The Sentinel: Medical Research

Understanding the Link Between Stress and Chronic Pain: Key Findings Revealed

Study says depression and anxiety caused by chronic pain may contribute to a poor quality of life and reduce life expectancy.

by Terri Dee
Indiana News Service

INDIANAPOLIS, IN - April is National Stress Awareness Month. Stress is the body's way of processing work, personal, and family pressures, or other triggers.

A new study in the Journal of the American Medical Association has found a link between stress and chronic pain, which is defined as pain that persists for three months or more and lasts beyond the normal healing time of an injury or illness.

Former chiropractor Dr. Sean Pastuch is CEO of Active Life, a personal coaching company focusing on chronic pain-management options.

He suggested that biological, psychological and social interventions could be effective forms of treatment.

What is viewed as pleasurable to some may feel painful to others.

"The connection between all of those three things -- the physical, the mental, and the emotional -- is that when we think about pain, no one's defining what the word means," said Pastuch. "So, if we evaluate what the word 'pain' means, then we come to find that in order for there to be pain, there needs to be a negative emotional component to it."

He said that if you feel something, you have to decide if you like the way it feels or not. And what is viewed as pleasurable to some may feel painful to others.

The study also says depression and anxiety caused by chronic pain may contribute to a poor quality of life and reduce life expectancy.

A 2022 Indiana Chronic Care Policy Alliance report shows almost 8% of adults have chronic pain, with arthritis as the leading disorder.

Patsuch said patients face obstacles in finding a physician who can identify their pain, which means fewer or no opportunities to receive treatment.

"The reason why doctors struggle to help people with chronic pain, and why the confidence level among doctors is low," said Pastuch, "is because of all the medical schools, fewer than 15 actually have dedicated curriculum to supporting a patient with chronic pain."

Of the medical schools that offer a pain-management curriculum, he said the majority focus on students in the anesthetics department.

Patsuch suggested that when a patient is with their doctor, to use words other than "it just hurts." They need to be able to describe what hurts and ask, "How do I want to resolve it?"

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Strength training can help women live longer, healthier lives

by Paul Arco
OSF Healthcare

ROCKFORD - It’s no great surprise to read that men and women both benefit from working out.

But women may receive greater benefits from regular exercise than men, according to a study published in the Journal of the American College of Cardiology.

Photo provided

Mary O’Meara
OSF Cardiovascular Institute

The study centered on the importance of exercise as a way to avoid dying prematurely. The researchers studied data from 400,000 people and found that women who exercised were 24% less likely to die early from any cause. Men who exercised, however, were 15% less likely to die early.

The study also revealed that the women who exercise had a 36% lower risk of dying from a cardiovascular event, compared to men at 14%. That’s important because women have twice the risk of dying from a heart attack than a man.

Mary O’Meara is a nurse practitioner with OSF HealthCare. She says society still views heart attacks more as a man’s disease. That’s simply not true.

“Usually, a male is feeling this really bad chest pressure, chest pain going in the left arm into the jaw, very pale. Women, very often, will just complain of fatigue, nausea or heartburn. ‘I feel wiped out. I just can't walk across the room. I need to sit down,’” explains O’Meara. “Unfortunately, that can be a sign of a heart attack in a female, and it gets missed quite often.”

While any movement is good, O’Meara stresses the importance of women incorporating strength and/or resistance training, such as lifting weights. Frequency and the amount of weight depend on the person and their situation.

Photo: MovePrivateFitness/Pixabay

“For a long time, women were encouraged to do more aerobics-calisthenics. We were always thought of as the weaker sex, I guess you can say, and we weren't really encouraged to do any weight bearing exercise,” says O’Meara. “A lot of research has come back that states that women should be focusing on weight bearing exercises for several different reasons.”

Strength training can also help women as menopause becomes an issue. According to O’Meara, hormones start changing between the ages of 40 and 50 – a time when women start losing muscle and see an increase in body fat. Strength training can help with that change, along with other health issues.

“We found that weight bearing exercise can reduce our risk of dementia and Alzheimer's, and also reduce our risk of osteoporosis, which is a big one,” says O’Meara.

O’Meara also has a nutrition tip for her patients. Protein, she says, is important for women to prevent muscle loss, especially during menopause. O’Meara recommends 30 milligrams of protein before and 15 milligrams after a workout, to help rebuild muscle that has been naturally broken-down during exercise.

