New and Noteworthy Information—April 2015

Gout is inversely associated with the risk of developing Alzheimer’s disease, and uric acid may play a neuroprotective role, according to a study published March 4 in Annals of the Rheumatic Diseases. Researchers conducted a study using data from the Health Improvement Network, an electronic medical record database that is representative of the United Kingdom’s general population. Investigators identified 309 new cases of Alzheimer’s disease among 59,224 patients with gout (average age, 65) and 1,942 cases of Alzheimer’s disease among 238,805 people in the comparison group over a five-year follow up. After accounting for age, sex, BMI, socioeconomic status, lifestyle factors, prior heart conditions, and use of heart drugs, people with a history of gout had a 24% lower risk of developing Alzheimer’s disease.

In patients with ST-segment elevation myocardial infarction who are undergoing primary percutaneous coronary intervention (PCI), routine manual thrombectomy may not reduce the risk of cardiovascular death, compared with PCI alone, according to a study published online ahead of print March 16 in New England Journal of Medicine. In a randomized controlled trial that involved 10,732 patients at 87 hospitals in 20 countries, half of participants received PCI alone and half received PCI with manual thrombectomy. Death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or heart failure occurred within 180 days in 6.9% of the thrombectomy group and 7% of the PCI-alone group. “The message from this study is that thrombectomy should not be used as a routine strategy,” the researchers stated.

A broad range of pre-existing mental disorders are associated with the subsequent onset of severe or frequent headaches, according to a study published in the January issue of Journal of Pain. Researchers evaluated data from 19 World Health Organization World Mental Health Surveys completed by more than 50,000 subjects. The investigators looked at the association between pre-existing mood, anxiety, impulse control, and substance use disorders with subsequent onset of frequent or severe headaches. After adjusting for sex, age, and mental disorder comorbidity, the researchers found that mood, anxiety, and impulse control disorders increased the likelihood of developing severe and frequent headaches by 40%. Respondents with early-onset pre-existing mental disorders had a 21% higher risk for developing headaches than people with later-onset mental disorders.

Early symptoms of post-traumatic stress, such as anxiety, emotional numbness, flashbacks, and irritability, are the strongest predictors of later disability, according to a study published online ahead of print March 4 in Brain. The trial included 38 service members diagnosed with blast-related concussive traumatic brain injury and 34 service members without brain injury who volunteered to serve as controls. Early assessments of service members were conducted in Afghanistan during the first week after injury. Follow-up mental health assessments were conducted with standard interviews at six to 12 months afterward. Sixty-three percent of patients with brain injury were classified as moderately disabled, compared with 20% of people in the control group. The remaining 37% of the brain injury group were considered to have a good recovery.

Among teenagers, heavy marijuana use is associated with an abnormally shaped hippocampus and poor performance on long-term memory tasks, according to a study published online ahead of print March 11 in Hippocampus. Researchers examined 97 people, including matched groups of healthy controls, subjects with a marijuana use disorder, people with schizophrenia and no history of substance use disorders, and people with schizophrenia and a marijuana use disorder. Participants had started using marijuana daily between ages 16 and 17 and continued for about three years. Overall, the longer participants used marijuana, the more abnormal the shape of their hippocampus became. Young adults with schizophrenia who abused cannabis as teens also performed about 26% more poorly on memory tests than young adults with schizophrenia who never abused cannabis.

The combination of enalapril and folic acid, compared with enalapril alone, significantly reduces the risk of a first stroke in adults with hypertension, according to a study published online ahead of print March 15 in JAMA. Researchers randomized 20,702 adults with hypertension and no history of stroke or heart attack to daily treatment with a single-pill combination containing 10 mg of enalapril and 0.8 mg of folic acid or to a tablet containing 10 mg of enalapril alone. During a median treatment duration of 4.5 years, first stroke occurred in 282 participants in the enalapril–folic acid group, compared with 355 participants in the enalapril group. Analyses also showed significant reductions in the risk of ischemic stroke and cardiovascular events among participants in the enalapril– folic acid group.

