Regular exercise can extend cognitive life expectancy

The life expectancy of Americans has grown dramatically over the past 50 years thanks to major advances in medical science. Unfortunately, advancing age has brought with it an increase in age-related conditions including visual loss, arthritis, vascular disease and kidney disease.

Neurodegenerative conditions including Alzheimer’s disease and other related dementias have presented some of the greatest challenges to enjoying these advancing years.

Approximately 5.7 million Americans suffer from Alzheimer’s disease. It is a disease that robs its victims of their most intimate memories and the ability to learn new information. These numbers will grow as the population ages and this has lead to the application of a new measure termed “cognitive life expectancy.“

Cognitive life expectancy is best defined as the length of time adults can live with good versus declining brain health. A recent study presented at a national meeting estimates that Americans have an average of 12 years of good cognitive health beyond age 65.

A series of recent articles published in the journal Neurology and its related publications have looked at proven ways to increase cognitive life expectancy through exercise.

In general, fitness activities were considered to be aerobic, resistance and a combination of aerobic and resistance. Mind-body exercises including yoga and tai chi were considered as a separate mode.

In one comprehensive review of the literature on this topic, a combination of one hour per day, three times per week of any of these modalities resulted in improved cognitive testing.

A study of Swedish women over a period of 44 years found that women with a high level of cardiovascular fitness during midlife had an 88 percent decrease in dementia compared to a medium fitness group.

Participation in a regular exercise program can be a big factor in extending the cognitive lifespan. Although this can be helpful at any age, following an exercise regimen beginning in early life has the most benefit.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Overuse injuries in youth sports have become common

Youth sports have evolved over recent decades. Among the most obvious changes are the higher levels of competition. It is not uncommon for an athlete to compete for several different teams during the same season. This uncontrolled exposure to injury often results in overuse orthopedic injuries in children.

Overuse injuries are the result of chronic repetitive trauma to a joint. As opposed to an acute injury, the symptoms are subtle and gradually worsen, making diagnosis of these injuries more challenging.

Typically, these injuries affect the bones, muscles and tendons in a joint. They include sprains, strains and stress fractures. Treatment includes rest, ice and anti-inflammatory medications.

A recent study presented at the American Orthopedic Society for Sports Medicine looked at 149 Japanese pitchers ages 7-11. None of the athletes entered in the study had elbow pain at the beginning of the season. Those who threw more than 50 pitches a day and 200 pitches per week while playing in more than 70 games per year were more likely to develop elbow pain.

Some American little leagues do not allow an athlete to throw more than 50 pitches per game. Another solution to overuse is to play multiple sports that use different skills and biomechanics.

“Pain is the principal sign that it’s time to take a break,” reports Dr. Ashok Kotaratharra, a local pediatrician at UCFS. “Trying to hang in despite discomfort may lead to permanent injury.”

Parents should carefully monitor workout schedules and be sure that young athletes receive proper coaching to avoid overuse injuries that can shorten a potentially stellar sports career.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Be careful when exercising in the hot weather this summer

Athletes accustomed to performing their regular outdoor training regimens often continue despite drastic changes in climate. During summer months, this persistence can result in severe injury.

The human body strives to maintain an ideal body temperature of 98.6 degrees Fahrenheit. This requires the interaction of temperature receptors in the skin that relay information to the brain.

The hypothalamus is the area of the brain that interprets this information and, in the case of elevated temperatures, signals muscles and sweat glands to begin a cooling process. Any malfunction in the process, or subjecting the body to overwhelming temperatures, can result in heat-related illness.

Heat stroke is the most severe of the heat-related illnesses. It typically occurs when the body temperature rises in excess of 103 degrees.

The body responds by increasing the heart rate to pump more blood to the skin, where it can become cooled. It also pumps more blood to muscles to keep up with metabolic demand.

In an effort to lower the core temperature, blood is diverted from the brain and other essential organs. Symptoms include a racing heart rate, lightheadedness, muscle cramps, headache and confusion. If ignored, these symptoms can lead to a loss of consciousness.