Additionally, O'Meara is a proponent of healthy fats. She encourages patients to incorporate grape seed oils, olive oils, fish oils, flax seed oils, nuts and avocados into their diets. Her philosophy is that good fats battle bad fats, and good fats protect our heart.

O’Meara stresses that it's never too late for women to start exercising. Even a short walk or work around the home, for instance, can go a long way to a healthier future.

“You read many testimonials from people who were couch potatoes and never exercised,” she says. “And then, they go into these exercises and do wonderful things that have really made a difference.”

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hMPV: It has been around for a while and most of us don't have to really worry

Photo: Juliia Abramova/PEXELS

Infants and toddlers are at the greatest risk of suffering from an hMPV infection, a seasonal virus in the news identified more than two decades ago. While generally harsh the first time, symptoms are usually mild with subsequent reinfections.

(SNS) - A recent outbreak of hMPV in China in the current news cycle around the world because the China government is taking the rapid spread seriously, taking a preventive stance, asking citizens to wash their hands frequently, masking up, and pushing early testing.

Is there a reason to worry?

According to the Journal of the American Medical Association (JAMA), "In adults of all ages, HMPV is a common infection, and, although often asymptomatic, it can result in serious infection that requires hospitalization."

Exactly who is at high risk of suffering from complications

Young Children: Infants and toddlers are especially vulnerable to serious respiratory conditions, such as bronchiolitis and pneumonia.
Older Adults: Individuals aged 65 or above, as well as those with chronic health concerns such as asthma or COPD, are more likely to have complications.
Pregnant Women: HMPV during pregnancy can result in respiratory issues, which may endanger both the mother and infants' health.
Immunocompromised Individuals: Those with weakened immune systems, whether due to medical conditions or treatments like chemotherapy, are at a higher risk of experiencing severe symptoms.

What is hMPV?

hMPV was first discovered in 2001 by scientists from the Netherlands in a group of children where tests for other known respiratory viruses were negative. It is in the same category of viral infections as the Pneumoviridae family and respiratory syncytial virus, or RSV.

It is believed the virus originated in birds before adapting to infect humans. Genetic studies indicate it likely circulated among humans for decades before it was identified by scientists.

According to the CDC, hMPV is a virus that can cause upper and lower respiratory infections. Because we spend more time indoors during colder months, hMPV is more likely to circulate during the winter and spring months when other similar diseases, such as RSV and the flu, are prevalent.

The American Lung Association says that hMPV is most commonly spread from person to person through close contact with someone who is infected. Shaking hands, hugging or kissing as well as coming in contact with viral material from coughing and sneezing or touching objects such as toys or doorknobs are the usual methods of infection.

Resembling other respiratory illnesses, diagnosis and treatment can be assessed via three methods. There is a PCR test, much like the now standard COVID-19 test, available for doctors. The hMPV is a molecular test that detects the virus' genetic material with high accuracy and is regarded as the gold standard for diagnosis. Doctors can also use a Rapid Antigen Test. While providing faster results, they are less sensitive in detecting the virus compared to PCR tests.

The final method is the more evasive Bronchoscopy, which looks for changes in the lung tissue. A bronchoscopy is a standard procedure that allows a doctor to examine the inside of the lungs, trachea, and bronchi using a thin, lighted tube called a bronchoscope. The procedure is commonly used to diagnose and treat a variety of lung conditions.

hMPV usually causes symptoms similar to the common cold that lasts roughly 2-5 days and goes away. Most children who get infected with hMPV are age 5 or younger. According to Cleveland Clinic, you can get HMPV again, but symptoms are usually mild after your first infection. Severe symptoms and complications affect a small number of children (5-16%) who may develop a lower respiratory tract infection such as pneumonia. The majority of the infections occurred in children under the age of 14,

Once infected, patients will develop varying levels of immunity to subsequent exposures according to Cleveland Clinic. "You can get HMPV again, but symptoms are usually mild after your first infection."

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Robust new app in clinical trials may help with concussion diagnois

NORMAL - Miami Dolphins quarterback Tua Tagovailoa recently suffered his third confirmed concussion in 25 months – just another reminder that football and other contact sports pose the threat of a traumatic brain injury. Research indicates it’s important to accurately and immediately diagnose a concussion because the consequences of misdiagnosis or faulty management can lead to major disability or death.

