• "Hospitalized survivors of transportation collisions have high rates of acute stress disorder, posttraumatic stress disorder (PTSD), depression, and anxiety symptoms that may affect their ability to recover.
  
  Trauma teams, trauma centers, and first responders should be aware that patients are going to be having a high degree of psychological symptoms.
  
  Several variables were correlated to psychopathology, including history of treatment for psychological problems, alcohol/drug use, postcollision fear of dying, prior number of collisions in the past year, prior number of stressful events in the lifetime, greater perception of control of events that caused the collision, and collision-related guilt.
  
  In addition, the patients with more extremely stressful events in their lifetime or other collisions in the past year were more likely to have PTSD symptoms. Most people felt they had little or no control over the events that caused the collision, but those who did were more likely to have depressive symptoms and guilt.
  
  The study has implications for early screening of survivors and early intervention and training of healthcare providers to identify psychopathology, but health centers don't call in a mental health professional in trauma cases unless they can actually see someone has a problem."
   
• "A new prevalence study suggests that men have a 67% increased risk for mild cognitive impairment (MCI) relative to women.
  
  MCI in the general population of 80- to 89-year-olds in our population is high around 16.5%. the prevalence of MCI is higher in men compared to women.
  
  Prevalence of MCI and Dementia Diagnosis Prevalence (%)
  Normal cognition 73.6
  MCI 16.5
  Dementia 9.9
  
  ...the prevalence in men and women combined increased with increasing age, from about 10% in 70- to 74-year-olds to about 25% in 85- to 89-year-olds. A similar pattern was seen in men, but the prevalence of MCI was higher than for women, increasing from about 12% to 40% in the oldest group.
  
  When they adjusted for age and education, the odds ratio was even higher for men vs women and was unchanged by additional adjustment for marital status or burden of disease.
  
  First, there may be sex differences in the prevalence of risk factors for MCI in middle age and in the later stages of life. Alternatively, there may be sex differences in the progression of MCI to dementia. If you just look at prevalence, it might appear that MCI is higher in men than women if women are progressing faster from MCI to dementia. There may also be differences in the rate of mortality among persons with MCI." American Academy of Neurology 60th Annual Meeting. Presented April 16, 2008.
• "New research suggests that heavy drinking and smoking significantly lower the age of onset for Alzheimer's disease (AD), with an individual effect that is roughly equivalent to the APOE e4 allele alone. Heavy smokers developed AD 2.3 years sooner than nonsmokers and that heavy drinkers developed the disease 4.8 years earlier than those who were not heavy drinkers. Individuals with the APOE e4 variant developed AD 3 years earlier than those without the variant.
  
  However, study subjects with all 3 risk factors developed the disease an average of 8.5 years earlier than their counterparts who had none of these risks.
  
  While moderate alcohol consumption has been shown to protect against AD, heavy drinking has been shown to increase AD risk. We know the prevalence of Alzheimer's increases with age and roughly doubles every 5 years starting at about age 65. If disease onset could be delayed by about 5 years, it is estimated that the overall prevalence of Alzheimer's could be reduced by almost 50%. So modifiable factors that could delay disease could have a dramatic effect."
• "High serum total cholesterol levels in midlife increase the risk of developing Alzheimer's disease 3 decades later. Alzheimer's disease was 1.5 times more prevalent in men and women who had total cholesterol levels of 249 to 500 mg/dL when they were middle-aged than in people with normal cholesterol levels.
  
  High cholesterol increased Alzheimer's risk regardless of midlife diabetes, hypertension, and obesity; smoking; and late-life stroke. Subjects in the highest quartile for cholesterol level in their 40s had an increased risk for AD compared with those in the lowest quartile.
  
  Even less severely elevated cholesterol was associated with an increased risk for dementia. The researchers did observe a trend toward an increased risk for vascular dementia in this patient population, but the difference was not statistically significant."
  American Academy of Neurology 60th Annual Meeting.
• "A survey of Australian children with attention-deficit/hyperactivity disorder (ADHD) found that 73% had mild to severe sleep disturbances, which affected both the children and their parents. Most often, the children had difficulty falling asleep, resisted going to bed, and were tired upon awakening.
  
  This was the first study to demonstrate that among children with ADHD, those with sleep problems had a poorer quality of life and school attendance, and their caregivers had poorer mental health and work attendance.
  
  ADHD is the most common mental health disorder in children, affecting up to 11% of Australian children aged 6 to 17 years old, the group writes. Up to 50% of parents of children with ADHD report that their children have difficulty in initiating and maintaining sleep.
  
  Compared with children with no sleep problems, those with sleep problems had a poorer quality of life and were more likely be late for or miss school; increasing severity of sleep problems were associated with increasing prevalence of poor outcomes.
  
  Only 45% of caregivers (107 caregivers) reported that their pediatricians asked about their children's sleep, and of these, 60% (65 caregivers) reported receiving advice.
  
  Compared with caregivers of children without sleep disorders, those with children who had moderate or severe sleep disorders were more likely to be clinically depressed, stressed, anxious, or often late for work.
  
  Sleep issues such as difficulty falling asleep, resisting going to bed, and tiredness upon awakening could be addressed by behavioral strategies such as setting limits around bedtime resistance, instigating a good sleep routine, and using rewards. Difficulty falling asleep due to anxiety could be managed by anxiety-management techniques such as visual relaxation and self-talk. These strategies are standard clinical care practices for children without ADHD who have sleep problems, but the effectiveness of these approaches in children with ADHD remains to be determined." Arch Pediatr Adolesc Med. 2008;162:336-342.
• "A recent study found that, among 91 toddlers who had been born prematurely and weighed from 1 pound to 3.28 pounds (460 to1490 g) at birth, 25% screened positive for early signs of autistic features.
  
  The findings suggest that "routine, systematic screening of very-low-birth-weight infants for early signs of autism is important. It's [also] important to perform formal diagnostic autism testing in those who test positive to confirm whether this initial positive screening does in fact translate into autism spectrum disorders.
  
  Advances in neonatal intensive care have dramatically increased the survival of preterm infants, but there is an increasing population of very-low-birth-weight children who experience significant disabilities in socialization, communication, and behavior, the group writes.
  
  The study was prompted in part because the team had clinically observed that some very preterm infants displayed unusual social behaviors at follow-up visits. In addition, validated screening tests to detect early signs of autism have now become available.
  
  The infants were more likely to screen positive for early signs of autism if they had the following risk factors: male sex, abnormal MRI studies, lower birth weight, lower gestational age, maternal infection, maternal acute intrapartum hemorrhage, and more severe illness at birth.
  
  Early autistic behaviors seem to be an underrecognized feature of very-low-birth-weight infants. The results from this study suggest that early screening for signs of autism may be warranted in this high-risk population, followed by definitive autism testing in those with positive screening results. Pediatrics 2008;121:758-765.

©2008 David B. Adams, Ph.D.