“Here are three tips for exercising in hot weather,” reports Dr. Douglas Casa, Professor of Kinesiology at the University of Connecticut. “1) Take it easy — you can not push as hard as you can in cool conditions, so back off a little; 2) If you ever start to feel something is amiss, listen to your body and lower your intensity and seek cooler conditions; 3) have cold fluids and cooling towels at the ready for you or your children when exercising in the heat.“

Caution when exercising in extreme heat can avoid serious injury.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Heart failure amongst athletes always leads to questions

The recent tragic death of Hall of Fame basketball player and coach Anne Donovan has attracted the attention of many Connecticut Sun fans. What is most bewildering to many is how a highly-trained 56-year-old athlete passes away from heart failure.

The human heart consists of four muscular chambers: the right and left atria and the right and left ventricles. These chambers work in a coordinated fashion to pump blood from the right chambers to the lungs where it becomes enriched with oxygen and from the left chambers where blood is pumped to the brain and other organs.

Maintaining this coordination requires rhythmic stimulation from a network of nerves within the heart and blood vessels that nourish the heart muscle. Any malfunction of these components will lead to heart failure and subsequently deprive essential organs of needed oxygen.

The most common cause of heart failure in athletes is cardiomyopathy. This results from abnormalities that directly affect the heart muscle.

Similar to other muscles, the heart increases in size and efficiency as a response to the increasing demand of large muscles in athletes. This physiologic change in the heart muscle can hide other cardiac problems that affect the rhythm and blood supply to the heart muscle.

One way of detecting these changes in anticipation of a catastrophe is to perform advanced diagnostic studies including echocardiography that images the heart at rest and under stress.

“Structural changes of the heart in athletes such as enlarged chamber size and increased wall thickness are adaptive and physiological. However, some of these changes may overlap with cardiomyopathy,” reports Dr. Kai Chen, co-director of Sports Cardiology at the Calhoun Cardiac Center at UConn. “Early symptoms include an unexpected drop in performance, shortness of breath during exercise, chest tightness, and lightheadedness.“

Careful attention to cardiac symptoms during workouts can be lifesaving for athletes.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Beware of ticks at outdoor events

Athletes who compete in outdoor events in Connecticut must be especially mindful of ticks that carry a variety of bacterial infections. Although unlike viral infections, these conditions can be treated with antibiotics. The key is to identify and treat them quickly to avoid permanent injury.

Ticks are insects that survive by biting and digesting the blood of domestic and wild animals. They also bite humans and in turn transmit diseases from the animal to the human. As the population of potentially diseased animals has increased, so has the frequency of these illnesses.

Lyme disease is the most familiar and most common tick-borne bacterial infection. There are approximately 300,000 cases each year, most of these in the northeast.

Borrelia is the infectious agent in Lyme disease. Early symptoms are flu-like with joint pain, fever and a typical rash. If untreated the infection can spread to the nervous system. If infection is suspected, treatment with antibiotics within 72 hours of the tick bite can avoid Lyme disease entirely.

“Babesiosis and Anaplasmosis are other tick-borne diseases now being recognized more often,” reports Dr. Michael Rajkumar, a local infectious disease specialist. “These infections can cause severe illness and are sometimes fatal in certain populations such as infants, patients with immunodeficiencies and patients with certain blood disorders.“

Symptoms of Babesiosis are similar to Lyme disease but a persistent high fever and chills are an early hallmark. Treatment includes antibiotics combined with anti-malarial drugs.

Anaplasmosis, previously known as Ehrlichiosis, presents with symptoms one to two weeks after infection with a flu-like illness that can also lead to headaches and confusion if untreated.

Careful self-examination after competing or working out in tick-infested areas can be lifesaving.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Summer fun can be ruined by insect bites

The arrival of summer brings longer days, warmer temperatures and increased opportunity for outdoor activities. It also brings the opportunity for infections transmitted via insect bites. Among these infections are the arboviruses.

Arbovirus is a general term used to describe a variety of viral infections transmitted by infected arthropods. Among these are mosquitoes and ticks. The symptoms vary between the extremes of mild joint pain to life threatening brain infections.

Although Lyme disease presents with similar symptoms to arboviruses, it is the result of a bacterial infection that can be treated with antibiotics.