Illinois State University senior Cyerra Hibbert knows about concussions. She’s had multiple ones while playing soccer in high school and at ISU, the most recent just a month ago. Hibbert is one of the first athletes to test a new FlightPath concussion app. The lead app developer is *Adam Cross, MD, a pediatric hospitalist and clinical informaticist for OSF HealthCare and director of the OSF Children’s Innovation Lab at Jump Simulation & Education Center in Peoria, Illinois. He is working with co-lead Inki Kim, of the Health Care Engineering Systems Center at the Grainger College of Engineering at the University of Illinois Urbana-Champaign.

The concussion assessment app is a grant-funded project through Jump ARCHES, a research collaborative that partners teams of clinicians and engineers working together to improve patient outcomes and reduce health care costs. The FlightPath app is being tested at Illinois State, Illinois Wesleyan and Bradley Universities as part of a clinical trial and research coalition. Hibbert used the FlightPath app after receiving instructions from her athletic trainer six days after she received a blow to the head during a game.

Cyerra Hibbert has suffered multiple concussions while playing soccer in high school and for the ISU Redbirds. Hibbert is one of the first athletes to test a new FlightPath concussion app.

Photo provided

Hibbert was able to finish the test. It only takes about two minutes to collect more than a million data points as a person tries to catch a hummingbird within a 3D space on a screen.

“After a while it did bring a little confusion or if I wasn’t aware of where the bird flew on or off the screen, that did trick a little bit of my memory and concentration skills, so I do think it’s definitely approachable," Hibbert explains. “It’s definitely doable. I think just based on your outcome will determine where you are in your concussion level.”

Photo provided

Dr. Adam Cross

Dr. Cross says the single biggest risk factor for prolonged time to recovery is delayed diagnosis, so FlightPath is his answer with its ability to diagnose a concussion within minutes. His research team has done some internal testing.

“Regarding how well it detects differences in impairments with people – how well they can determine if someone is functioning, acting appropriately, or if there's if there's something else going on. The challenge has been really doing that with individuals that have true concussion,” says Dr. Cross.

Athletes with a suspected concussion are challenged by FlightPath to walk in their environment while trying to keep a hummingbird in a bubble on the screen.

“The players themselves are trying out this app while concussed after having been consented earlier on in the year so that we can get data around how they perform with this app while concussed versus not concussed, and comparing that to the normal, typical present-day evaluation techniques that the trainers perform.”

Photo provided

Dr. Karan Rai

Dr. Cross stresses, right now, the clinical trial does not involve trainers using the app to help make decisions. He says the research is not that far along and data collection needs to happen first. But, Karan Rai, MD, a sports medicine physician with OSF HealthCare who also serves as the team doctor for ISU Athletics, says eventually, the data from FlightPath could help beyond diagnosis.

“It in turn can help us with making prognoses, coming up with recovery timelines, implementing certain vestibular therapy. Other than diagnostic purposes, we can extrapolate that data to help us come up with a better treatment plan as well.”

Takes the pressure off

Both Hibbert and Dr. Rai are excited to be part of what they consider ground-breaking research that has the potential for helping athletes in the future. Hibbert, who plans to go into medical sales, says it’s helpful to have an objective tool for an evaluation. She thinks it takes the pressure off athletes.

“Because as athletes, we’re always eager to be on the field or play the game and to have that mindset to be better and get back on your feet as quickly as you can. I think this app will allow you to really settle and to really take your time with your symptoms.”

The clinical trial is looking at whether FlightPath can do as good or better as traditional methods in diagnosing a concussion. So far, Dr. Rai says nearly 15 athletes who have suffered a concussion have completed a FlightPath assessment and it’s been performing well.

“Results are early so far but in our sample size we found some associations at least where FlightPath has shown some abnormalities similar to what other examinations have found as well, whether that’s the SCAT test or the ImPACT test.”

There are other concussion applications commercially available, but Dr. Cross suggests none are as robust as FlightPath.

“There aren't any, as far as I've seen, that use this mixed reality approach to gather the kinds of data that we're gathering. This is very rich data in a very short time in our app. One of the things that makes it so unique and sets it apart is that we get so much data about so many different manifestations of concussion in such a short time.”

Testing is expected to take at least two years. After testing, the app will be submitted to the FDA for clinical approval.

