Mark J. Fuerst

The ability to balance on 1 leg may be an important test for brain health, according to a new study.

"Individuals showing poor balance on 1 leg should receive increased attention, as this may indicate an increased risk for brain disease and cognitive decline," said lead author Yasuharu Tabara, PhD, Associate Professor at the Center for Genomic Medicine at Kyoto University Graduate School of Medicine in Kyoto, Japan. “Postural instability was found to be associated with early pathological changes in the brain and functional decline, even in apparently healthy subjects.”

In addition to common clinical risk factors, postural instability has been postulated to be associated with cerebral small-vessel disease in older, frail patients. The researchers conducted a cross-sectional study of nearly 1,400 adults, average age 67 years, to understand the possible link between postural instability and asymptomatic cerebral small-vessel disease.

To measure 1-leg standing time, the participants stood with their eyes open and raised 1 leg. The maximum time for keeping the leg raised was 60 seconds. They performed this examination twice and the better of the 2 times was used in the study analysis.

Cerebral small vessel disease was evaluated using brain magnetic resonance imaging. Mild cognitive impairment was assessed using a computer-based questionnaire, and carotid intima-media thickness as an index of atherosclerosis was measured via ultrasonography.

The study did not assess participants' histories of falling, how fast they could walk or any gait abnormalities.

The researchers found that the inability to balance on 1 leg for longer than 20 seconds was associated with cerebral small vessel disease. They noted that about one-third of those with more than 2 lacunar infarction lesions had trouble balancing, and 16% of those with 1 lacunar infarction lesion had trouble balancing. Some 30% of those with more than 2 microbleed lesions had trouble balancing, and 15.3% with 1 microbleed lesion had trouble balancing.

Overall, those with cerebral diseases were older, had high blood pressure and had thicker carotid arteries than those who did not have cerebral small vessel disease. However, after adjustment for these covariates, people with more microbleeds and lacunar infarctions in the brain had shorter 1-legged standing times. Short 1-legged standing times were also independently linked with lower cognitive scores.

This is 1 of the first studies to examine how long a person can stand on 1 leg as an indication of overall brain health.

Previously, the researchers had also found a strong link between struggling to stand on 1 leg and increased age, with marked shorter 1-leg standing time in patients age 60 and over.

"1-leg standing time is a simple measure of postural instability and might be a consequence of the presence of brain abnormalities," said Dr Tabara.

The 1-leg standing test is an easy way to determine if patients have early signs of being at risk for a stroke and cognitive impairment and whether they need additional evaluation, Dr Tabara said.

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The 1-leg standing test is an easy way to determine if a patient has early signs of being at risk for a stroke and cognitive impairment and whether additional evaluation is needed,

Simple Balance Test May Indicate Stroke Risk

So many good headache studies  . . . so little time!

Here is a brief synopsis of 2 new articles on headache that we randomly culled from pubmed-each with full text and links - that we thought you would want to know about, but which you might easily miss.

Commercially available mobile phone headache diary apps: a systematic review.

Headache diaries are often used by patients to self-monitor their headaches. With advances in mobile technology, mobile electronic diary apps are becoming increasingly common. This review identified and evaluated all commercially available mobile headache diary apps for the 2 most popular mobile phone platforms: iOS and Android.

Based on a set of 7 criteria that define an ideal headache diary app:
• Of the 38 apps identified, none met all 7 app criteria.
• The 3 highest scoring apps were iHeadache, ecoHeadache,  and Headache Diary Pro.
• Only 18% of the apps were created with scientific or clinical headache expertise.
•  None of the apps reported on psychometric properties.

Although headache diary apps have proliferated, most do not meet reasonable quality standards. More emphasis on the quality of these tools is needed, which are easily accessed and used by patients to self-manage their headaches.

Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial.

About half of patients with chronic headache have medication-overuse headache, caused by use of headache medication 10 to 15 days per month (depending on type of medication) for at least 3 months. This double-blind, pragmatic and cluster-randomized controlled trial included more than 25,000 patients who were screened for medication-overuse headache by 50 general practitioners. About half of these clinicians received training in brief intervention, which involved providing feedback about an individual patient’s risk of medication-overuse headache and specific recommendations about how to reduce overuse; the other clinicians continued business as usual with their patients.


• Headache and medication days were reduced by 7.3 and 7.9 days per month (95% CI 3.2 to 11.3 and 3.2 to 12.5) in the brief intervention group compared to the business-as-usual group, respectively.
• Chronic headache resolved in 50% of patients who received brief intervention and in only 6% of those in the business-as-usual group.

Brief intervention provides clinicians with a powerful, time efficient instrument for managing medication-overuse headaches. The treatment is behavioral, simple and inexpensive, and has no side effects.
 

1.  Hundert AS, Huguet A, McGrath PJ et al. Commercially available mobile phone headache diary apps: 

2014 Aug 19;2(3):e36.
2. Espen Saxhaug Kristoffersen ES, Straand J, Vetvik KG, et al. Brief intervention for medication-overuse headache in primary care. 

The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial. 

 11 August 2014. doi:10.1136/jnnp-2014-308548
 

So many good headache studies  . . . so little time! Here's a little help.

Mark J. Fuerst

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Simple Balance Test May Indicate Stroke Risk

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