroke outcomes.

Happiness, health, and mortality

www.thelancet.com Vol 388 July 2, 2016 27 3 Mora PA, Di Bonaventura MD, Idler E, Leventhal EA, Leventhal H. Psychological factors infl uencing self-assessments of health: toward an understanding of the mechanisms underlying how people rate their own health. Ann Behav Med 2008; 36: 292–303. 4 Benyamini Y. Positive aff ect and function as infl uences on self-assessments of health: expanding our view beyond illness and disability. J Gerontol B Psychol Sci Soc Sci 2000; 55: P107–16. 5 Lindert J, Bain PA, Kubzansky LD, Stein C. Well-being measurement and the WHO health policy Health 2010: systematic review of measurement scales. Eur J Public Health 2015; 25: 731–40. 6 Fredrickson BL, Grewen KM, Coff ey KA, et al. A functional genomic perspective on human well-being. Proc Natl Acad Sci USA 2013; 110: 13684–89. 7 Boehm JK, Kubzansky LD. The heart’s content: the association between positive psychological well-being and cardiovascular health. Psychol Bull 2012; 138: 655–91. To assume that self-rated health is not comprised of elements of happiness is unrealistic. Findings from other studies show that health ratings are informed by positive feelings, a sense of vitality, functional health, and the presence of disease or symptoms. Liu and colleagues’ conclusion, which resulted in widespread headlines, is effectively based on analyses that examined the association of happiness with mortality after statistically controlling for happiness. Moreover, the so-called happiness measure used in the study by Liu and colleagues captured a simple hedonic state that represents and inadequate mental health assessment. Related single-item measures of control and stress are notoriously weak, and few social scientists view these types of single-item measures as able to capture wellbeing. Previous work by various authors has also shown that goal-oriented or purposeful facets of wellbeing are often more robustly associated with physical health than are simple happiness measures. Even with Liu and colleagues’ inadequate assessment of psychological wellbeing, the fact that the happiness measure continued to predict mortality after adjustment for all factors except for self-rated health, including behaviours and objective health measures, is striking.

Anterior temporal lobectomy for older adults with mesial temporal sclerosis

OBJECTIVE To compare postoperative seizure-free survival between older and younger adults. METHODS A retrospective cohort of 107 temporal lobe epilepsy patients with a diagnosis of mesial temporal sclerosis (MTS) received anterior temporal lobectomy (ATL) between 1993 and 2014. We divided the lower three quartiles (younger) and top quartile (older, all 47+ years) of patients, then reviewed patient registry and electronic medical records to determine time to first self-reported seizure after ATL, the primary outcome (mean=3.5years of follow-up, SD=3.6). We also assessed Engel classifications, intraoperative and postoperative treatment complications, and social disability. We used Cox proportional hazard models to assess the association between individual traits and time of seizure recurrence. RESULTS During follow-up, 35/107 (32.7%) patients had post-operative seizure(s). After adjustment for potential confounders there were no significant differences in the probability of post-operative seizures between the older and younger groups, though we had limited precision (hazard ratio of 0.67 [0.28-1.59]), (p=0.36). There were more treatment complications and disability in older patients (18% vs. 1.3% for any complications, 84.62% vs. 58.23% for driving disability, and 84.6% vs. 60.7% for work disability, p<0.05). CONCLUSION Older patients appear to have more complications after ATL, compared with younger patients. Age, however, does not appear to have a large independent association with seizure recurrence.

Autonomy and the “demanding encounter” in clinical neurology

We describe a case of psychogenic nonepileptic seizures as an example of what has been called the demanding encounter in clinical neurology. Patients in these encounters are more likely to see themselves as informed consumers who expect to receive requested diagnostic tests and treatments from health care providers, potentially creating a conflict over treatment goals and appropriate limit setting. Demanding encounters are associated with physician burnout and patient dissatisfaction. We survey some of the ethical frameworks introduced to navigate this type of encounter. We argue that physicians are obligated to identify the underlying beliefs that are leading to requests for unnecessary testing and treatment and that, by addressing these beliefs, providers have the best chance of establishing a respectful, meaningful therapeutic relationship with their patients.