Chemical contaminates found in Illinois rivers threaten food chain

SNS - Scientists tested nine fish species from four northern Illinois rivers for contamination with per- or polyfluoroalkyl substances, synthetic chemicals found in numerous industrial and commercial products and known to be harmful to human health. They found fish contaminated with PFAS in every one of their 15 test sites. Elevated levels of PFOS, one type of PFAS compound, were found in nearly all fish tested.

Study found that there were high levels of PFASs contamination levels in channel catfish found in Illinois waterways.

G.C./Pixabay

The qualities that make PFAS desirable for industrial uses — their durability and stability under stresses such as high heat or exposure to water, for example — also make these chemicals particularly problematic in the environment and hazardous to human and animal health, said Joseph Irudayaraj, a professor of bioengineering at the University of Illinois Urbana-Champaign who led the new study.

The findings are reported in the journal Science of the Total Environment.

Short-chain PFASs (per- and polyfluoroalkyl substances) are widely used as alternatives to long-chain PFASs. Long-chain PFASs become gradually regulated under REACH (EC No. 1907/2006) and other international regulations, due to having persistent, bioaccumulative and toxic properties and/or being toxic for reproduction. The increasingly used short-chain PFASs are assumed to have a lower bioaccumulation potential.

“PFAS contain multiple carbon-fluorine bonds, one of the strongest bonds in organic chemistry,” Irudayaraj said, who is also a professor in the Beckman Institute for Advanced Science and Technology and an affiliate of the Carl R. Woese Institute for Genomic Biology and the Carle Illinois College of Medicine at the U. of I. “Because of this, they are also very hard to break down. They persist for a long time because they are very, very stable.”

Considering such permanent exposure, it is very difficult to estimate long-term adverse effects in organisms. Enriched in edible parts of plants, the accumulation in food chains is unknown.

There are nearly 15,000 PFAS chemicals, according to the U.S. Environmental Protection Agency. These are classified either as short-chain PFAS, which have less than six carbon-fluorine bonds, and long-chain PFAS, with six or more of these bonds, Irudayaraj said.

Long-chain PFAS were widely used before awareness grew about the hazards of these chemicals. More recently, many industries switched to using short-chain PFAS.

“It was thought that the short-chain PFAS were less toxic, and that they could more easily degrade,” he said. “But surprisingly, that was not the case.”

Now, both types of PFAS are found in groundwater, soil and human tissues.

Short-chain PFASs have a high mobility in soil and water, and final degradation products are extremely persistent. This results in a fast distribution to water resources, and consequently, also to a contamination of drinking water resources. Once emitted, short-chain PFASs remain in the environment. A lack of appropriate water treatment technologies results in everlasting background concentrations in the environment, and thus, organisms are permanently and poorly reversibly exposed. Considering such permanent exposure, it is very difficult to estimate long-term adverse effects in organisms. Enriched in edible parts of plants, the accumulation in food chains is unknown.

“About 99% of people living in the U.S. have PFAS in their system,” Irudayaraj said.

Studies on animals have shown that short-chain PFAS (per- and polyfluoroalkyl substances) are almost completely absorbed when ingested or inhaled but not much through the skin. Both short- and long-chain PFAS don't break down easily in the body due to their strong chemical bonds. Even if these chemicals start off in different forms, they eventually turn into acids through several steps, which can be more toxic than the original chemicals. One such toxic substance, perfluorohexyl ethanoic acid (FHEA), has been found in various tissues from deceased people, according to research published by The Danish Environmental Protection Agency in 2015.

The time it takes for these acids to leave the blood varies depending on the specific chemical, the species, and even the sex of the animal. In general, sulfonates (a type of PFAS) take longer to be eliminated than carboxylates (another type), and longer chains take longer to leave the body than shorter ones. In animals, the time is often shorter for females due to differences in how their bodies process these chemicals. The time these substances stay in the blood can range from a few hours to days in rodents, a bit longer in monkeys, and much longer in humans, sometimes lasting years. However, shorter-chain PFAS tend to leave the body faster, except for PFHxS (a six-carbon chain PFAS), which has a longer half-life in humans than some other PFAS like PFOA and PFOS.

Despite a voluntary phasing out of some PFAS in industry in the U.S. and efforts to reduce PFAS pollution, these chemicals are still found in drinking water, household products, food packaging and agricultural products, he said.

