Early Life Working Impacts Cognitive Decline, Cleveland Clinic Awarded NIH Grant, Earlier Treatment More Effective in Parkinson Disease


Neurology News Network for the week ending November 21, 2020.

This week Neurology News Network covered a study that demonstrated the effects working in the paid labor force may have on memory decline in women, a recently awarded grant by the National Institutes of Health to Cleveland Clinic, and results from a trial that showed the benefits of starting earlier treatment in patients with Parkinson disease.

Welcome to this special edition of Neurology News Network. I’m Marco Meglio. Please excuse our appearance this week as a majority of the US workforce, including the NeurologyLive team, moves to working remote as we come together to help reduce the spread of the novel coronavirus.

Recently released results from a study published in Neurology suggest that participation in the paid labor force may protect against later-life memory decline. Women who worked for pay in early adulthood and midlife experienced slower rates of later-life memory decline, regardless of marital and parenthood status. Lead author Elizabeth R. Mayeda, assistant professor, UCLA School of Public Health, and colleagues collected data on women from the Health and Retirement Study, and found that between age 60 and 70 years, the average rate of memory decline was 50% greater among women whose work-family profiles did not include working for pay post-childbearing, compared with those who were working mothers. Between ages 60 and 70 years, average memory score decline was 0.69 standardized units among working married mothers. In comparison, average memory score decline was 1.25 standardized units among non-working married mothers.

Cleveland Clinic announced they have been awarded a $2.6 million grant from the National Institute on Aging to develop and validate 2 automated tools – a risk calculator to identify patients at high risk of cognitive decline and a screening tool to test for the condition. An interdisciplinary team at Cleveland Clinic aims to create a low-cost, time-efficient procedure that can be used in primary care settings to identify and screen patients at high risk of cognitive decline. The team’s five-year research project involves two phases. In the first, researchers will focus on developing and validating a low-cost risk calculator that estimates patients’ likelihood of experiencing cognitive declines over the next five years. They will collaborate with Michael Kattan, PhD, chair of the Department of Quantitative Health Sciences in Cleveland Clinic’s Lerner Research Institute. The tool uses information from the medical record, such as health status indicators, demographics and socioeconomic status, to predict who is at high risk for developing cognitive deficits.

New observational study data suggest that early initiation of treatment in patients with Parkinson disease may offer small improvements in Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores but does not appear to worsen outcomes. Using a cohort of 302 patients with de novo Parkinson disease from the Parkinson's Progression Markers Initiative (PPMI), Bastiaan R. Bloem, medical director, Department of Neurology, Radboud University Medical Center, and colleagues observed that after 2 years there was a small improvement for those who started treatment earlier, though it was not significant. Additionally, there were similar nonsignificant improvements in subsequent years. The group added that the findings of this assessment support prior randomized controlled trial findings of a lack of clinical disease progression with earlier initiation of dopaminergic treatment. As well, the absence of strong evidence of more adverse effects with earlier treatment (levodopa‐induced dyskinesias or motor fluctuations) can alleviate the concerns regarding those effects with early initiation of dopaminergic therapy.

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