New and Noteworthy Information—March 2014

Patients who are dementia-free but have two parents with late-onset Alzheimer’s disease may show signs of the disease during brain imaging decades before symptoms appear, researchers reported online ahead of print February 12 in Neurology. A total of 52 persons with normal cognition—including four demographically balanced groups with maternal, paternal, and maternal and paternal family history of late-onset Alzheimer’s disease, as well as those with a negative family history—underwent MRI, ¹¹C-Pittsburgh compound B (PiB) PET, and ¹⁸F-fluoro-2-deoxyglucose PET. Subjects with both parents with a history of Alzheimer’s disease had more severe abnormalities in all three biomarkers, compared with the other groups, regarding the number of regions affected and magnitude of impairment. PiB retention and hypometabolism were most pronounced in participants with a maternal and paternal history of Alzheimer’s disease, according to the investigators.

Patients with nonvalvular atrial fibrillation are encouraged to take oral anticoagulants to prevent stroke, according to an updated guideline published in the February 25, 2014, issue of Neurology. Treatment with anticoagulants is especially important for people who have already had a stroke or a transient ischemic attack, according to the authors. The current guideline concludes that new anticoagulants such as dabigatran, rivaroxaban, and apixaban are at least as effective as, if not more effective than, warfarin and entail a lower risk of bleeding in the brain. An advantage of the new drugs is that they do not require frequent blood testing as warfarin does. The guideline also recommends new anticoagulants for the elderly, people with mild dementia, and people at moderate risk of falls.

Giving patients medications to lower blood pressure during the first 48 hours after a stroke may not reduce the likelihood of death or major disability, according to research published February 5 in JAMA. Within 48 hours of onset, 4,071 patients with nonthrombolysed ischemic stroke and elevated systolic blood pressure were randomized to receive antihypertensive treatment or to discontinuation of antihypertensive medications. Mean systolic blood pressure was reduced from 166.7 mm Hg to 144.7 mm Hg within 24 hours in the antihypertensive treatment group and from 165.6 mm Hg to 152.9 mm Hg in the control group within 24 hours after randomization. At 14 days or hospital discharge, researchers recorded 683 incidences of death or major disability in the antihypertensive treatment group and 681 incidences in the control group.

The FDA has granted accelerated approval for Northera (droxidopa) capsules for the treatment of neurogenic orthostatic hypotension (NOH) caused by primary autonomic failure (eg, Parkinson’s disease or multiple system atrophy). Accelerated approval is granted to medicines that fill a serious unmet medical need. The capsules have a boxed warning to alert health care professionals and patients about the risk of supine hypertension, which can cause stroke. Two clinical trials involving people with NOH demonstrated droxidopa’s effectiveness over a period of two weeks. The drug, which is manufactured by Chelsea Therapeutics in Charlotte, North Carolina, has not been demonstrated to provide improvement in patient symptoms beyond two weeks. The most common adverse events reported by clinical trial participants taking droxidopa were headache, dizziness, nausea, high blood pressure, and fatigue.

Earlier treatment with an antiepileptic drug (AED) results in a shorter total seizure duration among children with febrile status epilepticus, according to a study published online ahead of print February 6 in Epilepsia. A total of 199 children (ages 1 month to 6 years), were included in the prospective, multicenter study. The median time from seizure onset to first administration of an AED by EMS or emergency department personnel was 30 minutes. The mean seizure duration for children who were given medication before admission to the emergency department was 81 minutes, compared with 95 minutes for those who were not treated beforehand. The median time from first dose of an AED to the end of a seizure was 38 minutes. “Reducing the time from seizure onset to AED initiation was significantly related to shorter seizure duration,” the investigators concluded.

The FDA has granted 510(k) clearance to the Reveal LINQ Insertable Cardiac Monitor (ICM) System. The device is indicated for patients who have symptoms such as dizziness, palpitation, syncope, and chest pain that may suggest a cardiac arrhythmia, and for patients at increased risk for cardiac arrhythmias. The Reveal LINQ ICM is part of a system that allows physicians to monitor a patient’s heart continuously and wirelessly for as long as three years. The system also provides remote monitoring through the Carelink Network, which allows physicians to request notifications to alert them if their patients have had cardiac events. The Reveal LINQ ICM is approximately one-third the size of an AAA battery. The device is manufactured by Medtronic, which is headquartered in Minneapolis.