Responsive direct cortical stimulation safely and effectively reduces seizures in adults with medically refractory partial onset seizures, according to a study published February 24 in Neurology. The results are part of an ongoing, seven-year, multicenter, prospective, open-label study to evaluate the long-term efficacy and safety of the RNS System. A total of 256 participants were implanted with the neurostimulator and leads. Seizure frequency decreased in the majority of participants treated with responsive stimulation. The median percent reduction in seizures was 44% at one year and 53% at two years postimplant. The median percent reduction in seizures was 60% at the beginning of year three and 66% at the beginning of year six. The responder rates at the same time points were 58% and 59%, respectively.

Persistent insomnia is associated with increased risk for all-cause and cardiopulmonary mortality and a steeper increase in inflammation, according to a study published March 12 in American Journal of Medicine. Researchers assessed the persistence of insomnia complaints in 1,409 adult participants from the Tucson Epidemiological Study of Airway Obstructive Disease. The study began in 1972 and included multiple follow-up surveys until 1996 and continuous mortality follow-up data until 2011. Using data from the survey from 1972 through 1973 and from the 1990 through 1992 follow-up survey, the researchers found that serum C-reactive protein (CRP) levels increased over time in people with persistent insomnia. In those subjects for whom CRP data were available, persistent insomnia was associated with a 58% increase in mortality risk, after adjustments for confounding factors.

Prolonged sleep is a potentially useful marker to determine increased future stroke risk in a healthy aging population, according to a study published online ahead of print February 25 in Neurology. Researchers followed 9,692 people with a mean age of 62 who had never had a stroke. Participants were asked about their sleeping habits once and then again four years later. The participants were followed for an average of 9.5 years, and 346 people had a stroke. Of the 986 people who slept more than eight hours per night, 52 had a stroke, compared with 211 of the 6,684 people who slept an average amount. The relationship between long sleep and stroke remained the same after researchers accounted for high cholesterol, high blood pressure, physical activity, and BMI.

Higher levels of physical activity may reduce the effects of white matter hyperintensity burden on motor function in healthy older adults, according to a study published online ahead of print March 11 in Neurology. Researchers examined 167 people (average age, 80) who wore movement monitors on their wrists for as long as 11 days to measure exercise and nonexercise activity. Participants also took 11 motor performance tests. For the people in the top 10% of activity, greater amounts of brain damage did not influence scores on the movement tests. However, for people in the less active half of the population, greater amounts of brain damage were associated with lower scores on the movement tests. For all participants, the average score on the movement tests was 1.04.

Patients with Parkinson’s disease have reduced low- and high-contrast visual acuity, compared with controls, according to a study published January 1 in Journal of Parkinson’s Disease. Thirty-two patients with Parkinson’s disease and 71 control subjects underwent a neurologic examination, which included the Unified Parkinson’s Disease Rating Scale and vision testing using the Variable Contrast Acuity Chart displayed on an iPad. The chart was displayed at low and high contrast at distances of 40 cm and 2 m. Based on the number of letters correctly identified, patients with Parkinson’s disease saw about 10% fewer letters than control subjects in the low-contrast tests at either distance and in the high-contrast tests at 2 m. Researchers found no significant difference between Parkinson’s disease and control subjects in the high-contrast testing at 40 cm.

Statins may not lower the risk for Parkinson’s disease, according to a study published online ahead of print January 14 in Movement Disorders. The researchers examined blood cholesterol levels, medications, and Parkinson’s disease status in participants in the ongoing, long-term Atherosclerosis Risk in Communities study. Cholesterol readings were taken at three-year intervals between 1987 and 1998. Statin use before 1998 was associated with significantly higher risk of Parkinson’s disease after 1998. Higher total cholesterol, however, was associated with lower risk for Parkinson’s disease after adjustment for statin use and confounders. Compared with the lowest tertile of average total cholesterol, the odds ratios for Parkinson’s disease were 0.56 for the second tertile and 0.43 for the third tertile. These data are inconsistent with the hypothesis that statins protect against Parkinson’s disease.