The frequency of encountering these viruses varies on geography. The most common arboviruses in the northeast include West Nile Virus, Eastern Equine Encephalitis and Powassan Virus Disease.

Initial symptoms of each of these infections include fever, rash, headache and joint pain. Fortunately, in most cases, these symptoms are self-limited. Treatment is primarily symptomatic with hydration, rest and anti-inflammatory medications.

More serious symptoms occur when the infection attacks the central nervous system resulting in encephalitis. These symptoms include persistent headache, confusion, seizures and loss of consciousness. Unfortunately, there is no specific treatment for viral encephalitis.

Golfers, hikers, trail runners and mountain bikers are most susceptible to infection based on their level of exposure. The best way to avoid infection is by wearing long-sleeved, light-colored clothing with pant legs tucked into socks. Frequently applying insect repellant with DEET to exposed surfaces is recommended.

As in most viral infections, elderly and very young patients are at highest risk.

“Insect repellant should never be applied to newborns and young children should not use products with more than 30 percent DEET,” reports Dr. Ashok Kottarathara, a local pediatrician in practice at United Community and Family Services. “Wristbands, smartphone apps and sonic repellents do not work against mosquitoes. Removal of all stagnant or standing water is another extremely effective way of preventing breeding of mosquitoes”.

Avoiding exposure to insect bites can be crucial to a more pleasant and safe summer.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Carpal tunnel injury is rare for pitchers

Last week, Boston Red Sox starting pitcher David Price was forced to miss at least one start due to symptoms of numbness in his dominant left hand. He was eventually diagnosed with carpal tunnel syndrome (CTS), a condition not commonly associated with major league pitchers. Subsequently, a controversy has ensued based on speculation that the condition is actually related to Price’s avid participation in computer games.

The carpal tunnel is a structure in the wrist formed by several bones at the base known as the carpal bones with a ligamentous roof called the flexor retinaculum. Within the tunnel a large nerve, known as the median nerve, brings sensation and movement to a discrete portion of the hand.

Narrowing of the carpal tunnel may be the result of direct trauma that produces acute swelling, arthritic changes in the carpal bones and enlargement of the flexor retinaculum due to repetitive use.

The presenting symptoms of CTS are usually neurological in nature as a result of compression of the median nerve. Typical complaints include changes in sensation in the thumb, index and middle digits of the affected hand. These include a tingling sensation that comes on during the night or when first awakening. Early symptoms oddly improve with movement such as shaking the hand. Later symptoms include weakness with fine movements involving the thumb and index finger.

The diagnosis is made by clinical examination and electrodiagnostic studies that can specifically isolate the area of injury to the median nerve and quantify the severity of the damage.

“Carpal tunnel syndrome is a very uncommon injury in baseball pitchers,” reports Dr. Joel Ferreira, an orthopedic hand surgeon at the UConn Musculoskeletal Institute. “It’s typically caused by constant repetitive use of the hands from lifting/typing or vibratory tool use as well as sewing and crocheting. In my practice, I rarely see patients develop CTS from video games.“

Conservative management includes the use of nocturnal wrist splints and steroid injections. Surgical decompression is reserved for more severe damage to the median nerve. Although the cause of Price’s CTS may be debated, the treatment options are clear.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Athletic genes are just one factor for success

Connor Svab, a local baseball standout at St. Bernard’s, is in many ways a baseball paradox. In addition to playing infield and pitching, he also plays varsity basketball. At 5-10, 140 pounds, he does not seem to possess the physical prowess valued by many professional teams.

Nevertheless, Svab has gotten the attention of scouts and will be heading to Castleton University to further his baseball career. Interestingly, both his father and great grandfather played professional baseball.

Scientists in the field of evolution have constantly raised the question of nature versus nurture. The arguments in favor of both approaches to development are most prominent in the field of sports. Are some athletes destined to reach great heights from birth or is greatness the product of hard work and opportunity?

Genes are the foundation of heredity. They contain the recipe for the production of proteins that make up the human body. Each person has two of each gene, one contributed by each parent. Those contributions produce our physical characteristics.

