New and Noteworthy Information—May 2016

Patients who have type 1 diabetes have an increased risk of developing epilepsy, according to a study published online ahead of print March 31 in Diabetologia. This study cohort included 2,568 patients with type 1 diabetes, each of whom was frequency-matched by sex, residence, and index year with 10 patients without type 1 diabetes. Cox proportional hazard regression analysis was conducted to estimate the effects of type 1 diabetes on epilepsy risk. After adjusting for potential confounders, the type 1 diabetes cohort was 2.84 times more likely to develop epilepsy than the control cohort. “Metabolic abnormalities of type 1 diabetes, such as hyperglycemia and hypoglycemia, may have a damaging effect on the central nervous system and be associated with significant long-term neurological sequelae,” said the authors.

Antipsychotics are associated with a significantly increased mortality risk in patients with Parkinson’s disease, after adjusting for measurable confounders, according to a study published online ahead of print March 21 in JAMA Neurology. This retrospective matched-cohort study used data from the fiscal years of 1999 to 2010. The rates of 180-day mortality were compared in 7,877 patients initiating antipsychotic therapy and in 7,877 patients who did not initiate antipsychotic therapy. Antipsychotic use was associated with more than twice the hazard ratio of death, compared with nonuse. The hazard ratio was significantly higher for patients who used typical versus atypical antipsychotics. Among the atypical antipsychotics used, hazard ratios relative to nonuse of antipsychotics were, in descending order, 2.79 for olanzapine, 2.46 for risperidone, and 2.16 for quetiapine fumarate.

White matter tracts related to regulation of sleep and wakefulness, and limbic cognitive and sensorimotor regions, are disrupted in the right brain in patients with primary insomnia, according to a study published online ahead of print April 5 in Radiology. Investigators used tract-based spatial statistics to compare changes in diffusion parameters of white matter tracts from 23 patients with primary insomnia and 30 healthy controls. They evaluated how accurately these changes could distinguish patients with insomnia from healthy controls. Patients with primary insomnia had lower fractional anisotropy values mainly in the right anterior limb of the internal capsule, the right posterior limb of the internal capsule, the right anterior corona radiata, the right superior corona radiata, the right superior longitudinal fasciculus, the body of the corpus callosum, and the right thalamus.

Among Chinese adults, a higher level of fruit consumption is associated with lower blood pressure and blood glucose levels and, largely independent of these and other factors, with significantly lower risks of major cardiovascular diseases, according to a study published April 7 in the New England Journal of Medicine. Between 2004 and 2008, researchers recruited 512,891 adults between ages 30 and 79 from 10 locations in China. In all, 5,173 deaths from cardiovascular disease, 2,551 incident major coronary events, 14,579 ischemic strokes, and 3,523 intracerebral hemorrhages were recorded among the 451,665 participants without a history of cardiovascular disease or antihypertensive treatments at baseline. The adjusted hazard ratios for daily consumption versus nonconsumption were 0.75 for ischemic stroke and 0.64 for hemorrhagic stroke.

A low level of leisure-time physical activity is independently associated with greater decline in cognitive performance over time, according to a study published online ahead of print March 23 in Neurology. Researchers assessed cognition in participants in the Northern Manhattan Study using a standard neuropsychologic examination. The neuropsychologic examination was repeated five years later and subcategorized using standardized z scores over validated domains. No or low levels of leisure-time physical activity were associated with worse executive function, semantic memory, and processing speed scores on the first neuropsychologic examination. The associations were slightly attenuated and not significant after adjusting for vascular risk factors. Cognitively unimpaired participants who reported no to low leisure-time physical activity versus moderate to high levels declined more over time in processing speed and episodic memory.

Participation in the “Sleep for Success” education program is associated with significant improvement in children’s sleep and academic performance, according to a study published in Sleep Medicine. Using a community-based participatory research approach, researchers composed a program of four modules that addressed the children, their family and community, the school staff, and decision-makers within the school setting. In all, 71 students participated in the evaluation of the program. The effectiveness of the program was evaluated using nonrandomized, controlled before-and-after study groups that were assessed at two time points. In the intervention group, true sleep was extended by 18.2 minutes per night, sleep efficiency improved by 2.3%, and sleep latency was shortened by 2.3 minutes. Report card grades also improved significantly in English and mathematics.

