Motor learning in the VOR: the cerebellar component

This paper reviews results that support a model in which memory for VOR gain is initially encoded in the flocculus, and in which cerebellar LTD and LTP are responsible for gain increases and gain decreases, respectively. We also review data suggesting that after it is encoded, motor memory can either be disrupted, possibly by a local mechanism, or else consolidated. We show that consolidation can be rapid, in which case the frequency dependence of learning is unchanged and we will argue that this is consistent with a local mechanism of consolidation. In the longer term, however, the available evidence supports the transfer of memory out of the flocculus. In new experiments reported here, we address the mechanism of memory encoding. Pharmacological evidence shows that both mGluR1 and GABA(B) receptors in the flocculus are necessary for gain-up, but not for gain-down learning. Immunohistochemical experiments show that the two receptors are largely segregated on different dendritic spines on Purkinje cells. Together with what is already known of the mechanisms of cerebellar LTD and LTP, our data suggest that the direction of learning may be determined by interactions among groups of spines. Our results also provide new evidence for the existence of frequency channels for vestibular signals within the cerebellar cortex.

Formulation of evidence-based messages to promote the use of physical activity to prevent and manage Alzheimer's disease

Background

The impending public health impact of Alzheimer’s disease is tremendous. Physical activity is a promising intervention for preventing and managing Alzheimer’s disease. However, there is a lack of evidence-based public health messaging to support this position. This paper describes the application of the Appraisal of Guidelines Research and Evaluation II (AGREE-II) principles to formulate an evidence-based message to promote physical activity for the purposes of preventing and managing Alzheimer’s disease.

Methods

A messaging statement was developed using the AGREE-II instrument as guidance. Methods included (a) conducting a systematic review of reviews summarizing research on physical activity to prevent and manage Alzheimer’s disease, and (b) engaging stakeholders to deliberate the evidence and formulate the messaging statement.

Results

The evidence base consisted of seven systematic reviews focused on Alzheimer’s disease prevention and 20 reviews focused on symptom management. Virtually all of the reviews of symptom management conflated patients with Alzheimer’s disease and patients with other dementias, and this limitation was reflected in the second part of the messaging statement. After deliberating the evidence base, an expert panel achieved consensus on the following statement: “Regular participation in physical activity is associated with a reduced risk of developing Alzheimer’s disease. Among older adults with Alzheimer’s disease and other dementias, regular physical activity can improve performance of activities of daily living and mobility, and may improve general cognition and balance.” The statement was rated favourably by a sample of older adults and physicians who treat Alzheimer’s disease patients in terms of its appropriateness, utility, and clarity.

Conclusion

Public health and other organizations that promote physical activity, health and well-being to older adults are encouraged to use the evidence-based statement in their programs and resources. Researchers, clinicians, people with Alzheimer’s disease and caregivers are encouraged to adopt the messaging statement and the recommendations in the companion informational resource.

Canadian epilepsy priority-setting partnership: Toward a new national research agenda

BACKGROUND

Health research agendas are often set by researchers or by industry and may not reflect the needs and priorities of end users. This priority-setting partnership (PSP) for epilepsy was undertaken to identify the most pressing unanswered questions about epilepsy and seizures from the perspective of people with epilepsy (PWE) and their care providers.

METHODS

Using the methodology developed by the James Lind Alliance (JLA), evidence uncertainties were gathered via online surveys from stakeholders across Canada. Submissions were formed into summary questions and checked against existing evidence to determine if they were true uncertainties. Verified uncertainties were then ranked by patients, caregivers, and healthcare providers and a final workshop was held to reach a consensus on the top 10 priorities.

RESULTS

The final top 10 list reflects the priority areas of focus for research as identified by the Canadian epilepsy community, including genetic markers for diagnosis and treatment, concerns about living with the long-term effects of epilepsy, and addressing knowledge gaps in etiology and treatment approaches.

CONCLUSION

This project represents the first systematic evidence of patient- and clinician-centered research priorities for epilepsy. The results of this priority-setting exercise provide an opportunity for researchers and funding agencies to align their agendas with the values and needs of the epilepsy community in order to improve clinical outcomes and quality of life (QOL) for PWE.