The final stage of the normal inflammatory process may be disrupted in patients with Alzheimer’s disease, according to research published online ahead of print February 14 in Alzheimer’s and Dementia. Researchers analyzed specialized proresolving mediators (SPMs), receptors, a biosynthetic enzyme, and downstream effectors involved in inflammation resolution in postmortem hippocampal tissue from patients with and without Alzheimer’s disease. SPMs were analyzed in CSF. Levels of the SPM lipoxin A₄ (LXA₄) were reduced in patients with Alzheimer’s disease in the CSF and the hippocampus. An enzyme involved in LXA4 synthesis and two SPM receptors were elevated in brains of patients with Alzheimer’s disease. LXA₄ and RvD1 levels in CSF correlated with Mini-Mental State Examination scores. Stimulation of inflammation resolution may reduce neuronal death in the brain, said the investigators.

Toxic chemicals may be triggering the recent increases in neurodevelopmental disabilities among children, according to a study published in the March issue of Lancet Neurology. In 2006, researchers identified five industrial chemicals as developmental neurotoxicants. The current study offers updated findings about those chemicals and adds information on six newly recognized ones, including manganese, fluoride, chlorpyrifos and DDT (ie, pesticides), tetrachloroethylene (a solvent), and the polybrominated diphenyl ethers (flame retardants). The study found that manganese is associated with diminished intellectual function and impaired motor skills, solvents are linked to hyperactivity and aggressive behavior, and certain pesticides may cause cognitive delays. More neurotoxicants may remain undiscovered, according to the investigators, who propose a global prevention strategy to control what they call a pandemic of developmental neurotoxicity.

For relatives of patients with multiple sclerosis (MS), the risk of developing the disease may be lower than previously assumed, according to a study published in the March issue of Brain. Researchers from Karolinska Institutet assessed the familial risks for MS using population registers and health care registries. They identified 28,396 patients with MS, along with first- and second-degree relatives and cousins. The investigators used matched population-based controls to calculate relative risks and found lower estimates of familial MS risks than previously reported. Despite a well-established lower prevalence of MS among males, the relative risks were equal among maternal and paternal relations. Using 74,757 twin pairs, the researchers estimated the disease’s heritability to be 0.64 and its shared environmental component to be 0.01.

Football helmets differ in their ability to reduce the risk of concussion, researchers reported online ahead of print January 31 in the Journal of Neurosurgery. The investigators conducted a retrospective analysis of head impact data from 1,833 collegiate football players from 2005 to 2010 who wore helmet-mounted accelerometer arrays for games and practices. The researchers compared concussion rates between players who wore the Riddell VSR4 and Riddell Revolution helmets. A total of 1,281,444 head impacts were recorded, and 64 concussions were diagnosed. The investigators found that the relative risk of sustaining a concussion in a Revolution helmet versus a VSR4 helmet was 46.1%. “Although helmet design may never prevent all concussions from occurring in football, evidence illustrates that it can reduce the incidence of this injury,” the researchers concluded.

Women have a worse quality of life, compared with men, for as long as 12 months after a stroke, even after adjustment for key sociodemographic variables, stroke severity, and disability, according to a study published online ahead of print February 7 in Neurology. Researchers assessed the quality of life in 1,370 patients (53.7% male; median age, 65) with ischemic stroke or transient ischemic attack (TIA) at three and 12 months postdischarge. Women had a significantly lower quality of life at three and 12 months poststroke. After multivariable adjustment for sociodemographic, clinical, and stroke-related factors, the investigators found that women continued to have a lower quality of life at three and 12 months. Women also had a poorer outcome in the dimensions of mobility, pain or discomfort, and anxiety or depression at three and 12 months.

