Health and Disability

For the first time, researchers have determined that a brief, simple number naming test can differentiate between cognitively healthy elderly individuals and cognitively impaired people with Alzheimer's disease (AD), including those with mild cognitive impairment (MCI), as well as those with AD dementia. The study appears online in the journal Alzheimer's Disease and Associated Disorders, and was conducted by researchers at Boston University Alzheimer's Disease Center (BU ADC), with collaborators from Harvard Medical School and New York University School of Medicine.

AD can only be definitively diagnosed through postmortem examination of brain tissue. However, in recent years, the diagnosis of AD during life has become more accurate through the use of objective biological tests, including advanced brain scans and measures of proteins in cerebrospinal fluid and blood, in addition to lengthy formal cognitive evaluations. Prior to ordering these tests, clinicians, such as primary care physicians, must determine a patient's level of cognitive functioning to decide who may benefit from these relatively expensive and often invasive tests.

The King-Devick (K-D) test is a one- to two-minute rapid number naming test that has previously been found useful in the detection of concussion, as well as in detecting level of impairment in other neurological conditions such as Parkinson's disease and multiple sclerosis. The K-D test can be quickly administered by non-professional office staff on either a tablet (iPad) or in a paper version.

CDD is the strangest and most unsettling developmental condition you have probably never heard of. Also known as Heller’s syndrome, for the Austrian special educator who first described it in 1908, it is a late-blooming, viciously regressive form of autism. It’s rare, striking about 1 or 2 in every 100,000 children. After developing typically for two to ten years (the average is three or four), a child with CDD will suffer deep, sharp reversals along multiple lines of development, which may include language, social skills, play skills, motor skills, cognition and bladder or bowel control.

The speed and character of this reversal varies, but it often occurs in a horrifyingly short period — as short as a couple of months, says Gupta. In about 75 percent of cases, this loss of skills is preceded by days or weeks in which the child experiences intense anxiety and even terror: nightmares and waking nightmares and bouts of confused, jumpy disturbance that resemble psychosis. (In the 1970s and 1980s, the diagnostic term used for CDD in many countries was ‘disintegrative psychosis.’) During this anxiety-ridden prologue, known as a ‘prodrome,’ a child will often seem keenly aware that something is wrong. He’ll say he’s scared. He’ll pace and hold his head and say it hurts. As the increasingly frightened parents watch, he loses speech, motor skills, and most means of social contact. It is as if something is erasing everything he has become.

People with CDD, although quite impaired, may retain certain skills and abilities, some more than others. 

Research published Wednesday found that states that legalized medical marijuana — which is sometimes recommended for symptoms like chronic pain, anxiety or depression — saw declines in the number of Medicare prescriptions for drugs used to treat those conditions and a dip in spending by Medicare Part D, which covers the cost on prescription medications.

Because the prescriptions for drugs like opioid painkillers and antidepressants — and associated Medicare spending on those drugs — fell in states where marijuana could feasibly be used as a replacement, the researchers said it appears likely legalization led to a drop in prescriptions. That point, they said, is strengthened because prescriptions didn't drop for medicines such as blood-thinners, for which marijuana isn't an alternative.

The combination of a widely used heart medication and a commonly prescribedantibiotic seems to more than double the risk of sudden death in seniors, a new study says.

Spironolactone (brand name Aldactone) is a diuretic widely used in treating heart failure. It protects the heart by blocking a hormone that causes salt and fluid buildup.

But taking spironolactone alongside the antibiotic trimethoprim-sulfamethoxazole (brand names Septra, Bactrim) can cause blood potassium to rise to potentially life-threatening levels, said study lead author Tony Antoniou, a scientist with the Li Ka Shing Knowledge Institute at St. Michael's Hospital in Toronto.

"One of the consequences of a high potassium level is getting these irregular heart rhythms that can be quite dangerous and cause sudden deaths," Antoniou said.

For 78-year-old Tony, 3,4 DAP — which can be obtained at low cost from compounding pharmacies or for free through a compassionate-use program supported by a small privately held company, Jacobus Pharmaceuticals — is a lifesaver. But for Catalyst, the pharmaceutical company that purchased the North American rights to a slightly modified formulation of 3,4 DAP (Firdapse) in 2012, the drug represented a market opportunity to the tune of $300 million to $900 million annually ($60,000 to $100,000 or more per patient).

Although the FDA found Catalyst’s application insufficient and requested additional studies, approval remains possible. Tony and other patients like him live in fear that they will no longer be able to afford the treatment that has returned their quality of life. Sadly, Tony’s story is becoming an increasingly common and alarming refrain as countless patients, their insurers, and our health care system are literally paying the price.