Fish from the Rock River had the highest concentrations of PFAS in their tissues.

The manufacturers of chemical products using PFAS argue that the newer short-chain PFAS is safer than the widely known long-chain contaminants. Despite this assertion, the Auburn study's significant findings challenge these statements. The research indicates that short-chain chemicals are frequently present in drinking water systems and could potentially endanger human and environmental well-being. Additionally, current removal methods are relatively less efficient when it comes to eliminating short-chain PFAS in comparison to long-chain PFAS.

The Auburn study analyzed over 200 individual studies on PFAS finding that the short-chain contaminants may be just as harmful as the long-chain versions, if not more. The short-chain PFAS have been linked to hormonal and reproductive system harm.

The researchers in the U of I study focused on fish in northern Illinois rivers because they are close to urban and industrial areas. Industrial emissions and urban rainwater runoff may further contaminate local waterways with PFAS. Sport fishing is also popular across the state, including in areas inside and near Chicago. More than 666,000 fishing licenses were issued across the state of Illinois in 2020.

The researchers narrowed their research down to the fish in the Pecatonica River, Rock River, Sugar River and Yellow Creek from 2021-22. The team collected dozens of samples from nine species of fish, including bluegill, channel catfish, common carp, northern pike, smallmouth bass and walleye. The fish represented different levels of the food chain, from those that feed only on plants, like bluegill, to those eating other fish, such as channel catfish and northern pike.

Back in the lab, the scientists analyzed fish tissues for 17 PFAS chemicals. They found PFAS-contaminated fish in every river they tested and in every one of their 15 sampling sites. Fish from the Rock River had the highest concentrations of PFAS in their tissues. Contamination levels were highest in channel catfish, at the top of the food chain, and lowest in the plant eaters.

Carnivore diet challenges norms, reveals health transformations

The carnivore diet is just one type of a low carbohydrate diet. The ketogenic diet and the Atkins diet are also considered low carbohydrate diets.

Photo: Pixabay/PEXELS

by Tim Ditman
OSF Healthcare

URBANA - Though not everyone is sold on it, Philip Ovadia, MD, isn’t shy about the carnivore diet. And the cardiothoracic surgeon at OSF HealthCare has studies and a remarkable personal experience to back it up.

“I’ve been on a carnivore diet for five years. For another two to three years prior, I was on low carbohydrate diets in general,” Dr. Ovadia recalls.

“I have lost over 100 pounds and maintained the weight loss. I reversed my prediabetes. And today as I’m approaching 50 years old, I really feel better every day than I did in my 20s and 30s.”

Dr. Ovadia says anyone can try the carnivore diet, but you should do so with guidance from a health care provider.

The carnivore diet: what (and what not) to eat

Dr. Ovadia calls the carnivore diet “our ancestral diet.” He says as long as humans have been around, meat has been a fundamental part of their diet. Ancestral humans would add plants, like fruits and vegetables, “seasonally and sporadically,” he says.

Today, the carnivore diet looks about the same. A person consumes animal products like meat, dairy and eggs but abstains from plant products and processed food. Some people are stricter than others about what they choose depending on their needs. For example, some people cut out spices and seasonings on their meat, while others use them.

Yes, Dr. Ovadia admits this diet flies in the face of advice we’ve heard since we were kids.

One, we’ve been told to incorporate fruits and vegetables into your diet.

“There are no essential nutrients that are not available in animal products,” Dr. Ovadia retorts. “The animal has eaten the fruits and vegetables. In many cases, ruminant animals like cows have multiple stomachs that are better able to digest the plant products and better able to extract the nutrients. Those nutrients end up in the animal meat.

“When you really dig into the scientific literature around fruits and vegetables, their benefit is in substituting for processed food,” which is prevalent today, Dr. Ovadia adds. “In the context of someone eating a lot of processed food, when you start eating fruits and vegetables, you see improvements in health.”

Two, we’ve heard red meat increases the risk of heart disease and cancer. Dr. Ovadia says studies have proven that false.

Dr. Ovadia also points out that the carnivore diet is just one type of a low carbohydrate diet, and those diets have been studied. The ketogenic diet and the Atkins diet are other low carbohydrate diets.

“It’s not that there are negative studies or positive studies,” on the carnivore diet, Dr. Ovadia says. “There just aren’t a lot of studies.”

