CTE found in 99% of former, deceased NFL players’ brains: JAMA study (updated)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/07/h_research_Figure-4.-Annotated-Normal.-Mild-CTE.-Severe-CTE.jpg” thumb_width=”200″ /]Updated for additional information and analysis at conclusion. In the largest-ever case study published of CTE–chronic traumatic encephalopathyVA Boston Healthcare System (VABHS) and the Boston University School of Medicine’s CTE Center found mild to severe CTE pathology in nearly all of the brains of former football players studied. Jesse Mez, MD, BU Medical assistant professor of neurology and lead author on the JAMA study, said that “The data suggest that there is very likely a relationship between exposure to football and risk of developing [CTE].” The CTE is marked by defective tau (stained red in the brain sample pictures, click to expand), which is also evident in Parkinson’s and Alzheimer’s Disease.

Of the 202 brains donated to the VA-BU-CLF (Concussion Legacy Foundation) Brain Bank:

  • The most dramatic finding is the detection of CTE in 110 of 111 donated former NFL players’ brains (defined as having played one play in a regular NFL season game).
  • In addition, the brains of other football players were studied. CTE was detected in seven of eight Canadian Football League former players (88 percent), nine of 14 semi-professional players (64 percent), 48 of 53 college players (91 percent), and three of 14 high school players (21 percent).
  • The severity increased with length of play, with the majority of former college, semi-professional and professional players having severe pathology. The deceased high school players diagnosed with CTE had mild pathology findings. Age at death ranged from 23 to 89.
  • Player position mattered. Linemen, running backs, defensive backs, and linebackers, who take most of the punishment in football, were the bulk of the donated brains with CTE.

Separately, and with no knowledge of the pathology, backgrounds on each donor were compiled to gather medical history and symptoms. What was striking were the personality changes evident with even mild CTE. Dr. Mez: “We found cognitive, mood and behavioral symptoms were very common, even among players with mild CTE tau pathology. This suggests that tau pathology is only the tip of the iceberg and that other pathologies, such as neuroinflammation and axonal damage, contribute to the clinical symptoms.” 

Preliminary to the current study was UNITE (more…)

VR system integrating cognitive, physical training to reduce falls by 50 percent

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/03/vr-parkinsons-672×372.jpg” thumb_width=”175″ /]A virtual reality (VR) treadmill system has been developed that improves both muscle strength, coordination, and cognitive abilities to prevent falls in patients with Parkinson’s disease and dementia. Researcher Jeff Hausdorff at Tel Aviv University-Sourasky Medical Center is integrating traditional therapies that concentrate on developing muscle strength, balance and gait with cognitive factors for fall prevention: motor planning, attention, executive control, and judgment training. In a recent study of 282 patients in matched therapy groups (VR+treadmill versus treadmill alone), those who participated in the VR group fell 50 percent less after six months. The biggest improvement was seen in Parkinson’s patients. Video is below. (Photo and video from Center for the Study of Movement Cognition and Mobility). ApplySci/MIT

Telemedicine used in MS neuromodulation study at NYU Langone, with positive results (US)

MS patients in a small NYU Langone Medical Center-led pilot of neuromodulation and cognitive training using telemedicine supervision experienced significant improvement in complex attention and reaction time. Non-invasive transcranial direct current brain stimulation (tDCS) was added to a previously tested cognitive training program for MS patients. Telemedicine (real-time video) was used to deliver the training, monitor patients in the program and provide follow-up support.

The study control was a cognitive training (CT)-only group. According to the abstract, “after ten sessions, the tDCS group (n = 25) compared to the CT only group (n = 20) had significantly greater improvement in complex attention (p = 0.01) and response variability (p = 0.01) composites. The groups did not differ in measures of basic attention (p = 0.95) or standard cognitive measures (p = 0.99).” These results corresponded to the stimulation area in the dorsolateral prefrontal cortex, according to the lead researcher Leigh Charvet, PhD.

The current used in the tDCS unit helps neurons fire more readily, versus making them fire. The tDCS unit used was likely provided by NYC-based Soterix Medical, a developer of neuromodulation systems used in clinical trials. One of the study authors, Abhishek Datta, PhD, is their CTO.

The research is also promising in helping to deliver therapy to MS patients at home, reducing the travel need on both sides, and to develop analytics to optimize medication. In future, the researchers hope to expand the study group to Parkinson’s disease patients. MedCityNews, Neuromodulation (the official journal of the International Neuromodulation Society; abstract only, full study requires additional access)

Parkinson’s disease monitoring app promising for advanced clinical decisions

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2016/07/Kinesia1.png” thumb_width=”150″ /]A study in the July Journal of Parkinson’s Disease presents a small (N=40) study on the use of wearable sensor data and the KinesiaOne mobile app to assist in clinical decisions around advanced therapy referral for Parkinson’s disease patients. The KinesiaOne sensor is worn on the fingertip and tracks motor response on the mobile app (left). The patients were followed for one year, with half receiving standard care and half using motion sensor-based remote monitoring once per month in conjunction with standard care. Remote monitoring led to five times more advanced therapy patient referrals, compared to standard care alone (63.6 percent versus 11.8 percent, p <  0.01). These therapies are highly considered due to their nature–deep brain stimulation (DBS) or an implantable medication pump–and this initial screening may lead to more advanced algorithms and/or continuous monitoring, which the KinesiaOne developer, Great Lakes NeuroTechnologies, also has. Release, JPD abstract, Mobihealthnews Also see our short article on Ireland’s Beats Medical.