High levels of high-density lipoprotein (HDL) cholesterol and low levels of low-density lipoprotein (LDL) cholesterol may be correlated with lower levels of amyloid plaque deposition in the brain, according to a study published in the February issue of JAMA Neurology. Investigators examined 74 individuals age 70 or older, including three participants with mild dementia, 33 cognitively normal participants, and 38 people with mild cognitive impairment. Cerebral amyloid-beta was measured with carbon C11–labeled Pittsburgh Compound B (PiB) PET. Statistical models that controlled for age and APOE ɛ4 revealed independent associations among the levels of LDL cholesterol, HDL cholesterol, and PiB index. Higher LDL cholesterol and lower HDL cholesterol levels were associated with a higher PiB index. The finding suggests an important role for cholesterol in amyloid-beta processing, said the researchers.

Patients with acute ischemic stroke who receive prompt treatment with t-PA may avoid a lengthy stay in an ICU, according to a study published February 12 in PLOS One. In a retrospective chart review of 153 patients who received IV t-PA for stroke, those with an NIH Stroke Scale (NIHSS) score of 10 or higher had a 7.7-times higher risk of requiring ICU resources, compared with patients who presented with an NIHSS score lower than 10. Eighty-one percent of patients with ICU needs developed them before the end of t-PA infusion, while 7% of those without ICU needs at the end of the t-PA infusion required ICU care later on. “We propose that patients without ICU needs by the end of the t-PA infusion might be safely monitored in a non-ICU setting if NIHSS at presentation is low,” the researchers advised.

—Erik Greb and Colby Stong

Patients who are dementia-free but have two parents with late-onset Alzheimer’s disease may show signs of the disease during brain imaging decades before symptoms appear, researchers reported online ahead of print February 12 in Neurology. A total of 52 persons with normal cognition—including four demographically balanced groups with maternal, paternal, and maternal and paternal family history of late-onset Alzheimer’s disease, as well as those with a negative family history—underwent MRI, ¹¹C-Pittsburgh compound B (PiB) PET, and ¹⁸F-fluoro-2-deoxyglucose PET. Subjects with both parents with a history of Alzheimer’s disease had more severe abnormalities in all three biomarkers, compared with the other groups, regarding the number of regions affected and magnitude of impairment. PiB retention and hypometabolism were most pronounced in participants with a maternal and paternal history of Alzheimer’s disease, according to the investigators.

Patients with nonvalvular atrial fibrillation are encouraged to take oral anticoagulants to prevent stroke, according to an updated guideline published in the February 25, 2014, issue of Neurology. Treatment with anticoagulants is especially important for people who have already had a stroke or a transient ischemic attack, according to the authors. The current guideline concludes that new anticoagulants such as dabigatran, rivaroxaban, and apixaban are at least as effective as, if not more effective than, warfarin and entail a lower risk of bleeding in the brain. An advantage of the new drugs is that they do not require frequent blood testing as warfarin does. The guideline also recommends new anticoagulants for the elderly, people with mild dementia, and people at moderate risk of falls.

Giving patients medications to lower blood pressure during the first 48 hours after a stroke may not reduce the likelihood of death or major disability, according to research published February 5 in JAMA. Within 48 hours of onset, 4,071 patients with nonthrombolysed ischemic stroke and elevated systolic blood pressure were randomized to receive antihypertensive treatment or to discontinuation of antihypertensive medications. Mean systolic blood pressure was reduced from 166.7 mm Hg to 144.7 mm Hg within 24 hours in the antihypertensive treatment group and from 165.6 mm Hg to 152.9 mm Hg in the control group within 24 hours after randomization. At 14 days or hospital discharge, researchers recorded 683 incidences of death or major disability in the antihypertensive treatment group and 681 incidences in the control group.

The FDA has granted accelerated approval for Northera (droxidopa) capsules for the treatment of neurogenic orthostatic hypotension (NOH) caused by primary autonomic failure (eg, Parkinson’s disease or multiple system atrophy). Accelerated approval is granted to medicines that fill a serious unmet medical need. The capsules have a boxed warning to alert health care professionals and patients about the risk of supine hypertension, which can cause stroke. Two clinical trials involving people with NOH demonstrated droxidopa’s effectiveness over a period of two weeks. The drug, which is manufactured by Chelsea Therapeutics in Charlotte, North Carolina, has not been demonstrated to provide improvement in patient symptoms beyond two weeks. The most common adverse events reported by clinical trial participants taking droxidopa were headache, dizziness, nausea, high blood pressure, and fatigue.

