Neurology
Observational Study: Synergistic effects of early menopause and vascular risk on cognitive decline in postmenopausal women
27 Apr, 2024 | 18:20h | UTCStudy Design and Population:
This study analyzed data from 8,360 postmenopausal women and an equal number of age-matched male participants from the Canadian Longitudinal Study on Aging. Researchers assessed the independent and combined effects of age at menopause, vascular risk factors, and history of hormone therapy on cognitive outcomes. Participants’ cognitive function was measured using a global cognitive composite at baseline and again at a 3-year follow-up.
Main Findings:
The study found a synergistic interaction between early menopause (ages 35-48) and high vascular risk, significantly associated with lower cognitive scores at follow-up. Specifically, earlier menopause combined with higher vascular risk resulted in greater cognitive decline, compared to their individual effects. Notably, hormone therapy did not modify this association. This pattern was not observed in female participants with average or later menopause ages, nor in the age-matched male cohort.
Implications for Practice:
The findings underscore the importance of considering both endocrine and vascular health as predictive markers in dementia prevention strategies, particularly for women. These results suggest that women with early menopause and vascular risk factors should be closely monitored to mitigate their higher risk of cognitive impairment.
Reference (link to abstract – $ for full-text):
Retrospective Cohort Study: Delirium associated with increased risk of subsequent dementia and higher mortality in older adults
27 Apr, 2024 | 15:54h | UTCStudy Design and Population:
This retrospective cohort study utilized hospital administrative data from both public and private hospitals in New South Wales, Australia, spanning from July 2001 to March 2020. The study examined data from 650,590 patients aged 65 years or older, who did not have dementia at baseline. Diagnoses of dementia and delirium were identified using ICD-10 codes. The cohort was carefully matched into 55,211 pairs based on personal and clinical characteristics, focusing on those who developed delirium and their outcomes over a follow-up period exceeding five years.
Main Findings:
The analysis found that patients who experienced delirium had a 39% increased risk of mortality (hazard ratio: 1.39, 95% CI: 1.37-1.41) and a threefold increase in the risk of developing dementia (subdistribution hazard ratio: 3.00, 95% CI: 2.91-3.10) compared to those without delirium. The risk associated with dementia was notably stronger among men. Furthermore, each additional episode of delirium was linked to a 20% increased risk of subsequent dementia (subdistribution hazard ratio: 1.20, 95% CI: 1.18-1.23).
Implications for Practice:
The strong association between delirium and increased risks of death and incident dementia in older adults highlights the importance of delirium as a clinical marker that warrants significant attention. These findings suggest that enhanced monitoring and management of delirium in hospital settings could be crucial for identifying patients at higher risk of adverse outcomes, including dementia. Efforts to improve delirium management might not only address immediate clinical needs but also assist in stratifying risk and tailoring post-discharge care plans to better support the long-term health of these patients. Further research is needed to explore effective strategies for delirium intervention and to determine how these approaches can impact long-term cognitive outcomes and overall mortality.
Reference (free full-text):
Cohort Study: Elevated autism spectrum disorder risk in children exposed to valproate during pregnancy
21 Mar, 2024 | 13:16h | UTCStudy Design and Population: This cohort study utilized two health care utilization databases in the United States, covering the period from 2000 to 2020, to investigate the association between prenatal exposure to antiseizure medications and the risk of autism spectrum disorder (ASD) in children. The study compared children exposed to topiramate, valproate, or lamotrigine during the second half of pregnancy to those unexposed to any antiseizure medication, specifically focusing on a population-based cohort of pregnant women and their offspring.
Main Findings: The cumulative incidence of ASD at 8 years of age was found to be higher in children exposed to these medications compared to the general population. Notably, the incidence was 6.2% for children exposed to topiramate, 10.5% for valproate, and 4.1% for lamotrigine among children born to mothers with epilepsy. However, after adjusting for potential confounders, the increased risk of ASD remained significant only for valproate exposure, with a hazard ratio of 2.67, indicating a substantial risk compared to unexposed children. Topiramate and lamotrigine showed no significant increase in risk after adjustment.
Implications for Practice: The findings underscore the importance of carefully considering the risks and benefits of using antiseizure medications during pregnancy. Specifically, valproate should be used with caution, if at all, given its significant association with an increased risk of ASD in offspring. This study supports the need for targeted counseling and monitoring of pregnant women with epilepsy and highlights the necessity for further research to fully understand the neurodevelopmental impact of prenatal exposure to antiseizure medications.
