New and Noteworthy Information—December 2015

The risk of epilepsy is increased in children with hospital-diagnosed pertussis infections, compared with the general population, but the absolute risk is low, according to a Danish study published in the November 3 issue of JAMA. Researchers used data from population-based medical registries covering all Danish hospitals to identify all patients with pertussis born between 1978 and 2011 and followed up through 2011. Investigators used the Civil Registration System to identify 10 individuals from the general population for each patient with pertussis, matched on sex and year of birth. They identified 4,700 patients with pertussis, of whom 90 developed epilepsy during the follow-up. The cumulative incidence of epilepsy at age 10 was 1.7% for patients with pertussis and 0.9% for the matched comparison cohort.

Chronic users of antiepileptic drugs have poorer standing balance, compared with nonusers, according to a longitudinal twin and sibling study published in the November issue of Epilepsia. Researchers studied 26 twin and sibling pairs. Siblings were of the same gender, but only one in each pair had exposure to antiepileptic drugs. Clinical and laboratory balance examinations were conducted twice, and at least one year elapsed between examinations. The mean within-pair differences in balance measures were calculated cross-sectionally at baseline and follow-up, and longitudinally. Researchers found no significant mean within-pair difference at baseline in age (mean, 44), weight, and height. Cross-sectional sway measures from posturography and clinical static balance tests showed poorer performance in antiepileptic drug users, compared with nonusers, on several test conditions at baseline and follow-up.

Treatment for symptomatic intracerebral hemorrhage (sICH) after thrombolysis for stroke does not significantly reduce the likelihood of in-hospital mortality or hematoma expansion, according to a retrospective study published online ahead of print October 26 in JAMA Neurology. Of 3,894 patients treated with IV rt-PA within 4.5 hours after onset of ischemic stroke symptoms, 128 had sICH. The median time from initiation of rt-PA to sICH diagnosis was 470 minutes, and the median time from diagnosis to treatment of sICH was 112 minutes. The in-hospital mortality rate was 52.3%, and 26.8% of participants had hematoma expansion. In multivariable models, code status change to comfort measures after sICH diagnosis was the sole factor associated with increased in-hospital mortality. Severe hypofibrinogenemia was associated with hematoma expansion and occurred in 36.3% of patients without hematoma expansion.

Gaucher disease or mutations in the β-glucocerebrosidase gene (GBA) may protect individuals from deficiency in visual color discrimination, according to a study published September 14 in Journal of Parkinson’s Disease. Investigators tested groups of patients on the Farnsworth-Munsell 100 hue test (FMHT) and calculated their mean Total Error Scores (TES). Patients were classified as having Parkinson’s disease only, Gaucher disease only, Parkinson’s disease and Gaucher disease, GBA mutations, GBA mutations and Parkinson’s disease, or as controls. Patients with Parkinson’s disease only had the highest mean TES, and patients with Gaucher disease only had the lowest mean TES. GBA carriers without Parkinson’s disease made more errors than patients with Gaucher disease only, which was approximately the same number of errors as healthy controls.

Brain scans of people in a coma may help predict who will regain consciousness, according to a study published online ahead of print November 11 in Neurology. Researchers compared 27 prospectively recruited comatose patients who had severe brain injury (14 with traumatic injury and 13 with anoxic injury) with 14 age-matched healthy participants. Standardized clinical assessment and functional MRI were performed at an average of four days after withdrawal of sedation. Patients who were comatose showed a significant disruption of functional connectivity of brain areas spontaneously synchronized with posterior cingulate cortex, regardless of etiology of injury. The functional connectivity strength between the posterior cingulate cortex and the medial prefrontal cortex was significantly different between comatose patients who subsequently recovered and those who subsequently scored an unfavorable outcome three months after brain injury.

Raloxifene does not have a significant cognitive effect for women with Alzheimer’s disease, according to a study published online ahead of print November 4 in Neurology. Investigators conducted a randomized, double-blind, placebo-controlled pilot study with a planned treatment period of 12 months. Women with mild to moderate late-onset Alzheimer’s disease were randomized to high-dose (ie, 120 mg) oral raloxifene or identical placebo provided once daily. Forty-two women randomized to raloxifene or placebo were included in intent-to-treat analyses, and 39 women contributed 12-month outcomes. Results on the Alzheimer’s Disease Assessment Scale, cognitive subscale showed no cognitive benefits in the raloxifene-treated group. Raloxifene and placebo groups did not differ significantly on secondary analyses of dementia rating, activities of daily living, behavior, or a global cognition composite score.

