Radically different
The first Wednesday of May marks World Maternal Mental Health Day, now celebrating a decade of advocacy to prioritise maternal mental health. Maternal depression is a prevalent illness that increases the risk of maternal morbidity and mortality, and contributes to adverse outcomes for offspring and family. Despite its substantial burden, maternal depression remains underdetected and undertreated.
Perinatal psychiatry is a recent specialty. Only a few countries offer specific training and specialised care, even though it is considered a major public health issue worldwide.1 Perinatal psychiatry remains ill-defined and has often been reduced to women’s mental health during pregnancy and postpartum. However, the World Psychiatric Association recognises that perinatal mental health is both a maternal (if not parental) and an infant mental health issue.2 Peripartum depression is considered the most common health risk for parents and their offspring.
People who have experienced a heart attack, including those who had a “silent” heart attack that hadn’t been previously diagnosed, showed faster declines in memory and thinking skills over time, according to a study published in the journal Stroke. Researchers found that evidence of a previous myocardial infarction was associated with an accelerated rate of cognitive decline and a higher likelihood of developing cognitive impairment during more than a decade of follow-up, indicating this a cohort of patients who may need to take more proactive measures to retain cognitive acuity as they age.
“Having had a heart attack in the past may speed up the decline in memory and thinking over time,” said study lead author Mohamed Ridha, MD, an assistant professor of neurology at The Ohio State University. “Given the rising burden of dementia and cognitive decline among Americans, it is important to understand how cardiovascular disease affects their brain health. This knowledge can help heart attack survivors take steps to improve their brain health as they age.”
The research analyzed data from 20,923 adults enrolled in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study, a national cohort designed to examine racial and geographic disparities in stroke outcomes in the United States. Participants, who were enrolled between 2003 and 2007, had interpretable electrocardiograms and no evidence of cognitive impairment at the start of the study. Their average age was 63 years, with 62% identified as White adults and 38% as Black adults.
The team used a combination of self-reported medical history and electrocardiogram readings to determine if participants had evidence of a prior heart attack. The patients in the study were categorized into groups: those who had self-reported a heart attack, a clinically recognized heart attack confirmed by electrocardiogram, and silent heart attack, defined as electrocardiographic evidence of myocardial infarction without a prior diagnosis.
All participants took part in an annual telephone-based cognitive screening for a median of 10.1 years. The six-question assessment evaluated orientation and memory recall, with lower scores indicating poorer cognitive performance. Investigators adjusted for other factors that are known to be associated with cognitive decline including age, sex, race, education, exercise frequency, diabetes, smoking, blood pressure, depression, kidney function, and cardiovascular events that occurred during follow-up.
Among the study population, 2,183 participants had evidence of prior myocardial infarction at baseline. Of those cases, 1,098 were self-reported heart attacks, 281 were clinically recognized heart attacks confirmed by electrocardiogram, and 804 were silent heart attacks. Nearly 37% of all heart attacks identified in the study were clinically silent.
Compared with participants without a prior heart attack, heart attack survivors had an annual risk of developing cognitive impairment that was 5% higher that patients who had not suffered a heart attack. The accelerated decline was observed across all categories of prior heart attack, including silent myocardial infarction and was also consistent across races and sex.
The study adds to prior research that has linked cardiovascular disease and dementia risk and noted the importance of identifying such patients. “Previous investigations of incident coronary ischemic events have demonstrated that the impact on cognitive function is not immediate but manifests as a subsequent accelerated rate of long-term cognitive decline,” the researchers wrote. “Vascular contributions to cognitive impairment, including stroke, are prevalent and potentially modifiable factors underlying cognitive decline.”
The findings could help clinicians provide preventative care, since electrocardiograms and patient history are commonly available in routine practice. These tools could help clinicians identify patients who may benefit from counseling and monitoring related to cognitive health and Ridha noted that clinicians caring for heart attack survivors should discuss ways to reduce the risk of cognitive decline and dementia as patients age.
While the biological mechanisms linking heart attack and cognitive decline remain uncertain, the discussion proposed possible contributors, including microvascular disease, silent cerebral infarcts, systemic inflammation, reduced blood flow to the brain, and impaired amyloid clearance.
The post Prior Heart Attack Linked to Faster Cognitive Decline Over Time appeared first on Inside Precision Medicine.
Using specialized contact lenses to stimulate the brain could offer a novel route to treating depression, preclinical research suggests.
The research, in mice, demonstrates how wearable neuromodulation devices can provide a versatile platform for mood and other brain disorders.
It brings eye-based neurotherapies a step closer towards clinical reality and reveals the feasibility of using contact lenses as a bioelectronic strategy for the treatment of depression.
The findings appear in the latest issue of Cell Reports Physical Science.
“Our work opens up an entirely new frontier of treating brain disorders through the eye,” said lead author Jang-Ung Park, PhD, from Yonsei University.
“We believe this wearable, drug-free approach holds tremendous promise for transforming how depression and other brain conditions are treated, including anxiety, drug addiction, and cognitive decline.”
Depression is increasingly recognized as a disorder involving structural and functional abnormalities in brain networks.
Conventional treatments—such as pharmacological therapy, electroconvulsive therapy, and deep brain stimulation—target these abnormalities but can be invasive and are often limited in their efficacy or tolerability.
Park and team note that the eye provides a compelling gateway for indirect brain modulation due to its embryological derivation from the brain and extensive connectivity.
Studies also suggest that visual impairment with higher prevalence of depression, further recognizing the importance of the eye-brain axis.
To investigate this avenue further, the researchers developed a contact lens that uses transcorneal electrical stimulation (TES) based on temporal interference (TI) to stimulate the brain. This delivers two electrical signals to the retina, which only become active where they intersect, allowing specific areas of the brain to be targeted.
The platform circumvents the invasiveness and limited tolerability of conventional brain stimulation therapies by using the retina as a precise interface for the eye-brain axis.
Electrodes made from ultrathin layers of gallium oxide and platinum allow the lens to be flexible and transparent, conforming to the cornea and preserving natural vision.
The researchers examined the efficacy of the lenses in a stress-induced mouse model that recapitulated key behavioral and biological features associated with depression.
Depressed mice received either no intervention, temporal interference, or the SSRI fluoxetine and were compared with control mice that were not depressed before and after treatment. Machine learning was applied for comprehensive efficacy evaluation.
The team reported that the lenses restored behavioral, neural, and biological deficits in depression.
TI-TES enhanced behavioral resilience, restored prefrontal-hippocampal oscillatory synchrony, and normalized depression-related biomarkers.
When machine-learning integration was used to integrate behavior, brain activity, and biomarkers, it consistently grouped the mice with lenses with the non-depressed control mice rather than the untreated depressed mice.
The researchers acknowledge their research is in its early stages, and that the current study employed a wired configuration to ensure precise waveform control and stimulation stability during proof-of-concept validation.
“Like any new medical technology, our contact lenses will need to go through rigorous clinical evaluation in patients before reaching the market,” said Park.
“Next, we plan to make the lens fully wireless, test it for long-term safety in larger animals, and personalize the stimulation for each user before advancing into clinical trials in patients.”
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