—Kimberly Williams

Gout is inversely associated with the risk of developing Alzheimer’s disease, and uric acid may play a neuroprotective role, according to a study published March 4 in Annals of the Rheumatic Diseases. Researchers conducted a study using data from the Health Improvement Network, an electronic medical record database that is representative of the United Kingdom’s general population. Investigators identified 309 new cases of Alzheimer’s disease among 59,224 patients with gout (average age, 65) and 1,942 cases of Alzheimer’s disease among 238,805 people in the comparison group over a five-year follow up. After accounting for age, sex, BMI, socioeconomic status, lifestyle factors, prior heart conditions, and use of heart drugs, people with a history of gout had a 24% lower risk of developing Alzheimer’s disease.

In patients with ST-segment elevation myocardial infarction who are undergoing primary percutaneous coronary intervention (PCI), routine manual thrombectomy may not reduce the risk of cardiovascular death, compared with PCI alone, according to a study published online ahead of print March 16 in New England Journal of Medicine. In a randomized controlled trial that involved 10,732 patients at 87 hospitals in 20 countries, half of participants received PCI alone and half received PCI with manual thrombectomy. Death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or heart failure occurred within 180 days in 6.9% of the thrombectomy group and 7% of the PCI-alone group. “The message from this study is that thrombectomy should not be used as a routine strategy,” the researchers stated.

A broad range of pre-existing mental disorders are associated with the subsequent onset of severe or frequent headaches, according to a study published in the January issue of Journal of Pain. Researchers evaluated data from 19 World Health Organization World Mental Health Surveys completed by more than 50,000 subjects. The investigators looked at the association between pre-existing mood, anxiety, impulse control, and substance use disorders with subsequent onset of frequent or severe headaches. After adjusting for sex, age, and mental disorder comorbidity, the researchers found that mood, anxiety, and impulse control disorders increased the likelihood of developing severe and frequent headaches by 40%. Respondents with early-onset pre-existing mental disorders had a 21% higher risk for developing headaches than people with later-onset mental disorders.

Early symptoms of post-traumatic stress, such as anxiety, emotional numbness, flashbacks, and irritability, are the strongest predictors of later disability, according to a study published online ahead of print March 4 in Brain. The trial included 38 service members diagnosed with blast-related concussive traumatic brain injury and 34 service members without brain injury who volunteered to serve as controls. Early assessments of service members were conducted in Afghanistan during the first week after injury. Follow-up mental health assessments were conducted with standard interviews at six to 12 months afterward. Sixty-three percent of patients with brain injury were classified as moderately disabled, compared with 20% of people in the control group. The remaining 37% of the brain injury group were considered to have a good recovery.

Among teenagers, heavy marijuana use is associated with an abnormally shaped hippocampus and poor performance on long-term memory tasks, according to a study published online ahead of print March 11 in Hippocampus. Researchers examined 97 people, including matched groups of healthy controls, subjects with a marijuana use disorder, people with schizophrenia and no history of substance use disorders, and people with schizophrenia and a marijuana use disorder. Participants had started using marijuana daily between ages 16 and 17 and continued for about three years. Overall, the longer participants used marijuana, the more abnormal the shape of their hippocampus became. Young adults with schizophrenia who abused cannabis as teens also performed about 26% more poorly on memory tests than young adults with schizophrenia who never abused cannabis.

The combination of enalapril and folic acid, compared with enalapril alone, significantly reduces the risk of a first stroke in adults with hypertension, according to a study published online ahead of print March 15 in JAMA. Researchers randomized 20,702 adults with hypertension and no history of stroke or heart attack to daily treatment with a single-pill combination containing 10 mg of enalapril and 0.8 mg of folic acid or to a tablet containing 10 mg of enalapril alone. During a median treatment duration of 4.5 years, first stroke occurred in 282 participants in the enalapril–folic acid group, compared with 355 participants in the enalapril group. Analyses also showed significant reductions in the risk of ischemic stroke and cardiovascular events among participants in the enalapril– folic acid group.