Nonpharmacologic sleep interventions may help optimize outcomes in patients with chronic pain, according to data published in the November issue of Sleep. Investigators analyzed 11 randomized controlled trials, involving 1,066 participants, that evaluated the effect of nonpharmacologic sleep treatments on self-reported sleep quality, pain, and well-being in patients with long-term pain. They extracted means and standard deviations of sleep quality, pain, fatigue, depression, anxiety, and physical and psychologic functioning for the treatment and control groups at baseline, post treatment, and final follow-up. Nonpharmacologic sleep treatments in patients with chronic pain were associated with a large improvement in sleep quality, a small reduction in pain, and moderate improvement in fatigue at post treatment. The effects on sleep quality and fatigue were maintained for as long as one year, when a moderate reduction in depression also was observed.

CSF biomarkers of angiogenesis are increased in Parkinson’s disease and associated with gait difficulties, blood–­brain barrier dysfunction, white matter lesions, and cerebral microbleeds, according to a study published online ahead of print October 28 in Neurology. This cross-sectional analysis included 38 elderly controls and 100 patients with Parkinson’s disease. Patients with Parkinson’s disease without dementia displayed higher CSF levels of vascular endothelial growth factor, placental growth factor, and vascular endothelial growth factor 2, and lower levels of angiopoietin 2, compared with controls. Similar alterations in vascular endothelial growth factor, placental growth factor, and angiopoietin 2 levels were observed in patients with Parkinson’s disease with dementia. Abnormal angiogenesis may be important in Parkinson’s disease pathogenesis and contribute to dopa-resistant symptoms, said the researchers.

Despite comparable reductions in total sleep time, partial sleep loss from sleep continuity disruption is more detrimental to positive mood than partial sleep loss from delaying bedtime, even when controlling for concomitant increases in negative mood, according to a study published in the November issue of Sleep. Participants were randomized to receive three consecutive nights of sleep continuity disruption by forced nocturnal awakenings, or one of the following two control conditions: restricted sleep opportunity or uninterrupted sleep. Compared with controls with restricted sleep opportunity, participants who underwent forced awakenings had significantly less slow wave sleep after the first night of sleep deprivation, and significantly lower positive mood after the second night of sleep deprivation. The differential change in slow wave sleep statistically mediated the observed group differences in positive mood.

Among patients who underwent transcatheter atrial septal defect closure (ASD), the use of clopidogrel and aspirin, compared with aspirin plus placebo, resulted in a lower monthly frequency of migraine attacks over three months, according to a study published online ahead of print November 9 in JAMA. A total of 171 patients without migraine were randomized to receive dual antiplatelet therapy or single antiplatelet therapy (ie, aspirin and placebo) for three months following transcatheter ASD closure. The mean age of the participants was 49, and 62% were women. Among patients with migraines following the procedure, those who received clopidogrel had less-severe migraine attacks. No patients who received clopidogrel had moderately or severely disabling migraine attacks, and 37% of the placebo group had such attacks.

The Consortium of Multiple Sclerosis Centers (CMSC) has issued a statement asserting that prescribers must retain the right to decide on the best treatment and medication for each patient with MS. “The varied and individualized course of MS mandates full access to symptomatic management as well as disease-modifying therapies, which, in the best judgment of the prescriber, offer optimal treatment outcomes. Medications to treat symptoms are carefully decided on an individual basis and by best-practice regimens,” said the CMSC. “Lack of understanding of the disease course and the challenges of MS treatment result in poor decision making practices by the insurance plans and specialty pharmacies and subsequent denial of prescribed medications.... CMSC proposes a collaborative care model in which providers, patients, and insurers work together to address these concerns.”