The combination of rosuvastatin, candesartan, and hydrochlorothiazide is associated with a significantly lower rate of cardiovascular events than dual placebo in people who do not have cardiovascular disease, according to a study published online ahead of print April 2 in the New England Journal of Medicine. Researchers randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to 10 mg/day of rosuvastatin or placebo, and to 16 mg/day of candesartan, plus 12.5 mg/day of hydrochlorothiazide or placebo. The decrease in the low-density lipoprotein cholesterol level was 33.7 mg/dL greater in the combined-therapy group than in the dual-placebo group, and the decrease in systolic blood pressure was 6.2 mm Hg greater with combined therapy than with dual placebo.

Right hemisphere white matter integrity is related to speech fluency measures in patients with chronic aphasia, according to a study published online ahead of print March 30 in Neurology. The study included 33 people with an average age of 58 who had a stroke on the left side of their brain. Fractional anisotropy values for the right middle temporal gyrus, precentral gyrus, and pars opercularis significantly predicted speech fluency, but fractional anisotropy values of the pars triangularis and superior parietal lobule did not. A multiple regression analysis showed that combining fractional anisotropy of the significant right hemisphere regions with the lesion load of the left arcuate fasciculus provided the best model for predicting speech fluency. Fractional anisotropy of corpus callosum fibers connecting left and right supplementary motor areas was also correlated with speech fluency.

Differences in white matter microstructure may partially account for the variance in functional outcomes among veterans with combat-related mild traumatic brain injury (mTBI), according to a study published online ahead of print March 29 in Radiology. From 2010 to 2013, an initial post deployment evaluation, including clinical assessment and brain MRI with diffusion tensor imaging, was performed in combat veterans who sustained mTBI while deployed. Veterans who did and did not return to work were also compared for differences in clinical variables by using t and χ² tests. After a mean follow-up of 1.4 years, 34 of 57 veterans had returned to work. Cumulative health care visits over time were inversely correlated with diffusion anisotropy of the splenium of the corpus callosum and adjacent parietal white matter.

Cognitive status and intelligibility may be associated with everyday communicative outcomes in Parkinson’s disease, according to a study published online ahead of print March 16 in the Journal of Parkinson’s Disease. Investigators searched five online databases in May 2015 and also conducted supplementary searches. In all, 4,816 records were identified through database searches, and 16 additional records were identified through supplementary searches. Forty-one articles were suitable for full-text screening, and 15 articles met the eligibility criteria. Ten studies assessed the role of cognitive status, and nine found that participants with greater cognitive impairment had greater everyday communication difficulties. Four studies assessed the role of intelligibility, and all found that participants with greater intelligibility impairment had greater everyday communication difficulties. Effects often were weak, however, and not consistent.

Common variants near FOXF2 are associated with increased stroke susceptibility, according to a study published online ahead of print April 7 in the Lancet Neurology. Researchers completed a genome-wide analysis of common genetic variants associated with incident stroke risk in 18 population-based cohorts consisting of 84,961 participants, of whom 4,348 had stroke. Investigators completed validation analyses for variants yielding a significant association with all stroke, ischemic stroke, cardioembolic ischemic stroke, or noncardioembolic ischemic stroke. Study authors replicated seven of eight known loci associated with risk for ischemic stroke and identified a novel locus at chromosome 6p25 associated with risk of all stroke. The rs12204590 stroke risk allele was also associated with increased white matter hyperintensity in adults without stroke. Young patients with segmental deletions of FOXF2 showed extensive white matter hyperintensity.

Young women with musculoskeletal pain complaints may have comorbid sleep problems that require treatment, according to a study published in the April issue of Pain. Researchers investigated the cross-sectional and longitudinal relationship between sleep problems and chronic pain, and musculoskeletal pain, headache, and abdominal pain severity in a general population of adults between ages 19 and 22. They studied whether relationships were moderated by sex and whether symptoms of anxiety and depression, fatigue, or physical inactivity mediated these effects. Follow-up data were collected in 1,753 participants. Sleep problems were associated with chronic pain, musculoskeletal pain, headache, and abdominal pain severity. They also predicted chronic pain and an increase in musculoskeletal pain severity at three years of follow-up. The effect was stronger in females than in males.

