New and Noteworthy Information—March 2017

Serum levels of ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) were unable to distinguish between patients with mild traumatic brain injury (mTBI) and patients with orthopedic trauma, according to a study published online ahead of print January 27 in the Journal of Neurotrauma. The results cast doubt on the value of these proposed biomarkers in diagnosing mTBI, the researchers said. Serum UCH-L1 and GFAP were longitudinally measured in 73 patients with acute orthopedic injury and in 93 patients with CT-negative mTBI when they arrived at the hospital and one, two, three, and seven days after admission, as well as at a follow-up visit between three and 10 months after injury. Levels of GFAP were higher in patients with orthopedic trauma than in patients with mTBI on arrival, but subsequent levels did not differ between groups. Levels of UCH-L1 did not significantly differ between the groups.

High-dose immunosuppressive therapy and autologous hematopoietic cell transplantation without maintenance therapy is effective for inducing long-term sustained remission of active relapsing-remitting multiple sclerosis at five years, according to a study published online ahead of print February 1 in Neurology. Twenty-five participants were evaluated for transplant, and 24 participants underwent high-dose immunosuppressive therapy and hematopoietic cell transplantation. Median follow-up was 62 months. Event-free survival (ie, survival without disability progression, relapse, or new lesions on MRI) was 69.2%. Progression-free survival, clinical relapse-free survival, and MRI activity-free survival were 91.3%, 86.9%, and 86.3%, respectively. Adverse events were consistent with toxic effects associated with high-dose immunosuppressive therapy and hematopoietic cell transplantation, including cytopenia and infection. Neurologic disability improved among participants who survived and completed the study, with a median change in Expanded Disability Status Scale score of -0.5.

Estimated glomerular filtration rate on admission is an important predictor of poststroke short-term outcomes, according to a cohort study published in the February issue of Stroke. Investigators analyzed data from 232,236 patients with ischemic stroke in Get With The Guidelines-Stroke. Patients were age 65 or older. In all, 11.8% of patients died during hospitalization or were discharged to hospice, and 38.6% were discharged home. Renal dysfunction was independently associated with an increased risk of in-hospital mortality that was highest among those with an estimated glomerular filtration rate of less than 15 mL/min/1.73 m2 without dialysis (odds ratio, 2.52). In addition, receiving dialysis and having an estimated glomerular filtration rate of less than 29 mL/min/1.73 m2 were associated with lower odds of being discharged home.

Habitual sleep duration in monozygotic twins may be associated with distinct patterns of differential gene expression and pathway enrichment that affect immune response, according to a study published in the January issue of Sleep. Investigators selected 11 healthy monozygotic twin pairs (82% female; mean age, 42.7) based on subjective sleep duration discordance and then monitored participants' habitual sleep duration with two weeks of wrist actigraphy. Peripheral blood leukocyte RNA from fasting blood samples was obtained on the final day of actigraphic measurement and hybridized to Illumina humanHT-12 microarrays. The mean 24-hour sleep duration of the total sample was 439.2 minutes. Mean within-pair sleep duration difference per 24 hours was 64.4 minutes. The researchers observed distinctive pathway enrichment based on sleep duration differences. Habitual short sleep was associated with upregulation of genes involved in transcription, ribosome, translation, and oxidative phosphorylation. Genes that were downregulated with short sleep were highly enriched in immunoinfammatory pathways, as well as developmental programs, coagulation cascade, and cell adhesion.

A brain-computer interface that can decipher the thoughts of people who are unable to communicate may help people with completely locked-in syndrome, according to a study published January 31 in PLOS Biology. Researchers studied a brain-computer interface in four patients with advanced amyotrophic lateral sclerosis and completely locked-in syndrome. Patients responded to "yes" or "no" questions by thinking their answers. The noninvasive brain-computer interface assessed changes in frontocentral cortical oxygenation, measured using functional near-infrared spectroscopy, to determine patients' answers. Patients communicated with an above-chance-level correct response rate over 70%. EEG oscillations and electrooculographic signals did not exceed the chance-level threshold for correct communication.  

