New and Noteworthy Information for February 2012

Using a nicotine patch may induce cognitive improvement in patients with amnestic mild cognitive impairment (MCI) who do not smoke, researchers reported in the January 10 Neurology. All 74 subjects enrolled in the study had amnestic MCI and did not smoke; the investigators randomized 39 participants to receive 15 mg of transdermal nicotine daily for six months and 35 to receive placebo daily for the same time period. Results showed that participants safely tolerated the transdermal nicotine and that they improved on measures of attention, memory, and mental processing, but not in clinical overall impression of change. “We conclude that this initial study provides evidence for nicotine–induced cognitive improvement in subjects with MCI; however, whether these effects are clinically important will require larger studies,” the researchers wrote.

Physicians may need to be cautious of potential drug interactions when selecting seizure medications for people with HIV/AIDs, according to a new guideline issued by the American Academy of Neurology and published in the online January 4 Neurology. A systematic review of the literature showed that antiepileptic drug (AED) and antiretroviral drug administration may be indicated in up to 55% of patients taking  antiretrovirals. Investigators found that clinicians might need to adjust the dosage of seizure drugs such as phenytoin and valproic acid to avoid adversely affecting patients’  antiretroviral levels. “It may be important to avoid enzyme-inducing AEDs in people on antiretroviral regimens that include protease inhibitors or nonnucleoside reverse transcriptase inhibitors, as pharmacokinetic interactions may result in virologic failure,” the study authors said. The researchers recommend that physicians use pharmacokinetic assessment to monitor patients who must be on certain AED regimens for seizure control.

Subclinical atrial tachyarrhythmias were frequently observed in patients with pacemakers and were linked with a heightened risk of ischemic stroke or systemic embolism, according to a study published in the January 12 New England Journal of Medicine. For three months, researchers monitored 2,580 patients 65 and older for subclinical atrial tachyarrhythmias, defined as episodes of atrial rate of greater than 190 beats per minute for more than six minutes. The patients, who had hypertension and no history of atrial fibrillation, had recently been implanted with a pacemaker or defibrillator and were followed for a mean of 2.5 years for ischemic stroke or systemic embolism. Of the 2,580 patients, 261 experienced subclinical atrial tachyarrhythmias, which were associated with an increased risk of clinical atrial fibrillation and of ischemic stroke or systemic embolism. “The data from the present study support the concept that there is a link between subclinical atrial fibrillation and cryptogenic stroke,” the investigators stated.

The FDA has permitted marketing of the Stratify JCV (John Cunningham Virus) Antibody ELISA test to help determine the risk of progressive multifocal leukoencephalopathy (PML) in patients taking natalizumab to treat multiple sclerosis (MS) or Crohn’s disease. The test, which cannot diagnose PML, is intended to be used in conjunction with other clinical data from patients, such as the presence of anti-JCV antibodies, treatment with natalizumab for longer than two years, and treatment with certain immunosuppressants before receiving natalizumab. By considering these patient risk factors as well as the results of the Stratify JCV Antibody ELISA test, physicians may better assess the risks of continuing natalizumab treatment in patients on immunomodulatory therapy. The test will be available only to professionals, administered by prescription, and performed at Focus Diagnostics’ Reference Laboratory in Cypress, California.

Patients who experience stroke and later develop delirium are likely to have a higher mortality, longer hospitalizations, and a greater degree of dependence after discharge, researchers reported in the January 19 online Stroke. Investigators determined that 10 of 78 eligible studies met approval criteria for eligibility, validity, and quality, and a review of those studies showed that patients with stroke and delirium had higher in-patient mortality as well as mortality at 12 months, compared to patients without delirium. Furthermore, patients with stroke and delirium remained in the hospital for more time than those without delirium. Patients with stroke and delirium were also more likely to be discharged to an institution, such as a nursing home. “Early recognition and prevention of delirium may improve outcomes in stroke patients,” the researchers concluded.   

