Narrowing of Neck Artery Without Warning May Signal Memory and Thinking Decline

For the first time, researchers have demonstrated that narrowing of the carotid artery in the neck without any symptoms may be linked to problems in learning, memory,  thinking and decision-making, compared to people with similar risk factors but no narrowing in the neck artery, according to a study released today that will be presented at the American Academy of Neurology’s 66th Annual Meeting in Philadelphia, April 26 to May 3, 2014.

“To date, the focus of diagnosis and management of carotid artery blockages has been prevention of stroke since that was the only harm that these blockages were thought to cause to patients,” said Brajesh K. Lal, MD, with the VA Maryland Health Care System’s Baltimore VA Medical Center and the University of Maryland School of Medicine in Baltimore. “These results underscore the importance of assessing the status of memory and thinking in people with carotid artery narrowing.”

Narrowing of arteries occurs when plaques build up in the artery, and they can harm the brain by restricting proper blood flow or by showering little pieces of plaque into the brain.

The study involved 67 people with the condition, called asymptomatic carotid stenosis (ACS), with a 50-percent reduction in the diameter of the artery and 60 people with vascular risk factors but without the condition. Risk factors included diabetes, high blood pressure, high blood cholesterol and coronary artery disease. The participants underwent extensive testing for overall thinking abilities, and for specific aspects of thinking such as: processing speed, learning, memory, decision-making and language.

The study found that the ACS group performed significantly worse on the overall memory and thinking tests. On testing of specific aspects of thinking, they performed worse on tests for motor and processing speed, and learning and memory. Language scores did not differ between the two groups.

“If these findings are confirmed in larger studies, they hold significant implications for new treatment targets and open the door for more questions such as: should these patients be treated more aggressively with medications, cognitive rehabilitation, or even surgery to open up the artery,” said Lal. “I anticipate a large number of follow-up studies searching for causes and the best treatment option for this newly identified morbidity associated with carotid narrowing.”

The study was supported by the US Department of Veterans Affairs.

Learn more about cognition at www.aan.com/patients.

The American Academy of Neurology, an association of more than 27,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visit
http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

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Medicare Patients Face Danger Going To Doctors’ Offices Says AAHomecare

Dorena Hyatt of Meyersdale, Pa., has been disabled since the age of 12.  “My disability affected my legs and I am no longer able to walk,” said Hyatt. Now 65 years old, she lives alone and maintains her independence by using a power wheelchair.

A component on Hyatt’s chair recently broke, causing the electric unit to hang off the frame. But getting her chair fixed proved to be a bigger problem than it should have been.

“After talking to my durable medical equipment supplier I was told that they could not replace certain parts without physically going to a doctor to get a prescription to fix the part. It took two weeks to get an appointment, and it was well over two weeks that I had a malfunctioning chair,” said Hyatt. “Living in fear that the chair could malfunction at any time, knowing I could not perform my daily activities was a horrible burden.”

Yet, Medicare required Hyatt’s doctor to re-evaluate her need for the chair and confirm that the chair was broken. So, she had to find a way to get to her doctor’s office before her medical equipment supplier could make repairs.

The day of her doctor’s appointment Hyatt took her broken, unsafe chair on public transportation, which is infrequent where she lives, for her face-to-face exam. “In the middle of winter, the ice and snow on the sidewalks and streets potentially put my life in danger. And the chair could have stopped functioning at any point to or from the doctor’s office,” said Hyatt.

“I consider the doctor’s appointment to be an unnecessary step since the doctor did not provide the chair to me, nor does the doctor perform maintenance on the chair. Having to go to the doctor was an unbelievable burden to me because I did not trust the chair and it added too much time to getting the chair fixed in a reasonable manner,” Hyatt explained. “Would you want a family member to go through this? I am a grandmother with a disability who is desperately fighting to keep her independence, and laws like this do not help disabled citizens. Change the laws.”

Although the Centers for Medicare and Medicaid Services required face-to-face exams for certain products prior to passage of the Affordable Care Act, these requirement were expanded in the new law. As of April 1, a face-to-face exam must be performed within six months of a prescription for the following:

  • All claims for purchases or initial rentals
  • When there is a change in the prescription for the accessory, supply, drug, etc.
  • If a local coverage determination requires periodic prescription renewal (i.e., policy requires a new prescription on a scheduled or periodic basis)
  • When an item is replaced
  • When there is a change in the supplier
  • When required by state law

The American Association for Homecare represents durable medical equipment providers, manufacturers, and others in the homecare community that serve the medical needs of millions of Americans who require oxygen systems, wheelchairs, medical supplies, inhalation drug therapy, and other medical equipment and services in their homes. Members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org.

SOURCE American Association for Homecare

CONTACT: Julie Driver, 202-372-0749, julied@aahomecare.org

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