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Author: DENT Neurologic Institute

What is Rett Syndrome? | #OverpowerRett

Imagine the symptoms of autism, cerebral palsy, and epilepsy affecting one child who cannot speak. That is Rett syndrome.

Rett syndrome is a rare genetic neurological disorder that occurs almost exclusively in girls and leads to severe impairments, affecting nearly every aspect of the child’s life: their ability to speak, walk, eat, and even breathe easily. 

The hallmark of Rett syndrome is near constant repetitive hand movements. Rett syndrome is usually recognized in children between 6 to 18 months as they begin to miss developmental milestones or lose abilities they had gained.

What causes Rett Syndrome?

The clinical features of Rett syndrome were first described in 1966 by Dr. Andreas Rett. Patients with these clinical features were subsequently given the designation of Rett syndrome in 1983 in recognition of Dr. Rett’s original report. Rett syndrome is still considered a clinical diagnosis based on specific developmental history and clinical criteria. These clinical criteria were last revised in 2010.

Rett syndrome is caused by mutations on the X chromosome on a gene called MECP2. There are more than 900 different mutations found on the MECP2 gene. Most of these mutations are found in eight different “hot spots.”

Rett syndrome is not a degenerative disorder with individuals living to middle age or beyond. It is not inherited. Rett syndrome occurs worldwide in 1 of every 10,000 female births, and is even more rare in boys. 

Rett syndrome can present with a wide range of disability, ranging from mild to severe. The course and severity of Rett syndrome is defined by the location, type, and severity of the mutation and X-inactivation.

Symptoms

Symptoms for Rett Syndrome may not reveal themselves from six months until 18 months after an infant is born. One day your child is healthy and happy, grasping for things as babies do. The next day you notice they are experiencing:

  • Breathing difficulties
  • Cardiac Issues
  • Swallowing and digestive issues
  • Scoliosis
  • Seizures
  • Repetitive hand movements

These are just some of the symptoms of Rett Syndrome, a neurological disorder primarily affecting girls. Symptoms may be more severe in boys. 

A mutated gene may be the cause of this disorder that affects all racial and ethnic groups around the world. That’s why it’s essential to know about Rett Syndrome Awareness Month in October.

Males with Rett

In 1999 it was reported that mutations in the MECP2 gene, located on the X chromosome, were associated with the clinical presentation of Rett syndrome. Since the ability to test the MECP2 gene has been available, there have been over 60 males reported with mutations in the MECP2 gene. 

A few of these males had a clinical picture consistent with the clinical criteria for Rett syndrome; however, most of these males presented with a different clinical presentation. Most males with mutations in MECP2 gene present with an earlier onset of symptoms, typically with significant problems beginning at or shortly after birth.

The determination of Rett syndrome is still based on clinical criteria and the clinical presentation. Over 95% of females with classic Rett syndrome will have a mutation in the MECP2 gene. Mutations in the MECP2 gene by themselves are not sufficient to make a diagnosis of Rett syndrome. Patients with mutations in the MECP2 gene that do not meet the clinical criteria for Rett syndrome are given the designation of MECP2-related disorders.

How can you help?

Having a loved one with Rett Syndrome can be difficult. They often have behavioral problems and extreme levels of anxiety because they can hear and understand us, but cannot respond or move well on their own. Here are ways you can help someone you know who has Rett Syndrome: 

Socialize. Kids must spend time with their peers, but when they can’t talk, it makes things difficult. Try teaching them yes and no with the direction they move their eyes, or even giving them a choice board so they can point to their answers. Taking a trip to the movie theater with friends is also a good idea because speaking will be minimal from both ends.

Be active. Again, this is something that can be hard when a child has trouble moving on their own. But, if you can help them on a short walk, go for a swim, or even ride horses, it can help with both physical and mental strength. Plus, it’s something the whole family can enjoy together.

Keep learning and be mindful.  There is constant research happening with Rett Syndrome. Hopefully, someday, a cure or better treatment will be discovered. The more you learn and are aware of what is truly going on in your child’s mind and body, the better you can react in ways that will make them feel comfortable.

5 Things You Might Not Know About Rett Syndrome

  1. The mutation is random. One of the most frustrating things about studying the gene mutation is that it occurs with conception, and other family members may not experience it.
  2. Sufferers can outgrow it. Many live satisfying lives well past middle age and into their later years.
  3. Babies seem healthy until it appears. Unlike other kinds of disorders, Rett Syndrome babies seem entirely normal until symptoms appear between six and 18 months after a female child is born.
  4. Varied symptoms. Rett Syndrome symptoms can include scoliosis, irregular breathing during the day, and sleep disturbances at night.
  5. Love and support make a difference. People impacted by Rett Syndrome can improve immeasurably with the love, understanding, and support of their family and friends.

To learn more or donate to Rett Syndrome, visit these organizations:

World Stroke Day

If you or someone you know wants to make an appointment at the DENT Stroke Clinic, call 716-250-2000 or click here for more information.

World Stroke Day 2019 is October 29. The world stroke campaign’s goal is to raise awareness of stroke symptoms and the leading causes of strokes. 

One in four people will have a stroke in their lifetime. Most strokes are preventable with a few simple steps. Here are the top tips that help to reduce the risk of stroke.

Control high blood pressure

Half of all strokes are associated with hypertension. Knowing your blood pressure and controlling it with lifestyle changes or medication will reduce your risk of stroke.

Exercise 5 times per week

Over a third of all strokes happen to people who do not get enough exercise. 20-30 minutes of moderate exercise five times per week will reduce your stroke risk.

Eat a healthy balanced diet

Almost a quarter of all strokes are connected to poor nutrition. Eating a diet that is high in fresh fruits and vegetables, and reducing consumption of processed food will reduce your risk of stroke. 

Reduce your cholesterol

More than 1 in 4 strokes are linked to high levels of “bad” LDL cholesterol. Eating low saturated fats, avoiding processed food, and exercise will help to reduce your risk. If you are unable to maintain a healthy cholesterol level with lifestyle changes, your doctor may advise medication to help. 

Maintain a healthy weight

Being overweight or obese was found in almost 1 in 5 strokes. Maintaining a healthy Body Mass Index (BMI) or Hip to Waist Ratio will help you reduce your risk.