Earlier treatment with an antiepileptic drug (AED) results in a shorter total seizure duration among children with febrile status epilepticus, according to a study published online ahead of print February 6 in Epilepsia. A total of 199 children (ages 1 month to 6 years), were included in the prospective, multicenter study. The median time from seizure onset to first administration of an AED by EMS or emergency department personnel was 30 minutes. The mean seizure duration for children who were given medication before admission to the emergency department was 81 minutes, compared with 95 minutes for those who were not treated beforehand. The median time from first dose of an AED to the end of a seizure was 38 minutes. “Reducing the time from seizure onset to AED initiation was significantly related to shorter seizure duration,” the investigators concluded.

The FDA has granted 510(k) clearance to the Reveal LINQ Insertable Cardiac Monitor (ICM) System. The device is indicated for patients who have symptoms such as dizziness, palpitation, syncope, and chest pain that may suggest a cardiac arrhythmia, and for patients at increased risk for cardiac arrhythmias. The Reveal LINQ ICM is part of a system that allows physicians to monitor a patient’s heart continuously and wirelessly for as long as three years. The system also provides remote monitoring through the Carelink Network, which allows physicians to request notifications to alert them if their patients have had cardiac events. The Reveal LINQ ICM is approximately one-third the size of an AAA battery. The device is manufactured by Medtronic, which is headquartered in Minneapolis.

The final stage of the normal inflammatory process may be disrupted in patients with Alzheimer’s disease, according to research published online ahead of print February 14 in Alzheimer’s and Dementia. Researchers analyzed specialized proresolving mediators (SPMs), receptors, a biosynthetic enzyme, and downstream effectors involved in inflammation resolution in postmortem hippocampal tissue from patients with and without Alzheimer’s disease. SPMs were analyzed in CSF. Levels of the SPM lipoxin A₄ (LXA₄) were reduced in patients with Alzheimer’s disease in the CSF and the hippocampus. An enzyme involved in LXA4 synthesis and two SPM receptors were elevated in brains of patients with Alzheimer’s disease. LXA₄ and RvD1 levels in CSF correlated with Mini-Mental State Examination scores. Stimulation of inflammation resolution may reduce neuronal death in the brain, said the investigators.

Toxic chemicals may be triggering the recent increases in neurodevelopmental disabilities among children, according to a study published in the March issue of Lancet Neurology. In 2006, researchers identified five industrial chemicals as developmental neurotoxicants. The current study offers updated findings about those chemicals and adds information on six newly recognized ones, including manganese, fluoride, chlorpyrifos and DDT (ie, pesticides), tetrachloroethylene (a solvent), and the polybrominated diphenyl ethers (flame retardants). The study found that manganese is associated with diminished intellectual function and impaired motor skills, solvents are linked to hyperactivity and aggressive behavior, and certain pesticides may cause cognitive delays. More neurotoxicants may remain undiscovered, according to the investigators, who propose a global prevention strategy to control what they call a pandemic of developmental neurotoxicity.

For relatives of patients with multiple sclerosis (MS), the risk of developing the disease may be lower than previously assumed, according to a study published in the March issue of Brain. Researchers from Karolinska Institutet assessed the familial risks for MS using population registers and health care registries. They identified 28,396 patients with MS, along with first- and second-degree relatives and cousins. The investigators used matched population-based controls to calculate relative risks and found lower estimates of familial MS risks than previously reported. Despite a well-established lower prevalence of MS among males, the relative risks were equal among maternal and paternal relations. Using 74,757 twin pairs, the researchers estimated the disease’s heritability to be 0.64 and its shared environmental component to be 0.01.