Responsive direct cortical stimulation safely and effectively reduces seizures in adults with medically refractory partial onset seizures, according to a study published February 24 in Neurology. The results are part of an ongoing, seven-year, multicenter, prospective, open-label study to evaluate the long-term efficacy and safety of the RNS System. A total of 256 participants were implanted with the neurostimulator and leads. Seizure frequency decreased in the majority of participants treated with responsive stimulation. The median percent reduction in seizures was 44% at one year and 53% at two years postimplant. The median percent reduction in seizures was 60% at the beginning of year three and 66% at the beginning of year six. The responder rates at the same time points were 58% and 59%, respectively.

Persistent insomnia is associated with increased risk for all-cause and cardiopulmonary mortality and a steeper increase in inflammation, according to a study published March 12 in American Journal of Medicine. Researchers assessed the persistence of insomnia complaints in 1,409 adult participants from the Tucson Epidemiological Study of Airway Obstructive Disease. The study began in 1972 and included multiple follow-up surveys until 1996 and continuous mortality follow-up data until 2011. Using data from the survey from 1972 through 1973 and from the 1990 through 1992 follow-up survey, the researchers found that serum C-reactive protein (CRP) levels increased over time in people with persistent insomnia. In those subjects for whom CRP data were available, persistent insomnia was associated with a 58% increase in mortality risk, after adjustments for confounding factors.

Prolonged sleep is a potentially useful marker to determine increased future stroke risk in a healthy aging population, according to a study published online ahead of print February 25 in Neurology. Researchers followed 9,692 people with a mean age of 62 who had never had a stroke. Participants were asked about their sleeping habits once and then again four years later. The participants were followed for an average of 9.5 years, and 346 people had a stroke. Of the 986 people who slept more than eight hours per night, 52 had a stroke, compared with 211 of the 6,684 people who slept an average amount. The relationship between long sleep and stroke remained the same after researchers accounted for high cholesterol, high blood pressure, physical activity, and BMI.

Higher levels of physical activity may reduce the effects of white matter hyperintensity burden on motor function in healthy older adults, according to a study published online ahead of print March 11 in Neurology. Researchers examined 167 people (average age, 80) who wore movement monitors on their wrists for as long as 11 days to measure exercise and nonexercise activity. Participants also took 11 motor performance tests. For the people in the top 10% of activity, greater amounts of brain damage did not influence scores on the movement tests. However, for people in the less active half of the population, greater amounts of brain damage were associated with lower scores on the movement tests. For all participants, the average score on the movement tests was 1.04.

Patients with Parkinson’s disease have reduced low- and high-contrast visual acuity, compared with controls, according to a study published January 1 in Journal of Parkinson’s Disease. Thirty-two patients with Parkinson’s disease and 71 control subjects underwent a neurologic examination, which included the Unified Parkinson’s Disease Rating Scale and vision testing using the Variable Contrast Acuity Chart displayed on an iPad. The chart was displayed at low and high contrast at distances of 40 cm and 2 m. Based on the number of letters correctly identified, patients with Parkinson’s disease saw about 10% fewer letters than control subjects in the low-contrast tests at either distance and in the high-contrast tests at 2 m. Researchers found no significant difference between Parkinson’s disease and control subjects in the high-contrast testing at 40 cm.

Statins may not lower the risk for Parkinson’s disease, according to a study published online ahead of print January 14 in Movement Disorders. The researchers examined blood cholesterol levels, medications, and Parkinson’s disease status in participants in the ongoing, long-term Atherosclerosis Risk in Communities study. Cholesterol readings were taken at three-year intervals between 1987 and 1998. Statin use before 1998 was associated with significantly higher risk of Parkinson’s disease after 1998. Higher total cholesterol, however, was associated with lower risk for Parkinson’s disease after adjustment for statin use and confounders. Compared with the lowest tertile of average total cholesterol, the odds ratios for Parkinson’s disease were 0.56 for the second tertile and 0.43 for the third tertile. These data are inconsistent with the hypothesis that statins protect against Parkinson’s disease.

