New and Noteworthy Information—July 2014

People with a higher education recover better from a moderate to severe traumatic brain injury (TBI), according to a study published May 6 in Neurology. Researchers found that patients with the equivalent of at least a college education were seven times more likely than those who did not finish high school to be disability-free one year after a TBI. The investigators examined 769 patients, 219 of whom were free of any detectable disability. The study authors theorized that TBI patients with increased cognitive reserve capabilities may heal in a different way that allows them to return to their pre-injury function. These patients also may be able to adapt and form new pathways in their brains to compensate for the injury.

The risk of stroke may be reduced by eating more fruits and vegetables, according to a study published online ahead of print May 8 in Stroke. Researchers conducted a meta-analysis of 20 studies published within the past 19 years to assess the effects of fruit and vegetable consumption on the risk of stroke; the combined studies included 760,629 men and 16,981 women who previously had strokes. The findings suggest that stroke risk decreased by 32% with every 200 grams of fruit consumed daily and 11% with every 200 grams of vegetables consumed daily. The investigators combined the results of six studies from the United States, six from Asia, and eight from Europe. “Improving diet and lifestyle is critical for heart and stroke risk reduction in the general population,” the researchers stated.

One-third of all unruptured intracranial aneurysms in people of working age ruptured during a lifelong follow-up, according to a study published online ahead of print May 22 in Stroke. Researchers monitored 118 patients (median age at diagnosis, 43.5) with aneurysms from 1956 until death or subarachnoid hemorrhage occurred. The risk of rupture was particularly high for female smokers with brain aneurysms 7 mm or more in diameter, and the size of an aneurysm had little impact on its risk for rupture, particularly for men. The risk of rupture among nonsmoking men was also exceptionally low. “Because even small unruptured intracranial aneurysms ruptured, treatment decisions of unruptured intracranial aneurysms should perhaps be based on the risk factor status,” the investigators concluded.

An international group of researchers in multiple sclerosis (MS) has proposed updated clinical course descriptions of the disease, according to a report published online ahead of print May 28 in Neurology. The International Advisory Committee on Clinical Trials of MS, which is jointly supported by the National MS Society and the European Committee for Treatment and Research in MS (ECTRIMS), suggested that clinicians not only determine a person’s course of MS, but also further subcategorize that course as active or not active and progressing or not progressing, based on clinical evidence of changes in disability. Another recommended area for further research by the committee includes long-term studies to track people with MS over time. “These revisions should make communication with patients and among physicians clearer and should also enhance the design, recruitment, and conduct of future clinical trials,” the investigators stated.

A moderate level of dietary protein intake may lower the risk of stroke, according to a meta-analysis that was published online ahead of print June 11 in Neurology. The analysis consisted of seven studies with a total of 254,489 participants who were followed for an average of 14 years. Overall, participants with the highest amount of protein in their diets were 20% less likely to develop a stroke, compared with those who had the lowest amount of protein in their diets. For every extra 20 grams per day of protein eaten, the risk of stroke decreased by 26%. The results accounted for other factors that could affect the risk of stroke, such as high cholesterol and smoking. “These results indicate that stroke risk may be reduced by replacing red meat with other protein sources, such as fish,” stated the researchers.

The FDA will review Genzyme’s resubmission of its supplemental Biologics License Application seeking approval of Lemtrada (alemtuzumab) for the treatment of patients with relapsing forms of multiple sclerosis (MS). The resubmission is based on data from the same clinical trials included in the original application. It also provides additional information and supplemental analyses to address issues previously outlined by the FDA in its December 27, 2013, Complete Response Letter. A six-month review period has been assigned, and Genzyme (Cambridge, Massachusetts) expects the FDA to begin that review in the fourth quarter.

The risk of developing cognitive impairment is significantly higher for individuals with poor cardiovascular health than for those with intermediate or ideal cardiovascular health, investigators reported June 11 in the Journal of the American Heart Association. The study included 17,761 people ages 45 and older who had normal cognitive function and no history of stroke (mental function was evaluated four years later). The researchers used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study to determine cardiovascular health status based on the American Heart Association Life’s Simple 7 score. Study findings showed that people with the lowest cardiovascular health scores were more likely to have impairment on learning, memory, and verbal fluency tests than were their counterparts with intermediate or better risk profiles.