 
Using a new noninvasive fMRI method, physicians may be able to predict who is more likely to continue experiencing symptoms months or years after concussion, according to a study published online ahead of print January 13 in the Journal of Neurotrauma. Investigators recruited 75 patients with mild traumatic brain injury (mTBI) and 47 healthy subjects as part of the prospective, multicenter Transforming Research and Clinical Knowledge in TBI pilot study. Researchers compared the functional connectivity of the resting-state networks between patients and controls, and group differences in the interactions between resting-state networks. They assessed patients' cognitive and behavioral performance at six months post injury. Spatial maps of resting-state networks involved in behavioral and cognitive processes differed between patients with mTBI and healthy controls, and these differences were predictive of patients' outcomes at six months post injury.

 
Among patients with Alzheimer's disease, lifelong bilingualism correlates with functional modulations in crucial neural networks, suggesting neural reserve and compensatory mechanisms, according to a study published online ahead of print January 30 in the Proceedings of the National Academy of Sciences. Eighty-five patients with Alzheimer's disease (45 German-Italian bilingual speakers and 40 monolingual speakers) matched for disease duration were included in this study. Bilingual individuals were on average five years older than people who did not speak another language. Consistent with models of cognitive reserve, cerebral hypometabolism was more severe in the group of bilingual individuals with Alzheimer's disease. Metabolic connectivity analyses supported a neuroprotective effect of bilingualism by showing increased connectivity in the executive control and the default mode networks in bilingual patients, compared with monolingual patients.

 
The Huntington's Disease Society of America (HDSA), in conjunction with the FDA, conducted two surveys to gather the perspectives of patients with Huntington's disease and juvenile Huntington's disease and their caregivers. Findings from the surveys were published online ahead of print January 24 in the Journal of Huntington's Disease. One survey covered disease symptoms that matter most to people with Huntington's disease, and the other covered current approaches to treatment. The surveys received a total of 3,631 responses. "The frequency and impact of symptoms appear to be felt more by caregivers than individuals with Huntington's Disease, especially when it comes to loss of abilities," said lead investigator George J. Yohrling, PhD, Senior Director of Mission and Scientific Affairs for the HDSA. "There was also a large difference in the perception of symptom frequency between caregivers and individuals with Huntington's disease."

 
Intentional and unintentional head impacts are independently associated with moderate to severe CNS symptoms in adult amateur soccer players, according to a study published online ahead of print February 1 in Neurology. Soccer players completed an online questionnaire about how often they played soccer during the previous two weeks, how many times they had unintentional head impacts, how many times they headed the ball, and the frequency and severity of CNS symptoms. A total of 222 players completed 470 questionnaires. Heading-related symptoms were reported in 20% of the questionnaires. Heading in the highest quartile was significantly associated with CNS symptoms when controlling for unintentional head impacts. People with unintentional head impacts were at increased risk for CNS symptoms when controlling for heading.

 
Meditation or music listening may significantly enhance subjective memory function and objective cognitive performance in adults with subjective cognitive decline, according to a study published February 3 in the Journal of Alzheimer's Disease. A total of 60 participants with subjective cognitive decline were randomized to a Kirtan Kriya meditation program or a music listening program. The researchers asked participants to practice 12 minutes each day for three months, then at their discretion for the ensuing three months. At baseline, three months, and six months, researchers measured memory and cognitive functioning. Fifty-three participants completed the study. Both groups showed marked and significant improvements at three months in memory and cognitive performance. At six months, overall gains were maintained or improved, with effect sizes ranging from medium to large.

 
Yoga and aerobic exercise interventions do not significantly reduce objectively measured sleep disturbances among midlife women who are experiencing hot flashes, according to a study published January 15 in the Journal of Clinical Sleep Medicine. Researchers conducted secondary analyses of a randomized controlled trial in the Menopause Strategies: Finding Lasting Answers for Symptoms and Health network. In the trial, 186 late transition and postmenopausal women ages 40 to 62 with hot flashes were randomized to 12 weeks of yoga, supervised aerobic exercise, or usual activity. Changes in the actigraphic sleep outcomes from baseline to weeks 11 to 12 were small and did not differ between groups. An exploratory analysis suggested that women with poor self-reported sleep quality at baseline potentially had improved sleep stability following yoga.

