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Adequate Sleep Associated With Lower Dementia Risk
Short and long daily sleep duration are risk factors for dementia and death in adults age 60 and older, according to a study published online ahead of print June 6 in the Journal of the American Geriatrics Society. In a prospective cohort study, researchers followed 1,517 adults without dementia for 10 years. Self-reported daily sleep durations were grouped into five categories. The association between daily sleep duration and risk of dementia and death was determined using Cox proportional hazards models. During follow-up, 294 participants developed dementia, and 282 died. Age- and sex-adjusted incidence rates of dementia and all-cause mortality were significantly greater in subjects who slept less than 5.0 hours/day or 10.0 or more hours/day than in people who slept from 5.0 to 6.9 hours/day.
Ohara T, Honda T, Hata J, et al. Association between daily sleep duration and risk of dementia and mortality in a Japanese community. J Am Geriatr Soc. 2018 Jun 6 [Epub ahead of print].
Rivaroxaban Not Superior to Aspirin for Stroke Prevention
Rivaroxaban is not superior to aspirin in the prevention of recurrent stroke, according to a study published June 7 in the New England Journal of Medicine. Researchers compared the efficacy and safety of rivaroxaban at a daily dose of 15 mg with aspirin at a daily dose of 100 mg for the prevention of recurrent stroke in patients with recent ischemic stroke that was presumed to be from cerebral embolism. The primary outcome was the first recurrence of ischemic or hemorrhagic stroke or systemic embolism in a time-to-event analysis. At 459 sites, 3,609 patients were randomly assigned to receive rivaroxaban, and 3,604 were randomized to aspirin. Recurrent ischemic stroke occurred in 172 patients in the rivaroxaban group and in 160 in the aspirin group.
Hart RG, Sharma M, Mundl H, et al. Rivaroxaban for stroke prevention after embolic stroke of undetermined source. N Engl J Med. 2018;378(23):2191-2201.
Disintegrating Brain Lesions May Indicate Worsening MS
Atrophied lesion volume may indicate increasing disability in patients with multiple sclerosis (MS), according to a study published online ahead of print June 1 in the Journal of Neuroimaging. A total of 192 patients with clinically isolated syndrome or MS received 3T MRI at baseline and at five years. Investigators quantified lesions at baseline and calculated new and enlarging lesion volumes during the study interval. Atrophied lesion volume was calculated by combining baseline lesion masks with follow-up SIENAX-derived CSF partial volume maps. The researchers evaluated correlations between these measures and disability, as measured by the Expanded Disability Status Scale (EDSS). Atrophied lesion volume was different between MS subtypes and exceeded new lesion volume accumulation in progressive MS. Atrophied lesion volume was the only significant correlate of EDSS change.
Dwyer MG, Bergsland N, Ramasamy DP, et al. Atrophied brain lesion volume: a new imaging biomarker in multiple sclerosis. J Neuroimaging. 2018 Jun 1 [Epub ahead of print].
Do Migraineurs Seek Behavioral Treatment After a Referral?
A significant number of migraineurs are not using effective behavioral treatments for migraine, according to a study published online ahead of print June 5 in Pain Medicine. In a prospective cohort study, researchers tracked 234 patients with migraine who presented to an academic headache center and referred 69 of them for behavioral treatment with an appropriately trained therapist. Fifty-three of the referred patients completed a follow-up interview within three months of their initial appointment and were included in the analysis. Of the patients referred for behavioral treatment, 30 made an appointment. Investigators found no differences between people who started behavioral therapy and people who did not. Study authors did find that people who had previously seen a psychologist for migraine were more likely to initiate therapy.
Minen MT, Azarchi S, Sobolev R, et al. Factors related to migraine patients’ decisions to initiate behavioral migraine treatment following a headache specialist’s recommendation: a prospective observational study. Pain Med. 2018 Jun 5 [Epub ahead of print].
TIA Associated With Increased Five-Year Risk of Stroke
People with transient ischemic attack (TIA) are at risk for a cardiovascular event in the following five years, according to a study published June 7 in the New England Journal of Medicine. Researchers evaluated patients who had had a TIA within seven days before enrollment in a registry of TIA clinics. Of 61 sites, 42 had follow-up data on more than 50% of their enrolled patients at five years. The study’s primary outcome was a composite of stroke, acute coronary syndrome, or death from cardiovascular causes, with an emphasis on events that occurred in the second through fifth years. At five years, stroke had occurred in 345 of the 3,847 patients included in the follow-up study, and 149 of them had a stroke during the second through fifth years of follow-up.