Stop smoking and avoid smoky environments

Almost 1 in 10 strokes were associated with smoking. Stopping smoking will reduce your risk of stroke and the risks of people who live around you. Getting help to quit increases your chances of success.

Reduce your alcohol intake

Over 1M strokes each year were linked to excessive alcohol consumption. If you drink, keep it a limit of 1-2 units of alcohol a day. 

Identify and treat atrial fibrillation

People with AP are 5x more likely to have a stroke than the general population. If you are over 50, talk to your doctor about AF screening. If you have AF, talk about treatments that will reduce your risk. 

Manage diabetes

If you have diabetes, you are at a higher risk of stroke. Diabetes and stroke also share several risk factors, including diet and exercise. If you have diabetes, talk to your doctor about how to reduce your stroke risk. 

Manage stress and depression

Almost 1 in 6 strokes are linked to mental well-being. Managing stress, depression, anger, and anxiety are all critical to reducing stroke risk. 

Recognize signs FAST

F.A.S.T. is a way to recognize signs of a stroke. 

FACE (has their mouth drooped?)

ARMS (can they lift both arms?)

SPEECH

TIME (time is critical!)

Why choose DENT?

There are about 1.5 Million strokes in the US each year. Nearly half of these are severe, requiring immediate hospitalization and often aggressive intervention. On the other hand, approximately 750,000 strokes occur with only passing symptoms. These mild strokes or Transient Ischemic Attacks (TIAs) are alarming, but often result in little or no deficit.

TIAs are critically vital warning signs of a potential devastating stroke. TIA symptoms must not be ignored. The Dent Mild Stroke/TIA clinic is run by experts in stroke neurology that have fine-tuned the diagnosis and treatment of this disease, resulting in a significantly reduction in the risk of a recurrent stroke. 

Learn more about our comprehensive stroke center here.

Find out more about stroke risk factors and prevention at www.WorldStrokeCampaign.org

Suicide Prevention and Mental Health Awareness

Mental Health Promotion and Suicide Prevention Livestream Recap with Dr. Horacio Capote, Director of the DENT Psychiatry Clinic.

Talking about Mental Health and Suicide Prevention is very important. A million people a year died by suicide. 

“There are a lot of myths to discuss and a lot of questions that you may have, so hopefully we will be able to cover a lot of these topics,” says Dr. Capote.

Myth: you can make someone suicidal by bringing up the topic

“This is completely false,” stats Dr. Capote. “In fact, many people are eager to discuss it, share it, and have an outlet.”

If you have suspicion that someone might have suicidal thoughts, it does not hurt to ask. You’re not going to do anybody any harm by asking. Instead, it shows that you are empathetic and that you care.

Myth: there is nothing you can do

“The data shows us that everyone is completely conflicted about suicide, all the way to the end,” explains Dr. Capote.

There are many places to intervene, and several things you can do. The first thing is to have curiosity to reach out and be willing to be part of the solution.

Recognize the warning signs:

Someone might show warning signs for suicide if they:

  • Suddenly are obsessed about death (talking about it, writing about it, etc.)
  • Have a change in personality
  • Have a change in behavior

“These are signs that something is going on that is worth identifying, and there are more major signs of trouble,” says Dr. Capote. 

These significant signs of trouble are:

  • A family history of suicide
  • If that individual has attempted suicide before
  • If that individual has a mental illness

“People with schizophrenia and many other mental illnesses have a much higher risk for suicide compared to the general population,” explains Dr. Capote. 

Treatment Options

“Sometimes, we tend to get a little pessimistic about treatment,” says Dr. Capote.

It is important to note that there are many many types of treatment, not just medication treatment. There are many forms of psychotherapy (psychodynamic psychotherapy, supportive psychotherapy), cognitive-behavioral therapy, dialectical behavioral therapy, and lifestyle management.

Lifestyle management include how you eat and exercise. Active people feel engaged and empowered. The Meditteranean diet is good for the brain. 

“The Meditteranean diet is probably just a fancy way of saying ‘eat colorful foods,'” Dr. Capote jokes. “If it is colorful, not bleached, and not processed, you know it has a lot of antioxidants that are helpful and protect your brain.”

Why choose DENT Neurologic Institute

There are a variety of treatments, and DENT Neurologic Institute, fortunately, has all of them available. 

“To my knowledge, DENT is perhaps one of the few places that may offer these various treatments in one location,” says Dr. Capote. “We are the only free-standing outpatient institute in the country that offers electroconvulsive therapy.”

If you or someone you know wants to become a patient at DENT, call us at 716-250-2000. Click here to learn more about our Psychiatry Center. 

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741741.

Spasticity Clinic Livestream Recap

On September 13th, we went Live ith Dr. Bennett Myers, Co-Director of DENT’s new Spasticity Clinic. Spasticity is, unfortunately, a prevalent problem that we see at DENT Neurologic Institute.

What is Spasticity?

In its broadest terms, spasticity refers to abnormal muscle contraction that is produced by an injury to the brain and spinal cord. Often, it can be confused with muscle spasm. 

All of us have had muscle spasms in our neck, back, or arms. Muscle spasm also refers to a kind of abnormal muscle contraction. It is fundamentally different than spasticity. 

The difference is not always evident to most people. 

“Neurologists who are skilled in diagnosis and assessing patients can usually pick [the differences] up quite readily,” explains Dr. Myers. “There needs to be some sort of injury to the brain or spinal cord to produce spasticity.”

Most Common Causes + Diagnosis

The most common causes of spasticity that we often see are diseases of the central nervous system, like Multiple Sclerosis, Cerebral Palsy, or brain tumors. Spasticity is not a disease in itself; it’s more of a symptom of a lot of different types of conditions.

Most patients who show up to the Spasticity Clinic already have a diagnosis for whatever is wrong with their central nervous system that is reducing the spasticity.

“Since most patients who come to the clinic already have a diagnosis, our focus at the DENT Spasticity Clinic is focusing on management of the spasticity,” explains Dr. Myers. 

Why do you need to manage spasticity? 

Not all spasticity needs management. 

“Some patients will have some weakness in their legs,” explains Dr. Myers, “and the spasticity is helpful to them. It helps keep them upright and enables them to walk.”