APOE4 greatly increases the likelihood of microbleeds in some men, according to a study published online ahead of print October 16 in Neurobiology of Aging. These microbleeds contribute to memory loss. Investigators examined brain scans of 658 participants (ages 48 to 91) in the Alzheimer’s Disease Neuroimaging Initiative. Of those subjects, 402 had mild cognitive impairment (MCI), 90 had early-stage Alzheimer’s disease, and 166 were cognitively normal. Researchers also analyzed scans of 448 other subjects (ages 36 to 88). Of those people, 152 had MCI, 152 had Alzheimer’s disease, and 144 were cognitively normal. Male carriers of APOE4 with MCI or Alzheimer’s disease had twice as many microbleeds in their brains as women with similar diagnoses. Researchers should evaluate whether sex steroids can reduce the microbleeds, said the authors.

The Lewy Body Composite Risk Score (LBCRS) increases the diagnostic probability that Lewy body pathology is contributing to dementia and may improve clinical detection and enrollment for clinical trials, according to a study published September 1 in Alzheimer’s Dementia. The LBCRS was tested in a consecutive series of 256 patients and compared with the Clinical Dementia Rating and gold-standard measures of cognition, motor symptoms, function, and behavior. Mean LBCRS scores were significantly different between patients with dementia with Lewy bodies and those with Alzheimer’s disease. Mean LBCRS scores also were significantly different between patients with mild cognitive impairment (MCI) due to dementia with Lewy bodies and patients with MCI due to Alzheimer’s disease. The LBCRS also was able to discriminate between dementia with Lewy bodies and other causes of dementia.

—Kimberly Williams

The risk of epilepsy is increased in children with hospital-diagnosed pertussis infections, compared with the general population, but the absolute risk is low, according to a Danish study published in the November 3 issue of JAMA. Researchers used data from population-based medical registries covering all Danish hospitals to identify all patients with pertussis born between 1978 and 2011 and followed up through 2011. Investigators used the Civil Registration System to identify 10 individuals from the general population for each patient with pertussis, matched on sex and year of birth. They identified 4,700 patients with pertussis, of whom 90 developed epilepsy during the follow-up. The cumulative incidence of epilepsy at age 10 was 1.7% for patients with pertussis and 0.9% for the matched comparison cohort.

Chronic users of antiepileptic drugs have poorer standing balance, compared with nonusers, according to a longitudinal twin and sibling study published in the November issue of Epilepsia. Researchers studied 26 twin and sibling pairs. Siblings were of the same gender, but only one in each pair had exposure to antiepileptic drugs. Clinical and laboratory balance examinations were conducted twice, and at least one year elapsed between examinations. The mean within-pair differences in balance measures were calculated cross-sectionally at baseline and follow-up, and longitudinally. Researchers found no significant mean within-pair difference at baseline in age (mean, 44), weight, and height. Cross-sectional sway measures from posturography and clinical static balance tests showed poorer performance in antiepileptic drug users, compared with nonusers, on several test conditions at baseline and follow-up.

Treatment for symptomatic intracerebral hemorrhage (sICH) after thrombolysis for stroke does not significantly reduce the likelihood of in-hospital mortality or hematoma expansion, according to a retrospective study published online ahead of print October 26 in JAMA Neurology. Of 3,894 patients treated with IV rt-PA within 4.5 hours after onset of ischemic stroke symptoms, 128 had sICH. The median time from initiation of rt-PA to sICH diagnosis was 470 minutes, and the median time from diagnosis to treatment of sICH was 112 minutes. The in-hospital mortality rate was 52.3%, and 26.8% of participants had hematoma expansion. In multivariable models, code status change to comfort measures after sICH diagnosis was the sole factor associated with increased in-hospital mortality. Severe hypofibrinogenemia was associated with hematoma expansion and occurred in 36.3% of patients without hematoma expansion.

Gaucher disease or mutations in the β-glucocerebrosidase gene (GBA) may protect individuals from deficiency in visual color discrimination, according to a study published September 14 in Journal of Parkinson’s Disease. Investigators tested groups of patients on the Farnsworth-Munsell 100 hue test (FMHT) and calculated their mean Total Error Scores (TES). Patients were classified as having Parkinson’s disease only, Gaucher disease only, Parkinson’s disease and Gaucher disease, GBA mutations, GBA mutations and Parkinson’s disease, or as controls. Patients with Parkinson’s disease only had the highest mean TES, and patients with Gaucher disease only had the lowest mean TES. GBA carriers without Parkinson’s disease made more errors than patients with Gaucher disease only, which was approximately the same number of errors as healthy controls.

