The Potential Effects of a Compounded Methylcobalamin Nasal Spray on Short-term Memory Loss After Intracranial Hemorrhage: A Case Report.

Short-term memory loss is a common complication after intracranial hemorrhage or traumatic brain injury. FDA-approved cholinesterase inhibitors for memory symptoms of Alzheimer's disease have not been proven effective for improving memory impairment resulting from a hemorrhagic event. The purpose of this case study was to present the potential effectiveness of a compounded nasal spray containing methylcobalamin in improving short-term memory function in a patient post-intracranial hemorrhage. The patient started to administer the methylcobalamin nasal spray once daily after suffering from short-term memory loss for four years. His verbal memory, visual memory, and quality of life were assessed by the Hopkins Verbal Learning Test-Revised, Benton Visual Retention Test, and the 36-Item Short Form Survey, respectively, at baseline and 30 days after treatment. The delayed recall test was repeated after 60 days. After 30 days of treatment, the patient received improved scores in both verbal and visual memory tests, as well as improved self-reported quality of life. The patient became less dependent on phone reminders in daily life. The improvement in delayed recall remained significant after 60 days of treatment. This case report suggests a potentially safe and effective therapy for attenuating short-term memory impairment after intracranial hemorrhage.

Osteoporosis screening in postmenopausal women aged 50-64 years: BMI alone compared with current screening tools.

OBJECTIVES: Consensus on when to initiate DXA screening for early postmenopausal women (< 65 years of age) is lacking. Low body mass index (BMI) has been proposed as one of the major risk factors for osteoporosis. This study sought to compare the predictive performance of BMI alone with 5 screening modalities (the U.S. Preventive services task force [USPSTF] FRAX threshold of 9.3%, a risk factor based approach [≥ 1 risk factors], the osteoporosis self-assessment tool [OST < 2], the osteoporosis risk assessment instrument [ORAI ≥ 9], and the simple calculated osteoporosis risk estimation [SCORE ≥ 6]) in identifying early postmenopausal women with osteoporosis. METHODS: Postmenopausal women aged 50-64 years presenting for a DXA test were recruited between January 1, 2007, and March 1, 2009. Demographic data and osteoporosis risk factors were obtained through a telephone survey. The performance of each screening tool in predicting osteoporosis was compared. RESULTS: Of 445 study participants, 95% were White, 38 had osteoporosis (T-score ≤ -2.5). BMI (< 28) was associated with the highest Sensitivity (95%), the lowest Negative Likelihood Ratio (LR-) of 0.14, an AUC of 0.73, and the number needed to scan (NNS) of 8. The USPSTF approach had the lowest sensitivity (24%), highest LR- (0.91), lowest AUC (0.62), and highest NNS (9). Among 5 established modalities, SCORE (≥ 6) appears to be the best (sensitivity: 92%, LR-: 0.24, AUC: 0.75, NNS: 9). CONCLUSION: BMI (< 28) had a comparable numerical screening performance overall to the current screening modalities. BMI (< 28) could be considered a potential indicator when screening early postmenopausal White women for osteoporosis. However, a better osteoporosis screening tool remains to be developed.