 
Longitudinal data provide strong evidence of cognitive aging in midlife women, with substantial within-woman declines in processing speed and memory, according to a study published January 3 in PLoS One. Researchers used data from 2,124 participants from the Study of Women's Health Across the Nation. Participants completed annual tests of processing speed, verbal episodic memory, and working memory. Average age at baseline was 54. There were 7,185 cognitive assessments with a median follow-up time of 6.5 years. In mixed effects regression, adjusted for practice effects, retention, menopause symptoms, and covariates, scores on two of four cognition tests declined. Mean decline in cognitive speed was 0.28 per year or 4.9% in 10 years, and mean decline in verbal episodic memory (delayed testing) was 0.02 per year or 2% in 10 years.  

 
The FDA has approved Emflaza (deflazacort) for the treatment of Duchenne muscular dystrophy in patients age 5 and older. The corticosteroid is available in an immediate-release tablet formulation (6 mg, 18 mg, 30 mg, and 36 mg) as well as an oral suspension formulation (22.75 mg/mL). In a multicenter, randomized, double-blind, placebo-controlled study of 196 male pediatric patients, patients who received deflazacort had improved muscle strength at 12 weeks, compared with patients who received placebo. Through the 52-week study, an overall stability in average muscle strength was maintained in patients who received deflazacort. Results on several timed measures of patient function (eg, time to stand from supine, time to climb four stairs, and time to walk or run 30 feet) also numerically favored deflazacort 0.9 mg/kg/day at week 12. Marathon Pharmaceuticals, headquartered in Northbrook, Illinois, markets Emflaza.

—Kimberly Williams

Serum levels of ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) were unable to distinguish between patients with mild traumatic brain injury (mTBI) and patients with orthopedic trauma, according to a study published online ahead of print January 27 in the Journal of Neurotrauma. The results cast doubt on the value of these proposed biomarkers in diagnosing mTBI, the researchers said. Serum UCH-L1 and GFAP were longitudinally measured in 73 patients with acute orthopedic injury and in 93 patients with CT-negative mTBI when they arrived at the hospital and one, two, three, and seven days after admission, as well as at a follow-up visit between three and 10 months after injury. Levels of GFAP were higher in patients with orthopedic trauma than in patients with mTBI on arrival, but subsequent levels did not differ between groups. Levels of UCH-L1 did not significantly differ between the groups.

High-dose immunosuppressive therapy and autologous hematopoietic cell transplantation without maintenance therapy is effective for inducing long-term sustained remission of active relapsing-remitting multiple sclerosis at five years, according to a study published online ahead of print February 1 in Neurology. Twenty-five participants were evaluated for transplant, and 24 participants underwent high-dose immunosuppressive therapy and hematopoietic cell transplantation. Median follow-up was 62 months. Event-free survival (ie, survival without disability progression, relapse, or new lesions on MRI) was 69.2%. Progression-free survival, clinical relapse-free survival, and MRI activity-free survival were 91.3%, 86.9%, and 86.3%, respectively. Adverse events were consistent with toxic effects associated with high-dose immunosuppressive therapy and hematopoietic cell transplantation, including cytopenia and infection. Neurologic disability improved among participants who survived and completed the study, with a median change in Expanded Disability Status Scale score of -0.5.

Estimated glomerular filtration rate on admission is an important predictor of poststroke short-term outcomes, according to a cohort study published in the February issue of Stroke. Investigators analyzed data from 232,236 patients with ischemic stroke in Get With The Guidelines-Stroke. Patients were age 65 or older. In all, 11.8% of patients died during hospitalization or were discharged to hospice, and 38.6% were discharged home. Renal dysfunction was independently associated with an increased risk of in-hospital mortality that was highest among those with an estimated glomerular filtration rate of less than 15 mL/min/1.73 m2 without dialysis (odds ratio, 2.52). In addition, receiving dialysis and having an estimated glomerular filtration rate of less than 29 mL/min/1.73 m2 were associated with lower odds of being discharged home.