—Kimberly Williams

Patients who have type 1 diabetes have an increased risk of developing epilepsy, according to a study published online ahead of print March 31 in Diabetologia. This study cohort included 2,568 patients with type 1 diabetes, each of whom was frequency-matched by sex, residence, and index year with 10 patients without type 1 diabetes. Cox proportional hazard regression analysis was conducted to estimate the effects of type 1 diabetes on epilepsy risk. After adjusting for potential confounders, the type 1 diabetes cohort was 2.84 times more likely to develop epilepsy than the control cohort. “Metabolic abnormalities of type 1 diabetes, such as hyperglycemia and hypoglycemia, may have a damaging effect on the central nervous system and be associated with significant long-term neurological sequelae,” said the authors.

Antipsychotics are associated with a significantly increased mortality risk in patients with Parkinson’s disease, after adjusting for measurable confounders, according to a study published online ahead of print March 21 in JAMA Neurology. This retrospective matched-cohort study used data from the fiscal years of 1999 to 2010. The rates of 180-day mortality were compared in 7,877 patients initiating antipsychotic therapy and in 7,877 patients who did not initiate antipsychotic therapy. Antipsychotic use was associated with more than twice the hazard ratio of death, compared with nonuse. The hazard ratio was significantly higher for patients who used typical versus atypical antipsychotics. Among the atypical antipsychotics used, hazard ratios relative to nonuse of antipsychotics were, in descending order, 2.79 for olanzapine, 2.46 for risperidone, and 2.16 for quetiapine fumarate.

White matter tracts related to regulation of sleep and wakefulness, and limbic cognitive and sensorimotor regions, are disrupted in the right brain in patients with primary insomnia, according to a study published online ahead of print April 5 in Radiology. Investigators used tract-based spatial statistics to compare changes in diffusion parameters of white matter tracts from 23 patients with primary insomnia and 30 healthy controls. They evaluated how accurately these changes could distinguish patients with insomnia from healthy controls. Patients with primary insomnia had lower fractional anisotropy values mainly in the right anterior limb of the internal capsule, the right posterior limb of the internal capsule, the right anterior corona radiata, the right superior corona radiata, the right superior longitudinal fasciculus, the body of the corpus callosum, and the right thalamus.

Among Chinese adults, a higher level of fruit consumption is associated with lower blood pressure and blood glucose levels and, largely independent of these and other factors, with significantly lower risks of major cardiovascular diseases, according to a study published April 7 in the New England Journal of Medicine. Between 2004 and 2008, researchers recruited 512,891 adults between ages 30 and 79 from 10 locations in China. In all, 5,173 deaths from cardiovascular disease, 2,551 incident major coronary events, 14,579 ischemic strokes, and 3,523 intracerebral hemorrhages were recorded among the 451,665 participants without a history of cardiovascular disease or antihypertensive treatments at baseline. The adjusted hazard ratios for daily consumption versus nonconsumption were 0.75 for ischemic stroke and 0.64 for hemorrhagic stroke.

A low level of leisure-time physical activity is independently associated with greater decline in cognitive performance over time, according to a study published online ahead of print March 23 in Neurology. Researchers assessed cognition in participants in the Northern Manhattan Study using a standard neuropsychologic examination. The neuropsychologic examination was repeated five years later and subcategorized using standardized z scores over validated domains. No or low levels of leisure-time physical activity were associated with worse executive function, semantic memory, and processing speed scores on the first neuropsychologic examination. The associations were slightly attenuated and not significant after adjusting for vascular risk factors. Cognitively unimpaired participants who reported no to low leisure-time physical activity versus moderate to high levels declined more over time in processing speed and episodic memory.

Participation in the “Sleep for Success” education program is associated with significant improvement in children’s sleep and academic performance, according to a study published in Sleep Medicine. Using a community-based participatory research approach, researchers composed a program of four modules that addressed the children, their family and community, the school staff, and decision-makers within the school setting. In all, 71 students participated in the evaluation of the program. The effectiveness of the program was evaluated using nonrandomized, controlled before-and-after study groups that were assessed at two time points. In the intervention group, true sleep was extended by 18.2 minutes per night, sleep efficiency improved by 2.3%, and sleep latency was shortened by 2.3 minutes. Report card grades also improved significantly in English and mathematics.