Polygenic Risk for Depression Increases Risk of Ischemic Stroke: From the Stroke Genetics Network Study

Background and Purpose— Although depression is a risk factor for stroke in large prospective studies, it is unknown whether these conditions have a shared genetic basis. Methods— We applied a polygenic risk score (PRS) for major depressive disorder derived from European ancestry analyses by the Psychiatric Genomics Consortium to a genome-wide association study of ischemic stroke in the Stroke Genetics Network of National Institute of Neurological Disorders and Stroke. Included in separate analyses were 12 577 stroke cases and 25 643 controls of European ancestry and 1353 cases and 2383 controls of African ancestry. We examined the association between depression PRS and ischemic stroke overall and with pathogenic subtypes using logistic regression analyses. Results— The depression PRS was associated with higher risk of ischemic stroke overall in both European (P=0.025) and African ancestry (P=0.011) samples from the Stroke Genetics Network. Ischemic stroke risk increased by 3.0% (odds ratio, 1.03; 95% confidence interval, 1.00–1.05) for every 1 SD increase in PRS for those of European ancestry and by 8% (odds ratio, 1.08; 95% confidence interval, 1.04–1.13) for those of African ancestry. Among stroke subtypes, elevated risk of small artery occlusion was observed in both European and African ancestry samples. Depression PRS was also associated with higher risk of cardioembolic stroke in European ancestry and large artery atherosclerosis in African ancestry persons. Conclusions— Higher polygenic risk for major depressive disorder is associated with increased risk of ischemic stroke overall and with small artery occlusion. Additional associations with ischemic stroke subtypes differed by ancestry.

Factors Associated With New‐Onset Depression Following Ischemic Stroke: The Women's Health Initiative

Background Psychosocial characteristics have a strong effect on risk of depression, and their direct treatment with behavioral interventions reduces rates of depression. Because new‐onset poststroke depression (NPSD) is frequent, devastating, and often treatment‐resistant, novel preventive efforts are needed. As a first step toward developing behavioral interventions for NPSD, we investigated whether prestroke psychosocial factors influenced rates of NPSD in a manner similar to the general population. Methods and Results Using the Womens Health Initiative, we analyzed 1424 respondents who were stroke‐free at enrollment and had no self‐reported history of depression from enrollment to their nonfatal ischemic stroke based on initiation of treatment for depression or the Burnam screening instrument for detecting depressive disorders. NPSD was assessed using the same method during the 5‐year poststroke period. Logistic regression provided odds ratios of NPSD controlling for multiple covariates. NPSD occurred in 21.4% (305/1424) of the analytic cohort and varied by stroke severity as measured by the Glasgow scale, ranging from 16.7% of those with good recovery to 31.6% of those severely disabled. Women with total anterior circulation infarction had the highest level (31.4%) of NPSD while those with lacunar infarction had the lowest (16.1%). Prestroke psychosocial measures had different associations with NPSD depending on functional recovery of the individual. Conclusions There is a difference in the relationship of prestroke psychosocial status and risk of NPSD depending on stroke severity; thus it may be that the same preventive interventions might not work for all stroke patients. One size does not fit all.

The value of a weekly newsletter in neurology

The Partners Neurology Residency Program spans two neurology departments in Boston. The neurology departments of the Brigham and Womens and Massachusetts General Hospitals comprise of 325 faculty members and 53 neurology residents. Given this large community and the vast number of opportunities that are available at these academic institutions, it is critical to have a system to disseminate information and inform the neurology community of important events. In the era of digital technology, email and web-based media provide an opportunity for efficient communication. One way in which this is accomplished is by means of a weekly newsletter detailing lectures, academic conferences and departmental meetings. This bulletin, our ‘Neurology Weekly Events,’ has become an important fixture in maintaining cohesion within the programme. Our weekly newsletter provides a comprehensive list of daily events for the upcoming week including time and …