If you over treat the spasticity, you can take someone who can walk and treat the spasticity, and now their legs are weaker, and they are unable to walk. 

“We always have to be very clear as to what we are trying to accomplish when treating the spasticity,” says Dr. Myers. When treating someone with spasticity, the specialists at DENT first identify what the cause is. Next, they figure out if the spasticity is causing problems for the patient and what those problems are. 

 

What is the goal of treatment?

Spasticity can be quite painful. Relieving pain for patients could be a goal of treatment. Sometimes, spasticity is not helpful, and it can interfere, which is more common in the arms and the hands. 

“For example, people [who] have had strokes. Maybe they are not paralyzed. There is a weakness, but they have some movement. The muscles become very spastic from the injuries to the brain, and the spasticity interferes with function,” says Dr. Myers. “So, our goal of treatment in that individual may be to improve function.”

Those who have more severe spasticity, it is not only painful, but it can be hard for them to care for themselves. “If a patient has severe spasticity of their arm, so their arm is curled up very tight, you can imagine it is hard t get a shirt on and off,” says Dr. Myers. “A goal of treatment for that individual may be to relieve the spasticity to make it easier for the patient to get dressed.”

What is a contraction or contracture?

We often treat spasticity to prevent contracture formation, which is scarring at the joints. 

“An example of this is if I took my arm, put it in a sling, and leave it there for three months. Later, if I took the sling off, I might not be able to move my arm at all,” says Dr. Myers. “Why is that? Neurologically I am fine, but the problem here is that the joints have stiffened up so severely and scarred down that now they do not move anymore.”

Someone who has had the issue after any type of injury to the brain or spinal cord will eventually have their joints tighten up and scar. The mentioned injury can be a painful situation. Often, preventing contracture formation is a goal when treating spasticity.

Steps take to diminish spasticity 

We don’t treat spasticity for the sake of it. We want to relieve pain, improve function, prevent contracture formation, and make our patients’ lives better in some way.

The treatment plan depends on how much of the body is involved and how bad the spasticity is. 

“Let’s take someone who has mild to moderate degree of spasticity, for example. The first thing we try is physical therapy, occupational therapy, stretching, and regular exercise,” Dr. Myers explains. “We will see if we can get an adequate handle on the spasticity without resorting to any medication.”

The treatment suggestions mentioned by Dr. Myers do not have any side effects. Our first form of treatment is trying to manage spasticity without an invasive or medication approach. “When we can be successful in that rate, usually everybody is quite happy,” says Dr. Myers.

“Often, that is not enough, and we need to be more interventional,” Dr. Myers adds in.

Interventional Treatments

The next step will often be medication. There are several medications that we commonly use that relieve spasticity. These usually work best in people where the spasticity is relatively widespread, or is severe. 

Most medicines that help with spasticity have the same side effect: sleepiness. 

“If I am making them semi-comatose where they’re sleeping 20 hours as a side effect, I am not doing them any favors,” says Dr. Myers. “That is often our limitation to using medication. If it is a high enough dose, I can relieve an awful lot of spasticity. However, if someone is sleeping all the time, then I haven’t improved their quality of life, which is the whole goal of why I am treating the spasticity.”

Why choose DENT?

The DENT Neurologic Institute is among the largest, most comprehensive neurology practices in the United States. We are focused on providing superior clinical care, advanced diagnostic services, clinical research, and education.

The breadth and scope of our clinical expertise has allowed the creation of our specialty clinics. Every clinic has the same mission: to provide a disease-specific approach to treatment. This unique and integrated model has strengthened our standards of care, quality measurement, outcomes, and participation in clinical research.

To make an appointment, please call 716-250-2000. More information about our new Spasticity Clinic will be released soon. 

Reasons to see a Spine Specialist | DENT Spine Center

Spine Specialist in Buffalo, NY | Neck pain and back pain can range from being an irritation to being debilitating. No matter the pain level or the injuries and conditions you may have, the DENT Spine Center has more treatment options now than ever before. 

Dr. Thomas Pfiffner, DENT’s Spine Specialist, can diagnose the cause of your pain and counsel a wide range of remedies. Dr. Pfiffner brings over 20 years of experience as a chiropractor to DENT.

In this blog post, we will highlight why you should consider seeing our Spine Specialist.

 

#1 – Team Access

Our team specializes in spine disorders, neuroradiology, chronic pain management, physiatry, and physical medicine and rehabilitation. On top of that, the DENT Spine Center, UB Neuro and Buffalo Rehab group are all conveniently located in one spot. 

 

#2 – Non-surgical Treatment

Every back and neck pain patient is unique, and our team can help determine a diagnosis outside of surgery. Surgery may seem like the obvious and only option if your neck and back pain is severe enough. However, a spine specialist can ease your neck pain or back pain in non-surgical manners. 

 

#3 – Are You Suffering From Debilitating Pain?

It might be time to call a Spine Specialist if your neck and spine problems are causing you to miss work or day-to-day activities. Signs or symptoms to see a Spine Specialist may include back or neck pain that :

  • Does not get better, or worsens
  • Produces numbness, tingling or weakness
  • Makes fine motor skills and/or general movement hard

Having one or more of these conditions that affect your activities can sometimes make you feel hopeless. The DENT Spine Center is focused on getting the right treatment plan for you.

 

#4 – Learning about the cause

What is really causing the problem? Are there any changes I can make to improve the pain? What treatment options will lead to normalcy? A spine specialist can answer all of these questions, plus more.

 

Why choose DENT?

Specializing in the brain and spine, patient-centered care is our primary focus at the DENT Spine Center. With on-site collaboration between DENT, Buffalo Rehab, Bennett Rehab and University at Buffalo Neurosurgery, we provide unparalleled coordination and expertise to manage the most complex spine conditions. Our full-service imaging with onsite neuroimaging and general radiology experts are from DENT and Western New York Imaging. 

DENT provides ongoing research and development on the region’s most sophisticated MRI. This brings state of the art diagnostic capabilities to our patients, while simultaneously delivering an experience that elevates patient comfort.

 

Expanded Imaging Services

DENT has recently expanded our Imaging Services at the new Spine Center on George Karl Boulevard, near Wehrle and Transit. In addition to MRI and Ultrasound services, DENT is seeing the return of CT, and is venturing in X-Ray for the first time.