Other things to know

Dr. Ovadia says studies and his own experience show the carnivore diet’s benefits: reversing or improving diabetes, obesity, autoimmune conditions, inflammatory bowel disease and mental health.

“People on the carnivore diet are often eating once or twice a day and not having snacks because they’re not hungry,” Dr. Ovadia says. “When you eat nutrient-dense animal foods, you find you’re hungry less often.”

If you have a medical condition, Dr. Ovadia stresses the need to keep in contact with a health care provider while on the carnivore diet.

“If someone with Type 2 diabetes goes on a very low carbohydrate diet, their medication may need to be adjusted. They’re not taking in carbohydrates, and their blood sugar can get low,” Dr. Ovadia warns. “I often see people with high blood pressure who are on medication that start these diets. Their blood pressure starts to get low, and their medication needs to be adjusted.”

Dr. Ovadia adds that people on the carnivore diet tend to have fewer bowel movements, but this is not usually accompanied by constipation.

ADHD in adults, online quizzes may spread misconceptions and mis-self-diagnosis

by Matt Sheehan
OSF Healthcare

We see depression leads to difficulty with concentration

PEORIA - If you spend time on social media, chances are you’ve seen an ad asking, “Do you have ADHD?”

The ads lead to a self-diagnosing quiz and often provides viewers with misconceptions about attention deficit hyperactivity disorder (ADHD), before they ever see a medical provider.

That’s where Kyle Boerke, PsyD, director of Behavioral Health Outpatient Services for OSF HealthCare, hopes to provide clarity.

ADHD starts in childhood, not in adulthood

“Are adults being diagnosed with ADHD? Absolutely, yes. Is it that they are developing ADHD in adulthood, that’s a no. We know enough about the research, that in order to receive a diagnosis of ADHD, we have to have symptoms starting in childhood. Somewhere near 7 years of age,” Dr. Boerke says.

If you’re having symptoms as an adult that appear to be ADHD, such as lack of focus, inability to sit still, fidgeting, or excessive talking, but you didn’t have these symptoms as a child, Dr. Boerke says you may be experiencing something else.

“We see depression leads to difficulty with concentration,” Dr. Boerke says. “Something inside of them will ring true (if they have ADHD), like if they always struggled with paying attention to their teacher in elementary school.”

What to do about an ADHD diagnosis?

“The easy answer is, we need to seek treatment from a professional,” Dr. Boerke says. “If you have thoughts that you’ve had ADHD symptoms for a long time and you take one of those online quizzes, that’s fine, that can be a starting point.” But he stresses, “I wouldn’t take that quiz and all of a sudden say ‘I have ADHD.’ A great place to start is with your primary care physician.”

Dr. Boerke adds that there’s no official test for ADHD. It’s a whole set of symptoms that include how it’s impacting your daily functioning and for how long.

There are three types of ADHD

1: Predominantly Inattentive

“They’re not going to be jumping all over the place, moving from activity to activity,” Dr. Boerke says. “It’s just going to be some hard times focusing, concentrating or finishing a task because your mind gets switched over to a different task all of a sudden.”

2: Predominantly Impulsive/Hyperactive

“These are the kids that just can’t sit still. They’re up out of their seats in the classroom, and this is really where ADHD in children to adults’ changes,” Dr. Boerke explains. “As we age, we do a better job managing the motoric end of things. It’s not uncommon to see kids have a hard time sitting still, it’s more uncommon to see somebody in a business meeting get up and walk around the room.”

3: Combined Presentation

Dr. Boerke describes the third type this way: “You have inattention, plus you have hyperactivity and impulsivity,” Dr. Boerke says.

Do I need to take medicine if I have ADHD?

Dr. Boerke says medicine alone isn’t the answer.

“The analogy I’ll use is Bear Grylls from Man vs. Wild. He’s an adventurer on a TV show where he goes out into the wild and he has to survive for a number of days,” Dr. Boerke says. “I liken ADHD to being on a Bear Grylls survivor show. He can do it. ADHD management without medication is like Bear gets dropped in the middle of the Florida Everglades and he has to trudge through the swamps, battle the alligators, get past the snakes and manage to get out. Can he do it? Yes, he does. Is it easy? It sure isn’t.”

Dr. Boerke says ADHD medication is as if Bear Grylls was in the Florida Everglades and producers drop him a rescue boat.