Amarenco P, Lavallée PC, Monteiro Tavares L, et al. Five-year risk of stroke after TIA or minor ischemic stroke. N Engl J Med. 2018;378(23):2182-2190.
Follow-Up Care for TBI Is Not Delivered Adequately
Follow-up care for patients with traumatic brain injury (TBI) is not delivered optimally, according to a study published May 25 in JAMA Network Open. In a cohort study, researchers surveyed 831 participants in the Transforming Research and Clinical Knowledge in TBI initiative about their care after hospital discharge. Follow-up care was defined as providing TBI-related educational materials at discharge, calling patients within two weeks after release, seeing a healthcare provider within two weeks, and seeing a healthcare provider within three months. Approximately 42% of participants reported receiving TBI-related educational material at discharge, and 44% reported seeing a physician or other medical practitioner within three months after injury. Of patients with a positive finding on CT, 39% had not seen a medical practitioner at three months after injury.
Seabury SA, Gaudette E, Goldman DP, et al. Assessment of follow-up care after emergency department presentation for mild traumatic brain injury and concussion: results from the TRACK-TBI study. JAMA Network Open. 2018;1(1):e180210.
Researchers Examine Mortality Rate of Pediatric Stroke
In-hospital mortality occurs in 2.6% of children with arterial ischemic stroke, according to a study published in the May issue of Pediatrics. The retrospective study included 915 infants younger than 1 month and 2,273 children age 1 month to 18 years with stroke at 87 hospitals in 24 countries. Death during hospitalization and cause of death were ascertained from medical records. A total of 14 neonates and 70 children died during hospitalization. Of 48 cases with reported causes of death, 31 were stroke-related. Remaining deaths were attributed to medical disease. In multivariable analysis, congenital heart disease, posterior plus anterior circulation stroke, and stroke presentation without seizures were associated with in-hospital mortality for neonates. Hispanic ethnicity, congenital heart disease, and posterior plus anterior circulation stroke were associated with in-hospital mortality for children.
Beslow LA, Dowling MM, Hassanein SMA, et al. Mortality after pediatric arterial ischemic stroke. Pediatrics. 2018;141(5).
FDA Approves zEEG Dry Electrode Headset
The FDA has approved the zEEG dry electrode EEG headset for clinical use. The zEEG headset is backed by a cloud platform that allows users to upload data instantly, provides tools for analysis, and enables remote interpretation by neurologists. A clinical study found that the zEEG headset provided EEG signal quality that was comparable to that of an approved, traditional EEG system. In two study cohorts, a total of 30 patients were studied for time periods of as long as two hours, and the zEEG device performed at least as well as the reference device, based on predefined acceptance criteria. Study results will be published in the coming months. Zeto, headquartered in Santa Clara, California, markets the device.
South Asian Americans Have High Cardiovascular Mortality
South Asians living in the United States have higher mortality from heart conditions caused by atherosclerosis, such as heart attack and stroke, according to a study published online ahead of print May 24 in Circulation. Investigators reviewed the literature relevant to South Asian populations’ demographics and risk factors, health behaviors, and interventions, including physical activity, diet, medications, and community strategies. South Asians have higher proportional mortality rates from atherosclerotic cardiovascular disease, compared with other Asian groups, largely because of the lower risk observed in East Asian populations. A majority of the risk in South Asians can be explained by the increased prevalence of known risk factors, especially factors related to insulin resistance. The authors found no unique risk factors in this population.
Volgman AS, Palaniappan LS, Aggarwal NT, et al. Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association. Circulation. 2018 May 24 [Epub ahead of print].
How Much Exercise Improves Cognition in Older Adults?
Exercising for at least 52 hours over six months is associated with improved cognitive performance in older adults with and without cognitive impairment, according to a study published online ahead of print May 30 in Neurology. Researchers reviewed data for 98 randomized, controlled exercise trials including 11,061 participants with an average age of 73. About 59% of the participants were healthy adults, 26% had mild cognitive impairment, and 15% had dementia. Researchers collected data on exercise session length, intensity, weekly frequency, and amount of exercise over time. Aerobic exercise was the most common form of exercise. In healthy people and people with cognitive impairment, longer term exposure to exercise, at least 52 hours conducted over an average of about six months, improved the brain’s processing speed.
Gomes-Osman J, Cabral DF, Morris TP, et al. Exercise for cognitive brain health in aging. Neurology. 2018 May 30 [Epub ahead of print].
