Medical Bulletin 30/ December/ 2024 - Video

Here are the top medical news for the day:

Link Between Socioeconomic Disparities and Brain Health in Aging and Dementia: Study Finds

A research paper is published in Nature Aging by an international team of researchers from the Multipartner Consortium reveals a direct link between structural inequality—such as socioeconomic disparities measured by a country-level index (GINI)—and changes in brain structure and connectivity associated with aging and dementia.

Key findings

1.Researchers found that higher levels of inequality are linked to reduced brain volume and disrupted connectivity, especially in temporo-posterior and cerebellar regions essential for memory and cognitive function.

2.The findings also revealed that Latinos with Alzheimer’s disease experience the most severe impacts, suggesting that environmental demands linked to structural inequality may exacerbate neurodegeneration in aging populations. In contrast, the milder effects observed in frontotemporal lobar degeneration support the hypothesis of a more significant genetic influence in this condition. Reduced brain volume and connectivity are frequently observed in patients with dementia and are associated with disease progression and severity.

3. Notably, associations persisted even after accounting for individual factors such as education, age, sex, and cognitive ability, underscoring the independent role of macro-level factors in shaping brain health. Living in a context of aggregate inequality affects brain health regardless of your specific socioeconomic level, demonstrating the far-reaching consequences of societal disparities on the brain.

First author Agustina Legaz, PhD from the ReDLat consortium, said,

“Our findings emphasize the urgency of integrating not only individual social determinants of health into global brain health research but also macro-level exposome factors, such as social and physical variables. These findings pave the way for future studies exploring the biological mechanisms linking aggregate inequality to aging and neurodegeneration.”

The study calls for a multi-level approach to brain health equity, examining the biological embedding of other macro-level exposome factors beyond socioeconomic inequality.

Reference: Legaz, A., Altschuler, F., Gonzalez-Gomez, R. et al. Structural inequality linked to brain volume and network dynamics in aging and dementia across the Americas. Nat Aging (2024). https://doi.org/10.1038/s43587-024-00781-2

Researchers Analyze Impact of MS Drugs on Pregnant Women and Their Babies

An analysis of over 3,700 pregnancies of women with multiple sclerosis indicates that the therapy doesn't lead to increased risks of miscarriage, premature birth or serious birth defects.

A research team headed by Professor Kerstin Hellwig from the Department of Neurology at Ruhr University Bochum, Germany, analyzed over 3,700 pregnancies of women with multiple sclerosis. More than 2,800 of them were treated with different immunomodulating agents before or during pregnancy. The researchers published their findings in The Lancet Regional Health Europe.

The data for the pregnancies included in the study came from the German Multiple Sclerosis and Pregnancy Registry and was collected between November 2006 and June 2023. 2,885 pregnancies were analyzed during which the mothers had received a so-called disease-modifying therapy (DMT). The substances used in the study included interferons, glatiramer actate, dimethyl fumarate, teriflunomide, S1P modulators, alemtuzumab, natalizumab, anti-CD20 antibodies and cladribine. 837 pregnant women had not received any medication for multiple sclerosis.

The researchers compared the frequency of spontaneous abortions, infections during pregnancy, premature births and birth defects and recorded the children's weight at birth. The primary finding was that exposure to most disease-modifying therapy during pregnancy was not associated with a statistically significant increase in the incidence of spontaneous abortions, premature births or major congenital defects.

Overall, the entire cohort showed an increased risk of low birth weight in relation to the duration of pregnancy. 18.8 percent of babies were affected.

While most disease-modifying therapy don't increase the risk of critical pregnancy complications, exposure to S1P modulators, natalizumab and anti-CD20 antibodies increases the likelihood of low birth weight and slowed intrauterine growth. This is a risk factor for both fetal and neonatal death as well as for numerous diseases in later life, including type 2 diabetes mellitus and cardiovascular diseases.

Reference: https://news.rub.de/english/press-releases/2024-12-18-medicine-how-do-ms-drugs-affect-pregnancy

Can Dancing Lower Depression Associated with Parkinson’s Disease?

Dancing lowers, the depression associated with Parkinson disease, and the benefits can be seen in multiple ways, a new study published in the Journal of Medical Internet Research involving York University researchers shows.

The study followed 23 participants in the Sharing Dance Parkinson's program at Canada's National Ballet School who had a diagnosis of Parkinson disease, as well as 11 healthy controls, who were mostly family members or caretakers of those with Parkinson disease. The participants took weekly dance classes for 8 months, which progressed from simple leg and foot work and pliés to interpretive movements, waltzes, and more complicated, choreographed dances.

The researchers honed in on a node in the brain, the subcallosal cingulate gyrus (SCG), that has been shown in previous research to be implicated in depression. They measured mood and depression scores in all participants using the Geriatric Depression Scale before and after every class and conducted regular MRI scans at York.

The researchers found that after each dance class, reported depression rates dropped, and the effect was cumulative from class to class, with significant improvements after 8 months. They also found that the MRI scans showed reduced signals in a frontal-cortex brain region associated with emotional regulation and that in a smaller subset of the participants, a significant decrease in depression scores was correlated with changes in the subcallosal cingulate gyrus node.

Dance is thought to have a double benefit, with music activating the brain's reward centers, and the movement acting on sensory and motor circuits. Faculty of Health associate professor Joseph DeSouza, an author of the study, who has been dancing with participants in the program for 14 years, says that while dancing is not a treatment for Parkinson disease per se, the benefits are clear.

Reference: https://www.yorku.ca/news/2024/12/13/dancing-the-blues-away-seen-in-brain-imaging-in-people-with-parkinson-disease-new-study-finds/

UC Davis Cardiologist Implants First Dual Chamber Leadless Pacemaker in a Child

UC Davis Director of Pediatric Electrophysiology Dan Cortez is the first to implant a dual chamber leadless pacemaker in a child. The case report was published in the journal PACE: Pacing and Clinical Electrophysiology.

A 13-year-old patient was referred to the UC Davis pediatric electrophysiology clinic for presyncope, a feeling of lightheadedness or dizziness without actually fainting, after being monitored for years for congenital complete heart block.

Pacemakers are typically placed in children with congenital complete heart block, a rare condition that can lead to sudden death and affects 1 in about 15,000 to 22,000 children.

After serial electrocardiograms and Holter monitors showed progressively lower average heart rates, Cortez talked with the patient and their family about pacemaker options.

Dual chamber leadless pacemakers help regulate the heart's rhythm by stimulating the heart's upper (atrial) and lower (ventricular) chambers. Because the patient wanted to remain active in sports without restrictions, leadless pacing was presented as an option, and the family agreed.

The AVEIR dual chamber leadless pacemaker was implanted via the patient's right internal jugular vein (instead of the femoral vein) so the patient could move easily and return to sports sooner. The minimally invasive procedure took place in the UC Davis Electrophysiology Lab.

The patient had no complications during or after the procedure. Three months later, the patient was able to resume exercise and play sports.

The AVEIR device is different from traditional pacemakers in part because it has no leads or cords and is absorbed by the heart. It is also 10 times smaller than a traditional pacemaker. This pacemaker has been implanted in adults across the country since it received FDA approval in 2023.

"Everyone, kids included, can now have the benefits of pacemakers without leads and without the complications that come with leads long term," Cortez said. "No matter what kind of pacing a kid needs -- atrial or ventricular, or both -- they can now safely receive leadless pacing and, after the short recovery period, have no restrictions to their activity level."

Reference: https://health.ucdavis.edu/news/headlines/first-dual-chamber-leadless-pacemaker-implanted-in-a-child/2024/12