Dramatic changes in health care have propelled social service integration to the forefront of health policy and care delivery transformation discussions. The Affordable Care Act has expanded health insurance to millions of low- and modest-income Americans, many of whom have social, environmental, and behavioral concerns that often define their health. Additionally, the spread of alternative payment models—accountable care organizations (ACOs), bundled payments, components of the Medicare Access and CHIP Reauthorization Act (MACRA)—increasingly hold health care providers financially accountable for patients’ health and the cost of treatment. As a result of these trends, health care providers are keenly interested in exploring ways to integrate health and social services. For the first time, linking medical and nonmedical services can help providers meet their bottom line—it is no longer just an act of charity.

In light of these opportunities—the emerging evidence, evolving financial incentives, and lingering operational questions from health systems—the Commonwealth Fund has initiated an investment in projects to produce information that will help health care payers and providers connect medical and nonmedical interventions to reinforce their organization’s financial and quality of care goals. As we are on the staff of a health care and health policy foundation, this is new terrain for us.

The Commonwealth Fund’s Health Care Delivery System Reform program has outlined the following criteria to help guide our selection of projects to fund: (1) those having results that support the mission of health care organizations, providers, and payers; (2) those run by risk-bearing organizations, since they are more likely to have a financial interest in nonmedical interventions; and 93) those that will accrue benefit to the health care sector in the near term (for example, within five years). By appealing to providers’ and payers’ vested interests, our approach seeks to inspire these groups to think more expansively about health to include patients’ social needs.

The publication, titled “Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis,” highlights a human study designed to reduce symptoms of RA, cytokine levels and inflammation by stimulating the vagus nerve with a small implanted device.

“This is the first study to evaluate whether stimulating the inflammatory reflex directly with an implanted electronic device can treat RA in humans,” said Professor Paul-Peter Tak, MD, PhD, FMedSci, the international principal investigator and lead author of the paper at the Division of Clinical Immunology & Rheumatology of the Academic Medical Center/University of Amsterdam. “We have previously shown that targeting the inflammatory reflex may reduce inflammation in animal models and in vitro models of RA. The direct correlation between vagus nerve stimulation and the suppression of several key cytokines like TNF as well as reduced RA signs and symptoms demonstrates proof of mechanism, which might be relevant for other immune-mediated inflammatory diseases as well.”

“Our findings suggest a new approach to fighting diseases with bioelectronic medicines, which use electrical pulses to treat diseases currently treated with potent and relatively expensive drugs,” said Anthony Arnold, Chief Executive Officer of SetPoint Medical. “These results support our ongoing development of bioelectronic medicines designed to improve the lives of people suffering from chronic inflammatory diseases and give healthcare providers new and potentially safer treatment alternatives at a much lower total cost for the healthcare system.”

Federal health officials last week approved the first pill to treat all major forms of hepatitis C, the latest in a series of drug approvals that have reshaped treatment of the liver-destroying virus.

The Food and Drug Administration approved the combination pill Epclusa, from Gilead Sciences, for patients with and without liver damage. The new drug's broad indication could make it easier to use than five other hepatitis drugs recently approved by the FDA, which are each tailored to different viral strains or stages of liver disease.

Gilead's previous two hepatitis drugs have raked in billions of dollars by replacing an older, less effective treatment. The company said Epclusa will cost $74,760 for a 12-week course of treatment, or roughly $890 a pill. That's less than the initial price for company's previous drug, Harvoni, which cost $1,125 a pill. Gilead's first hepatitis C drug, Sovaldi, cost roughly $1,000 per pill, touching off a national debate about drug costs.

Since 2014, the FDA has approved rival medications that have helped curb prices. Hepatitis C affects at least 2.7 million people in the U.S. and caused more than 19,000 deaths in 2014, according to federal estimates

Virginia Anderlini is 103 years old, and she is about to take her sixth trip into virtual reality.

In real life, she is sitting on the sofa in the bay window of her San Francisco assisted-living facility. Next to her, Dr. Sonya Kim gently tugs the straps that anchor the headset over Anderlini's eyes.

But in the virtual world, Anderlini is on a Hawaiian beach, and it's sunset, and she is surrounded by a glistening sea and a molten, purple-red sky. If she looks up, she sees the fronds of an enormous palm tree, and falling rainbow specks that dance in the air like the light from a disco ball.

"Hello, it's so nice to see you again," comes Kim's prerecorded voice from inside the headset. "It's such a beautiful day today, isn't it?"

"Oh my goodness!" says Anderlini, sounding delighted. She turns her head slowly from side to side, taking in the details of the virtual landscape: little grass shacks, twists of driftwood, outcroppings of volcanic rock. "Hey, that's really pretty!"