Researchers have developed an MRI technique that aids in the early diagnosis of Parkinson’s disease with 85% accuracy, according to a study published online ahead of print June 11 in Neurology. The investigators compared 19 people with early-stage Parkinson’s disease while not on medication with 19 healthy people, matched for gender and age. Data suggest that patients with Parkinson’s disease had much lower connectivity in the basal ganglia. The researchers defined a threshold level of connectivity within the basal ganglia network. Connectivity below this level helped to predict who had Parkinson’s disease with 100% sensitivity and 89.5% specificity. The study authors also conducted their MRI test in a second group of 13 early-stage Parkinson’s patients as a validation of the approach; they correctly identified 11 of the 13 patients.

Blood pressure in later life may affect brain pathology and cognitive performance, depending on blood pressure at midlife, according to a study that was published online ahead of print June 4 in Neurology. Researchers examined data regarding 4,057 older participants (average age, 76) without dementia whose blood pressure had been measured during middle age. The patients’ blood pressure was measured again, and participants underwent MRI and tests of memory and cognition. Higher blood pressure in late life was associated with an increased risk of brain lesions, especially among patients without high blood pressure in middle age. Among participants with high blood pressure in middle age, lower diastolic blood pressure in late life was associated with smaller brain volumes and decreased memory and cognitive performance.

A copper compound could provide a therapy for patients with amyotrophic lateral sclerosis (ALS), according to a study that was published June 4 in the Journal of Neuroscience. Mutations in copper–zinc-superoxide dismutase (SOD1) are believed to cause ALS in humans and transgenic mice. Investigators found that most SOD1 in the spinal cord of mouse models of ALS was copper deficient. Treatment with copper (ATSM) decreased the pool of copper-deficient SOD1 and increased the pool of fully metallated SOD1 in the mice’s spinal cords. In addition, the compound significantly extended the mice’s survival and improved their locomotor function. When the researchers tracked isotopically enriched copper, they found that the increase in fully metallated SOD1 depended on the transfer of copper from copper (ATSM) to SOD1, suggesting that increased copper content of mutant SOD1 improved survival and locomotor function.

Quantitative susceptibility (QS) MRI may reflect disease progression accurately in patients with multiple sclerosis (MS), according to a study published online ahead of print May 4 in Radiology. Twenty-five patients with relapsing-remitting MS or clinically isolated syndrome and 15 age- and sex-matched controls underwent 7-T MRI. Researchers computed quantitative maps of MRI susceptibility parameters. The QS maps identified voxel-level increases in iron deposition in the subcortical gray matter of patients with MS, compared with controls. QS was strongly correlated with patients’ Expanded Disability Status Scale (EDSS) scores. The volume of total white matter damage on QS maps correlated significantly with EDSS. Voxelwise QS indicated that age contributed to demyelination in patients with MS, suggesting that age-adjusted clinical scores may provide robust measures of disease severity.

—Kimberly Williams

People with a higher education recover better from a moderate to severe traumatic brain injury (TBI), according to a study published May 6 in Neurology. Researchers found that patients with the equivalent of at least a college education were seven times more likely than those who did not finish high school to be disability-free one year after a TBI. The investigators examined 769 patients, 219 of whom were free of any detectable disability. The study authors theorized that TBI patients with increased cognitive reserve capabilities may heal in a different way that allows them to return to their pre-injury function. These patients also may be able to adapt and form new pathways in their brains to compensate for the injury.

The risk of stroke may be reduced by eating more fruits and vegetables, according to a study published online ahead of print May 8 in Stroke. Researchers conducted a meta-analysis of 20 studies published within the past 19 years to assess the effects of fruit and vegetable consumption on the risk of stroke; the combined studies included 760,629 men and 16,981 women who previously had strokes. The findings suggest that stroke risk decreased by 32% with every 200 grams of fruit consumed daily and 11% with every 200 grams of vegetables consumed daily. The investigators combined the results of six studies from the United States, six from Asia, and eight from Europe. “Improving diet and lifestyle is critical for heart and stroke risk reduction in the general population,” the researchers stated.