Using a nicotine patch may induce cognitive improvement in patients with amnestic mild cognitive impairment (MCI) who do not smoke, researchers reported in the January 10 Neurology. All 74 subjects enrolled in the study had amnestic MCI and did not smoke; the investigators randomized 39 participants to receive 15 mg of transdermal nicotine daily for six months and 35 to receive placebo daily for the same time period. Results showed that participants safely tolerated the transdermal nicotine and that they improved on measures of attention, memory, and mental processing, but not in clinical overall impression of change. “We conclude that this initial study provides evidence for nicotine–induced cognitive improvement in subjects with MCI; however, whether these effects are clinically important will require larger studies,” the researchers wrote.

Physicians may need to be cautious of potential drug interactions when selecting seizure medications for people with HIV/AIDs, according to a new guideline issued by the American Academy of Neurology and published in the online January 4 Neurology. A systematic review of the literature showed that antiepileptic drug (AED) and antiretroviral drug administration may be indicated in up to 55% of patients taking  antiretrovirals. Investigators found that clinicians might need to adjust the dosage of seizure drugs such as phenytoin and valproic acid to avoid adversely affecting patients’  antiretroviral levels. “It may be important to avoid enzyme-inducing AEDs in people on antiretroviral regimens that include protease inhibitors or nonnucleoside reverse transcriptase inhibitors, as pharmacokinetic interactions may result in virologic failure,” the study authors said. The researchers recommend that physicians use pharmacokinetic assessment to monitor patients who must be on certain AED regimens for seizure control.

Subclinical atrial tachyarrhythmias were frequently observed in patients with pacemakers and were linked with a heightened risk of ischemic stroke or systemic embolism, according to a study published in the January 12 New England Journal of Medicine. For three months, researchers monitored 2,580 patients 65 and older for subclinical atrial tachyarrhythmias, defined as episodes of atrial rate of greater than 190 beats per minute for more than six minutes. The patients, who had hypertension and no history of atrial fibrillation, had recently been implanted with a pacemaker or defibrillator and were followed for a mean of 2.5 years for ischemic stroke or systemic embolism. Of the 2,580 patients, 261 experienced subclinical atrial tachyarrhythmias, which were associated with an increased risk of clinical atrial fibrillation and of ischemic stroke or systemic embolism. “The data from the present study support the concept that there is a link between subclinical atrial fibrillation and cryptogenic stroke,” the investigators stated.

The FDA has permitted marketing of the Stratify JCV (John Cunningham Virus) Antibody ELISA test to help determine the risk of progressive multifocal leukoencephalopathy (PML) in patients taking natalizumab to treat multiple sclerosis (MS) or Crohn’s disease. The test, which cannot diagnose PML, is intended to be used in conjunction with other clinical data from patients, such as the presence of anti-JCV antibodies, treatment with natalizumab for longer than two years, and treatment with certain immunosuppressants before receiving natalizumab. By considering these patient risk factors as well as the results of the Stratify JCV Antibody ELISA test, physicians may better assess the risks of continuing natalizumab treatment in patients on immunomodulatory therapy. The test will be available only to professionals, administered by prescription, and performed at Focus Diagnostics’ Reference Laboratory in Cypress, California.

Patients who experience stroke and later develop delirium are likely to have a higher mortality, longer hospitalizations, and a greater degree of dependence after discharge, researchers reported in the January 19 online Stroke. Investigators determined that 10 of 78 eligible studies met approval criteria for eligibility, validity, and quality, and a review of those studies showed that patients with stroke and delirium had higher in-patient mortality as well as mortality at 12 months, compared to patients without delirium. Furthermore, patients with stroke and delirium remained in the hospital for more time than those without delirium. Patients with stroke and delirium were also more likely to be discharged to an institution, such as a nursing home. “Early recognition and prevention of delirium may improve outcomes in stroke patients,” the researchers concluded.   