Brain scans of people in a coma may help predict who will regain consciousness, according to a study published online ahead of print November 11 in Neurology. Researchers compared 27 prospectively recruited comatose patients who had severe brain injury (14 with traumatic injury and 13 with anoxic injury) with 14 age-matched healthy participants. Standardized clinical assessment and functional MRI were performed at an average of four days after withdrawal of sedation. Patients who were comatose showed a significant disruption of functional connectivity of brain areas spontaneously synchronized with posterior cingulate cortex, regardless of etiology of injury. The functional connectivity strength between the posterior cingulate cortex and the medial prefrontal cortex was significantly different between comatose patients who subsequently recovered and those who subsequently scored an unfavorable outcome three months after brain injury.

Raloxifene does not have a significant cognitive effect for women with Alzheimer’s disease, according to a study published online ahead of print November 4 in Neurology. Investigators conducted a randomized, double-blind, placebo-controlled pilot study with a planned treatment period of 12 months. Women with mild to moderate late-onset Alzheimer’s disease were randomized to high-dose (ie, 120 mg) oral raloxifene or identical placebo provided once daily. Forty-two women randomized to raloxifene or placebo were included in intent-to-treat analyses, and 39 women contributed 12-month outcomes. Results on the Alzheimer’s Disease Assessment Scale, cognitive subscale showed no cognitive benefits in the raloxifene-treated group. Raloxifene and placebo groups did not differ significantly on secondary analyses of dementia rating, activities of daily living, behavior, or a global cognition composite score.

Nonpharmacologic sleep interventions may help optimize outcomes in patients with chronic pain, according to data published in the November issue of Sleep. Investigators analyzed 11 randomized controlled trials, involving 1,066 participants, that evaluated the effect of nonpharmacologic sleep treatments on self-reported sleep quality, pain, and well-being in patients with long-term pain. They extracted means and standard deviations of sleep quality, pain, fatigue, depression, anxiety, and physical and psychologic functioning for the treatment and control groups at baseline, post treatment, and final follow-up. Nonpharmacologic sleep treatments in patients with chronic pain were associated with a large improvement in sleep quality, a small reduction in pain, and moderate improvement in fatigue at post treatment. The effects on sleep quality and fatigue were maintained for as long as one year, when a moderate reduction in depression also was observed.

CSF biomarkers of angiogenesis are increased in Parkinson’s disease and associated with gait difficulties, blood–­brain barrier dysfunction, white matter lesions, and cerebral microbleeds, according to a study published online ahead of print October 28 in Neurology. This cross-sectional analysis included 38 elderly controls and 100 patients with Parkinson’s disease. Patients with Parkinson’s disease without dementia displayed higher CSF levels of vascular endothelial growth factor, placental growth factor, and vascular endothelial growth factor 2, and lower levels of angiopoietin 2, compared with controls. Similar alterations in vascular endothelial growth factor, placental growth factor, and angiopoietin 2 levels were observed in patients with Parkinson’s disease with dementia. Abnormal angiogenesis may be important in Parkinson’s disease pathogenesis and contribute to dopa-resistant symptoms, said the researchers.

Despite comparable reductions in total sleep time, partial sleep loss from sleep continuity disruption is more detrimental to positive mood than partial sleep loss from delaying bedtime, even when controlling for concomitant increases in negative mood, according to a study published in the November issue of Sleep. Participants were randomized to receive three consecutive nights of sleep continuity disruption by forced nocturnal awakenings, or one of the following two control conditions: restricted sleep opportunity or uninterrupted sleep. Compared with controls with restricted sleep opportunity, participants who underwent forced awakenings had significantly less slow wave sleep after the first night of sleep deprivation, and significantly lower positive mood after the second night of sleep deprivation. The differential change in slow wave sleep statistically mediated the observed group differences in positive mood.