Blood Biomarkers Detect Subconcussive Head Trauma
Blood biomarkers can detect the neurologic injury associated with repetitive subconcussive head trauma, according to a study published online ahead of print May 29 in the Journal of Neurosurgery. A total of 35 National Collegiate Athletic Association football players underwent blood sampling throughout the 2016 football season. Samples were analyzed for plasma concentrations of tau and serum concentrations of neurofilament light. Athletes were categorized as starters or nonstarters, and the investigators assessed between-group differences and time-course differences. In nonstarters, plasma concentrations of tau decreased over the season. Starters had lower plasma concentrations of tau. Plasma concentrations of tau could not be used to distinguish between starters and nonstarters. Serum concentrations of neurofilament light increased as head impacts increased, specifically in starters. Serum neurofilament light distinguished starters from nonstarters.
Oliver JM, Anzalone AJ, Stone JD, et al. Fluctuations in blood biomarkers of head trauma in NCAA football athletes over the course of a season. J Neurosurg. 2018 May 29 [Epub ahead of print].
Model Estimates Risk of Alzheimer’s Disease Dementia
Most people with preclinical Alzheimer’s disease will not develop dementia during their lifetimes, according to a study published online ahead of print May 7 in Alzheimer’s & Dementia. Researchers used a multistate model for Alzheimer’s disease along with US death rates to estimate lifetime and 10-year risks of Alzheimer’s disease dementia. Lifetime risks of Alzheimer’s disease dementia vary by age, gender, and preclinical or clinical disease state. A 70-year-old male with amyloid but no signs of neurodegeneration and no memory loss has a lifetime risk of 19.9%. The lifetime risks for a female with amyloidosis are 8.4% at age 90 and 29.3% at age 65. People younger than 85 with mild cognitive impairment, amyloidosis, and neurodegeneration have lifetime risks of Alzheimer’s disease dementia greater than 50%.
Brookmeyer R, Abdalla N. Estimation of lifetime risks of Alzheimer’s disease dementia using biomarkers for preclinical disease. Alzheimers Dement. 2018 May 7 [Epub ahead of print].
Depression Is Associated With Brain and Memory Outcomes
In a sample of mostly Caribbean Hispanic, stroke-free older adults, greater depressive symptoms were associated with worse episodic memory, smaller cerebral volume, and silent infarcts, according to a study published online ahead of print May 9 in Neurology. Researchers analyzed data from the Northern Manhattan Study. A total of 1,111 participants underwent baseline evaluations of depressive symptoms, MRI markers, and cognitive function. At baseline, 22% of participants had greater depressive symptoms. Greater depressive symptoms were significantly associated with worse baseline episodic memory in models adjusted for sociodemographics, vascular risk factors, behavioral factors, and antidepressant medications. Furthermore, greater depressive symptoms were associated with smaller cerebral parenchymal fraction and increased odds of subclinical brain infarcts, after adjustment for sociodemographics, behavioral factors, and vascular risk factors.
Al Hazzouri AZ, Caunca MR, Nobrega JC. Greater depressive symptoms, cognition, and markers of brain aging. Neurology. 2018 May 9 [Epub ahead of print].
—Kimberly Williams
Adequate Sleep Associated With Lower Dementia Risk
Short and long daily sleep duration are risk factors for dementia and death in adults age 60 and older, according to a study published online ahead of print June 6 in the Journal of the American Geriatrics Society. In a prospective cohort study, researchers followed 1,517 adults without dementia for 10 years. Self-reported daily sleep durations were grouped into five categories. The association between daily sleep duration and risk of dementia and death was determined using Cox proportional hazards models. During follow-up, 294 participants developed dementia, and 282 died. Age- and sex-adjusted incidence rates of dementia and all-cause mortality were significantly greater in subjects who slept less than 5.0 hours/day or 10.0 or more hours/day than in people who slept from 5.0 to 6.9 hours/day.
Ohara T, Honda T, Hata J, et al. Association between daily sleep duration and risk of dementia and mortality in a Japanese community. J Am Geriatr Soc. 2018 Jun 6 [Epub ahead of print].
Rivaroxaban Not Superior to Aspirin for Stroke Prevention
Rivaroxaban is not superior to aspirin in the prevention of recurrent stroke, according to a study published June 7 in the New England Journal of Medicine. Researchers compared the efficacy and safety of rivaroxaban at a daily dose of 15 mg with aspirin at a daily dose of 100 mg for the prevention of recurrent stroke in patients with recent ischemic stroke that was presumed to be from cerebral embolism. The primary outcome was the first recurrence of ischemic or hemorrhagic stroke or systemic embolism in a time-to-event analysis. At 459 sites, 3,609 patients were randomly assigned to receive rivaroxaban, and 3,604 were randomized to aspirin. Recurrent ischemic stroke occurred in 172 patients in the rivaroxaban group and in 160 in the aspirin group.