The combination of rosuvastatin, candesartan, and hydrochlorothiazide is associated with a significantly lower rate of cardiovascular events than dual placebo in people who do not have cardiovascular disease, according to a study published online ahead of print April 2 in the New England Journal of Medicine. Researchers randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to 10 mg/day of rosuvastatin or placebo, and to 16 mg/day of candesartan, plus 12.5 mg/day of hydrochlorothiazide or placebo. The decrease in the low-density lipoprotein cholesterol level was 33.7 mg/dL greater in the combined-therapy group than in the dual-placebo group, and the decrease in systolic blood pressure was 6.2 mm Hg greater with combined therapy than with dual placebo.

Right hemisphere white matter integrity is related to speech fluency measures in patients with chronic aphasia, according to a study published online ahead of print March 30 in Neurology. The study included 33 people with an average age of 58 who had a stroke on the left side of their brain. Fractional anisotropy values for the right middle temporal gyrus, precentral gyrus, and pars opercularis significantly predicted speech fluency, but fractional anisotropy values of the pars triangularis and superior parietal lobule did not. A multiple regression analysis showed that combining fractional anisotropy of the significant right hemisphere regions with the lesion load of the left arcuate fasciculus provided the best model for predicting speech fluency. Fractional anisotropy of corpus callosum fibers connecting left and right supplementary motor areas was also correlated with speech fluency.

Differences in white matter microstructure may partially account for the variance in functional outcomes among veterans with combat-related mild traumatic brain injury (mTBI), according to a study published online ahead of print March 29 in Radiology. From 2010 to 2013, an initial post deployment evaluation, including clinical assessment and brain MRI with diffusion tensor imaging, was performed in combat veterans who sustained mTBI while deployed. Veterans who did and did not return to work were also compared for differences in clinical variables by using t and χ² tests. After a mean follow-up of 1.4 years, 34 of 57 veterans had returned to work. Cumulative health care visits over time were inversely correlated with diffusion anisotropy of the splenium of the corpus callosum and adjacent parietal white matter.

Cognitive status and intelligibility may be associated with everyday communicative outcomes in Parkinson’s disease, according to a study published online ahead of print March 16 in the Journal of Parkinson’s Disease. Investigators searched five online databases in May 2015 and also conducted supplementary searches. In all, 4,816 records were identified through database searches, and 16 additional records were identified through supplementary searches. Forty-one articles were suitable for full-text screening, and 15 articles met the eligibility criteria. Ten studies assessed the role of cognitive status, and nine found that participants with greater cognitive impairment had greater everyday communication difficulties. Four studies assessed the role of intelligibility, and all found that participants with greater intelligibility impairment had greater everyday communication difficulties. Effects often were weak, however, and not consistent.

Common variants near FOXF2 are associated with increased stroke susceptibility, according to a study published online ahead of print April 7 in the Lancet Neurology. Researchers completed a genome-wide analysis of common genetic variants associated with incident stroke risk in 18 population-based cohorts consisting of 84,961 participants, of whom 4,348 had stroke. Investigators completed validation analyses for variants yielding a significant association with all stroke, ischemic stroke, cardioembolic ischemic stroke, or noncardioembolic ischemic stroke. Study authors replicated seven of eight known loci associated with risk for ischemic stroke and identified a novel locus at chromosome 6p25 associated with risk of all stroke. The rs12204590 stroke risk allele was also associated with increased white matter hyperintensity in adults without stroke. Young patients with segmental deletions of FOXF2 showed extensive white matter hyperintensity.

Young women with musculoskeletal pain complaints may have comorbid sleep problems that require treatment, according to a study published in the April issue of Pain. Researchers investigated the cross-sectional and longitudinal relationship between sleep problems and chronic pain, and musculoskeletal pain, headache, and abdominal pain severity in a general population of adults between ages 19 and 22. They studied whether relationships were moderated by sex and whether symptoms of anxiety and depression, fatigue, or physical inactivity mediated these effects. Follow-up data were collected in 1,753 participants. Sleep problems were associated with chronic pain, musculoskeletal pain, headache, and abdominal pain severity. They also predicted chronic pain and an increase in musculoskeletal pain severity at three years of follow-up. The effect was stronger in females than in males.