—Kimberly Williams

Gout is inversely associated with the risk of developing Alzheimer’s disease, and uric acid may play a neuroprotective role, according to a study published March 4 in Annals of the Rheumatic Diseases. Researchers conducted a study using data from the Health Improvement Network, an electronic medical record database that is representative of the United Kingdom’s general population. Investigators identified 309 new cases of Alzheimer’s disease among 59,224 patients with gout (average age, 65) and 1,942 cases of Alzheimer’s disease among 238,805 people in the comparison group over a five-year follow up. After accounting for age, sex, BMI, socioeconomic status, lifestyle factors, prior heart conditions, and use of heart drugs, people with a history of gout had a 24% lower risk of developing Alzheimer’s disease.

In patients with ST-segment elevation myocardial infarction who are undergoing primary percutaneous coronary intervention (PCI), routine manual thrombectomy may not reduce the risk of cardiovascular death, compared with PCI alone, according to a study published online ahead of print March 16 in New England Journal of Medicine. In a randomized controlled trial that involved 10,732 patients at 87 hospitals in 20 countries, half of participants received PCI alone and half received PCI with manual thrombectomy. Death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or heart failure occurred within 180 days in 6.9% of the thrombectomy group and 7% of the PCI-alone group. “The message from this study is that thrombectomy should not be used as a routine strategy,” the researchers stated.

A broad range of pre-existing mental disorders are associated with the subsequent onset of severe or frequent headaches, according to a study published in the January issue of Journal of Pain. Researchers evaluated data from 19 World Health Organization World Mental Health Surveys completed by more than 50,000 subjects. The investigators looked at the association between pre-existing mood, anxiety, impulse control, and substance use disorders with subsequent onset of frequent or severe headaches. After adjusting for sex, age, and mental disorder comorbidity, the researchers found that mood, anxiety, and impulse control disorders increased the likelihood of developing severe and frequent headaches by 40%. Respondents with early-onset pre-existing mental disorders had a 21% higher risk for developing headaches than people with later-onset mental disorders.

Early symptoms of post-traumatic stress, such as anxiety, emotional numbness, flashbacks, and irritability, are the strongest predictors of later disability, according to a study published online ahead of print March 4 in Brain. The trial included 38 service members diagnosed with blast-related concussive traumatic brain injury and 34 service members without brain injury who volunteered to serve as controls. Early assessments of service members were conducted in Afghanistan during the first week after injury. Follow-up mental health assessments were conducted with standard interviews at six to 12 months afterward. Sixty-three percent of patients with brain injury were classified as moderately disabled, compared with 20% of people in the control group. The remaining 37% of the brain injury group were considered to have a good recovery.

Among teenagers, heavy marijuana use is associated with an abnormally shaped hippocampus and poor performance on long-term memory tasks, according to a study published online ahead of print March 11 in Hippocampus. Researchers examined 97 people, including matched groups of healthy controls, subjects with a marijuana use disorder, people with schizophrenia and no history of substance use disorders, and people with schizophrenia and a marijuana use disorder. Participants had started using marijuana daily between ages 16 and 17 and continued for about three years. Overall, the longer participants used marijuana, the more abnormal the shape of their hippocampus became. Young adults with schizophrenia who abused cannabis as teens also performed about 26% more poorly on memory tests than young adults with schizophrenia who never abused cannabis.

The combination of enalapril and folic acid, compared with enalapril alone, significantly reduces the risk of a first stroke in adults with hypertension, according to a study published online ahead of print March 15 in JAMA. Researchers randomized 20,702 adults with hypertension and no history of stroke or heart attack to daily treatment with a single-pill combination containing 10 mg of enalapril and 0.8 mg of folic acid or to a tablet containing 10 mg of enalapril alone. During a median treatment duration of 4.5 years, first stroke occurred in 282 participants in the enalapril–folic acid group, compared with 355 participants in the enalapril group. Analyses also showed significant reductions in the risk of ischemic stroke and cardiovascular events among participants in the enalapril– folic acid group.