Among patients who underwent transcatheter atrial septal defect closure (ASD), the use of clopidogrel and aspirin, compared with aspirin plus placebo, resulted in a lower monthly frequency of migraine attacks over three months, according to a study published online ahead of print November 9 in JAMA. A total of 171 patients without migraine were randomized to receive dual antiplatelet therapy or single antiplatelet therapy (ie, aspirin and placebo) for three months following transcatheter ASD closure. The mean age of the participants was 49, and 62% were women. Among patients with migraines following the procedure, those who received clopidogrel had less-severe migraine attacks. No patients who received clopidogrel had moderately or severely disabling migraine attacks, and 37% of the placebo group had such attacks.

The Consortium of Multiple Sclerosis Centers (CMSC) has issued a statement asserting that prescribers must retain the right to decide on the best treatment and medication for each patient with MS. “The varied and individualized course of MS mandates full access to symptomatic management as well as disease-modifying therapies, which, in the best judgment of the prescriber, offer optimal treatment outcomes. Medications to treat symptoms are carefully decided on an individual basis and by best-practice regimens,” said the CMSC. “Lack of understanding of the disease course and the challenges of MS treatment result in poor decision making practices by the insurance plans and specialty pharmacies and subsequent denial of prescribed medications.... CMSC proposes a collaborative care model in which providers, patients, and insurers work together to address these concerns.”

APOE4 greatly increases the likelihood of microbleeds in some men, according to a study published online ahead of print October 16 in Neurobiology of Aging. These microbleeds contribute to memory loss. Investigators examined brain scans of 658 participants (ages 48 to 91) in the Alzheimer’s Disease Neuroimaging Initiative. Of those subjects, 402 had mild cognitive impairment (MCI), 90 had early-stage Alzheimer’s disease, and 166 were cognitively normal. Researchers also analyzed scans of 448 other subjects (ages 36 to 88). Of those people, 152 had MCI, 152 had Alzheimer’s disease, and 144 were cognitively normal. Male carriers of APOE4 with MCI or Alzheimer’s disease had twice as many microbleeds in their brains as women with similar diagnoses. Researchers should evaluate whether sex steroids can reduce the microbleeds, said the authors.

The Lewy Body Composite Risk Score (LBCRS) increases the diagnostic probability that Lewy body pathology is contributing to dementia and may improve clinical detection and enrollment for clinical trials, according to a study published September 1 in Alzheimer’s Dementia. The LBCRS was tested in a consecutive series of 256 patients and compared with the Clinical Dementia Rating and gold-standard measures of cognition, motor symptoms, function, and behavior. Mean LBCRS scores were significantly different between patients with dementia with Lewy bodies and those with Alzheimer’s disease. Mean LBCRS scores also were significantly different between patients with mild cognitive impairment (MCI) due to dementia with Lewy bodies and patients with MCI due to Alzheimer’s disease. The LBCRS also was able to discriminate between dementia with Lewy bodies and other causes of dementia.

—Kimberly Williams

The risk of epilepsy is increased in children with hospital-diagnosed pertussis infections, compared with the general population, but the absolute risk is low, according to a Danish study published in the November 3 issue of JAMA. Researchers used data from population-based medical registries covering all Danish hospitals to identify all patients with pertussis born between 1978 and 2011 and followed up through 2011. Investigators used the Civil Registration System to identify 10 individuals from the general population for each patient with pertussis, matched on sex and year of birth. They identified 4,700 patients with pertussis, of whom 90 developed epilepsy during the follow-up. The cumulative incidence of epilepsy at age 10 was 1.7% for patients with pertussis and 0.9% for the matched comparison cohort.

Chronic users of antiepileptic drugs have poorer standing balance, compared with nonusers, according to a longitudinal twin and sibling study published in the November issue of Epilepsia. Researchers studied 26 twin and sibling pairs. Siblings were of the same gender, but only one in each pair had exposure to antiepileptic drugs. Clinical and laboratory balance examinations were conducted twice, and at least one year elapsed between examinations. The mean within-pair differences in balance measures were calculated cross-sectionally at baseline and follow-up, and longitudinally. Researchers found no significant mean within-pair difference at baseline in age (mean, 44), weight, and height. Cross-sectional sway measures from posturography and clinical static balance tests showed poorer performance in antiepileptic drug users, compared with nonusers, on several test conditions at baseline and follow-up.