“But the reality is, he still has to get himself into the airboat. He has to start it, steer it, and do the work. It’s just easier to do the work,” Dr. Boerke adds. “Medication is not the fix. It can help, but if you don’t change your lifestyle, put in some organizational tools and do the things necessary, we’re still not going to get better and you’re going to rely on the medication.”

If you’re an adult and think you have ADHD, Dr. Boerke says seeking medical attention by a professional is the best first step. Then, your medical provider will help map out a plan moving forward. This can include ADHD medication and working to keep a strict routine to help you manage any ADHD symptoms.

Risk of dementia is nearly three times higher the first year after a stroke

DALLAS — Having a stroke may significantly increase the risk of developing dementia. The risk of dementia was the highest in the first year after a stroke and remained elevated over a period of twenty years, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2024. The meeting will be held in Phoenix, Feb. 7-9, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

“Our findings show that stroke survivors are uniquely susceptible to dementia, and the risk can be up to 3 times higher in the first year after a stroke. While the risk decreases over time, it remains elevated over the long-term,” said lead study author Raed Joundi, M.D., D.Phil., an assistant professor at McMaster University in Hamilton, Ontario, Canada, and an investigator at the Population Health Research Institute, a joint institute of McMaster University and Hamilton Health Sciences.

To evaluate dementia risk after stroke, the researchers used databases at the Institute for Clinical Evaluative Sciences (University of Toronto, Canada), which includes more than 15 million people in the Canadian province of Ontario. They identified 180,940 people who had suffered a recent stroke — either an ischemic stroke (clot-caused) or intracerebral hemorrhage (bleeding within the brain) — and matched those stroke survivors to two control groups — people in the general population (who had not had a heart attack or stroke) and those who had had a heart attack and not a stroke. Researchers evaluated the rate of new cases of dementia starting at 90 days after stroke over an average follow-up of 5.5 years. In addition, they analyzed the risk of developing dementia in the first year after the stroke and over time, up to 20 years.

The study found:

The risk of dementia was highest in the first year after stroke, with a nearly 3-fold increased risk, then decreasing to a 1.5-fold increased risk by the 5-year mark and remaining elevated 20 years later.
Dementia occurred in nearly 19% of stroke survivors over an average follow-up of 5.5 years.
The risk of dementia was 80% higher in stroke survivors than in the matched group from the general population. The risk of dementia was also nearly 80% higher in stroke survivors than in the matched control group who had experienced a heart attack.
The risk of dementia in people who had an intracerebral hemorrhage (bleeding in the brain) was nearly 150% higher than those in the general population.

“We found that the rate of post-stroke dementia was higher than the rate of recurrent stroke over the same time period,” Joundi said. “Stroke injures the brain including areas critical for cognitive function, which can impact day-to-day functioning. Some people go on to have a recurrent stroke, which increases the risk of dementia even further, and others may experience a progressive cognitive decline similar to a neurodegenerative condition.”

Each year, about 795,000 people experience a new or recurrent stroke. Approximately 610,000 of these are first attacks, and 185,000 are recurrent attacks, according to the American Heart Association’s Heart Disease and Stroke Statistics 2024 Update. According to the CDC, of those at least 65 years of age, there is an estimated 7 million adults with dementia in 2014 and projected to be nearly 14 million by 2060.

“Our study shows there is a large burden of dementia after acute stroke in Canada and identifies it is a common problem that needs to be addressed. Our findings reinforce the importance of monitoring people with stroke for cognitive decline, instituting appropriate treatments to address vascular risk factors and prevent recurrent stroke, and encouraging lifestyle changes, such as smoking cessation and increased physical activity, which have many benefits and may reduce the risk of dementia,” Joundi said. “More research is needed to clarify why some people who have a stroke develop dementia and others do not.”

A 2023 American Heart Association scientific statement, Cognitive Impairment After Ischemic and Hemorrhagic Stroke suggests post-stroke screenings and comprehensive interdisciplinary care to support stroke survivors with cognitive impairment.

A limitation of the study is that administrative data, hospital records and medication dispensary data were used for the analysis. Researchers were not able to perform cognitive assessments or neuroimaging (noninvasive images of the brain) on stroke survivors, therefore, there is no way to confirm the dementia diagnosis or type of dementia. However, the dementia definition was previously validated and shown to be accurate when compared to medical charts.