Reference: Sonia Hernández-Díaz et al. (2024). Cohort Study: Assessing Autism Spectrum Disorder Risk in Children Exposed to Antiseizure Medications During Pregnancy. N Engl J Med, 390(13), 1069-1079. DOI: 10.1056/NEJMoa2309359. Access the study here: [Link]
Systematic Analysis: Global Burden and Trends of Nervous System Disorders, 1990–2021
21 Mar, 2024 | 11:10h | UTCStudy Design and Population
This study, a systematic analysis conducted by the Global Burden of Disease Study 2021, aimed to estimate the global, regional, and national health loss attributable to 37 unique nervous system conditions from 1990 to 2021. The researchers estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) across 204 countries. The analysis included morbidity and deaths directly resulting from damage to the central or peripheral nervous system, as well as neurological health loss from conditions where nervous system morbidity is a secondary outcome.
Main Findings
The collective global burden of these nervous system conditions emerged as the leading cause of DALYs in 2021, affecting approximately 3.40 billion individuals (43.1% of the global population) and resulting in 443 million DALYs. Although global DALY counts for these conditions increased by 18.2% from 1990 to 2021, there was a notable decrease in the age-standardised rates of deaths and DALYs by 33.6% and 27.0%, respectively. The conditions contributing most significantly to the age-standardised DALYs were stroke, neonatal encephalopathy, migraine, and Alzheimer’s disease among others.
Implications for Practice
This analysis underscores the critical need for effective prevention, treatment, and rehabilitation strategies for nervous system disorders, which now lead the global disease burden. Highlighting an 18.2% increase in DALY counts over the study period, it calls for heightened public health attention and resource allocation towards these conditions. The findings support the prioritization of nervous system health on the global health agenda and stress the importance of further research into modifiable risk factors and equitable access to care.
Reference
GBD 2021 Nervous System Disorders Collaborators (2024). Systematic Analysis: Global Burden and Trends of Nervous System Disorders, 1990–2021. The Lancet Neurology, Volume(issue), Pages. DOI: https://doi.org/10.1016/S1474-4422(24)00038-3. Access the study here: Link
Perspective | Will unpredictable side effects dim the promise of new Alzheimer’s drugs?
8 Aug, 2023 | 13:30h | UTCWill unpredictable side effects dim the promise of new Alzheimer’s drugs? – Science (a few articles per month are free)
Related:
RCT | Donanemab slows early symptomatic Alzheimer’s progression, but raises serious safety concerns
RCT | Lecanemab slows cognitive decline in early Alzheimer’s disease but raises safety concerns
Review | Treatment of pediatric convulsive status epilepticus
4 Aug, 2023 | 11:42h | UTCTreatment of pediatric convulsive status epilepticus – Frontiers in Neurology
RCT | Recombinant human prourokinase demonstrates noninferiority to alteplase in acute ischemic stroke treatment
3 Aug, 2023 | 13:46h | UTCSee also: Visual Abstract
Study | Frequent soccer heading linked to cognitive impairment risk in retired players
3 Aug, 2023 | 13:12h | UTCInvited Commentary: Heading Frequency and Risk of Cognitive Impairment in Retired Male Professional Soccer Players – JAMA Network Open
Related:
Dementia risk in former professional footballers is related to player position and career length.
Study: Neurodegenerative Disease Mortality Increased Among Former Professional Soccer Players
Commentary on Twitter
In retired professional UK soccer players, repetitive heading was linked to an increased risk of cognitive impairment later in life by >2x (6-15/match) and >3x (>15x/match). https://t.co/lV2xNa1TTR
— JAMA Network Open (@JAMANetworkOpen) July 17, 2023
Review | Diagnosing delirium in perioperative and intensive care medicine
3 Aug, 2023 | 13:09h | UTCDiagnosing delirium in perioperative and intensive care medicine – Current Opinion in Anesthesiology
RCT | Multiple sclerosis disease-modifying therapy continuation versus discontinuation in older individuals
2 Aug, 2023 | 14:00h | UTCRisk of new disease activity in patients with multiple sclerosis who continue or discontinue disease-modifying therapies (DISCOMS): a multicentre, randomised, single-blind, phase 4, non-inferiority trial – The Lancet Neurology (link to abstract – $ for full-text)
Commentaries:
Discontinuing Multiple Sclerosis Therapies at Age 55 or Older – NEJM Journal Watch
RCT | Atogepant outperforms placebo in reducing migraines over 12 weeks
2 Aug, 2023 | 13:56h | UTCAtogepant for the preventive treatment of chronic migraine (PROGRESS): a randomised, double-blind, placebo-controlled, phase 3 trial – The Lancet (link to abstract – $ for full-text)
Cohort Study | Depression at any life stage linked to increased dementia incidence