Habitual sleep duration in monozygotic twins may be associated with distinct patterns of differential gene expression and pathway enrichment that affect immune response, according to a study published in the January issue of Sleep. Investigators selected 11 healthy monozygotic twin pairs (82% female; mean age, 42.7) based on subjective sleep duration discordance and then monitored participants' habitual sleep duration with two weeks of wrist actigraphy. Peripheral blood leukocyte RNA from fasting blood samples was obtained on the final day of actigraphic measurement and hybridized to Illumina humanHT-12 microarrays. The mean 24-hour sleep duration of the total sample was 439.2 minutes. Mean within-pair sleep duration difference per 24 hours was 64.4 minutes. The researchers observed distinctive pathway enrichment based on sleep duration differences. Habitual short sleep was associated with upregulation of genes involved in transcription, ribosome, translation, and oxidative phosphorylation. Genes that were downregulated with short sleep were highly enriched in immunoinfammatory pathways, as well as developmental programs, coagulation cascade, and cell adhesion.

A brain-computer interface that can decipher the thoughts of people who are unable to communicate may help people with completely locked-in syndrome, according to a study published January 31 in PLOS Biology. Researchers studied a brain-computer interface in four patients with advanced amyotrophic lateral sclerosis and completely locked-in syndrome. Patients responded to "yes" or "no" questions by thinking their answers. The noninvasive brain-computer interface assessed changes in frontocentral cortical oxygenation, measured using functional near-infrared spectroscopy, to determine patients' answers. Patients communicated with an above-chance-level correct response rate over 70%. EEG oscillations and electrooculographic signals did not exceed the chance-level threshold for correct communication.  

 
Using a new noninvasive fMRI method, physicians may be able to predict who is more likely to continue experiencing symptoms months or years after concussion, according to a study published online ahead of print January 13 in the Journal of Neurotrauma. Investigators recruited 75 patients with mild traumatic brain injury (mTBI) and 47 healthy subjects as part of the prospective, multicenter Transforming Research and Clinical Knowledge in TBI pilot study. Researchers compared the functional connectivity of the resting-state networks between patients and controls, and group differences in the interactions between resting-state networks. They assessed patients' cognitive and behavioral performance at six months post injury. Spatial maps of resting-state networks involved in behavioral and cognitive processes differed between patients with mTBI and healthy controls, and these differences were predictive of patients' outcomes at six months post injury.

 
Among patients with Alzheimer's disease, lifelong bilingualism correlates with functional modulations in crucial neural networks, suggesting neural reserve and compensatory mechanisms, according to a study published online ahead of print January 30 in the Proceedings of the National Academy of Sciences. Eighty-five patients with Alzheimer's disease (45 German-Italian bilingual speakers and 40 monolingual speakers) matched for disease duration were included in this study. Bilingual individuals were on average five years older than people who did not speak another language. Consistent with models of cognitive reserve, cerebral hypometabolism was more severe in the group of bilingual individuals with Alzheimer's disease. Metabolic connectivity analyses supported a neuroprotective effect of bilingualism by showing increased connectivity in the executive control and the default mode networks in bilingual patients, compared with monolingual patients.

 
The Huntington's Disease Society of America (HDSA), in conjunction with the FDA, conducted two surveys to gather the perspectives of patients with Huntington's disease and juvenile Huntington's disease and their caregivers. Findings from the surveys were published online ahead of print January 24 in the Journal of Huntington's Disease. One survey covered disease symptoms that matter most to people with Huntington's disease, and the other covered current approaches to treatment. The surveys received a total of 3,631 responses. "The frequency and impact of symptoms appear to be felt more by caregivers than individuals with Huntington's Disease, especially when it comes to loss of abilities," said lead investigator George J. Yohrling, PhD, Senior Director of Mission and Scientific Affairs for the HDSA. "There was also a large difference in the perception of symptom frequency between caregivers and individuals with Huntington's disease."

 
Intentional and unintentional head impacts are independently associated with moderate to severe CNS symptoms in adult amateur soccer players, according to a study published online ahead of print February 1 in Neurology. Soccer players completed an online questionnaire about how often they played soccer during the previous two weeks, how many times they had unintentional head impacts, how many times they headed the ball, and the frequency and severity of CNS symptoms. A total of 222 players completed 470 questionnaires. Heading-related symptoms were reported in 20% of the questionnaires. Heading in the highest quartile was significantly associated with CNS symptoms when controlling for unintentional head impacts. People with unintentional head impacts were at increased risk for CNS symptoms when controlling for heading.