Hart RG, Sharma M, Mundl H, et al. Rivaroxaban for stroke prevention after embolic stroke of undetermined source. N Engl J Med. 2018;378(23):2191-2201.
Disintegrating Brain Lesions May Indicate Worsening MS
Atrophied lesion volume may indicate increasing disability in patients with multiple sclerosis (MS), according to a study published online ahead of print June 1 in the Journal of Neuroimaging. A total of 192 patients with clinically isolated syndrome or MS received 3T MRI at baseline and at five years. Investigators quantified lesions at baseline and calculated new and enlarging lesion volumes during the study interval. Atrophied lesion volume was calculated by combining baseline lesion masks with follow-up SIENAX-derived CSF partial volume maps. The researchers evaluated correlations between these measures and disability, as measured by the Expanded Disability Status Scale (EDSS). Atrophied lesion volume was different between MS subtypes and exceeded new lesion volume accumulation in progressive MS. Atrophied lesion volume was the only significant correlate of EDSS change.
Dwyer MG, Bergsland N, Ramasamy DP, et al. Atrophied brain lesion volume: a new imaging biomarker in multiple sclerosis. J Neuroimaging. 2018 Jun 1 [Epub ahead of print].
Do Migraineurs Seek Behavioral Treatment After a Referral?
A significant number of migraineurs are not using effective behavioral treatments for migraine, according to a study published online ahead of print June 5 in Pain Medicine. In a prospective cohort study, researchers tracked 234 patients with migraine who presented to an academic headache center and referred 69 of them for behavioral treatment with an appropriately trained therapist. Fifty-three of the referred patients completed a follow-up interview within three months of their initial appointment and were included in the analysis. Of the patients referred for behavioral treatment, 30 made an appointment. Investigators found no differences between people who started behavioral therapy and people who did not. Study authors did find that people who had previously seen a psychologist for migraine were more likely to initiate therapy.
Minen MT, Azarchi S, Sobolev R, et al. Factors related to migraine patients’ decisions to initiate behavioral migraine treatment following a headache specialist’s recommendation: a prospective observational study. Pain Med. 2018 Jun 5 [Epub ahead of print].
TIA Associated With Increased Five-Year Risk of Stroke
People with transient ischemic attack (TIA) are at risk for a cardiovascular event in the following five years, according to a study published June 7 in the New England Journal of Medicine. Researchers evaluated patients who had had a TIA within seven days before enrollment in a registry of TIA clinics. Of 61 sites, 42 had follow-up data on more than 50% of their enrolled patients at five years. The study’s primary outcome was a composite of stroke, acute coronary syndrome, or death from cardiovascular causes, with an emphasis on events that occurred in the second through fifth years. At five years, stroke had occurred in 345 of the 3,847 patients included in the follow-up study, and 149 of them had a stroke during the second through fifth years of follow-up.
Amarenco P, Lavallée PC, Monteiro Tavares L, et al. Five-year risk of stroke after TIA or minor ischemic stroke. N Engl J Med. 2018;378(23):2182-2190.
Follow-Up Care for TBI Is Not Delivered Adequately
Follow-up care for patients with traumatic brain injury (TBI) is not delivered optimally, according to a study published May 25 in JAMA Network Open. In a cohort study, researchers surveyed 831 participants in the Transforming Research and Clinical Knowledge in TBI initiative about their care after hospital discharge. Follow-up care was defined as providing TBI-related educational materials at discharge, calling patients within two weeks after release, seeing a healthcare provider within two weeks, and seeing a healthcare provider within three months. Approximately 42% of participants reported receiving TBI-related educational material at discharge, and 44% reported seeing a physician or other medical practitioner within three months after injury. Of patients with a positive finding on CT, 39% had not seen a medical practitioner at three months after injury.
Seabury SA, Gaudette E, Goldman DP, et al. Assessment of follow-up care after emergency department presentation for mild traumatic brain injury and concussion: results from the TRACK-TBI study. JAMA Network Open. 2018;1(1):e180210.
Researchers Examine Mortality Rate of Pediatric Stroke
In-hospital mortality occurs in 2.6% of children with arterial ischemic stroke, according to a study published in the May issue of Pediatrics. The retrospective study included 915 infants younger than 1 month and 2,273 children age 1 month to 18 years with stroke at 87 hospitals in 24 countries. Death during hospitalization and cause of death were ascertained from medical records. A total of 14 neonates and 70 children died during hospitalization. Of 48 cases with reported causes of death, 31 were stroke-related. Remaining deaths were attributed to medical disease. In multivariable analysis, congenital heart disease, posterior plus anterior circulation stroke, and stroke presentation without seizures were associated with in-hospital mortality for neonates. Hispanic ethnicity, congenital heart disease, and posterior plus anterior circulation stroke were associated with in-hospital mortality for children.