—Kimberly Williams

Patients who have type 1 diabetes have an increased risk of developing epilepsy, according to a study published online ahead of print March 31 in Diabetologia. This study cohort included 2,568 patients with type 1 diabetes, each of whom was frequency-matched by sex, residence, and index year with 10 patients without type 1 diabetes. Cox proportional hazard regression analysis was conducted to estimate the effects of type 1 diabetes on epilepsy risk. After adjusting for potential confounders, the type 1 diabetes cohort was 2.84 times more likely to develop epilepsy than the control cohort. “Metabolic abnormalities of type 1 diabetes, such as hyperglycemia and hypoglycemia, may have a damaging effect on the central nervous system and be associated with significant long-term neurological sequelae,” said the authors.

Antipsychotics are associated with a significantly increased mortality risk in patients with Parkinson’s disease, after adjusting for measurable confounders, according to a study published online ahead of print March 21 in JAMA Neurology. This retrospective matched-cohort study used data from the fiscal years of 1999 to 2010. The rates of 180-day mortality were compared in 7,877 patients initiating antipsychotic therapy and in 7,877 patients who did not initiate antipsychotic therapy. Antipsychotic use was associated with more than twice the hazard ratio of death, compared with nonuse. The hazard ratio was significantly higher for patients who used typical versus atypical antipsychotics. Among the atypical antipsychotics used, hazard ratios relative to nonuse of antipsychotics were, in descending order, 2.79 for olanzapine, 2.46 for risperidone, and 2.16 for quetiapine fumarate.

White matter tracts related to regulation of sleep and wakefulness, and limbic cognitive and sensorimotor regions, are disrupted in the right brain in patients with primary insomnia, according to a study published online ahead of print April 5 in Radiology. Investigators used tract-based spatial statistics to compare changes in diffusion parameters of white matter tracts from 23 patients with primary insomnia and 30 healthy controls. They evaluated how accurately these changes could distinguish patients with insomnia from healthy controls. Patients with primary insomnia had lower fractional anisotropy values mainly in the right anterior limb of the internal capsule, the right posterior limb of the internal capsule, the right anterior corona radiata, the right superior corona radiata, the right superior longitudinal fasciculus, the body of the corpus callosum, and the right thalamus.

Among Chinese adults, a higher level of fruit consumption is associated with lower blood pressure and blood glucose levels and, largely independent of these and other factors, with significantly lower risks of major cardiovascular diseases, according to a study published April 7 in the New England Journal of Medicine. Between 2004 and 2008, researchers recruited 512,891 adults between ages 30 and 79 from 10 locations in China. In all, 5,173 deaths from cardiovascular disease, 2,551 incident major coronary events, 14,579 ischemic strokes, and 3,523 intracerebral hemorrhages were recorded among the 451,665 participants without a history of cardiovascular disease or antihypertensive treatments at baseline. The adjusted hazard ratios for daily consumption versus nonconsumption were 0.75 for ischemic stroke and 0.64 for hemorrhagic stroke.

A low level of leisure-time physical activity is independently associated with greater decline in cognitive performance over time, according to a study published online ahead of print March 23 in Neurology. Researchers assessed cognition in participants in the Northern Manhattan Study using a standard neuropsychologic examination. The neuropsychologic examination was repeated five years later and subcategorized using standardized z scores over validated domains. No or low levels of leisure-time physical activity were associated with worse executive function, semantic memory, and processing speed scores on the first neuropsychologic examination. The associations were slightly attenuated and not significant after adjusting for vascular risk factors. Cognitively unimpaired participants who reported no to low leisure-time physical activity versus moderate to high levels declined more over time in processing speed and episodic memory.

Participation in the “Sleep for Success” education program is associated with significant improvement in children’s sleep and academic performance, according to a study published in Sleep Medicine. Using a community-based participatory research approach, researchers composed a program of four modules that addressed the children, their family and community, the school staff, and decision-makers within the school setting. In all, 71 students participated in the evaluation of the program. The effectiveness of the program was evaluated using nonrandomized, controlled before-and-after study groups that were assessed at two time points. In the intervention group, true sleep was extended by 18.2 minutes per night, sleep efficiency improved by 2.3%, and sleep latency was shortened by 2.3 minutes. Report card grades also improved significantly in English and mathematics.