Treatment for symptomatic intracerebral hemorrhage (sICH) after thrombolysis for stroke does not significantly reduce the likelihood of in-hospital mortality or hematoma expansion, according to a retrospective study published online ahead of print October 26 in JAMA Neurology. Of 3,894 patients treated with IV rt-PA within 4.5 hours after onset of ischemic stroke symptoms, 128 had sICH. The median time from initiation of rt-PA to sICH diagnosis was 470 minutes, and the median time from diagnosis to treatment of sICH was 112 minutes. The in-hospital mortality rate was 52.3%, and 26.8% of participants had hematoma expansion. In multivariable models, code status change to comfort measures after sICH diagnosis was the sole factor associated with increased in-hospital mortality. Severe hypofibrinogenemia was associated with hematoma expansion and occurred in 36.3% of patients without hematoma expansion.

Gaucher disease or mutations in the β-glucocerebrosidase gene (GBA) may protect individuals from deficiency in visual color discrimination, according to a study published September 14 in Journal of Parkinson’s Disease. Investigators tested groups of patients on the Farnsworth-Munsell 100 hue test (FMHT) and calculated their mean Total Error Scores (TES). Patients were classified as having Parkinson’s disease only, Gaucher disease only, Parkinson’s disease and Gaucher disease, GBA mutations, GBA mutations and Parkinson’s disease, or as controls. Patients with Parkinson’s disease only had the highest mean TES, and patients with Gaucher disease only had the lowest mean TES. GBA carriers without Parkinson’s disease made more errors than patients with Gaucher disease only, which was approximately the same number of errors as healthy controls.

Brain scans of people in a coma may help predict who will regain consciousness, according to a study published online ahead of print November 11 in Neurology. Researchers compared 27 prospectively recruited comatose patients who had severe brain injury (14 with traumatic injury and 13 with anoxic injury) with 14 age-matched healthy participants. Standardized clinical assessment and functional MRI were performed at an average of four days after withdrawal of sedation. Patients who were comatose showed a significant disruption of functional connectivity of brain areas spontaneously synchronized with posterior cingulate cortex, regardless of etiology of injury. The functional connectivity strength between the posterior cingulate cortex and the medial prefrontal cortex was significantly different between comatose patients who subsequently recovered and those who subsequently scored an unfavorable outcome three months after brain injury.

Raloxifene does not have a significant cognitive effect for women with Alzheimer’s disease, according to a study published online ahead of print November 4 in Neurology. Investigators conducted a randomized, double-blind, placebo-controlled pilot study with a planned treatment period of 12 months. Women with mild to moderate late-onset Alzheimer’s disease were randomized to high-dose (ie, 120 mg) oral raloxifene or identical placebo provided once daily. Forty-two women randomized to raloxifene or placebo were included in intent-to-treat analyses, and 39 women contributed 12-month outcomes. Results on the Alzheimer’s Disease Assessment Scale, cognitive subscale showed no cognitive benefits in the raloxifene-treated group. Raloxifene and placebo groups did not differ significantly on secondary analyses of dementia rating, activities of daily living, behavior, or a global cognition composite score.

Nonpharmacologic sleep interventions may help optimize outcomes in patients with chronic pain, according to data published in the November issue of Sleep. Investigators analyzed 11 randomized controlled trials, involving 1,066 participants, that evaluated the effect of nonpharmacologic sleep treatments on self-reported sleep quality, pain, and well-being in patients with long-term pain. They extracted means and standard deviations of sleep quality, pain, fatigue, depression, anxiety, and physical and psychologic functioning for the treatment and control groups at baseline, post treatment, and final follow-up. Nonpharmacologic sleep treatments in patients with chronic pain were associated with a large improvement in sleep quality, a small reduction in pain, and moderate improvement in fatigue at post treatment. The effects on sleep quality and fatigue were maintained for as long as one year, when a moderate reduction in depression also was observed.