X-rays are available for pediatric and adult patients.

CT will be available from newborns to adults. Our new scanner has software to limit radiation exposure to our pediatric patients.

 

 

 

Our Spine Specialist and team is ready and excited to take care of you. To learn more, click here or call 716-250-2000 to make an appointment – help is one phone call away.

DENT congratulates Dr. Zhang on a successful ten years as Director of the DENT Dizziness, Balance and Tinnitus Center

In 2009, Dr. Zhang became the Director of the DENT Dizziness, Balance and Tinnitus Center. This week, Dr. Zhang celebrates 10 years in this role. Dr. Zhang has 12 years of extensive neuroscience research experience with almost 30 peer-reviewed publications in various neuroscience journals.

As one of the principal investigators, Dr. Zhang has been involved in multiple national clinical research projects in the areas of Restless Leg Syndrome, Neuropathic Pain, and Epilepsy. Currently, he is developing new research projects focusing on Meniere’s Disease, migraine-associated vertigo and imbalance/falls in elderly patients.

His patient focus is on balance disorders, dizziness/vertigo, sleep medicine and epilepsy as well as general neurology.

Dr. Zhang can provide comprehensive evaluation, diagnosis, and treatment all in one location. The treatment is mainly the combination of non-sedative dizziness preventive medications and vestibular therapy. The DENT Dizziness, Balance and Tinnitus Center offers Computerized Dynamic Posturography, a state-of-the-art technology, developed for NASA astronauts, to evaluate patients with unexplained falls or imbalanced conditions. This technology can also provide objective data to assess the ability for someone to return to a normal lifestyle following a sports concussion or work-related injury.  

Before the center opening, The Cleveland Clinic was one of the closest places Western New Yorkers would travel to for treatment.

Call 716-250-2000 to make an appointment and click here for more information on the Dizziness, Balance and Tinnitus Center.

 

 

Facebook Live Recap: Alzheimer’s Association International Conference Highlights

On Tuesday, August 27th we went live with Sarah Harlock, Program Director of the DENT Integrative Center for Memory, as she discussed Alzheimer’s Association International Conference Highlights. At this conference, researchers from all around the world came together to share information. A lot of the conference focused on lifestyle, which will be what Sarah focused on. 

 

The Finger Studies

 

A program in Finland conducted a 2-year study and looked at lifestyle factors. This was the first randomized control trial that proved that these lifestyle factors can prevent cognitive decline. This study was so successful that the “Worldwide Finger Study” has been initiated, where about 10 countries have signed up to replicate The Finger Study in their own country. 

 

The Pointer Study
 

In the United States, The Pointer Study will be starting soon. This two-year study will be operating out of specific universities in California, North Carolina, Texas, and Illinois.

“I am not sure if they have started recruiting yet. If they haven’t, they will be shortly,” said Sarah Harlock. “I am looking forward to hear more from The Pointer Study. I think we are going to see some really interesting data come out of that.”

 

Modifiable Risk Factors
 

At the conference, there were plenty of researchers that touched upon Modifiable Risk Factors. These are things that we can change, as opposed to Genes, which we cannot change. “These are modifiable, meaning we can control some of this,” explains Harlock. 

These Modifiable Risk Factors include: smoking, depression, physical activity, social stimulation/social isolation, diabetes, and diet. All of these factors are things that we have some sort of control over. They also have a big impact on the risk of developing cognitive impairment. It is really important to address these factors to reduce our risk. 

 

Same study, different results
 

A challenging part of research is that one week you can see an article that sounds great and has very positive results, and then a week later see a report that says the exact opposite. At the conference, that exact situation happened. 

Two studies contradicted each other. Study #1 showed that the genetic high-risk group, meaning they have a genetic factor that increases their risk of developing Alzheimer’s Disease, were able to reduce their risk of developing cognitive decline using the mentioned lifestyle elements. Study #2 shows that lifestyle factors did not change the risk of cognitive decline in the high-risk genetic group. 

 

Why are there differences? How can there be conflicting results? 
 

“It turns out that between these two studies, the ages they were looking at were different, the way they defined genetic risk was different, the way the measured cognitive impairment was different – they were not using the same assessment tools, and the length of time that they were following the subjects was different too – by several years,” Sarah Harlock explains. 

It can be hard to determine what is accurate and what to follow as these studies come in. There is a lot of research going on right now, and at DENT Neurologic Institute, we will report the most accurate information possible.

These Modifiable Risk Factors may not be news to everyone. We have known for a while that smoking is not good for you. It is not good for your heart, and whatever is not good for your heart is not good for your head. 

 

Physical Exercise
 

The amount of studies done on exercise is tremendous. One study presented at the conference was called the “Intense Physical Activity And Cognition Study”. This study found that intense exercise is more beneficial to you that moderate to light exercise.

“I am just going to say that any exercise is better than no exercise,” says Harlock, “but what this study showed is that having an exercise that was more intense and got your heart rate up, had a more protective effect than those who did light exercise.”

Another study that was talked about was the “Fitness for the Aging Brain” study. In this study, participants were put through an exercise program, and then they measured their cognition at 6 months, 12 months, and 18 months. The results showed a positive effect on their cognition. 

“What was interesting was that they tried to follow up with people 10 years later,” says Harlock. “They were not able to reach everyone in that study, but they were able to reach some. When they looked at the data, they did not see so much a cognitive benefit. Instead, they saw a benefit through the reduction of falls.”

Those who were participating in the exercise program were falling at a much lower rate than the non-exercise group. Benefits beyond cognition can be contributed to exercise. 

 

Diet
 

Every country and region has different access to food. Because of that, no specific diet was identified to be the solution. Basically, the studies have suggested a healthy diet.

“I always tell people that if you have any questions about what a healthy diet is, contact your insurance company and ask for information,” says Harlock. “You can also talk to your primary care doctor. It is individualized based on your own unique needs and any conditions you might have.”

No “superfood” was brought to the spotlight either. There was a huge emphasis on a healthy diet. If you are someone who needs assistance, you can also get a referral to a dietitian from your primary care doctor or your health insurance company. 

 

Sleep
 

Short-term memory

Sleep was another hot topic at the conference, as it is very important to memory and cognition. There are specific brain wave activities that occur in your sleep that help the hippocampus – the part of the brain responsible for short-term memory. 