Responsive direct cortical stimulation safely and effectively reduces seizures in adults with medically refractory partial onset seizures, according to a study published February 24 in Neurology. The results are part of an ongoing, seven-year, multicenter, prospective, open-label study to evaluate the long-term efficacy and safety of the RNS System. A total of 256 participants were implanted with the neurostimulator and leads. Seizure frequency decreased in the majority of participants treated with responsive stimulation. The median percent reduction in seizures was 44% at one year and 53% at two years postimplant. The median percent reduction in seizures was 60% at the beginning of year three and 66% at the beginning of year six. The responder rates at the same time points were 58% and 59%, respectively.

Persistent insomnia is associated with increased risk for all-cause and cardiopulmonary mortality and a steeper increase in inflammation, according to a study published March 12 in American Journal of Medicine. Researchers assessed the persistence of insomnia complaints in 1,409 adult participants from the Tucson Epidemiological Study of Airway Obstructive Disease. The study began in 1972 and included multiple follow-up surveys until 1996 and continuous mortality follow-up data until 2011. Using data from the survey from 1972 through 1973 and from the 1990 through 1992 follow-up survey, the researchers found that serum C-reactive protein (CRP) levels increased over time in people with persistent insomnia. In those subjects for whom CRP data were available, persistent insomnia was associated with a 58% increase in mortality risk, after adjustments for confounding factors.

Prolonged sleep is a potentially useful marker to determine increased future stroke risk in a healthy aging population, according to a study published online ahead of print February 25 in Neurology. Researchers followed 9,692 people with a mean age of 62 who had never had a stroke. Participants were asked about their sleeping habits once and then again four years later. The participants were followed for an average of 9.5 years, and 346 people had a stroke. Of the 986 people who slept more than eight hours per night, 52 had a stroke, compared with 211 of the 6,684 people who slept an average amount. The relationship between long sleep and stroke remained the same after researchers accounted for high cholesterol, high blood pressure, physical activity, and BMI.

Higher levels of physical activity may reduce the effects of white matter hyperintensity burden on motor function in healthy older adults, according to a study published online ahead of print March 11 in Neurology. Researchers examined 167 people (average age, 80) who wore movement monitors on their wrists for as long as 11 days to measure exercise and nonexercise activity. Participants also took 11 motor performance tests. For the people in the top 10% of activity, greater amounts of brain damage did not influence scores on the movement tests. However, for people in the less active half of the population, greater amounts of brain damage were associated with lower scores on the movement tests. For all participants, the average score on the movement tests was 1.04.

Patients with Parkinson’s disease have reduced low- and high-contrast visual acuity, compared with controls, according to a study published January 1 in Journal of Parkinson’s Disease. Thirty-two patients with Parkinson’s disease and 71 control subjects underwent a neurologic examination, which included the Unified Parkinson’s Disease Rating Scale and vision testing using the Variable Contrast Acuity Chart displayed on an iPad. The chart was displayed at low and high contrast at distances of 40 cm and 2 m. Based on the number of letters correctly identified, patients with Parkinson’s disease saw about 10% fewer letters than control subjects in the low-contrast tests at either distance and in the high-contrast tests at 2 m. Researchers found no significant difference between Parkinson’s disease and control subjects in the high-contrast testing at 40 cm.

Statins may not lower the risk for Parkinson’s disease, according to a study published online ahead of print January 14 in Movement Disorders. The researchers examined blood cholesterol levels, medications, and Parkinson’s disease status in participants in the ongoing, long-term Atherosclerosis Risk in Communities study. Cholesterol readings were taken at three-year intervals between 1987 and 1998. Statin use before 1998 was associated with significantly higher risk of Parkinson’s disease after 1998. Higher total cholesterol, however, was associated with lower risk for Parkinson’s disease after adjustment for statin use and confounders. Compared with the lowest tertile of average total cholesterol, the odds ratios for Parkinson’s disease were 0.56 for the second tertile and 0.43 for the third tertile. These data are inconsistent with the hypothesis that statins protect against Parkinson’s disease.

—Kimberly Williams