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Moved to substack

Dear Reader We have moved the preventive neurology unit blog to a new platform called substack . Google is discontinuing its Feedburner and has not added many new features to blogger for some time, which is why we have decided to move the site.  Thanks Gavin Giovannoni
Recent posts

Addicted to coffee

Are you addicted to coffee? Do you need a reason to justify your addiction? Read on!  Photo by Jakob Owens on Unsplash I justify my coffee addiction (6-8 espresso shots per day) by claiming that I am preventing myself from developing Parkinson’s disease in the future. This is #PreventiveNeurology in practice. Sadly coffee consumption doesn’t protect you from getting Alzheimer’s disease or all-cause dementia. However, I was thrilled to note that it seems to protect you from developing chronic liver disease and dying from liver disease. The molecular mechanisms underlying this are plausible. Caffeine is a non-selective blocker of the A2aA receptor, activation of which stimulates collagen production by hepatic stellate cells, which are the primary mediators of fibrosis. But as decaffeinated coffee is also protective it may be the other ingredients in coffee such as chlorogenic acid, kahweol and cafestol, which protect against liver fibrosis. Whatever the mechanism underlying coffee’s pr

Sleep, beautiful sleep

Photo by S L on Unsplash Human biology is systems biology; perturb one aspect of human biology and it will have downstream effects, which can be noted throughout the body. As you know sleep is critical for brain health; if you have poor sleep hygiene you are putting yourself at greater risk of developing dementia when you get older. Why?  In this study of cognitively normal older Chinese adults, spinal fluid soluble TREM2 (sTREM2) was associated with self-reported poor sleep hygiene using the Pittsburgh Sleep Quality Index. sTREM2 is shed from activated microglia or macrophages and is thought to be a marker of microglial activation. The implications are that this association may be causal, i.e. poor sleep is pro-inflammatory, both in the periphery and central nervous system and the latter contributes to driving neurodegeneration. Could improved sleep hygiene be anti-inflammatory? Or is the microglial activation simply a response to poorer clearance of CNS debris, which occurs when we

The Aducanumab shitstorm

Congratulations to  Al Sandrock , from Biogen, for never giving up on science and for being a  risk-taker extraordinaire .   Photo by Markus Winkler on Unsplash The FDA’s controversial approval of aducanumab for the treatment of Alzheimer’s disease on Monday has caused a shitstorm. The main reason is that in November the FDA’s independent advisory committee voted against recommending approval; they said the data failed to demonstrate persuasively that aducanumab slowed cognitive decline. In a NY Times article Dr Lon Schneider, director of the California Alzheimer’s Disease Center at the University of Southern California and one of the aducanumab site investigators said “This should not be approved, because substantial evidence of effectiveness hasn’t been shown and there’s very little potential that this will address the needs of patients.” What the FDA has done is use the so-called Accelerated Approval Pathway , which allows them to approve a drug for a serious or life-threatening

To be teetotal or not

In summary, any form and any amount of alcohol consumption is unhealthy for the brain. Photo by Hush Naidoo on Unsplash He was only 64 when his daughter noticed that his forgetfulness had started to impact on his ability to function independently. Her father had forgotten to pay the gas and electricity bill and social services had contacted her as next of kin to find out why. It was clear that years of excessive alcohol was having an impact on his memory. The scenario above is one that is played out across society thousands of times if not hundreds of thousands of times. This is why the study below from the UK biobank is so worrying; when it comes to brain volume, a crude measure of the brain's neuronal and cognitive reserve, there is no safe alcohol consumption limit. Importantly, comorbidities such as high blood pressure and obesity interacted with alcohol consumption to reduce brain health. Not surprisingly binging on alcohol made things worse and this was over and above the vo

Corpulence and poverty

Since stating my intention to join the  #BackTo21  campaign to get my BMI back to what it was when I was 21 years of age, I have had several emails and direct messages on social media questioning the wisdom of my intention.  Photo by NeONBRAND on Unsplash It is clear that despite BMI being a relatively poor metric of health there is overwhelming evidence that at a population level it predicts poor health outcomes. Importantly there is new data that indicates the target BMI for the prevention of type 2 diabetes and the metabolic syndrome depends on your ethnicity. For people of South Asian origin, there is a call to reset the BMI cutoff to 23.9, which for most people is within the normal range. At the same time, there is a call to classify obesity as an important social determinant of health. Arnaud Chiolero argues below for using BMI as a socioeconomic indicator. Do you agree? Isn’t it quite amazing that in a previous era corpulence was a sign of affluence, whereas in the modern era o

When last did you measure your blood pressure?

Do you have mild hypertension? If you don't know get measuring.  Photo by Mufid Majnun on Unsplash Defining mild-to-moderate hypertension as a disease when it is largely asymptomatic and is really only a risk factor for diseases as a result of end-organ damage caused by hypertension is a triumph of preventive medicine.  In medicine we define a disease as a clinicopathological correlate, i.e. there are clinical findings associated with a specific pathology that is unique and separates the specific disease from other disorders, which may mimic it. When mild-to-moderate hypertension develops there are usually no specific symptoms and when diagnosed early there is little of no end-organ signs of damage. In other words, hypertension is part of the prodrome for diseases that manifest many years later. However, the medical profession treats hypertension as a disease in itself. Why? I think it is because the epidemiological evidence showing hypertension is associated with poor outcomes is