People with multiple sclerosis who are diagnosed with colorectal cancer may be at a higher risk of dying from cancer or other causes over the next six months to one year than people with colorectal cancer who do not have multiple sclerosis, according to a study published in the September 15, 2021, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“These results warrant further investigation to determine what factors may lead to shorter survival times,” said study author Ruth Ann Marrie MD PhD of the University of Manitoba in Winnipeg, Canada, and a member of the American Academy of Neurology. “Are people with multiple sclerosis less likely to receive cancer treatment? Or are they less able to tolerate the effects of chemotherapy? Are factors specific to multiple sclerosis involved? How accommodating is the cancer care system for people with disabilities? These are among the many questions that need to be investigated.”

For the study, researchers looked at health records for 338 people with multiple sclerosis and colorectal cancer who lived in Ontario and Manitoba, Canada. Each person was matched with 4 people who had colorectal cancer but did not have multiple sclerosis, were the same age and sex, and had the same year of cancer diagnosis (1,352 people). The participants were an average age of 65 when they were diagnosed with cancer.

The study found that people with multiple sclerosis were 45% more likely to die of any cause at 6 months after the cancer diagnosis than people without multiple sclerosis and 34% more likely to die of any cause at one year after diagnosis. After that point, the risk of death was the same for the two groups. People with multiple sclerosis were more likely to die of cancer than people without multiple sclerosis only at the 6-month point after diagnosis, when their risk was 29% higher. The researchers adjusted for other factors that could affect risk of death, such as age, socioeconomic status, and having other conditions like heart disease or diabetes.

Over 5 years, the fatality rate in Ontario was 16.4 deaths per 100 person-years for people with multiple sclerosis who died from any cause compared to 11.5 deaths for people without multiple sclerosis. Person-years take into account the number of people in a study as well as the amount of time spent in the study. In Manitoba, those numbers were 19.8 deaths per 100 person-years for people with multiple sclerosis and 15.4 deaths for people without multiple sclerosis.

Looking at deaths due to cancer, the fatality rate was 12.7 deaths per 100 person-years for people with multiple sclerosis in Ontario, compared to 9.9 deaths for people without multiple sclerosis. In Manitoba, those numbers were 13.6 for people with multiple sclerosis and 13.0 for people without multiple sclerosis.

“Understanding more about the factors involved in treating cancer in people with multiple sclerosis and their outcomes will be helpful for people with multiple sclerosis and their doctors as they balance the benefits of cancer treatment with the potential adverse effects and consider life expectancy and quality of life,” Marrie said.

A limitation of the study was that researchers may not have accounted for all other conditions people may have had in addition to multiple sclerosis and colorectal cancer.

The study was supported by the multiple sclerosis Society of Canada.

Source: News Release

Existing treatments for movement impairments are “off the rack” rather than “custom-tailored,” but B J Fregly, a Rice University professor of mechanical engineering and bioengineering, wants to change that situation.

Fregly’s lab in the George R Brown School of Engineering has received a National Institutes of Health Research Project Grant to develop open-source software for designing individualized treatments for movement impairments using computational modeling and simulation.

The 4-year, $2.4 million grant is administered by the National Institute of Biomedical Imaging and Bioengineering.

The software will make it easy to create personalized computer models of individual patients and optimize treatment.

The personalized models account for each patient’s unique movement control, muscular and skeletal characteristics, while optimization makes it possible to identify better treatment solutions than could be found through clinical intuition. Clinical applications of the software include the design of custom-tailored neurorehabilitation protocols for stroke, physical therapy interventions for osteoarthritis and orthopedic surgery plans for bone cancer.

“The goal of most neuromusculoskeletal modeling research is improving the way we treat movement impairments,” said Fregly, who came to Rice in 2017 as a CPRIT Scholar in Cancer Research. “Though such models have become much more realistic in recent years, they still have not made a positive impact on the design of clinical treatments.

“This lack of clinical impact is surprising, given that comparable computational technology has transformed the design of airplanes, automobiles and other commercial products,” he said. “However, a computational approach to treatment design requires reverse-engineering a model of a patient’s neuromusculoskeletal system, which is extremely challenging.”

Though some researchers and clinicians remain skeptical about computational treatment design, Fregly believes the time is right to pursue the new approach, which he has already used to design a patient-specific rehabilitation treatment for knee osteoarthritis.

“With recent improvements in computational modeling capabilities, our ability to personalize a neuromusculoskeletal model to represent a specific patient and then use that model to predict an optimal treatment is no longer science fiction,” he said. “All we need is the right tool to simplify the model personalization and treatment optimization process.”

In the short term, Fregly suggests identifying a subset of movement impairments that are amenable to computational treatment design. “This way,” he said, “the field could generate some initial clinical ‘wins’ that would help propel it across the threshold of clinical utility and open up a new paradigm for treatment design.”

Source: News Release

The Mediterranean diet does not only have beneficial effects for the cardiovascular health of those who follow it, but it can allow them to improve their memory and prevent or delay the effects of cognitive deterioration connected to aging. However, these beneficial effects are not enjoyed equally by everyone, which leads to questioning the type of interventions based on dietary recommendations to adapt them to the individual features of each person.