One-third of all unruptured intracranial aneurysms in people of working age ruptured during a lifelong follow-up, according to a study published online ahead of print May 22 in Stroke. Researchers monitored 118 patients (median age at diagnosis, 43.5) with aneurysms from 1956 until death or subarachnoid hemorrhage occurred. The risk of rupture was particularly high for female smokers with brain aneurysms 7 mm or more in diameter, and the size of an aneurysm had little impact on its risk for rupture, particularly for men. The risk of rupture among nonsmoking men was also exceptionally low. “Because even small unruptured intracranial aneurysms ruptured, treatment decisions of unruptured intracranial aneurysms should perhaps be based on the risk factor status,” the investigators concluded.

An international group of researchers in multiple sclerosis (MS) has proposed updated clinical course descriptions of the disease, according to a report published online ahead of print May 28 in Neurology. The International Advisory Committee on Clinical Trials of MS, which is jointly supported by the National MS Society and the European Committee for Treatment and Research in MS (ECTRIMS), suggested that clinicians not only determine a person’s course of MS, but also further subcategorize that course as active or not active and progressing or not progressing, based on clinical evidence of changes in disability. Another recommended area for further research by the committee includes long-term studies to track people with MS over time. “These revisions should make communication with patients and among physicians clearer and should also enhance the design, recruitment, and conduct of future clinical trials,” the investigators stated.

A moderate level of dietary protein intake may lower the risk of stroke, according to a meta-analysis that was published online ahead of print June 11 in Neurology. The analysis consisted of seven studies with a total of 254,489 participants who were followed for an average of 14 years. Overall, participants with the highest amount of protein in their diets were 20% less likely to develop a stroke, compared with those who had the lowest amount of protein in their diets. For every extra 20 grams per day of protein eaten, the risk of stroke decreased by 26%. The results accounted for other factors that could affect the risk of stroke, such as high cholesterol and smoking. “These results indicate that stroke risk may be reduced by replacing red meat with other protein sources, such as fish,” stated the researchers.

The FDA will review Genzyme’s resubmission of its supplemental Biologics License Application seeking approval of Lemtrada (alemtuzumab) for the treatment of patients with relapsing forms of multiple sclerosis (MS). The resubmission is based on data from the same clinical trials included in the original application. It also provides additional information and supplemental analyses to address issues previously outlined by the FDA in its December 27, 2013, Complete Response Letter. A six-month review period has been assigned, and Genzyme (Cambridge, Massachusetts) expects the FDA to begin that review in the fourth quarter.

The risk of developing cognitive impairment is significantly higher for individuals with poor cardiovascular health than for those with intermediate or ideal cardiovascular health, investigators reported June 11 in the Journal of the American Heart Association. The study included 17,761 people ages 45 and older who had normal cognitive function and no history of stroke (mental function was evaluated four years later). The researchers used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study to determine cardiovascular health status based on the American Heart Association Life’s Simple 7 score. Study findings showed that people with the lowest cardiovascular health scores were more likely to have impairment on learning, memory, and verbal fluency tests than were their counterparts with intermediate or better risk profiles.

Researchers have developed an MRI technique that aids in the early diagnosis of Parkinson’s disease with 85% accuracy, according to a study published online ahead of print June 11 in Neurology. The investigators compared 19 people with early-stage Parkinson’s disease while not on medication with 19 healthy people, matched for gender and age. Data suggest that patients with Parkinson’s disease had much lower connectivity in the basal ganglia. The researchers defined a threshold level of connectivity within the basal ganglia network. Connectivity below this level helped to predict who had Parkinson’s disease with 100% sensitivity and 89.5% specificity. The study authors also conducted their MRI test in a second group of 13 early-stage Parkinson’s patients as a validation of the approach; they correctly identified 11 of the 13 patients.

Blood pressure in later life may affect brain pathology and cognitive performance, depending on blood pressure at midlife, according to a study that was published online ahead of print June 4 in Neurology. Researchers examined data regarding 4,057 older participants (average age, 76) without dementia whose blood pressure had been measured during middle age. The patients’ blood pressure was measured again, and participants underwent MRI and tests of memory and cognition. Higher blood pressure in late life was associated with an increased risk of brain lesions, especially among patients without high blood pressure in middle age. Among participants with high blood pressure in middle age, lower diastolic blood pressure in late life was associated with smaller brain volumes and decreased memory and cognitive performance.

