Neurology Alert
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Nutritional Interventions in Prodromal Alzheimer’s Disease: The 36-Month LipiDiDiet Multinutrient Clinical Trial
In a randomized, double-blind, placebo-controlled trial of Fortasyn Connect (Souvenaid), a nutraceutical drink, patients with prodromal Alzheimer’s disease demonstrated, over a 36-month period, a slower decline in cognitive functions compared to the control group.
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Disease-Modifying Therapy and Long-Term Disability in Multiple Sclerosis
In a multicenter, observational, retrospective “real world” analysis of a large cohort of relapsing multiple sclerosis (MS) patients, the authors found that being on disease-modifying therapy decreased the risk of long-term disability progression in both pediatric and adult MS patients.
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Multiple Sclerosis and Vascular Disease
This postmortem study of multiple sclerosis (MS) patients evaluated the presence and pathological significance of extracranial systemic and cerebral small vessel disease in patients with MS compared to healthy controls. MS patients had less systemic vascular disease and more small vessel disease in the brain compared to controls.
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Sporadic Creutzfeldt-Jakob Disease: A Genome-Wide Association Study
Sporadic Creutzfeldt-Jacob disease (sCJD), the most common form of human prion disease, is characterized as a rapidly fatal neurodegenerative process caused by propagation of a transmissible misfolded prion protein gene (PRNP). However, selective PRNP mutations only account for a small subset of sCJD cases, leading to interest in discovering additional genetic risk factors. Through a two-stage study design using genome-wide association studies, the authors have identified two novel risk loci, STX6 and GAL3ST1, which encode for proteins involved in cellular trafficking of prions and sphingolipid metabolism, respectively. These findings provide insights into sCJD pathogenesis and are an avenue for further research.
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Big Data Look at Optic Neuritis
In this population-based study of 11 million people in the United Kingdom, the incidence of optic neuritis was 3.7/100,000 person years, and was stable over the time period 1995-2019. The 10-year risk of developing multiple sclerosis in this population was 28.2%.
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Recurrent Stroke After Embolic Stroke of Undetermined Source
Twenty percent to 40% of ischemic strokes are classified as cryptogenic, meaning a specific cause cannot be identified. A subset of those have been classified by some investigators as embolic stroke of undetermined source. However, this remains a controversial category and classification.
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Can Anticoagulant Strategies Reduce Covert Brain Infarcts in Patients with Cardiovascular Disease?
Covert brain infarcts are detected on magnetic resonance imaging studies in the aging brain in about 10% of people at age 65 years, increasing to 25% at age 80 years. Most patients who develop dementia have a combination of multiple small infarcts, plus amyloid deposition. Prevention of covert infarcts is a strategy to mitigate the frequency and severity of late-life dementia.
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Carotid Endarterectomy vs. Medical Therapy in Patients with Asymptomatic Carotid Stenosis
Multiple randomized clinical trials have demonstrated that carotid endarterectomy is beneficial in patients who have symptomatic carotid stenosis, and currently, that is the recommendation for such patients. However, in the intervening years, advances in medical therapy, as well as significant improvement in the management of blood pressure, diabetes, diet, and exercise, have been shown to reduce stroke rate. Therefore, it is currently controversial whether carotid endarterectomy is still beneficial in asymptomatic patients with carotid artery stenosis compared to current medical management.
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Tranexamic Acid and Outcomes in Patients with Moderate or Severe TBI
In this randomized, placebo-controlled trial using tranexamic acid to treat patients with moderate or severe traumatic brain injury within two hours of injury, there was no significant difference between treatment groups in either mortality or functional recovery at six months.
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IqYmune for CIDP
IqYmune is a highly purified 10% concentration of human immunoglobulin obtained from healthy volunteers. It appears to have similar efficacy in the treatment of chronic inflammatory demyelinating polyneuropathy (CIDP) as conventional intravenous immunoglobulin, with 76% of the study patients showing a significant improvement in a standardized disability score.