2 Aug, 2023 | 13:49h | UTCAssociation of Early-, Middle-, and Late-Life Depression With Incident Dementia in a Danish Cohort – JAMA Neurology (link to abstract – $ for full-text)
Commentary: Depression Over Adulthood May Increase Risk of Dementia – Psychiatric News Alert
Review | First-line immunosuppression in neuromuscular diseases
1 Aug, 2023 | 14:09h | UTCFirst-line immunosuppression in neuromuscular diseases – Practical Neurology
Review | Multiple system atrophy
1 Aug, 2023 | 14:08h | UTCMultiple system atrophy – Practical Neurology
Review | Clinical assessment of parietal lobe function
1 Aug, 2023 | 14:03h | UTCClinical assessment of parietal lobe function – Practical Neurology
Review | Antiamyloid monoclonal antibody therapy for Alzheimer disease: emerging issues in neurology
31 Jul, 2023 | 14:07h | UTCNews Release: AAN issues guidance on new treatments for early Alzheimer’s disease – American Academy of Neurology
Phase 2 Trial | Oral orexin receptor 2 agonist shows promise in narcolepsy type 1, but raises hepatotoxic concerns
28 Jul, 2023 | 14:09h | UTCOral Orexin Receptor 2 Agonist in Narcolepsy Type 1 – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
In a randomized trial involving patients with narcolepsy, an oral orexin receptor 2 agonist reduced sleepiness and cataplexy but had liver toxic effects. Read the full trial results: https://t.co/Go7lmQTu62
— NEJM (@NEJM) July 26, 2023
RCT – 2ry Analysis | Elevated intracranial bleeding risk with low-dose aspirin in older adults
27 Jul, 2023 | 13:09h | UTCSee also: Visual Abstract
News Release: Low dose aspirin won’t help some older adults trying to avoid a stroke: study – Monash University
Commentary: Daily aspirin doesn’t prevent strokes in older, healthy people after all – The Conversation
Original Study: Randomized Trial: Effect of Aspirin on All-Cause Mortality in the Healthy Elderly
Related Guideline: USPSTF Recommendation Statement: Aspirin Use to Prevent Cardiovascular Disease.
Related Randomized Trials:
Randomized Trial: Aspirin for Primary Prevention of Cardiovascular Disease
Randomized Trial: Effects of Aspirin for Primary Prevention in Persons with Diabetes
Related Meta-Analysis:
Meta-Analysis: Efficacy and Safety of Aspirin for Primary Prevention of Cardiovascular Events
Related Opinions:
Aspirin for Primary Prevention: Is This the End of the Road?
Evidence evolving on aspirin as prevention – ACP Internist
#347 USPSTF Update: Aspirin for Primary Prevention of CVD – The Curbsiders
Mitigating neurological, cognitive, and psychiatric sequelae of COVID-19-related critical illness
26 Jul, 2023 | 13:28h | UTC
RCT | Vitamin D supplementation shows no cognitive benefit in mild cognitive impairment intervention
25 Jul, 2023 | 14:00h | UTCCommentary: Exercise and Cognitive Training Slow Thinking Declines. Vitamin D? Not So Much – HealthDay
Related:
RCT | No statistically significant impact of vitamin D on major cardiovascular events
2ry analysis of a RCT | Vitamin D supplementation does not affect cognitive function in older adults
Randomized Trial: Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease
Meta-Analysis: Vitamin D Not Effective for Cardiovascular Disease Prevention
Vitamin D, calcium, other vitamins, and supplements do not prevent cardiovascular diseases
Global, regional, and national burden of meningitis and its etiologies, 1990–2019
25 Jul, 2023 | 13:55h | UTC
Commentary on Twitter
Although largely preventable, meningitis still causes hundreds of thousands of deaths globally each year.
New @IHME_UW #GBDStudy in @TheLancetNeuro assesses incident cases and deaths due to acute infectious meningitis by aetiology and age from 1990–2019. https://t.co/S3KtMA7DMs pic.twitter.com/AYuSJHsNwK
— The Lancet (@TheLancet) July 20, 2023
Systematic Review | Existing research on post-stroke depression interventions lacks conclusive results
25 Jul, 2023 | 13:37h | UTC
RCT | Hearing intervention fails to impact 3-year cognitive decline in older adults
20 Jul, 2023 | 11:09h | UTCHearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial – The Lancet (link to abstract – $ for full-text)
Commentary on Twitter
#AAIC23 While hearing aids did not have an impact on cognitive decline over 3 years in a general population, treating hearing loss protected against cognitive decline in older adults at greater risk of dementia, finds a new trial: https://t.co/1UjGgDf5m5 pic.twitter.com/kuujeekCWW
— The Lancet (@TheLancet) July 18, 2023
Prospective Study | Intelligence likely remains intact after pediatric concussion
20 Jul, 2023 | 11:06h | UTCIQ After Pediatric Concussion – Pediatrics (free for a limited period)
Commentaries:
IQ After Pediatric Concussion: Clinical Considerations – Pediatrics
No Evidence Seen for Differences in IQ After Pediatric Concussion – HealthDay
Concussions do not affect IQ in children, study finds – News Medical
RCT | Ischemic stroke patients benefit from Panax notoginseng saponins therapy
20 Jul, 2023 | 10:57h | UTCSee also: Visual Abstract