Beslow LA, Dowling MM, Hassanein SMA, et al. Mortality after pediatric arterial ischemic stroke. Pediatrics. 2018;141(5).
FDA Approves zEEG Dry Electrode Headset
The FDA has approved the zEEG dry electrode EEG headset for clinical use. The zEEG headset is backed by a cloud platform that allows users to upload data instantly, provides tools for analysis, and enables remote interpretation by neurologists. A clinical study found that the zEEG headset provided EEG signal quality that was comparable to that of an approved, traditional EEG system. In two study cohorts, a total of 30 patients were studied for time periods of as long as two hours, and the zEEG device performed at least as well as the reference device, based on predefined acceptance criteria. Study results will be published in the coming months. Zeto, headquartered in Santa Clara, California, markets the device.
South Asian Americans Have High Cardiovascular Mortality
South Asians living in the United States have higher mortality from heart conditions caused by atherosclerosis, such as heart attack and stroke, according to a study published online ahead of print May 24 in Circulation. Investigators reviewed the literature relevant to South Asian populations’ demographics and risk factors, health behaviors, and interventions, including physical activity, diet, medications, and community strategies. South Asians have higher proportional mortality rates from atherosclerotic cardiovascular disease, compared with other Asian groups, largely because of the lower risk observed in East Asian populations. A majority of the risk in South Asians can be explained by the increased prevalence of known risk factors, especially factors related to insulin resistance. The authors found no unique risk factors in this population.
Volgman AS, Palaniappan LS, Aggarwal NT, et al. Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association. Circulation. 2018 May 24 [Epub ahead of print].
How Much Exercise Improves Cognition in Older Adults?
Exercising for at least 52 hours over six months is associated with improved cognitive performance in older adults with and without cognitive impairment, according to a study published online ahead of print May 30 in Neurology. Researchers reviewed data for 98 randomized, controlled exercise trials including 11,061 participants with an average age of 73. About 59% of the participants were healthy adults, 26% had mild cognitive impairment, and 15% had dementia. Researchers collected data on exercise session length, intensity, weekly frequency, and amount of exercise over time. Aerobic exercise was the most common form of exercise. In healthy people and people with cognitive impairment, longer term exposure to exercise, at least 52 hours conducted over an average of about six months, improved the brain’s processing speed.
Gomes-Osman J, Cabral DF, Morris TP, et al. Exercise for cognitive brain health in aging. Neurology. 2018 May 30 [Epub ahead of print].
Blood Biomarkers Detect Subconcussive Head Trauma
Blood biomarkers can detect the neurologic injury associated with repetitive subconcussive head trauma, according to a study published online ahead of print May 29 in the Journal of Neurosurgery. A total of 35 National Collegiate Athletic Association football players underwent blood sampling throughout the 2016 football season. Samples were analyzed for plasma concentrations of tau and serum concentrations of neurofilament light. Athletes were categorized as starters or nonstarters, and the investigators assessed between-group differences and time-course differences. In nonstarters, plasma concentrations of tau decreased over the season. Starters had lower plasma concentrations of tau. Plasma concentrations of tau could not be used to distinguish between starters and nonstarters. Serum concentrations of neurofilament light increased as head impacts increased, specifically in starters. Serum neurofilament light distinguished starters from nonstarters.
Oliver JM, Anzalone AJ, Stone JD, et al. Fluctuations in blood biomarkers of head trauma in NCAA football athletes over the course of a season. J Neurosurg. 2018 May 29 [Epub ahead of print].
Model Estimates Risk of Alzheimer’s Disease Dementia
Most people with preclinical Alzheimer’s disease will not develop dementia during their lifetimes, according to a study published online ahead of print May 7 in Alzheimer’s & Dementia. Researchers used a multistate model for Alzheimer’s disease along with US death rates to estimate lifetime and 10-year risks of Alzheimer’s disease dementia. Lifetime risks of Alzheimer’s disease dementia vary by age, gender, and preclinical or clinical disease state. A 70-year-old male with amyloid but no signs of neurodegeneration and no memory loss has a lifetime risk of 19.9%. The lifetime risks for a female with amyloidosis are 8.4% at age 90 and 29.3% at age 65. People younger than 85 with mild cognitive impairment, amyloidosis, and neurodegeneration have lifetime risks of Alzheimer’s disease dementia greater than 50%.