 
Meditation or music listening may significantly enhance subjective memory function and objective cognitive performance in adults with subjective cognitive decline, according to a study published February 3 in the Journal of Alzheimer's Disease. A total of 60 participants with subjective cognitive decline were randomized to a Kirtan Kriya meditation program or a music listening program. The researchers asked participants to practice 12 minutes each day for three months, then at their discretion for the ensuing three months. At baseline, three months, and six months, researchers measured memory and cognitive functioning. Fifty-three participants completed the study. Both groups showed marked and significant improvements at three months in memory and cognitive performance. At six months, overall gains were maintained or improved, with effect sizes ranging from medium to large.

 
Yoga and aerobic exercise interventions do not significantly reduce objectively measured sleep disturbances among midlife women who are experiencing hot flashes, according to a study published January 15 in the Journal of Clinical Sleep Medicine. Researchers conducted secondary analyses of a randomized controlled trial in the Menopause Strategies: Finding Lasting Answers for Symptoms and Health network. In the trial, 186 late transition and postmenopausal women ages 40 to 62 with hot flashes were randomized to 12 weeks of yoga, supervised aerobic exercise, or usual activity. Changes in the actigraphic sleep outcomes from baseline to weeks 11 to 12 were small and did not differ between groups. An exploratory analysis suggested that women with poor self-reported sleep quality at baseline potentially had improved sleep stability following yoga.

 
Longitudinal data provide strong evidence of cognitive aging in midlife women, with substantial within-woman declines in processing speed and memory, according to a study published January 3 in PLoS One. Researchers used data from 2,124 participants from the Study of Women's Health Across the Nation. Participants completed annual tests of processing speed, verbal episodic memory, and working memory. Average age at baseline was 54. There were 7,185 cognitive assessments with a median follow-up time of 6.5 years. In mixed effects regression, adjusted for practice effects, retention, menopause symptoms, and covariates, scores on two of four cognition tests declined. Mean decline in cognitive speed was 0.28 per year or 4.9% in 10 years, and mean decline in verbal episodic memory (delayed testing) was 0.02 per year or 2% in 10 years.  

 
The FDA has approved Emflaza (deflazacort) for the treatment of Duchenne muscular dystrophy in patients age 5 and older. The corticosteroid is available in an immediate-release tablet formulation (6 mg, 18 mg, 30 mg, and 36 mg) as well as an oral suspension formulation (22.75 mg/mL). In a multicenter, randomized, double-blind, placebo-controlled study of 196 male pediatric patients, patients who received deflazacort had improved muscle strength at 12 weeks, compared with patients who received placebo. Through the 52-week study, an overall stability in average muscle strength was maintained in patients who received deflazacort. Results on several timed measures of patient function (eg, time to stand from supine, time to climb four stairs, and time to walk or run 30 feet) also numerically favored deflazacort 0.9 mg/kg/day at week 12. Marathon Pharmaceuticals, headquartered in Northbrook, Illinois, markets Emflaza.

—Kimberly Williams

Serum levels of ubiquitin C-terminal hydrolase-L1 (UCH-L1) and glial fibrillary acidic protein (GFAP) were unable to distinguish between patients with mild traumatic brain injury (mTBI) and patients with orthopedic trauma, according to a study published online ahead of print January 27 in the Journal of Neurotrauma. The results cast doubt on the value of these proposed biomarkers in diagnosing mTBI, the researchers said. Serum UCH-L1 and GFAP were longitudinally measured in 73 patients with acute orthopedic injury and in 93 patients with CT-negative mTBI when they arrived at the hospital and one, two, three, and seven days after admission, as well as at a follow-up visit between three and 10 months after injury. Levels of GFAP were higher in patients with orthopedic trauma than in patients with mTBI on arrival, but subsequent levels did not differ between groups. Levels of UCH-L1 did not significantly differ between the groups.

High-dose immunosuppressive therapy and autologous hematopoietic cell transplantation without maintenance therapy is effective for inducing long-term sustained remission of active relapsing-remitting multiple sclerosis at five years, according to a study published online ahead of print February 1 in Neurology. Twenty-five participants were evaluated for transplant, and 24 participants underwent high-dose immunosuppressive therapy and hematopoietic cell transplantation. Median follow-up was 62 months. Event-free survival (ie, survival without disability progression, relapse, or new lesions on MRI) was 69.2%. Progression-free survival, clinical relapse-free survival, and MRI activity-free survival were 91.3%, 86.9%, and 86.3%, respectively. Adverse events were consistent with toxic effects associated with high-dose immunosuppressive therapy and hematopoietic cell transplantation, including cytopenia and infection. Neurologic disability improved among participants who survived and completed the study, with a median change in Expanded Disability Status Scale score of -0.5.