“These brainwave activities that happen during sleep encode information that is gained during the day,” Sarah Harlock explains. “So, if there is disruption in your sleep, there’s an opportunity for the process of encoding, remembering or storing this information to be disrupted. Again, sleep just becomes critical.”

There is that older generations do not need as much sleep – and that is simply not true. Studies are showing that people need 7 to 8 hours of sleep a night to avoid the amyloid deposit or amyloid buildup in the brain, which is common in Alzheimer’s. 

Getting enough sleep is imperative, and insomnia is certainly an issue that can negatively impact your cognitive health. Recently, research has determined that insomnia can increase your risk of developing Alzheimer’s disease.

Insomnia and Sleep Apnea

Menopausal women are at a higher risk of insomnia than men of the same age. Researchers are identifying this as a possible reason that more women are developing Alzheimer’s than men.

Sleep Apnea is another issue that increases the risk of not only Alzheimer’s, but cardiovascular issues too.

“Again, it is really important that you are paying attention to your sleep,” emphasizes Harlock. “Trying not to nap during the day, watching your caffeine intake, and reducing screen time right before bed are all things that can certainly help with your sleep hygiene.”

It could be possible that a sleep test is needed. The DENT Sleep Center has a fully equipped diagnostic laboratory, including six private suites where patients sleep while being monitored by trained technicians.

 

Social Stimulation
 

This is another key component that is part of the Finger Study, and part of the modifiable risk factors. For the mental stimulation aspect, they talked about formal education. Beyond formal education, there is lifelong learning that we can be doing that will help assist us with building up brain reserves. This goes beyond watching TV.

“You need to be doing more for your brain,” says Harlock. “Find activities that are enjoyable, challenge your brain, and make you think about things in a new way.”

As people age, it is not uncommon to see them become more isolated. They may have mobility issues that stop them from doing social activities or going to the gym. They might also no longer have their driving privileges and can no longer enjoy the things they use to. 

 

Combining the Modifiable Risk Factors
 

Not everything has to happen in isolation. Our social activities can happen at an exercise program, our exercise can happen while as we’re walking to the library or our mental stimulation, we can eat a healthy meal while with friends. Combining these lifestyle choices so you don’t think about setting up a whole new plan for getting through your day will help make sure you tackle all of these elements. 

 

5 Key Points
 

Key Point 1 – Modifiable Risk Factors can counteract genetic risk for Alzheimer’s

Making adjustments to your lifestyle to support at least 4 of these Modifiable Risk Factors can reduce your risk of Alzheimer’s by 60%, as opposed to those who do not make any efforts, or only do one of them. 

“This is exciting,” Harlock says, “and very, very important to adhere to the healthy lifestyle as it may counteract the genetic risk for Alzheimer’s disease. A lot of people say that Alzheimer’s is in their genes, and there is nothing they can do about it. The reality is, there is something they can do about it.”

Key Point 2 – Cognitive Stimulation can counteract some negative things, like air pollution

These studies are showing that we may be able to reduce our risk of having a higher cognitive reserve built through formal education and cognitive stimulation. This benefits the aging brain by reducing the risk of dementia among people who were exposed to high levels of air pollution.

“That was a really interesting study that came out as well,” says Harlock, “So this idea of brain reserve and cognitive stimulation and so on can counteract some of the negative things – like air pollution.”

Key Point 3 – Early Adult to Midlife smoking can be associated with cognitive impairment 

The conference confirmed that early adult to midlife smoking can be associated with cognitive impairment, as early as when people are in their 40’s.

“So, once again it’s one of those things that if you are smoking, talk to your doctor about this. We do know that it’s one of those modifiable risk factors,” explains Sarah Harlock.

Key Point 4 – Drinking too much can increase the risk of dementia

Alcohol use disorder can significantly increase the risk of dementia in older women. Studies in the past have discussed diets that promote a small or moderate amount of alcohol as safe or beneficial to the brain. A study presented at the conference presented that too much alcohol increases the risk of dementia in women later in life.

“Alcohol is something that needs to be moderated and make sure that you are using safe levels,” says Harlock.

Key Point 5 – We must be looking at the condition much earlier than they are now

Rather than waiting for signs of memory loss, language problems, or cognitive issues, we need to be looking at and adjusting our lifestyle choices much, much earlier than we are now. 

 

Never too early or too late
 

There was a study called My Brain Robbie that was aimed at school-aged children and them adapting to a healthy lifestyle. The children ended up taking the information home to their parents, which helped the parents make healthier choices as well. 

“You are never too young to start these healthy brain habits,” says Harlock. “But, it is also important to note that is it never too late to start them, either.”

Making these healthy choices can not just lower your risk of developing these conditions, but it may slow down cognitive loss. Click here if you or someone you know is interested in DENT’s Memory Center.

DENT Neurologic Institute is officially recognized as a Partner in Multiple Sclerosis (MS) Care

Buffalo—DENT Neurologic Institute, a leading provider of care for people living with MS in Buffalo has been officially recognized as a Partner in MS Care, Center for Comprehensive MS Care through the National Multiple Sclerosis Society’s Partners in MS Care program. This formal recognition honors DENT Neurologic Institute’s commitment to providing exceptional, coordinated MS care; and a continuing partnership with the Society to address the challenges of people affected by MS.

Buffalo, NY is considered a world hot spot for the prevalence of patients diagnosed with MS.

The Society’s Partners in MS Care program recognizes committed providers, like DENT, whose practices support the Society’s initiative of affordable access to high quality MS healthcare for everyone living with MS – regardless of geography, disease progression, and other disparities.

DENT Neurologic Institute is the only recipient of this specific award in Upstate New York. DENT has been designated as the only Comprehensive Care Center in our region.

Partners in MS Care – Centers for Comprehensive Care are led by clinicians with demonstrated knowledge and experience in treating MS; offer and coordinate a full array of medical, nursing, mental health, rehabilitation and social services and have a strong collaborative relationship with the National MS Society. We have shown our level of dedication to the patients in our community by being one of the first centers in the country to offer new, novel therapies to the patients in our community. DENT is often a chosen site to participate in MS research opportunities. Our staff are also recognized nationally for the expertise on MS and the understanding of what it takes to run such an integrated practice.