Brookmeyer R, Abdalla N. Estimation of lifetime risks of Alzheimer’s disease dementia using biomarkers for preclinical disease. Alzheimers Dement. 2018 May 7 [Epub ahead of print].
Depression Is Associated With Brain and Memory Outcomes
In a sample of mostly Caribbean Hispanic, stroke-free older adults, greater depressive symptoms were associated with worse episodic memory, smaller cerebral volume, and silent infarcts, according to a study published online ahead of print May 9 in Neurology. Researchers analyzed data from the Northern Manhattan Study. A total of 1,111 participants underwent baseline evaluations of depressive symptoms, MRI markers, and cognitive function. At baseline, 22% of participants had greater depressive symptoms. Greater depressive symptoms were significantly associated with worse baseline episodic memory in models adjusted for sociodemographics, vascular risk factors, behavioral factors, and antidepressant medications. Furthermore, greater depressive symptoms were associated with smaller cerebral parenchymal fraction and increased odds of subclinical brain infarcts, after adjustment for sociodemographics, behavioral factors, and vascular risk factors.
Al Hazzouri AZ, Caunca MR, Nobrega JC. Greater depressive symptoms, cognition, and markers of brain aging. Neurology. 2018 May 9 [Epub ahead of print].
—Kimberly Williams
Adequate Sleep Associated With Lower Dementia Risk
Short and long daily sleep duration are risk factors for dementia and death in adults age 60 and older, according to a study published online ahead of print June 6 in the Journal of the American Geriatrics Society. In a prospective cohort study, researchers followed 1,517 adults without dementia for 10 years. Self-reported daily sleep durations were grouped into five categories. The association between daily sleep duration and risk of dementia and death was determined using Cox proportional hazards models. During follow-up, 294 participants developed dementia, and 282 died. Age- and sex-adjusted incidence rates of dementia and all-cause mortality were significantly greater in subjects who slept less than 5.0 hours/day or 10.0 or more hours/day than in people who slept from 5.0 to 6.9 hours/day.
Ohara T, Honda T, Hata J, et al. Association between daily sleep duration and risk of dementia and mortality in a Japanese community. J Am Geriatr Soc. 2018 Jun 6 [Epub ahead of print].
Rivaroxaban Not Superior to Aspirin for Stroke Prevention
Rivaroxaban is not superior to aspirin in the prevention of recurrent stroke, according to a study published June 7 in the New England Journal of Medicine. Researchers compared the efficacy and safety of rivaroxaban at a daily dose of 15 mg with aspirin at a daily dose of 100 mg for the prevention of recurrent stroke in patients with recent ischemic stroke that was presumed to be from cerebral embolism. The primary outcome was the first recurrence of ischemic or hemorrhagic stroke or systemic embolism in a time-to-event analysis. At 459 sites, 3,609 patients were randomly assigned to receive rivaroxaban, and 3,604 were randomized to aspirin. Recurrent ischemic stroke occurred in 172 patients in the rivaroxaban group and in 160 in the aspirin group.
Hart RG, Sharma M, Mundl H, et al. Rivaroxaban for stroke prevention after embolic stroke of undetermined source. N Engl J Med. 2018;378(23):2191-2201.
Disintegrating Brain Lesions May Indicate Worsening MS
Atrophied lesion volume may indicate increasing disability in patients with multiple sclerosis (MS), according to a study published online ahead of print June 1 in the Journal of Neuroimaging. A total of 192 patients with clinically isolated syndrome or MS received 3T MRI at baseline and at five years. Investigators quantified lesions at baseline and calculated new and enlarging lesion volumes during the study interval. Atrophied lesion volume was calculated by combining baseline lesion masks with follow-up SIENAX-derived CSF partial volume maps. The researchers evaluated correlations between these measures and disability, as measured by the Expanded Disability Status Scale (EDSS). Atrophied lesion volume was different between MS subtypes and exceeded new lesion volume accumulation in progressive MS. Atrophied lesion volume was the only significant correlate of EDSS change.
Dwyer MG, Bergsland N, Ramasamy DP, et al. Atrophied brain lesion volume: a new imaging biomarker in multiple sclerosis. J Neuroimaging. 2018 Jun 1 [Epub ahead of print].
Do Migraineurs Seek Behavioral Treatment After a Referral?