Estimated glomerular filtration rate on admission is an important predictor of poststroke short-term outcomes, according to a cohort study published in the February issue of Stroke. Investigators analyzed data from 232,236 patients with ischemic stroke in Get With The Guidelines-Stroke. Patients were age 65 or older. In all, 11.8% of patients died during hospitalization or were discharged to hospice, and 38.6% were discharged home. Renal dysfunction was independently associated with an increased risk of in-hospital mortality that was highest among those with an estimated glomerular filtration rate of less than 15 mL/min/1.73 m2 without dialysis (odds ratio, 2.52). In addition, receiving dialysis and having an estimated glomerular filtration rate of less than 29 mL/min/1.73 m2 were associated with lower odds of being discharged home.

Habitual sleep duration in monozygotic twins may be associated with distinct patterns of differential gene expression and pathway enrichment that affect immune response, according to a study published in the January issue of Sleep. Investigators selected 11 healthy monozygotic twin pairs (82% female; mean age, 42.7) based on subjective sleep duration discordance and then monitored participants' habitual sleep duration with two weeks of wrist actigraphy. Peripheral blood leukocyte RNA from fasting blood samples was obtained on the final day of actigraphic measurement and hybridized to Illumina humanHT-12 microarrays. The mean 24-hour sleep duration of the total sample was 439.2 minutes. Mean within-pair sleep duration difference per 24 hours was 64.4 minutes. The researchers observed distinctive pathway enrichment based on sleep duration differences. Habitual short sleep was associated with upregulation of genes involved in transcription, ribosome, translation, and oxidative phosphorylation. Genes that were downregulated with short sleep were highly enriched in immunoinfammatory pathways, as well as developmental programs, coagulation cascade, and cell adhesion.

A brain-computer interface that can decipher the thoughts of people who are unable to communicate may help people with completely locked-in syndrome, according to a study published January 31 in PLOS Biology. Researchers studied a brain-computer interface in four patients with advanced amyotrophic lateral sclerosis and completely locked-in syndrome. Patients responded to "yes" or "no" questions by thinking their answers. The noninvasive brain-computer interface assessed changes in frontocentral cortical oxygenation, measured using functional near-infrared spectroscopy, to determine patients' answers. Patients communicated with an above-chance-level correct response rate over 70%. EEG oscillations and electrooculographic signals did not exceed the chance-level threshold for correct communication.  

 
Using a new noninvasive fMRI method, physicians may be able to predict who is more likely to continue experiencing symptoms months or years after concussion, according to a study published online ahead of print January 13 in the Journal of Neurotrauma. Investigators recruited 75 patients with mild traumatic brain injury (mTBI) and 47 healthy subjects as part of the prospective, multicenter Transforming Research and Clinical Knowledge in TBI pilot study. Researchers compared the functional connectivity of the resting-state networks between patients and controls, and group differences in the interactions between resting-state networks. They assessed patients' cognitive and behavioral performance at six months post injury. Spatial maps of resting-state networks involved in behavioral and cognitive processes differed between patients with mTBI and healthy controls, and these differences were predictive of patients' outcomes at six months post injury.

 
Among patients with Alzheimer's disease, lifelong bilingualism correlates with functional modulations in crucial neural networks, suggesting neural reserve and compensatory mechanisms, according to a study published online ahead of print January 30 in the Proceedings of the National Academy of Sciences. Eighty-five patients with Alzheimer's disease (45 German-Italian bilingual speakers and 40 monolingual speakers) matched for disease duration were included in this study. Bilingual individuals were on average five years older than people who did not speak another language. Consistent with models of cognitive reserve, cerebral hypometabolism was more severe in the group of bilingual individuals with Alzheimer's disease. Metabolic connectivity analyses supported a neuroprotective effect of bilingualism by showing increased connectivity in the executive control and the default mode networks in bilingual patients, compared with monolingual patients.