“We are so proud to partner with DENT Neurologic Institute to enhance coordinated, comprehensive care for the people who live with MS in Buffalo,” said Stephani Kunes, of the National MS Society, Upstate New York. “In earning this recognition, DENT has demonstrated extraordinary leadership in MS care, making a tremendous impact on people affected by MS in our community,” Stephanie Kunes continued.

 

For more information, please visit www.nationalMSsociety.org/partnersinMScare or call 1-800-344-4867.

 

 

Cannabis: A Medical Update | Facebook Live Recap

During the Facebook Live we went over what is new in the Cannabis world. The Dent Cannabis Clinic sees about 115 Cannabis patients on a daily basis.  We have over 30 individuals seeing patients for various reasons for using Cannabis. When we talk about Cannabis, there are three types of Cannabis: recreational, Medical, and Hemp-based products. 

 

Type 1: Recreational Cannabis

 

Recreational Cannabis is what you hear about smoking and is legal in 10 states. 

“I don’t deal with that [recreational Cannabis],” Dr. Mechtler says. “It is hard for me to support recreational Cannabis when individuals have to smoke it. At the end of the day, I’m a Physician. For me to promote smoking, when I have been anti-smoking my whole career, would be very difficult.”

When Recreational and Medical Cannabis are compared, there is a huge difference. Recreational Cannabis is mostly high THC and low CBD. Naturally, the plant does not produce a lot of CBD. There are some exceptions to the rule, but the higher the CBD content, the higher the price of the product. 

 

Type 2: Medical Cannabis

 

Legal in 33 states, including New York State, Medical Cannabis allows the physician to change the THC to CBD ratio to help with specific medical disorders, many of which are neurological. This includes, but is not limited to: MS, ALS, Neuropathy, Spinal Cord Injury, Epilepsy and HIV. In New York State, they added Chronic Pain, Substance Abuse and Opioid Abuse.

“With these indications, we can now look at a patient at our Cannabis Clinic,” Dr. Mechtler explains. “Most of our patients come here because of Chronic Pain, but other disorders also happen. We see close to 10% of all patients in New York State.

 

Type 3: Hemp-Based CBD Products

 

 The Hemp Farm Act of 2018 that was signed in December 2018 has lead to hemp-based CBD products being sold nationally. It comes from the same plant. The difference between hemp and recreational cannabis is that in hemp, you have less than 0.3% THC. 

“That number is very important. Once it is above 0.3% THC, it is not legal to sell in stores,” says Dr. Mechtler. “It is very low THC and high CBD. People who are looking for CBD are looking for its health benefits. The are four main health benefits of CBD. The first is that It’s an anti-inflammatory, like ibuprofen but without the stomach problems. Second, it is a pain killer, but without the problems of Opioids, such as addiction. Third, it is an anxiety medication without the side effects. Lastly, it helps you sleep without the side effects of Ambien.”

CBD is natural with minimum side effects. This is something that can help anybody, and is a product you can find almost everywhere.

 

Be cautious of where you buy CBD

 

The problem with CBD right now is that it is not regulated. Arno Hazekamp did a study where  he bought 46 different CBD products online. These products were checked to see what exactly the CBD content was. The CBD content was 0 in 39% of these products. This tells us that there is a 39% chance that the product you have does not have any CBD. The other problem is that the THC level in the products were high. Some of them were 57% THC. Those products should not be legal, but it is not regulated. 

Products with CBD need to be regulated and third-party tested. What does that mean? This means that when you buy a CBD product, look for a QR code. The QR code, when scanned, will give you all the information about the product from a third party. It will tell you what is in the product you just bought. 

“There are two things you have to look for,” says Dr. Mechtler. “First, what is the actual CBD content and what is the THC content? That is very important. Second, you are looking for what we call contaminants. These products can have contaminants such as: heavy metals, insecticides, pesticides, and fungus.” 

Not all products have third party testing, as it could make the product more expensive. In addition, not all third party testing tests for contaminants. As a consumer you need to understand that what you are buying is not regulated by the government. 

At Dent, a full spectrum physician formulated CBD stored located on the first floor, called Mend. Mendis a retail hemp-based CBD store owned by Jushi, Inc as is a tenant within the Dent Tower building in Amherst. Dent is not affiliated with the store, however, our providers believe in the high quality products that it produces and feel strongly that our patients can benefit from utilizing their products.

The Mend products are third-party tested for CBD and THC amounts, as well as for contaminants. They offer soft gels, lotion, and tincture (eye drop in the mouth).  The formula is based on the research from Dent. 

 

The MORE Act 

 

New legislation waiting to be passed in New York, called the MORE Act,  states the change in federal law to take Cannabis off of the Controlled Substance Act, which is category one. This will allow researchers in Cannabis to see more patients and do research without the any issues with the federal government. The MORE Act is hoped to be passed by the end of this year.

 

Retrospective Cannabis Research in the Elderly Population

 

One of the unique things about Dent is the amount of patients we see. However, current legislation makes it difficult to do prospective research. A prospective study watches for outcomes, such as the development of a disease, during the study period and relates this to other factors such as suspected risk or protection factor(s). The study usually involves taking a cohort of subjects and watching them over a long period. 

What we are able to do is retrospective research. A retrospective study looks backwards and examines exposures to suspected risk or protection factors in relation to an outcome that is established at the start of the study. It has been difficult to tell providers what to give patients because we do not have that data. The things that you typically have with a pharmaceutical medication, like dosage and safety, we don’t have yet with Cannabis.

“What we have been doing is creating a database and looking at different patient populations to see what works, what doesn’t work, what is safe and what is not safe,” explains Paul Hart, Research Assistant at Dent. 

This last year, the researchers at Dent looked closely at how the Elderly population reacted to Cannabis. What dosage can they receive while having the least amount of side effects? This research was presented at the  American Academy of Neurology (AAN), and it was selected for press release. That means that the AAN saw our research, thought that it was beneficial enough and helpful enough to be presented at their annual meeting. 

“Our research had the average population age of about 81 years. This population is probably on several different medications, and has different side effects from those medications,” explains Hart. “If they switch to Cannabis as an alternative, they should have fewer side effects. We found that only 30% of patients had side effects, and of that, half were resolved from changing.”