A significant number of migraineurs are not using effective behavioral treatments for migraine, according to a study published online ahead of print June 5 in Pain Medicine. In a prospective cohort study, researchers tracked 234 patients with migraine who presented to an academic headache center and referred 69 of them for behavioral treatment with an appropriately trained therapist. Fifty-three of the referred patients completed a follow-up interview within three months of their initial appointment and were included in the analysis. Of the patients referred for behavioral treatment, 30 made an appointment. Investigators found no differences between people who started behavioral therapy and people who did not. Study authors did find that people who had previously seen a psychologist for migraine were more likely to initiate therapy.
Minen MT, Azarchi S, Sobolev R, et al. Factors related to migraine patients’ decisions to initiate behavioral migraine treatment following a headache specialist’s recommendation: a prospective observational study. Pain Med. 2018 Jun 5 [Epub ahead of print].
TIA Associated With Increased Five-Year Risk of Stroke
People with transient ischemic attack (TIA) are at risk for a cardiovascular event in the following five years, according to a study published June 7 in the New England Journal of Medicine. Researchers evaluated patients who had had a TIA within seven days before enrollment in a registry of TIA clinics. Of 61 sites, 42 had follow-up data on more than 50% of their enrolled patients at five years. The study’s primary outcome was a composite of stroke, acute coronary syndrome, or death from cardiovascular causes, with an emphasis on events that occurred in the second through fifth years. At five years, stroke had occurred in 345 of the 3,847 patients included in the follow-up study, and 149 of them had a stroke during the second through fifth years of follow-up.
Amarenco P, Lavallée PC, Monteiro Tavares L, et al. Five-year risk of stroke after TIA or minor ischemic stroke. N Engl J Med. 2018;378(23):2182-2190.
Follow-Up Care for TBI Is Not Delivered Adequately
Follow-up care for patients with traumatic brain injury (TBI) is not delivered optimally, according to a study published May 25 in JAMA Network Open. In a cohort study, researchers surveyed 831 participants in the Transforming Research and Clinical Knowledge in TBI initiative about their care after hospital discharge. Follow-up care was defined as providing TBI-related educational materials at discharge, calling patients within two weeks after release, seeing a healthcare provider within two weeks, and seeing a healthcare provider within three months. Approximately 42% of participants reported receiving TBI-related educational material at discharge, and 44% reported seeing a physician or other medical practitioner within three months after injury. Of patients with a positive finding on CT, 39% had not seen a medical practitioner at three months after injury.
Seabury SA, Gaudette E, Goldman DP, et al. Assessment of follow-up care after emergency department presentation for mild traumatic brain injury and concussion: results from the TRACK-TBI study. JAMA Network Open. 2018;1(1):e180210.
Researchers Examine Mortality Rate of Pediatric Stroke
In-hospital mortality occurs in 2.6% of children with arterial ischemic stroke, according to a study published in the May issue of Pediatrics. The retrospective study included 915 infants younger than 1 month and 2,273 children age 1 month to 18 years with stroke at 87 hospitals in 24 countries. Death during hospitalization and cause of death were ascertained from medical records. A total of 14 neonates and 70 children died during hospitalization. Of 48 cases with reported causes of death, 31 were stroke-related. Remaining deaths were attributed to medical disease. In multivariable analysis, congenital heart disease, posterior plus anterior circulation stroke, and stroke presentation without seizures were associated with in-hospital mortality for neonates. Hispanic ethnicity, congenital heart disease, and posterior plus anterior circulation stroke were associated with in-hospital mortality for children.
Beslow LA, Dowling MM, Hassanein SMA, et al. Mortality after pediatric arterial ischemic stroke. Pediatrics. 2018;141(5).
FDA Approves zEEG Dry Electrode Headset
The FDA has approved the zEEG dry electrode EEG headset for clinical use. The zEEG headset is backed by a cloud platform that allows users to upload data instantly, provides tools for analysis, and enables remote interpretation by neurologists. A clinical study found that the zEEG headset provided EEG signal quality that was comparable to that of an approved, traditional EEG system. In two study cohorts, a total of 30 patients were studied for time periods of as long as two hours, and the zEEG device performed at least as well as the reference device, based on predefined acceptance criteria. Study results will be published in the coming months. Zeto, headquartered in Santa Clara, California, markets the device.
South Asian Americans Have High Cardiovascular Mortality
South Asians living in the United States have higher mortality from heart conditions caused by atherosclerosis, such as heart attack and stroke, according to a study published online ahead of print May 24 in Circulation. Investigators reviewed the literature relevant to South Asian populations’ demographics and risk factors, health behaviors, and interventions, including physical activity, diet, medications, and community strategies. South Asians have higher proportional mortality rates from atherosclerotic cardiovascular disease, compared with other Asian groups, largely because of the lower risk observed in East Asian populations. A majority of the risk in South Asians can be explained by the increased prevalence of known risk factors, especially factors related to insulin resistance. The authors found no unique risk factors in this population.