 
The Huntington's Disease Society of America (HDSA), in conjunction with the FDA, conducted two surveys to gather the perspectives of patients with Huntington's disease and juvenile Huntington's disease and their caregivers. Findings from the surveys were published online ahead of print January 24 in the Journal of Huntington's Disease. One survey covered disease symptoms that matter most to people with Huntington's disease, and the other covered current approaches to treatment. The surveys received a total of 3,631 responses. "The frequency and impact of symptoms appear to be felt more by caregivers than individuals with Huntington's Disease, especially when it comes to loss of abilities," said lead investigator George J. Yohrling, PhD, Senior Director of Mission and Scientific Affairs for the HDSA. "There was also a large difference in the perception of symptom frequency between caregivers and individuals with Huntington's disease."

 
Intentional and unintentional head impacts are independently associated with moderate to severe CNS symptoms in adult amateur soccer players, according to a study published online ahead of print February 1 in Neurology. Soccer players completed an online questionnaire about how often they played soccer during the previous two weeks, how many times they had unintentional head impacts, how many times they headed the ball, and the frequency and severity of CNS symptoms. A total of 222 players completed 470 questionnaires. Heading-related symptoms were reported in 20% of the questionnaires. Heading in the highest quartile was significantly associated with CNS symptoms when controlling for unintentional head impacts. People with unintentional head impacts were at increased risk for CNS symptoms when controlling for heading.

 
Meditation or music listening may significantly enhance subjective memory function and objective cognitive performance in adults with subjective cognitive decline, according to a study published February 3 in the Journal of Alzheimer's Disease. A total of 60 participants with subjective cognitive decline were randomized to a Kirtan Kriya meditation program or a music listening program. The researchers asked participants to practice 12 minutes each day for three months, then at their discretion for the ensuing three months. At baseline, three months, and six months, researchers measured memory and cognitive functioning. Fifty-three participants completed the study. Both groups showed marked and significant improvements at three months in memory and cognitive performance. At six months, overall gains were maintained or improved, with effect sizes ranging from medium to large.

 
Yoga and aerobic exercise interventions do not significantly reduce objectively measured sleep disturbances among midlife women who are experiencing hot flashes, according to a study published January 15 in the Journal of Clinical Sleep Medicine. Researchers conducted secondary analyses of a randomized controlled trial in the Menopause Strategies: Finding Lasting Answers for Symptoms and Health network. In the trial, 186 late transition and postmenopausal women ages 40 to 62 with hot flashes were randomized to 12 weeks of yoga, supervised aerobic exercise, or usual activity. Changes in the actigraphic sleep outcomes from baseline to weeks 11 to 12 were small and did not differ between groups. An exploratory analysis suggested that women with poor self-reported sleep quality at baseline potentially had improved sleep stability following yoga.

 
Longitudinal data provide strong evidence of cognitive aging in midlife women, with substantial within-woman declines in processing speed and memory, according to a study published January 3 in PLoS One. Researchers used data from 2,124 participants from the Study of Women's Health Across the Nation. Participants completed annual tests of processing speed, verbal episodic memory, and working memory. Average age at baseline was 54. There were 7,185 cognitive assessments with a median follow-up time of 6.5 years. In mixed effects regression, adjusted for practice effects, retention, menopause symptoms, and covariates, scores on two of four cognition tests declined. Mean decline in cognitive speed was 0.28 per year or 4.9% in 10 years, and mean decline in verbal episodic memory (delayed testing) was 0.02 per year or 2% in 10 years.  

 
The FDA has approved Emflaza (deflazacort) for the treatment of Duchenne muscular dystrophy in patients age 5 and older. The corticosteroid is available in an immediate-release tablet formulation (6 mg, 18 mg, 30 mg, and 36 mg) as well as an oral suspension formulation (22.75 mg/mL). In a multicenter, randomized, double-blind, placebo-controlled study of 196 male pediatric patients, patients who received deflazacort had improved muscle strength at 12 weeks, compared with patients who received placebo. Through the 52-week study, an overall stability in average muscle strength was maintained in patients who received deflazacort. Results on several timed measures of patient function (eg, time to stand from supine, time to climb four stairs, and time to walk or run 30 feet) also numerically favored deflazacort 0.9 mg/kg/day at week 12. Marathon Pharmaceuticals, headquartered in Northbrook, Illinois, markets Emflaza.

—Kimberly Williams