One of the focuses is to get patients off of Opioids to help ensure our patients do not form an addiction or have serious side effects. Although we have a long way to go, a solid foundation has been put into place from our funding.

 

Chronic Migraine and Cannabis

 

Chronic Migraine is a debilitating disease that affects millions of Americans. The Dent research team looked at 316 patients at Dent who incorporated Cannabis into their Chronic Migraine plan. 

“We looked at Quantitative data, numbers that we can find out from patients, but also Qualitative,” explained Vincent Bargnes, Research Assistant at Dent. “We took a look at what numbers we can pull from how Cannabis has been affecting these patients, but also the non-number things, see how it makes them feel.”

The research team at Dent saw an improvement in 88% of our patients. There was also a decrease in monthly headache days – from about 24 days to about 17. Additionally, we found that 56% of patients who were on Opioids reduce the amount of Opioids. Improvements in anxiety, mood and sleep were also found.  “It was very, very well tolerated with minimal side effects,” explains Bargnes. 

With excellent results, the Dent team has been trying to get these findings published. Unfortunately, the finding have been rejected by both organizations that Dent has submitted to. 

“This is the problem in cannabis research,” Dr. Mechtler explains. “Not only does the Federal Government give us a difficulty using cannabis in research on human beings even though it’s been used as 12,000 years. But also, the establishment of medicine is resistant to the science that we are producing here, which is very unfortunate. Now trust me, we are not giving up, we are moving forward and will find a journal that will publish our findings.”

 

The Cost of Cannabis

 

We see that the average cost of treatment is about $200 a month. The Dent Research team looked at underserved populations to get a better understanding of cost as a factor of their treatment plan.

The Dent Research team ran a study that looked at 1,200 people that are in the Cannabis Clinic and looked to see how they are doing with Medical Cannabis. “What we found is that 80% of all people that use Medical Cannabis had some positive outcome from using the treatment,” explains Chris Ralyea, Research Assistant at Dent. “We also saw that in the underserved populations, the ability to afford medical cannabis went down significantly. The retention rates in what we call normal populations at about 70%. In the underserved population, the retention rate was about 50%.” This means we are losing half the underserved population, visit after visit. 

What is the Opioid use? Are we able to reduce the amount of Opioids our patients are using? “We found that about 36% of all patients included in this study were able to reduce their use of Opioids by using Medical Cannabis, even if it was a lower dosage than what we recommend here in our clinic,” explains Ralyea. 

 

Geriatric Research

 

The geriatric research had patients from 75 to 102 years old. Age is not an issue. “Our publications showed that in that population, we don’t see significant side effects. So, it’s safe,” reports Dr. Mechtler. “We don’t see people getting high. Nobody comes to us because they want to abuse Medical Cannabis.”

 

Dr. Laszlo Mechter is also working with an insurance company in Western New York to do some research with Albany to see what happens when you pay for Medical Cannabis. “I can tell you right now, some initial research has shown that people who take Medical Cannabis save payers a significant amount of money on the use of other drugs,” explains Dr. Mechtler. “I have so many patients that throw away 4-5 medications since they have been on Medical Cannabis.”

 

 

The Dent Cannabis Clinic
 

One of the biggest complaints we have received is the wait time for an appointment at the Cannabis Clinic. “We have added more providers on, and are excited to say that our wait time is cut down,” says Amanda McFayden, DENT Cannabis Clinic Program Director. “Right now we are accepting referrals.”

To be seen at the Dent Cannabis Clinic, have your primary doctor fill out the Cannabis Clinic referral form. Once we receive that form, it will be reviewed and you will be put with the appropriate provider. We do not accept workers comp older than 2 years. We do not accept self-pay, we go through insurance. Feel free to call 716-250-2000 for any further questions.Click here for more information about the Dent Cannabis Clinic.

 

 

 

22 Facts About the Brain | World Brain Day

The brain is a very complex part of your body. It has the ability to send and receive a large amount of information. Because of this, there are still many mysteries about the human brain. Here are some quick facts to help you understand the most complicated organ in your body.

 

1. Multitasking is impossible

When we think we’re multitasking, we’re actually context-switching. That is, we’re quickly switching back-and-forth between different tasks, rather than doing them at the same time. The book Brain Rules explains how detrimental “multitasking” can be: Research shows your error rate goes up 50 percent and it takes you twice as long to do things.

 

2. An adult brain weighs about 3 pounds

The cerebrum makes up 85% of the brain’s weight, and the brain makes up about 2% of a human’s body weight. The texture of the brain is like a firm jelly. The heaviest normal human brain weighed 4.43 pounds. It belonged to the Russian Writer Ivan Turgenev. And the smallest brain, just 2.41 pounds, belonged to a woman.

 

3. About 75% of the brain is made up of water

This means that dehydration, even as small as 2%, can have a negative effect on brain functions. Dehydration and a loss of sodium and electrolytes can cause acute changes in memory and attention. To prevent any loss of body or brain function, take steps to keep your body properly hydrated.

 

4. The human brain will triple its size the first year of life

 A two year old baby will have an 80% fully grown brain. It will continue to grow until you’re about 18 years old. It isn’t until about the age of 25 that the human brain reaches full maturity. The human brain is the largest brain of all vertebrates relative to body size.

 

5. Headaches are caused by a chemical reaction

Chemical activity in your brain, the nerves or blood vessels surrounding your skull, or the muscles of your head and neck (or some combination of these factors) can play a role in primary headaches. Serotonin is a chemical necessary for communication between nerve cells. When serotonin or estrogen levels change, the result for some is a headache or migraine. Serotonin levels may affect both sexes, while fluctuating estrogen levels affect women only.

 

6. The human brain contains approximately one hundred billion neurons 

This is about the same as the number of stars in the Milky Way galaxy. These neurons are connected by trillions of connections, or synapses. Experts call this a “neuron forest”. Information runs between these neurons in your brain for everything we see, think, or do. These neurons move information at different speeds. The fastest speed for information to pass between neurons is about 250 mph. That being said, neurons only make up 10% of the brain.

 

7. It is a myth that humans only use 10% of our brain

We actually use all of it. We’re even using more than 10 percent when we sleep. Although it’s true that at any given moment all of the brain’s regions are not concurrently firing, brain researchers using imaging technology have shown that, like the body’s muscles, most are continually active over a 24-hour period.