Sonde Health using voice as a biomarker for diagnosis

Back in 2013, we profiled Max Little of the UK-based Parkinson’s Voice Initiative, who was in the fairly early stages of voice testing and analysis to aid early diagnosis of this disease. By 2015, he had over 17,000 voice samples, was partnering with the Michael J Fox Foundation, and was seeking to develop a non-invasive, quick, accurate test based on acoustic markers. Dr Little is an Oxford University PhD, currently a Wellcome Trust/MIT fellow at the MIT Media Lab. The Voice Initiative has additional support from PatientsLikeMe, Twilio and Aculabcloud.  But also developed at MIT, by Thomas Quatieri’s team at MIT’s Lincoln Laboratory, is a broader platform for voice diagnosis. This has been applied to mental health conditions such as depression, respiratory and cardiovascular conditions, and in pilots for TBI, cognitive impairment and…Parkinson’s. This has been licensed to Sonde Health, which hasn’t much on their website but is out of the Boston-based PureTech R&D/venture firm. The acoustic markers they cite are ‘dynamic changes in pitch and harmonics, articulation timing and hoarseness or breathiness that indicate and requires no analysis of words’. MedCityNews, MedTechBoston

Hacking your way to managing your illness

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/07/Health-Hacker.png” thumb_width=”125″ /]Health + Hacking doesn’t necessarily mean another data breach. In another context, it means Patients Are Doing It For Themselves and not waiting for an app to help them manage their medical situation. They are self- constructing, deconstructing or repurposing software (or hardware like Fitbits, smartwatches and smartphones) to create customized solutions for themselves and to share with others. A lively young Swedish engineer, through building her own mobile apps to help manage her Parkinson’s disease, is building apps for others and finds her biggest challenge is the wide variety of symptoms.Stage 1 diabetes is a health hackers magnet, with hacks creating new features for continuous glucose monitoring (more…)

Redesign of Kinect to detect, prevent Parkinson’s freezing of gait (UK)

Two researchers at London’s Brunel University have repurposed a common Microsoft Kinect game controller to detect and help prevent the freezing of gait (FOG) that is a common result of Parkinson’s disease. FOG strikes without warning–the muscles freeze and the sufferer generally falls. To both detect falls and help prevent them, the Brunel researchers mounted a laser projector on the ceiling controlled by the Kinect. If a fall happens, it initiates a video conference call to assist the person. The prevention comes in with projecting visual cues–lines ahead on the floor, which has been found to help unfreeze the muscles. According to the Brunel release, it has passed proof of concept stage and is moving to patient trials. The further proof will be if this can scale. Brunel University News

The hypealicious, hyperluxus Apple Watch debut–what the healtherati are interested in

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2013/02/gimlet-eye.jpg” thumb_width=”150″ /]L’œil de Gimlet eyes the Apple Watch. What’s down the road is more important than Monday’s unveil. Certainly The Eye, an adorer of all things over-the-top, would love to have the $10,000-and-up 18 karat, Daddy Warbucks, Solid Gold Cadillac edition of the Apple Watch. It is the sheer hyperluxus, Mercedes-Maybach S600-ness of it all that races my pulse. Stop at $4,000? Nein! $10,000 and up lends a golden glow to all those ordinary, plastic-banded, Mickey Mouse-faced $349 and up versions for the Applepolloi that take that pulse, burp your wrist when you’re not moving enough, open the garage door, play tunes and let you draw little thingies on the face that you can send to your friends. (Urp) What’s even better than a Merc-Maybach in Conspicuous Consumption-Ville? That it will be out of date in a year, unless Apple has a trade-in policy.

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/03/Tim-Cook-previews-the-App-008.jpg” thumb_width=”200″ /] Cue Tim Cook and the Happy Dance of the Watches. (Photo: Zuma/Rex via Guardian)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/03/Apple-Goldfinger.jpg” thumb_width=”200″ /]Cue Shirley Bassey. (Gigaom via Twitter)

Ah, but let us get down to business and cut our swathe through the fog d’hype. (Editor Donna just walked in the door…)

As predicted and projected, the Apple Watch in stores 24 April in Australia, Canada, China, France, Germany, Hong Kong, Japan, UK and US goes light and standard on health measurement features: accelerometer, heart rate sensors, running and weekly activity reports. What’s different? Wrist burps you if you’re a lazy, sitting sod. (Not a great feature for deep meditators or napsters.) The leak from two weeks ago feinted health through downplaying the functionality of the Watch. Back in September, claims included blood pressure and stress monitoring. [TTA 18 Feb]

Now for the right cross. It’s not the Watch, it’s the ResearchKit. Apple gets serious in health apps beyond HealthKit, partnering with the stars in the medical research firmament. As reported: (more…)