A copper compound could provide a therapy for patients with amyotrophic lateral sclerosis (ALS), according to a study that was published June 4 in the Journal of Neuroscience. Mutations in copper–zinc-superoxide dismutase (SOD1) are believed to cause ALS in humans and transgenic mice. Investigators found that most SOD1 in the spinal cord of mouse models of ALS was copper deficient. Treatment with copper (ATSM) decreased the pool of copper-deficient SOD1 and increased the pool of fully metallated SOD1 in the mice’s spinal cords. In addition, the compound significantly extended the mice’s survival and improved their locomotor function. When the researchers tracked isotopically enriched copper, they found that the increase in fully metallated SOD1 depended on the transfer of copper from copper (ATSM) to SOD1, suggesting that increased copper content of mutant SOD1 improved survival and locomotor function.

Quantitative susceptibility (QS) MRI may reflect disease progression accurately in patients with multiple sclerosis (MS), according to a study published online ahead of print May 4 in Radiology. Twenty-five patients with relapsing-remitting MS or clinically isolated syndrome and 15 age- and sex-matched controls underwent 7-T MRI. Researchers computed quantitative maps of MRI susceptibility parameters. The QS maps identified voxel-level increases in iron deposition in the subcortical gray matter of patients with MS, compared with controls. QS was strongly correlated with patients’ Expanded Disability Status Scale (EDSS) scores. The volume of total white matter damage on QS maps correlated significantly with EDSS. Voxelwise QS indicated that age contributed to demyelination in patients with MS, suggesting that age-adjusted clinical scores may provide robust measures of disease severity.

—Kimberly Williams

People with a higher education recover better from a moderate to severe traumatic brain injury (TBI), according to a study published May 6 in Neurology. Researchers found that patients with the equivalent of at least a college education were seven times more likely than those who did not finish high school to be disability-free one year after a TBI. The investigators examined 769 patients, 219 of whom were free of any detectable disability. The study authors theorized that TBI patients with increased cognitive reserve capabilities may heal in a different way that allows them to return to their pre-injury function. These patients also may be able to adapt and form new pathways in their brains to compensate for the injury.

The risk of stroke may be reduced by eating more fruits and vegetables, according to a study published online ahead of print May 8 in Stroke. Researchers conducted a meta-analysis of 20 studies published within the past 19 years to assess the effects of fruit and vegetable consumption on the risk of stroke; the combined studies included 760,629 men and 16,981 women who previously had strokes. The findings suggest that stroke risk decreased by 32% with every 200 grams of fruit consumed daily and 11% with every 200 grams of vegetables consumed daily. The investigators combined the results of six studies from the United States, six from Asia, and eight from Europe. “Improving diet and lifestyle is critical for heart and stroke risk reduction in the general population,” the researchers stated.

One-third of all unruptured intracranial aneurysms in people of working age ruptured during a lifelong follow-up, according to a study published online ahead of print May 22 in Stroke. Researchers monitored 118 patients (median age at diagnosis, 43.5) with aneurysms from 1956 until death or subarachnoid hemorrhage occurred. The risk of rupture was particularly high for female smokers with brain aneurysms 7 mm or more in diameter, and the size of an aneurysm had little impact on its risk for rupture, particularly for men. The risk of rupture among nonsmoking men was also exceptionally low. “Because even small unruptured intracranial aneurysms ruptured, treatment decisions of unruptured intracranial aneurysms should perhaps be based on the risk factor status,” the investigators concluded.

An international group of researchers in multiple sclerosis (MS) has proposed updated clinical course descriptions of the disease, according to a report published online ahead of print May 28 in Neurology. The International Advisory Committee on Clinical Trials of MS, which is jointly supported by the National MS Society and the European Committee for Treatment and Research in MS (ECTRIMS), suggested that clinicians not only determine a person’s course of MS, but also further subcategorize that course as active or not active and progressing or not progressing, based on clinical evidence of changes in disability. Another recommended area for further research by the committee includes long-term studies to track people with MS over time. “These revisions should make communication with patients and among physicians clearer and should also enhance the design, recruitment, and conduct of future clinical trials,” the investigators stated.

A moderate level of dietary protein intake may lower the risk of stroke, according to a meta-analysis that was published online ahead of print June 11 in Neurology. The analysis consisted of seven studies with a total of 254,489 participants who were followed for an average of 14 years. Overall, participants with the highest amount of protein in their diets were 20% less likely to develop a stroke, compared with those who had the lowest amount of protein in their diets. For every extra 20 grams per day of protein eaten, the risk of stroke decreased by 26%. The results accounted for other factors that could affect the risk of stroke, such as high cholesterol and smoking. “These results indicate that stroke risk may be reduced by replacing red meat with other protein sources, such as fish,” stated the researchers.