Football helmets differ in their ability to reduce the risk of concussion, researchers reported online ahead of print January 31 in the Journal of Neurosurgery. The investigators conducted a retrospective analysis of head impact data from 1,833 collegiate football players from 2005 to 2010 who wore helmet-mounted accelerometer arrays for games and practices. The researchers compared concussion rates between players who wore the Riddell VSR4 and Riddell Revolution helmets. A total of 1,281,444 head impacts were recorded, and 64 concussions were diagnosed. The investigators found that the relative risk of sustaining a concussion in a Revolution helmet versus a VSR4 helmet was 46.1%. “Although helmet design may never prevent all concussions from occurring in football, evidence illustrates that it can reduce the incidence of this injury,” the researchers concluded.

Women have a worse quality of life, compared with men, for as long as 12 months after a stroke, even after adjustment for key sociodemographic variables, stroke severity, and disability, according to a study published online ahead of print February 7 in Neurology. Researchers assessed the quality of life in 1,370 patients (53.7% male; median age, 65) with ischemic stroke or transient ischemic attack (TIA) at three and 12 months postdischarge. Women had a significantly lower quality of life at three and 12 months poststroke. After multivariable adjustment for sociodemographic, clinical, and stroke-related factors, the investigators found that women continued to have a lower quality of life at three and 12 months. Women also had a poorer outcome in the dimensions of mobility, pain or discomfort, and anxiety or depression at three and 12 months.

High levels of high-density lipoprotein (HDL) cholesterol and low levels of low-density lipoprotein (LDL) cholesterol may be correlated with lower levels of amyloid plaque deposition in the brain, according to a study published in the February issue of JAMA Neurology. Investigators examined 74 individuals age 70 or older, including three participants with mild dementia, 33 cognitively normal participants, and 38 people with mild cognitive impairment. Cerebral amyloid-beta was measured with carbon C11–labeled Pittsburgh Compound B (PiB) PET. Statistical models that controlled for age and APOE ɛ4 revealed independent associations among the levels of LDL cholesterol, HDL cholesterol, and PiB index. Higher LDL cholesterol and lower HDL cholesterol levels were associated with a higher PiB index. The finding suggests an important role for cholesterol in amyloid-beta processing, said the researchers.

Patients with acute ischemic stroke who receive prompt treatment with t-PA may avoid a lengthy stay in an ICU, according to a study published February 12 in PLOS One. In a retrospective chart review of 153 patients who received IV t-PA for stroke, those with an NIH Stroke Scale (NIHSS) score of 10 or higher had a 7.7-times higher risk of requiring ICU resources, compared with patients who presented with an NIHSS score lower than 10. Eighty-one percent of patients with ICU needs developed them before the end of t-PA infusion, while 7% of those without ICU needs at the end of the t-PA infusion required ICU care later on. “We propose that patients without ICU needs by the end of the t-PA infusion might be safely monitored in a non-ICU setting if NIHSS at presentation is low,” the researchers advised.

—Erik Greb and Colby Stong

Patients who are dementia-free but have two parents with late-onset Alzheimer’s disease may show signs of the disease during brain imaging decades before symptoms appear, researchers reported online ahead of print February 12 in Neurology. A total of 52 persons with normal cognition—including four demographically balanced groups with maternal, paternal, and maternal and paternal family history of late-onset Alzheimer’s disease, as well as those with a negative family history—underwent MRI, ¹¹C-Pittsburgh compound B (PiB) PET, and ¹⁸F-fluoro-2-deoxyglucose PET. Subjects with both parents with a history of Alzheimer’s disease had more severe abnormalities in all three biomarkers, compared with the other groups, regarding the number of regions affected and magnitude of impairment. PiB retention and hypometabolism were most pronounced in participants with a maternal and paternal history of Alzheimer’s disease, according to the investigators.

Patients with nonvalvular atrial fibrillation are encouraged to take oral anticoagulants to prevent stroke, according to an updated guideline published in the February 25, 2014, issue of Neurology. Treatment with anticoagulants is especially important for people who have already had a stroke or a transient ischemic attack, according to the authors. The current guideline concludes that new anticoagulants such as dabigatran, rivaroxaban, and apixaban are at least as effective as, if not more effective than, warfarin and entail a lower risk of bleeding in the brain. An advantage of the new drugs is that they do not require frequent blood testing as warfarin does. The guideline also recommends new anticoagulants for the elderly, people with mild dementia, and people at moderate risk of falls.