These are the main results of a study published in Clinical Nutrition, led by researchers from the Research Group in Integrated Pharmacology and Systems Neuroscience and from the Research Group in Cardiovascular Risk and Nutrition of the Instituto Hospital del Mar for Medical Research (IMIM-Hospital del Mar) through the group in Psychology and Mental Health of the Biomedical Research Institute of Bellvitge (IDIBELL) and the University Hospital of Bellvitge, all from Physiopathology of Obesity and Nutrition group CIBEROBN. Also, part of the research was the University of Valencia, the Rivira i Virgili University and the University of Navarre.

The study followed a group of 487 volunteers, practically half of which were men and half women and with an average age of 65 years, for 3 years. They all participated in the PREDIMED-PLUS trial, a multi-center study that 23 Spanish research centers take part in and which analyzes the effect of the traditional Mediterranean diet with energetic restrictions, promoting physical activity and behavioral intervention, on weight loss and the prevention of cardiovascular diseases.

At the beginning of the study, participants were overweight or obese and met at least 3 criteria of the metabolic syndrome, which includes hypertension, hyperglucaemia, an excess of fat around the waist, low levels of HDL cholesterol, and high levels of triglycerides.

The metabolic syndrome is very common, being present in close to 1 in 4 adults globally, and entails a higher risk of suffering heart disease, cerebrovascular accidents, type-2 diabetes, and cognitive deterioration.

Improved adherence to the diet improves memory

With neuropsychological tests, the researchers analyzed the cognitive status of the volunteers at the beginning of the study and 1 and 3 years later. The researchers established their performance regarding memory and other cognitive functions, including the ability to make decisions, reason, pay attention, plan, or ignore certain impulses.

According to previous studies, within a period of 3 years, people with metabolic syndrome who do not follow any type of intervention would have seen their global cognition decrease by almost 0.4 points and their memory by 0.1. However, with the study’s recommendations, they recorded improvements of over 0.6 points in global cognition and close to 0.9 in memory. The units used to measure cognition have been standardized in order to compare different neuropsychological tests.

For the set of patients, the results show a direct link between the adherence to the Mediterranean diet and cognitive improvement. Adherence to a low-calorie Mediterranean diet was measured with a poll of 17 items that explore the consumption of extra-virgin olive oil and the number of rations of fruit and vegetables they eat a day, among other matters. Scores over 11 points are considered a high adherence to the Mediterranean diet. Thus, for each point of improvement regarding the adherence to this type of diet, the memory improved by .12 points.

According to the research, this improvement can be due to the weight loss and the increase in physical activity, which is also linked to an improved quality of life. In this sense, Rafael de la Torre, one of the main researchers of the study, says that this “is important, taking into account that people may not notice cognitive changes, but they can be more relevant when combined with improvements to their quality of life.”

Meanwhile, Fernando Fernández-Aranda, leader of the project from the IDIBELL and Bellvitge Hospital, says that “thanks to this study we have established benefits of the Mediterranean diet beyond weight loss, such as the verbal memory or attention, which clearly benefit.”

Not everyone has the same benefits, according to Natàlia Soldevila-Domènech, first signee of the study. Women, the oldest people, those with a lower level of education, and those with type-2 diabetes obtain the least benefits from following the Mediterranean diet. In this regard, she says that “despite seeing that women have less cognitive improvement than men, these improvements occurred in all participants. Everyone benefits from following the Mediterranean diet, just some more than others.”

Meanwhile, the volunteers with the lowest cognitive performance at the beginning of the study regarding memory and other cognitive functions have the least adherence to the Mediterranean diet and are the ones who have the least possibilities of achieving significant weight loss.

“We wanted to know which volunteers lost weight and which did not, and why some did and some did not, from the point of view of cognition and their behavior,” explains Rafael de la Torre.

Specifically, those who at the beginning of the study had the best auditory memory, higher planning and decision-making abilities, lower reaction times, and less impulsiveness, were between 20% and 50% more likely to achieve the study’s goal of losing 8% of their weight over the 3 years. According to the research, this is because most people with these cognitive abilities had a high adherence to the low-calorie Mediterranean diet, which led to clinically relevant weight loss.

For these reasons, the authors say the results obtained must make it possible to identify the groups with the most difficulties to benefit from these lifestyle interventions, to customize the measures and thus make it easier for them to adopt the healthy life guidelines proposed, thus also helping prevent cognitive deterioration.

Source: News Release

A new international clinical practice guide provides 13 recommendations for interventions to improve physical function for children with cerebral palsy. The recommendations, which are published in Developmental Medicine & Child Neurology, were developed by an expert panel, with input from additional experts and from affected patients and their families.

The guide notes that therapies should consider patient-chosen goals, provide support to empower families, and be based on a team approach. The guide also provides specific recommendations to improve walking ability, hand use, selfcare and leisure.

“This research is really exciting for children and young people with cerebral palsy across the globe as it highlights the importance of therapy focusing on what is most important to each individual,” said lead author Michelle Jackman PhD of John Hunter Children’s Hospital, in Australia. “No longer is it best practice to focus on changing muscles and movements alone; it’s about focusing on real life activities and being able to do the things you love.”

Source: News Release