Volgman AS, Palaniappan LS, Aggarwal NT, et al. Atherosclerotic cardiovascular disease in South Asians in the United States: epidemiology, risk factors, and treatments: a scientific statement from the American Heart Association. Circulation. 2018 May 24 [Epub ahead of print].
How Much Exercise Improves Cognition in Older Adults?
Exercising for at least 52 hours over six months is associated with improved cognitive performance in older adults with and without cognitive impairment, according to a study published online ahead of print May 30 in Neurology. Researchers reviewed data for 98 randomized, controlled exercise trials including 11,061 participants with an average age of 73. About 59% of the participants were healthy adults, 26% had mild cognitive impairment, and 15% had dementia. Researchers collected data on exercise session length, intensity, weekly frequency, and amount of exercise over time. Aerobic exercise was the most common form of exercise. In healthy people and people with cognitive impairment, longer term exposure to exercise, at least 52 hours conducted over an average of about six months, improved the brain’s processing speed.
Gomes-Osman J, Cabral DF, Morris TP, et al. Exercise for cognitive brain health in aging. Neurology. 2018 May 30 [Epub ahead of print].
Blood Biomarkers Detect Subconcussive Head Trauma
Blood biomarkers can detect the neurologic injury associated with repetitive subconcussive head trauma, according to a study published online ahead of print May 29 in the Journal of Neurosurgery. A total of 35 National Collegiate Athletic Association football players underwent blood sampling throughout the 2016 football season. Samples were analyzed for plasma concentrations of tau and serum concentrations of neurofilament light. Athletes were categorized as starters or nonstarters, and the investigators assessed between-group differences and time-course differences. In nonstarters, plasma concentrations of tau decreased over the season. Starters had lower plasma concentrations of tau. Plasma concentrations of tau could not be used to distinguish between starters and nonstarters. Serum concentrations of neurofilament light increased as head impacts increased, specifically in starters. Serum neurofilament light distinguished starters from nonstarters.
Oliver JM, Anzalone AJ, Stone JD, et al. Fluctuations in blood biomarkers of head trauma in NCAA football athletes over the course of a season. J Neurosurg. 2018 May 29 [Epub ahead of print].
Model Estimates Risk of Alzheimer’s Disease Dementia
Most people with preclinical Alzheimer’s disease will not develop dementia during their lifetimes, according to a study published online ahead of print May 7 in Alzheimer’s & Dementia. Researchers used a multistate model for Alzheimer’s disease along with US death rates to estimate lifetime and 10-year risks of Alzheimer’s disease dementia. Lifetime risks of Alzheimer’s disease dementia vary by age, gender, and preclinical or clinical disease state. A 70-year-old male with amyloid but no signs of neurodegeneration and no memory loss has a lifetime risk of 19.9%. The lifetime risks for a female with amyloidosis are 8.4% at age 90 and 29.3% at age 65. People younger than 85 with mild cognitive impairment, amyloidosis, and neurodegeneration have lifetime risks of Alzheimer’s disease dementia greater than 50%.
Brookmeyer R, Abdalla N. Estimation of lifetime risks of Alzheimer’s disease dementia using biomarkers for preclinical disease. Alzheimers Dement. 2018 May 7 [Epub ahead of print].
Depression Is Associated With Brain and Memory Outcomes
In a sample of mostly Caribbean Hispanic, stroke-free older adults, greater depressive symptoms were associated with worse episodic memory, smaller cerebral volume, and silent infarcts, according to a study published online ahead of print May 9 in Neurology. Researchers analyzed data from the Northern Manhattan Study. A total of 1,111 participants underwent baseline evaluations of depressive symptoms, MRI markers, and cognitive function. At baseline, 22% of participants had greater depressive symptoms. Greater depressive symptoms were significantly associated with worse baseline episodic memory in models adjusted for sociodemographics, vascular risk factors, behavioral factors, and antidepressant medications. Furthermore, greater depressive symptoms were associated with smaller cerebral parenchymal fraction and increased odds of subclinical brain infarcts, after adjustment for sociodemographics, behavioral factors, and vascular risk factors.
Al Hazzouri AZ, Caunca MR, Nobrega JC. Greater depressive symptoms, cognition, and markers of brain aging. Neurology. 2018 May 9 [Epub ahead of print].
—Kimberly Williams