 

8. Cholesterol is key to learning and memory

The brain has a higher cholesterol content than any other organ.  In fact, about 25% of the body’s cholesterol resides within the brain. The brain is highly dependent on cholesterol, but its cholesterol metabolism is unique. Because the blood-brain barrier prevents brain cells from taking up cholesterol from the blood, the brain must produce its own cholesterol. The brain’s cholesterol is much more stable than the cholesterol in other organs, but when it breaks down, it is recycled into new cholesterol right in the brain.

 

9. Dreams are believed to be a combination of imagination, physiological factors, and neurological factors

The limbic system in the mid-brain deals with emotions in both waking and dreaming and includes the amygdala, which is mostly associated with fear and is especially active during dreams. Dreams are proof that your brain is working even when you are sleeping. The average human has about 4-7 dreams per night.

 

10. Short term memory lasts about 20-30 seconds

This has to do with your brain’s capacity for holding small amounts of information in the active mind. The brain keeps this information in an available state for easy access, but only does so for about a minute and a half. Most people hold memory for numbers around 7 seconds, and memory for letters around 9 seconds. In addition, the brain can store up to 7 digits in its working memory. That is why the telephone numbers in the United States are 7 digits long.

 

11. A brain freeze is really a warning signal

Officially called a sphenopalatine ganglioneuralgia, a brain freeze happens when you eat or drink something that’s too cold. It chills the blood vessels and arteries in the very back of the throat, including the ones that take blood to your brain. These constrict when they’re cold and open back up when they’re warm again, causing the pain in your forehead. This is your brain telling you to stop what you are doing to prevent unwanted changes due to temperature. 

 

12. The brain can’t feel pain

There are no pain receptors in the brain itself. But the meninges (coverings around the brain), periosteum (coverings on the bones), and the scalp all have pain receptors. Surgery can be done on the brain and technically the brain does not feel that pain.

 

13. The human brain gets smaller as we get older

Human brain keeps developing until you are in your late 40s. It is the only organ in the human body to undergo development for such a long time. It also sees more changes than any other organ. Around mid-life, the brain will begin to shrink. However, size doesn’t matter in the brain. There is no evidence that a larger brain is smarter than a smaller one.

 

14. Alcohol effects your brain in ways that include blurred vision, slurred speaking, an unsteady walk, and more

These usually disappear once you become sober again. However, if you drink often for long periods of time, there is evidence that alcohol can affect your brain permanently and not reverse once you become sober again. Long term effects include memory issues and some reduced cognitive function.

 

15. Your brain is a random thought generator

In 2005, the National Science Foundation published an article regarding research about human thoughts per day. The average person has about 12,000 to 60,000 thoughts per day. Of those, 95% are exactly the same repetitive thoughts as the day before and about 80% are negative.

 

16. Your brain uses 20% of the oxygen and blood in your body

Your brain needs a constant supply of oxygen. As little as five minutes without oxygen can cause some brain cells to die, leading to severe brain damage. Also, the harder you think, the more oxygen and fuel your brain will use from your blood – up to 50%. 

 Every minute, 750-1,000 milliliters of blood flows through the brain. This is enough to fill a bottle of wine or liter bottle of soda.

 

17. Exercise is just as good for your brain as it is for your body

Aerobic exercise raises your heart rate and increases blood flow to your brain. As your increased breathing pumps more oxygen into your bloodstream, more oxygen is delivered to your brain. This leads to neurogenesis—or the production of neurons—in certain parts of your brain that control memory and thinking.  Neurogenesis increases brain volume, and this cognitive reserve is believed to help buffer against the effects of dementia. 

It has been noted that exercise promotes the production of neurotrophins, leading to greater brain plasticity, and therefore, better memory and learning. In addition to neurotrophins, exercise also results in an increase in neurotransmitters in the brain, specifically serotonin and norepinephrine, which boost information processing and mood.

 

18. The visual areas of the brain are in the back

The part of your brain responsible for vision, the occipital lobe, is located in the back. This is why if you get banged in the back of your head, you will see stars. The left side of your brain controls the vision on your right side, and vise versa. Your brain also processes sound on the opposite sides of the head.

 

19. Brain activity can power a small light bulb

When you are awake, your brain generates about 12-25 watts of electricity – which is enough to power a small light bulb. The brain also works fast. The information going from your arms/legs to your brain travels at a speed of 150-260 miles per hour. The brain consumes glucose from the body to produce this amount of the energy.

 

20. Reading out loud uses different brain circuits than reading silently

 Reading aloud promotes brain development. Children first learn to read by speaking words out loud. Once that knowledge is established, then they learn to read to themselves. It’s indeed one of the strange facts about the brain because we usually teach our children to read and talk politely. But to promote brain development in your child, you should read and talk aloud in front of them.

 

21. Your brain is mostly fat

Consisting of minimum 60% fat, your brain is the fattiest organ in your body. This is why healthy fats, such as omega-3s and omega-6s, are vital for brain and overall body health. Healthy fat helps stabilize the cell walls in the brain. It can also reduce inflammation and helps the immune system function properly. 

 

22. Sleep is imperative 

Your body and brain require rest in order to function properly. Judgement, memory, and reaction time can all be impaired when someone does not have enough sleep. This is due to the fact that sleep deprivation kills brain cells. Proper sleep is also essential for memory retention. During sleep, the brain accumulates all the memories from the day.

Feeling tired? Go ahead and yawn. Yawning cools down the brain, research suggests. Sleep deprivation raises brain temperature.

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The complexity of the brain is hard to understand – even for doctors and scientists. DENT provides the highest quality and compassionate patient care to the Western New York region, the direct result of a tireless commitment to staying on the forefront of medical advances and breakthrough technology.

By maintaining valuable partnerships with other specialized clinicians, and a dedication to employing the brightest minds in the medical and clinical research fields, you can rest assured knowing when you come to DENT you are receiving the best care possible. 

Click here if you or someone you know is interested in being seen at DENT.

 

 

 

 

 

Resources:

72 Amazing Human Brain Facts (Based on the Latest Science)

How a Migraine Happens

A tour inside the brain