Study Could Help Identify 'Coma' Patients More Likely To Recover

A study published this week could help doctors to identify patients with brain injuries, in seemingly unresponsive states, who are more likely to recover.

In the study, published in the journal Brain on Monday, researchers identified what may be the source of a curious phenomenon known as "hidden consciousness" or cognitive motor dissociation (CMD).

Hidden consciousness is seen in patients with acute brain injury who appear to be in a coma or other unresponsive state.

Patients with CMD seem to be able to hear and comprehend verbal commands even though they cannot carry out those instructions because the body does not respond, study author Jan Claassen, a researcher at Columbia University and critical care neurologist at New York-Presbyterian/Columbia University Irving Medical Center, said in a statement.

The CMD phenomenon has only been identified in the past few years and is still poorly understood.

Methods have been developed to detect CMD in unresponsive patients. These include analyzing changes in electrical activity or cerebral blood flow recorded by an electroencephalogram (EEG) or functional magnetic resonance imaging (fMRI) respectively. But both of these methods currently have their limitations.

Nevertheless, it is thought that around 15 to 20 percent of patients who appear to be in a coma or another unresponsive state display signs of CMD when evaluated with such methods, Claassen told Newsweek. The detection of CMD is reshaping their understanding of patients in comatose or other unresponsive states.

Clinicians define when a patient is in a "coma" purely based on the clinical examination, Claassen said. They apply this label to patients who display a complete absence of arousal (for example, eye opening) and awareness.

Patients with CMD do not seem to be able to follow commands and may in clinical examination appear to be in a coma.

But an analysis of EEG or functional MRI, recorded while patients are given verbal commands, reveals that the brains of these unresponsive patients are being activated in a similar way to conscious patients, Claassen said. This supports the interpretation that patients with CMD are to some degree conscious.

Identifying patients with CMD has important clinical implications for interactions, communication with families and the guidance of therapeutic decisions, according to the study.

Importantly, in prior research, Claassen and colleagues have been able to associate CMD with the recovery of consciousness and long-term recovery of independence in brain-damaged patients.

Researchers have been trying to develop more effective screening methods to identify which patients are likely to be in a state of hidden consciousness. But progress has been hampered by the fact that the brain mechanisms underlying the phenomenon have remained a mystery. This is where the latest study comes in.

In previous research, Claassen and colleagues found that subtle brainwaves detectable with EEG are the strongest predictor of hidden consciousness and eventual recovery for patients with brain injuries.

For the latest study, the scientists used EEG to examine 107 unresponsive patients with acute brain injury. Almost half of the patients appeared comatose, while one quarter were in a vegetative state—i.e. their eyes were open but they could not follow commands.

The remaining patents were in a minimally conscious state—meaning they could track an examiner with their eyes or look at them but were not able to follow any commands.

Using the EEG, scientists can identify when patients are trying, but are unable, to respond to a command such as "keep opening and closing your right hand."

This method detected CMD in 21 of the patients. The scientists then analyzed structural MRI brains scans from all the patients.

Using a special analysis technique, the team were able to identify patterns of brain injury that the patients with CMD shared and contrast those to the individuals who did not display signs of hidden consciousness.

The researchers found that all of the CMD patients had intact brain structures related to arousal and command comprehension. This supports the idea that they were able to hear and understand the verbal commands.

But they also found that the CMD patients had damage to brain regions responsible for integrating and carrying out motor commands, which is why they were unable to take action.

"Our study suggests that patients with hidden consciousness can hear and comprehend verbal commands, but they cannot carry out those commands because of injuries in brain circuits that relay instructions from the brain to the muscles," Claassen said in the statement.

The findings could lead to more frequent and earlier diagnosis of CMD. This, in turn, could help better predict which brain-injured individuals are more likely to recover with rehabilitation, according to the scientists.

More research is required before the approaches documented in the study can be applied to clinical practice. But the latest study shows that it may be possible to screen for CMD using widely available structural brain-imaging techniques.

Due to the technical complexity of CMD detection, at this time it is only available in a few academic centers. As a result, the vast majority of patients with hidden consciousness in the United States and around the world remain undiagnosed.

"Not every critical care unit may have resources and staff that is trained in using EEG to detect hidden consciousness, so MRI may offer a simple way to identify patients who require further screening and diagnosis," Claassen said in the statement.

Study: Adding More Olive Oil to Your Diet May Help Reduce the Risk of Dying From Dementia

Fact checked by Nick Blackmer

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Replacing some fats like margarine or mayonnaise with olive oil in your diet could help reduce the risk of dying from dementia—a particularly important finding as many countries face rising rates of Alzheimer’s disease and related dementias.

The claim comes from a new study presented Monday at NUTRITION 2023, the annual meeting of the American Society of Nutrition. It’s the first study to investigate the relationship between diet and dementia-related death.