Giving patients medications to lower blood pressure during the first 48 hours after a stroke may not reduce the likelihood of death or major disability, according to research published February 5 in JAMA. Within 48 hours of onset, 4,071 patients with nonthrombolysed ischemic stroke and elevated systolic blood pressure were randomized to receive antihypertensive treatment or to discontinuation of antihypertensive medications. Mean systolic blood pressure was reduced from 166.7 mm Hg to 144.7 mm Hg within 24 hours in the antihypertensive treatment group and from 165.6 mm Hg to 152.9 mm Hg in the control group within 24 hours after randomization. At 14 days or hospital discharge, researchers recorded 683 incidences of death or major disability in the antihypertensive treatment group and 681 incidences in the control group.

The FDA has granted accelerated approval for Northera (droxidopa) capsules for the treatment of neurogenic orthostatic hypotension (NOH) caused by primary autonomic failure (eg, Parkinson’s disease or multiple system atrophy). Accelerated approval is granted to medicines that fill a serious unmet medical need. The capsules have a boxed warning to alert health care professionals and patients about the risk of supine hypertension, which can cause stroke. Two clinical trials involving people with NOH demonstrated droxidopa’s effectiveness over a period of two weeks. The drug, which is manufactured by Chelsea Therapeutics in Charlotte, North Carolina, has not been demonstrated to provide improvement in patient symptoms beyond two weeks. The most common adverse events reported by clinical trial participants taking droxidopa were headache, dizziness, nausea, high blood pressure, and fatigue.

Earlier treatment with an antiepileptic drug (AED) results in a shorter total seizure duration among children with febrile status epilepticus, according to a study published online ahead of print February 6 in Epilepsia. A total of 199 children (ages 1 month to 6 years), were included in the prospective, multicenter study. The median time from seizure onset to first administration of an AED by EMS or emergency department personnel was 30 minutes. The mean seizure duration for children who were given medication before admission to the emergency department was 81 minutes, compared with 95 minutes for those who were not treated beforehand. The median time from first dose of an AED to the end of a seizure was 38 minutes. “Reducing the time from seizure onset to AED initiation was significantly related to shorter seizure duration,” the investigators concluded.

The FDA has granted 510(k) clearance to the Reveal LINQ Insertable Cardiac Monitor (ICM) System. The device is indicated for patients who have symptoms such as dizziness, palpitation, syncope, and chest pain that may suggest a cardiac arrhythmia, and for patients at increased risk for cardiac arrhythmias. The Reveal LINQ ICM is part of a system that allows physicians to monitor a patient’s heart continuously and wirelessly for as long as three years. The system also provides remote monitoring through the Carelink Network, which allows physicians to request notifications to alert them if their patients have had cardiac events. The Reveal LINQ ICM is approximately one-third the size of an AAA battery. The device is manufactured by Medtronic, which is headquartered in Minneapolis.

The final stage of the normal inflammatory process may be disrupted in patients with Alzheimer’s disease, according to research published online ahead of print February 14 in Alzheimer’s and Dementia. Researchers analyzed specialized proresolving mediators (SPMs), receptors, a biosynthetic enzyme, and downstream effectors involved in inflammation resolution in postmortem hippocampal tissue from patients with and without Alzheimer’s disease. SPMs were analyzed in CSF. Levels of the SPM lipoxin A₄ (LXA₄) were reduced in patients with Alzheimer’s disease in the CSF and the hippocampus. An enzyme involved in LXA4 synthesis and two SPM receptors were elevated in brains of patients with Alzheimer’s disease. LXA₄ and RvD1 levels in CSF correlated with Mini-Mental State Examination scores. Stimulation of inflammation resolution may reduce neuronal death in the brain, said the investigators.