Brain growth also plays a prominent role in how a human develops. Specifically, the brain consists of a variety of networks that pass information to different areas within the brain. A brain cell is made up of a cell body and an elongated axon. The axon gradually becomes encased in an insulating material called myelin. Signals are transmitted along the myelin. Brain development is a dynamic process that spans through childhood and adolescence.

The maturation process includes making the brain operate more efficiently. It does this through a process of neuroplasticity. The brain eliminates some networks while making other regions of the brain operate faster and more precise. This can involve motor as well as sensory functions and result in rapid decision-making and reaction to a particular situation. This obviously can be a huge advantage in sports. It is believed that environment plays a big role in this phase of development. 

Lengthy discussions and analysis that center on baseball may have played a big role in the baseball development of Connor Svab.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

Concussions now a big part of retirement decisions

Wrestling fans are excited about the recent return of Daniel Bryan to the ring. Bryan, a star performer, was forced to retire two years ago due to multiple concussions. His return after multiple, comprehensive neurological evaluations has raised many questions regarding the criteria for medical retirement from sports after concussion.

Concussion is best defined as a group of neurologic symptoms that arise after a force is applied to the brain. Recovery from these symptoms can vary but the general accepted time frame is 10 days. This is often longer in children. The persistence of these symptoms is associated with post-concussion syndrome.

Repeated blows to the brain can result in permanent impairment with persistent headaches, cognitive difficulties, sleep abnormalities, emotional disturbances and other neurologic symptoms.

The often-asked question is: "How many blows can the brain tolerate before resulting in permanent damage?"

The human brain is a highly individualized organ. It consists of a mass of nerve cells that each has a threshold for injury. The challenge for physicians is to determine that threshold based on the symptoms suffered and the length of the recovery period.

There are some basic rules that indicate the need to retire from participation in high-velocity collision or combat sports. These include:

1. Persistent abnormalities on cognitive and psychological testing that can be linked to concussion
2. Structural abnormalities found in the brain that may be related to trauma or predispose the athlete to permanent injury
3. A demonstrated decreased threshold for injury over multiple, successive concussions

Another recent change in the presentation of sports-related concussion has been the desire to voluntarily withdraw from high-risk sports. Athletes, even at the highest levels of sport, are choosing that the risks outweigh the benefits.

In the case of Bryan or any other athlete, it is worth the time investment to seek out a highly qualified physician who works with athletes.

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu

NFLPA draws up a playbook for player safety

A playbook is a collection of strategies that allows a team to deceive their opponent at crucial times during the course of a contest. Football players are aware of the importance of their playbook and the secrecy that surrounds its contents. The National Football League Players Association (NFLPA) has taken the playbook concept and applied it to improving the health of all its members and their families.

The recently released NFLPA Health Playbook is a compendium of easy-to-understand health information that addresses common illnesses facing both active and former players. It was designed and written by members of the NFLPA Mackey-White Health and Safety Committee. It is divided into four broad sections:

1. Performance
2. Medical diseases and conditions
3. Orthopedics and musculoskeletal conditions
4. Neurology and neurotrauma

Specific topics were chosen based on information obtained through research conducted as part of the Football Player Health Study at Harvard University.

The performance section discusses the evaluation and treatment of sleep disorders, as well as a variety of mental health disorders. Among the medical conditions, diabetes mellitus and the potential complications from it are explained along with a variety of treatments. This section also addresses hypertension, hypercholesterolemia and peripheral neuropathy. The chapters covering neurologic conditions and concussions are highly informative.

“The NFLPA is committed to ensuring that our player members receive the best medical care in the world,” reports Sean Sansiveri, NFLPA vice president of business and legal affairs. “This playbook serves as our latest effort to equip players and their families with the knowledge and resources necessary to achieve overall wellness for their betterment as people and patients.”

Although the NFLPA Health Playbook provides a concise, thorough review of health topics designed to support active and former football players, it is actually an excellent guide for all athletes and the general public.

Like other playbooks, the health playbook will be continually updated as new medical issues and treatments develop. The full publication is available online as a courtesy of the NFLPA, and can be found by searching “NFLPA Health Playbook.”

Dr. Alessi is a neurologist in Norwich and serves as an on-air contributor for ESPN. He is director of UConn NeuroSport and can be reached at agalessi@uchc.edu.