CSF biomarkers of angiogenesis are increased in Parkinson’s disease and associated with gait difficulties, blood–­brain barrier dysfunction, white matter lesions, and cerebral microbleeds, according to a study published online ahead of print October 28 in Neurology. This cross-sectional analysis included 38 elderly controls and 100 patients with Parkinson’s disease. Patients with Parkinson’s disease without dementia displayed higher CSF levels of vascular endothelial growth factor, placental growth factor, and vascular endothelial growth factor 2, and lower levels of angiopoietin 2, compared with controls. Similar alterations in vascular endothelial growth factor, placental growth factor, and angiopoietin 2 levels were observed in patients with Parkinson’s disease with dementia. Abnormal angiogenesis may be important in Parkinson’s disease pathogenesis and contribute to dopa-resistant symptoms, said the researchers.

Despite comparable reductions in total sleep time, partial sleep loss from sleep continuity disruption is more detrimental to positive mood than partial sleep loss from delaying bedtime, even when controlling for concomitant increases in negative mood, according to a study published in the November issue of Sleep. Participants were randomized to receive three consecutive nights of sleep continuity disruption by forced nocturnal awakenings, or one of the following two control conditions: restricted sleep opportunity or uninterrupted sleep. Compared with controls with restricted sleep opportunity, participants who underwent forced awakenings had significantly less slow wave sleep after the first night of sleep deprivation, and significantly lower positive mood after the second night of sleep deprivation. The differential change in slow wave sleep statistically mediated the observed group differences in positive mood.

Among patients who underwent transcatheter atrial septal defect closure (ASD), the use of clopidogrel and aspirin, compared with aspirin plus placebo, resulted in a lower monthly frequency of migraine attacks over three months, according to a study published online ahead of print November 9 in JAMA. A total of 171 patients without migraine were randomized to receive dual antiplatelet therapy or single antiplatelet therapy (ie, aspirin and placebo) for three months following transcatheter ASD closure. The mean age of the participants was 49, and 62% were women. Among patients with migraines following the procedure, those who received clopidogrel had less-severe migraine attacks. No patients who received clopidogrel had moderately or severely disabling migraine attacks, and 37% of the placebo group had such attacks.

The Consortium of Multiple Sclerosis Centers (CMSC) has issued a statement asserting that prescribers must retain the right to decide on the best treatment and medication for each patient with MS. “The varied and individualized course of MS mandates full access to symptomatic management as well as disease-modifying therapies, which, in the best judgment of the prescriber, offer optimal treatment outcomes. Medications to treat symptoms are carefully decided on an individual basis and by best-practice regimens,” said the CMSC. “Lack of understanding of the disease course and the challenges of MS treatment result in poor decision making practices by the insurance plans and specialty pharmacies and subsequent denial of prescribed medications.... CMSC proposes a collaborative care model in which providers, patients, and insurers work together to address these concerns.”

APOE4 greatly increases the likelihood of microbleeds in some men, according to a study published online ahead of print October 16 in Neurobiology of Aging. These microbleeds contribute to memory loss. Investigators examined brain scans of 658 participants (ages 48 to 91) in the Alzheimer’s Disease Neuroimaging Initiative. Of those subjects, 402 had mild cognitive impairment (MCI), 90 had early-stage Alzheimer’s disease, and 166 were cognitively normal. Researchers also analyzed scans of 448 other subjects (ages 36 to 88). Of those people, 152 had MCI, 152 had Alzheimer’s disease, and 144 were cognitively normal. Male carriers of APOE4 with MCI or Alzheimer’s disease had twice as many microbleeds in their brains as women with similar diagnoses. Researchers should evaluate whether sex steroids can reduce the microbleeds, said the authors.

The Lewy Body Composite Risk Score (LBCRS) increases the diagnostic probability that Lewy body pathology is contributing to dementia and may improve clinical detection and enrollment for clinical trials, according to a study published September 1 in Alzheimer’s Dementia. The LBCRS was tested in a consecutive series of 256 patients and compared with the Clinical Dementia Rating and gold-standard measures of cognition, motor symptoms, function, and behavior. Mean LBCRS scores were significantly different between patients with dementia with Lewy bodies and those with Alzheimer’s disease. Mean LBCRS scores also were significantly different between patients with mild cognitive impairment (MCI) due to dementia with Lewy bodies and patients with MCI due to Alzheimer’s disease. The LBCRS also was able to discriminate between dementia with Lewy bodies and other causes of dementia.

—Kimberly Williams