Toxic chemicals may be triggering the recent increases in neurodevelopmental disabilities among children, according to a study published in the March issue of Lancet Neurology. In 2006, researchers identified five industrial chemicals as developmental neurotoxicants. The current study offers updated findings about those chemicals and adds information on six newly recognized ones, including manganese, fluoride, chlorpyrifos and DDT (ie, pesticides), tetrachloroethylene (a solvent), and the polybrominated diphenyl ethers (flame retardants). The study found that manganese is associated with diminished intellectual function and impaired motor skills, solvents are linked to hyperactivity and aggressive behavior, and certain pesticides may cause cognitive delays. More neurotoxicants may remain undiscovered, according to the investigators, who propose a global prevention strategy to control what they call a pandemic of developmental neurotoxicity.

For relatives of patients with multiple sclerosis (MS), the risk of developing the disease may be lower than previously assumed, according to a study published in the March issue of Brain. Researchers from Karolinska Institutet assessed the familial risks for MS using population registers and health care registries. They identified 28,396 patients with MS, along with first- and second-degree relatives and cousins. The investigators used matched population-based controls to calculate relative risks and found lower estimates of familial MS risks than previously reported. Despite a well-established lower prevalence of MS among males, the relative risks were equal among maternal and paternal relations. Using 74,757 twin pairs, the researchers estimated the disease’s heritability to be 0.64 and its shared environmental component to be 0.01.

Football helmets differ in their ability to reduce the risk of concussion, researchers reported online ahead of print January 31 in the Journal of Neurosurgery. The investigators conducted a retrospective analysis of head impact data from 1,833 collegiate football players from 2005 to 2010 who wore helmet-mounted accelerometer arrays for games and practices. The researchers compared concussion rates between players who wore the Riddell VSR4 and Riddell Revolution helmets. A total of 1,281,444 head impacts were recorded, and 64 concussions were diagnosed. The investigators found that the relative risk of sustaining a concussion in a Revolution helmet versus a VSR4 helmet was 46.1%. “Although helmet design may never prevent all concussions from occurring in football, evidence illustrates that it can reduce the incidence of this injury,” the researchers concluded.

Women have a worse quality of life, compared with men, for as long as 12 months after a stroke, even after adjustment for key sociodemographic variables, stroke severity, and disability, according to a study published online ahead of print February 7 in Neurology. Researchers assessed the quality of life in 1,370 patients (53.7% male; median age, 65) with ischemic stroke or transient ischemic attack (TIA) at three and 12 months postdischarge. Women had a significantly lower quality of life at three and 12 months poststroke. After multivariable adjustment for sociodemographic, clinical, and stroke-related factors, the investigators found that women continued to have a lower quality of life at three and 12 months. Women also had a poorer outcome in the dimensions of mobility, pain or discomfort, and anxiety or depression at three and 12 months.

High levels of high-density lipoprotein (HDL) cholesterol and low levels of low-density lipoprotein (LDL) cholesterol may be correlated with lower levels of amyloid plaque deposition in the brain, according to a study published in the February issue of JAMA Neurology. Investigators examined 74 individuals age 70 or older, including three participants with mild dementia, 33 cognitively normal participants, and 38 people with mild cognitive impairment. Cerebral amyloid-beta was measured with carbon C11–labeled Pittsburgh Compound B (PiB) PET. Statistical models that controlled for age and APOE ɛ4 revealed independent associations among the levels of LDL cholesterol, HDL cholesterol, and PiB index. Higher LDL cholesterol and lower HDL cholesterol levels were associated with a higher PiB index. The finding suggests an important role for cholesterol in amyloid-beta processing, said the researchers.

Patients with acute ischemic stroke who receive prompt treatment with t-PA may avoid a lengthy stay in an ICU, according to a study published February 12 in PLOS One. In a retrospective chart review of 153 patients who received IV t-PA for stroke, those with an NIH Stroke Scale (NIHSS) score of 10 or higher had a 7.7-times higher risk of requiring ICU resources, compared with patients who presented with an NIHSS score lower than 10. Eighty-one percent of patients with ICU needs developed them before the end of t-PA infusion, while 7% of those without ICU needs at the end of the t-PA infusion required ICU care later on. “We propose that patients without ICU needs by the end of the t-PA infusion might be safely monitored in a non-ICU setting if NIHSS at presentation is low,” the researchers advised.

—Erik Greb and Colby Stong