“Our study reinforces dietary guidelines recommending vegetable oils such as olive oil and suggests that these recommendations not only support heart health but potentially brain health, as well,” presenting study author Anne-Julie Tessier, RD, PhD, a postdoctoral fellow at the Harvard T.H. Chan School of Public Health, said in a news release. “Opting for olive oil, a natural product, instead of fats such as margarine and commercial mayonnaise is a safe choice and may reduce the risk of fatal dementia.”

Dementia is not a specific condition but an umbrella term for a range of conditions that involve losing the ability to think and remember enough to interfere with daily life and activities. Alzheimer’s disease, which affects more than 6 million Americans, is the most common form of dementia. It’s also considered fatal because it has no cure.

Related: How to Tell the Difference Between Normal Age-Related Memory Changes and Dementia

For the study, which has not yet been peer-reviewed or published in a scientific journal, scientists analyzed data from more than 90,000 Americans over the course of three decades—60,582 participants were women; 31,801 were men. Over the course of the study, 4,749 participants died from dementia.

Researchers found that participants who consumed more than half a tablespoon of olive oil each day had a 28% lower risk of dying from dementia, compared to those who never or rarely consumed olive oil.

Further, replacing 5 grams or about one teaspoon of margarine or mayonnaise a day with olive oil was associated with an 8–14% lower risk of fatal dementia. This was independent of overall diet quality, researchers said.

It’s also important to note that the individuals who died of dementia were more likely to be APOe4 carriers, a gene that increases the risk of Alzheimer’s disease and causes their bodies to make more cholesterol. Results were still consistent after adjusting for APOe4.

Though the research is observational and doesn’t prove that olive oil causes a reduced risk of fatal dementia, it does suggest that olive oil may have properties that are beneficial for brain health in addition to its heart health benefits.

“Some antioxidant compounds in olive oil can cross the blood-brain barrier, potentially having a direct effect on the brain,” Tessier said in the news release. “It is also possible that olive oil has an indirect effect on brain health by benefitting cardiovascular health.”

Related: A New Study Links Olive Oil Intake to Lower Risks of Heart Disease and Alzheimer's

The Dietary Guidelines for Americans already recommend limiting saturated fats and replacing them with unsaturated fats like olive oil to help lower “bad” LDL cholesterol in the blood and reduce the risk of cardiovascular disease.

A 2021 study published in the Journal of the American College of Cardiology found that the same olive oil measurement used in the new study—more than half a tablespoon of olive oil a day—was associated with a 14% lower risk of heart disease, compared to no olive oil consumption.

Olive oil has also been shown to help reduce inflammation and lessen the risk of type 2 diabetes. Replacing other fats like mayonnaise, butter, and margarine with olive oil has been associated with an 8–34% lower risk of death from all causes—including cancer-related mortality, neurodegenerative disease-related mortality, and respiratory disease-related mortality—as well.

While the new study has promising results and supports current research for the addition of olive oil as part of a healthy diet, more research needs to be done on olive oil’s impact on brain health and dementia-related death, and potentially determine optimal olive oil measurements.

Overall, the new research is in line with current dietary recommendations and adds even more evidence for using olive oil in place of other less-healthy fats like mayonnaise and margarine. It also offers hope that adopting healthy eating patterns that incorporate olive oil can help to prevent or slow down the progression of dementia.

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Teenage smokers have different brains than non-smoking teens, study suggests

CDC: 1 in 10 young adults are vaping regularly

A new study suggests that the brains of teenagers who take up smoking may be different from those of adolescents who don't take up the habit —  data that could help treat and prevent nicotine addiction from an early age. 

A research team led by the universities of Cambridge and Warwick in Britain and Fudan University in China found that teens who started smoking cigarettes by 14 years of age had significantly less grey matter in a section of the brain's left frontal lobe. 

Tuesday's findings, published in the scientific journal Nature Communications, indicate that adolescents with less grey matter on the left frontal lobe have less cognitive function and therefore are more inclined to break rules and develop bad habits such as smoking. 

The left frontal lobe is linked to decision-making and rule-breaking. Grey matter is the brain tissue that processes information, and its growth and development peaks for humans in their teenage years.   

Notably, researchers found that the right part of the same brain region also had less grey matter in teenage smokers. 

The right frontal lobe of the brain is linked to the seeking of sensations and the research team found that the right frontal lobe shrinks for teenagers who smoke regularly -- which may lead to addiction and affect the ways adolescents seek pleasure.

Scientists hope the combined results may help in intervening and preventing teenagers from taking up the bad habit before addiction takes hold. 

"Smoking is perhaps the most common addictive behaviour in the world, and a leading cause of adult mortality," said Cambridge University Professor Trevor Robbins, who co-authored the study. 

"The initiation of a smoking habit is most likely to occur during adolescence. Any way of detecting an increased chance of this, so they can target interventions, could help save millions of lives," Robbins said in a press release on Tuesday. 

Around 1,600 young people try their first cigarette before the age of 18 every day in the United States, and nearly half a million Americans die prematurely each year from smoking or exposure to secondhand smoke, according to the CDC. 

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