Using a nicotine patch may induce cognitive improvement in patients with amnestic mild cognitive impairment (MCI) who do not smoke, researchers reported in the January 10 Neurology. All 74 subjects enrolled in the study had amnestic MCI and did not smoke; the investigators randomized 39 participants to receive 15 mg of transdermal nicotine daily for six months and 35 to receive placebo daily for the same time period. Results showed that participants safely tolerated the transdermal nicotine and that they improved on measures of attention, memory, and mental processing, but not in clinical overall impression of change. “We conclude that this initial study provides evidence for nicotine–induced cognitive improvement in subjects with MCI; however, whether these effects are clinically important will require larger studies,” the researchers wrote.

Physicians may need to be cautious of potential drug interactions when selecting seizure medications for people with HIV/AIDs, according to a new guideline issued by the American Academy of Neurology and published in the online January 4 Neurology. A systematic review of the literature showed that antiepileptic drug (AED) and antiretroviral drug administration may be indicated in up to 55% of patients taking  antiretrovirals. Investigators found that clinicians might need to adjust the dosage of seizure drugs such as phenytoin and valproic acid to avoid adversely affecting patients’  antiretroviral levels. “It may be important to avoid enzyme-inducing AEDs in people on antiretroviral regimens that include protease inhibitors or nonnucleoside reverse transcriptase inhibitors, as pharmacokinetic interactions may result in virologic failure,” the study authors said. The researchers recommend that physicians use pharmacokinetic assessment to monitor patients who must be on certain AED regimens for seizure control.

Subclinical atrial tachyarrhythmias were frequently observed in patients with pacemakers and were linked with a heightened risk of ischemic stroke or systemic embolism, according to a study published in the January 12 New England Journal of Medicine. For three months, researchers monitored 2,580 patients 65 and older for subclinical atrial tachyarrhythmias, defined as episodes of atrial rate of greater than 190 beats per minute for more than six minutes. The patients, who had hypertension and no history of atrial fibrillation, had recently been implanted with a pacemaker or defibrillator and were followed for a mean of 2.5 years for ischemic stroke or systemic embolism. Of the 2,580 patients, 261 experienced subclinical atrial tachyarrhythmias, which were associated with an increased risk of clinical atrial fibrillation and of ischemic stroke or systemic embolism. “The data from the present study support the concept that there is a link between subclinical atrial fibrillation and cryptogenic stroke,” the investigators stated.

The FDA has permitted marketing of the Stratify JCV (John Cunningham Virus) Antibody ELISA test to help determine the risk of progressive multifocal leukoencephalopathy (PML) in patients taking natalizumab to treat multiple sclerosis (MS) or Crohn’s disease. The test, which cannot diagnose PML, is intended to be used in conjunction with other clinical data from patients, such as the presence of anti-JCV antibodies, treatment with natalizumab for longer than two years, and treatment with certain immunosuppressants before receiving natalizumab. By considering these patient risk factors as well as the results of the Stratify JCV Antibody ELISA test, physicians may better assess the risks of continuing natalizumab treatment in patients on immunomodulatory therapy. The test will be available only to professionals, administered by prescription, and performed at Focus Diagnostics’ Reference Laboratory in Cypress, California.

Patients who experience stroke and later develop delirium are likely to have a higher mortality, longer hospitalizations, and a greater degree of dependence after discharge, researchers reported in the January 19 online Stroke. Investigators determined that 10 of 78 eligible studies met approval criteria for eligibility, validity, and quality, and a review of those studies showed that patients with stroke and delirium had higher in-patient mortality as well as mortality at 12 months, compared to patients without delirium. Furthermore, patients with stroke and delirium remained in the hospital for more time than those without delirium. Patients with stroke and delirium were also more likely to be discharged to an institution, such as a nursing home. “Early recognition and prevention of delirium may improve outcomes in stroke patients,” the researchers concluded.