The combination of rosuvastatin, candesartan, and hydrochlorothiazide is associated with a significantly lower rate of cardiovascular events than dual placebo in people who do not have cardiovascular disease, according to a study published online ahead of print April 2 in the New England Journal of Medicine. Researchers randomly assigned 12,705 participants at intermediate risk who did not have cardiovascular disease to 10 mg/day of rosuvastatin or placebo, and to 16 mg/day of candesartan, plus 12.5 mg/day of hydrochlorothiazide or placebo. The decrease in the low-density lipoprotein cholesterol level was 33.7 mg/dL greater in the combined-therapy group than in the dual-placebo group, and the decrease in systolic blood pressure was 6.2 mm Hg greater with combined therapy than with dual placebo.

Right hemisphere white matter integrity is related to speech fluency measures in patients with chronic aphasia, according to a study published online ahead of print March 30 in Neurology. The study included 33 people with an average age of 58 who had a stroke on the left side of their brain. Fractional anisotropy values for the right middle temporal gyrus, precentral gyrus, and pars opercularis significantly predicted speech fluency, but fractional anisotropy values of the pars triangularis and superior parietal lobule did not. A multiple regression analysis showed that combining fractional anisotropy of the significant right hemisphere regions with the lesion load of the left arcuate fasciculus provided the best model for predicting speech fluency. Fractional anisotropy of corpus callosum fibers connecting left and right supplementary motor areas was also correlated with speech fluency.

Differences in white matter microstructure may partially account for the variance in functional outcomes among veterans with combat-related mild traumatic brain injury (mTBI), according to a study published online ahead of print March 29 in Radiology. From 2010 to 2013, an initial post deployment evaluation, including clinical assessment and brain MRI with diffusion tensor imaging, was performed in combat veterans who sustained mTBI while deployed. Veterans who did and did not return to work were also compared for differences in clinical variables by using t and χ² tests. After a mean follow-up of 1.4 years, 34 of 57 veterans had returned to work. Cumulative health care visits over time were inversely correlated with diffusion anisotropy of the splenium of the corpus callosum and adjacent parietal white matter.

Cognitive status and intelligibility may be associated with everyday communicative outcomes in Parkinson’s disease, according to a study published online ahead of print March 16 in the Journal of Parkinson’s Disease. Investigators searched five online databases in May 2015 and also conducted supplementary searches. In all, 4,816 records were identified through database searches, and 16 additional records were identified through supplementary searches. Forty-one articles were suitable for full-text screening, and 15 articles met the eligibility criteria. Ten studies assessed the role of cognitive status, and nine found that participants with greater cognitive impairment had greater everyday communication difficulties. Four studies assessed the role of intelligibility, and all found that participants with greater intelligibility impairment had greater everyday communication difficulties. Effects often were weak, however, and not consistent.

Common variants near FOXF2 are associated with increased stroke susceptibility, according to a study published online ahead of print April 7 in the Lancet Neurology. Researchers completed a genome-wide analysis of common genetic variants associated with incident stroke risk in 18 population-based cohorts consisting of 84,961 participants, of whom 4,348 had stroke. Investigators completed validation analyses for variants yielding a significant association with all stroke, ischemic stroke, cardioembolic ischemic stroke, or noncardioembolic ischemic stroke. Study authors replicated seven of eight known loci associated with risk for ischemic stroke and identified a novel locus at chromosome 6p25 associated with risk of all stroke. The rs12204590 stroke risk allele was also associated with increased white matter hyperintensity in adults without stroke. Young patients with segmental deletions of FOXF2 showed extensive white matter hyperintensity.

Young women with musculoskeletal pain complaints may have comorbid sleep problems that require treatment, according to a study published in the April issue of Pain. Researchers investigated the cross-sectional and longitudinal relationship between sleep problems and chronic pain, and musculoskeletal pain, headache, and abdominal pain severity in a general population of adults between ages 19 and 22. They studied whether relationships were moderated by sex and whether symptoms of anxiety and depression, fatigue, or physical inactivity mediated these effects. Follow-up data were collected in 1,753 participants. Sleep problems were associated with chronic pain, musculoskeletal pain, headache, and abdominal pain severity. They also predicted chronic pain and an increase in musculoskeletal pain severity at three years of follow-up. The effect was stronger in females than in males.

—Kimberly Williams