The FDA will review Genzyme’s resubmission of its supplemental Biologics License Application seeking approval of Lemtrada (alemtuzumab) for the treatment of patients with relapsing forms of multiple sclerosis (MS). The resubmission is based on data from the same clinical trials included in the original application. It also provides additional information and supplemental analyses to address issues previously outlined by the FDA in its December 27, 2013, Complete Response Letter. A six-month review period has been assigned, and Genzyme (Cambridge, Massachusetts) expects the FDA to begin that review in the fourth quarter.

The risk of developing cognitive impairment is significantly higher for individuals with poor cardiovascular health than for those with intermediate or ideal cardiovascular health, investigators reported June 11 in the Journal of the American Heart Association. The study included 17,761 people ages 45 and older who had normal cognitive function and no history of stroke (mental function was evaluated four years later). The researchers used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study to determine cardiovascular health status based on the American Heart Association Life’s Simple 7 score. Study findings showed that people with the lowest cardiovascular health scores were more likely to have impairment on learning, memory, and verbal fluency tests than were their counterparts with intermediate or better risk profiles.

Researchers have developed an MRI technique that aids in the early diagnosis of Parkinson’s disease with 85% accuracy, according to a study published online ahead of print June 11 in Neurology. The investigators compared 19 people with early-stage Parkinson’s disease while not on medication with 19 healthy people, matched for gender and age. Data suggest that patients with Parkinson’s disease had much lower connectivity in the basal ganglia. The researchers defined a threshold level of connectivity within the basal ganglia network. Connectivity below this level helped to predict who had Parkinson’s disease with 100% sensitivity and 89.5% specificity. The study authors also conducted their MRI test in a second group of 13 early-stage Parkinson’s patients as a validation of the approach; they correctly identified 11 of the 13 patients.

Blood pressure in later life may affect brain pathology and cognitive performance, depending on blood pressure at midlife, according to a study that was published online ahead of print June 4 in Neurology. Researchers examined data regarding 4,057 older participants (average age, 76) without dementia whose blood pressure had been measured during middle age. The patients’ blood pressure was measured again, and participants underwent MRI and tests of memory and cognition. Higher blood pressure in late life was associated with an increased risk of brain lesions, especially among patients without high blood pressure in middle age. Among participants with high blood pressure in middle age, lower diastolic blood pressure in late life was associated with smaller brain volumes and decreased memory and cognitive performance.

A copper compound could provide a therapy for patients with amyotrophic lateral sclerosis (ALS), according to a study that was published June 4 in the Journal of Neuroscience. Mutations in copper–zinc-superoxide dismutase (SOD1) are believed to cause ALS in humans and transgenic mice. Investigators found that most SOD1 in the spinal cord of mouse models of ALS was copper deficient. Treatment with copper (ATSM) decreased the pool of copper-deficient SOD1 and increased the pool of fully metallated SOD1 in the mice’s spinal cords. In addition, the compound significantly extended the mice’s survival and improved their locomotor function. When the researchers tracked isotopically enriched copper, they found that the increase in fully metallated SOD1 depended on the transfer of copper from copper (ATSM) to SOD1, suggesting that increased copper content of mutant SOD1 improved survival and locomotor function.

Quantitative susceptibility (QS) MRI may reflect disease progression accurately in patients with multiple sclerosis (MS), according to a study published online ahead of print May 4 in Radiology. Twenty-five patients with relapsing-remitting MS or clinically isolated syndrome and 15 age- and sex-matched controls underwent 7-T MRI. Researchers computed quantitative maps of MRI susceptibility parameters. The QS maps identified voxel-level increases in iron deposition in the subcortical gray matter of patients with MS, compared with controls. QS was strongly correlated with patients’ Expanded Disability Status Scale (EDSS) scores. The volume of total white matter damage on QS maps correlated significantly with EDSS. Voxelwise QS indicated that age contributed to demyelination in patients with MS, suggesting that age-adjusted clinical scores may provide robust measures of disease severity.

—Kimberly Williams