Catching up with: Mobisante, Parkinson’s Voice Initiative

(Editor’s note: This Editor is always gratified to see that some of the tech developments your Editors covered in early days pop up again having moved successfully forward. This article and the next on minimally disruptive healthcare follow up on articles respectively in April, December and June 2013.)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/01/Mobisante-185×185.jpg” thumb_width=”150″ /] Mobile ultrasound developer Mobisante is alive, well and well beyond their kit days we profiled back in 2011 (when they gained FDA approval) and last in April 2013. The smartphone is now a dedicated integrated mobile device called the MobiUS SP1 with applications in primary care, ob/gyn, emergency and vascular medicine, with the entire system under 12 ounces. It also has a big brother in a tablet-based system. Both are highly portable and take quick imaging to the max (and developing countries). Interview with Sailesh Chutani, CEO and co-founder. Hat tip to reader Sandeep Pulim MD of @Point Of Care via Twitter

The Parkinson’s Voice Initiative headed by the UK’s Max Little, currently a visiting professor at MIT, is moving forward having collected voice samples from 17,000 volunteers. He is seeking to develop a non-invasive, quick, accurate test for Parkinson’s through analyzing the patient’s voice patterns. Mr Little is adding to this the Michael J. Fox Foundation challenge in analyzing movement data captured through smartphones. Originally profiled in November and December 2013. Fast Company: Co.Exist (which also has his 2012 TED talk). Hat tip to Ashley Gold in today’s Morning eHealth (POLITICO)’s ‘What We’re Clicking’.

Ear implant crossed with gene therapy for auditory repair (AU)

A hopeful Pointer to the Future for those with hearing loss–or, in fact, with nerve damage of other types–is the research out of the University of New South Wales (UNSW) on their developing a DNA-based genetic treatment, delivered by a cochlear implant, to restore hearing in deafened guinea pigs. The recombinant DNA enters the cochlear cells to produce neurotrophins, proteins that cause auditory nerve endings to regenerate, improving pitch perception and tonal range. Unfortunately the effect lasted only a few months, so that further work is required before the treatment even nears human trials. Study co-author Gary Housley also cited other implant-extending usages, such as deep brain stimulation used in Parkinson’s disease treatment and retinal implants. Published this month in Science Translational Medicine (abstract only, subscription required for full access.) The Verge, Engadget (short UNSW video included)

Bridging ‘the neurologist gap’ in Parkinson’s via telemedicine

While Max Little’s ’30-second Parkinson’s diagnosis’ [TTA 13 Nov] is still in test, what about current patients and their treatment? Telemedicine (video consults) to the rescue! Neurologist Ray Dorsey, MD of the University of Rochester tested a ‘one free consult’ offer with a group of 55 recruited via networking site PatientsLikeMe, who were located in the five states where he is licensed to practice, using a free, secure conference platform from Vidyo. The single consult (which sounds extended or multi-part: history, neurologic examination, and recommendations) was with patients at various stages ranging from initial evaluation to third opinion. 33 of 35 consecutive patients completed the survey, reporting 90 percent satisfaction and 85 percent the same or better level of personal connection. (more…)

Diagnosing Parkinson’s in a 30 second phone call

…and with 99 percent accuracy is the claim made in this TED video by Max Little, an applied mathematician who has devised a voice test/analysis explained in this video. The challenge is to enable early diagnosis as there is no blood test and other diseases can mimic Parkinson’s disease. Neurological tests must be done in a doctor’s office and cost $300. This is algorithmically based, non-invasive and uses precision voice analysis. Parkinson’s is one of the most widespread neurological diseases, affecting 6.3 million people worldwide (the Parkinson’s Disease Foundation estimates 7-10 million) with at least 1 million in the US and 127,000 in the UK (Parkinson’s UK). He now is examining 10,000 voices gathered on his website, the Parkinson’s Voice Initiative with Aculab and PatientsLikeMe. Mr. Little is a TEDGlobal 2012 Fellow and a Wellcome Trust-MIT Postdoctoral Research Fellow. TED Talks page. Hat tip to readers Bob Pyke and Wen Dombrowski, MD.

[This video is no longer available on this site but may be findable via an internet search]

Google Glass for gait improvement

The University of Twente in the Netherlands is doing some unusual research in developing an app to help improve the gait of a group at high risk of falls–those with Parkinson’s disease. Current research has found that certain patterns and rhythms when viewed or heard improve gait, such as stripes on the floor or a metronome’s ticking. Glass or another intelligent glasses would display these pattern and/or rhythmic sound, and it would interact with the cameras and accelerometers already built into the devices. The MIRA Institute for Biomedical Technology and Technical Medicine is working on the project together with the Donders Institute for Brain, Cognition and Behaviour (Nijmegen), the Medisch Spectrum Twente hospital and the VUmc University Medical Centre in Amsterdam. Smart glasses can improve gait of Parkinson’s patients  It also sounds like an investigatory area for smartphones and fitness bracelets. Hat tip to contributing editor Toni Bunting.