New and Noteworthy Information—November

Hormone therapy may reduce the risk of Alzheimer’s disease for women who take the treatment at a time near menopause, but if hormone therapy is begun after menopause it may not reduce such risk, according to a study in the October 30 Neurology. Researchers followed 1,768 women who were part of a population-based study and found that 176 women developed Alzheimer’s disease between 1995 and 2006. Women who used any type of hormone therapy within five years of menopause had a 30% less risk of Alzheimer’s disease. However, those who began hormone therapy five or more years after menopause did not have a reduced disease risk. In addition, women who began opposed compounds in the three years prior to the baseline assessment had an increased risk of Alzheimer’s disease. The association of hormone therapy use and risk of Alzheimer’s disease may depend on the timing of use and deserves further study, the investigators concluded.

Engaging in physical activity may protect older adults from brain atrophy and white matter lesions, researchers reported in the October 23 Neurology. The study examined self-reported leisure and physical activity at age 70 among a sample of 691 adults. At age 73, participants were assessed for structural brain biomarkers, and the investigators found that a higher level of physical activity was significantly associated with higher fractional anisotropy, less atrophy, lower white matter load, and larger gray and normal-appearing white matter volumes. These associations remained significant after adjustments for age, social class, and health status. The researchers noted that although their results support the role of physical activity as a potential neuroprotective factor, “the direction of causation is unclear from this observational study.”

Poor physical performance is associated with greater odds of dementia in persons age 90 or older, according to a study published in the online October 22 Archives of Neurology. The 629 participants (72.5% women) were from The 90+ Study, a population-based, longitudinal, epidemiologic study of aging and dementia. Participants’ mean age was 94, and all-cause dementia was the main outcome measure. Measures of physical performance included a 4-m walk, five chair stands, standing balance, and grip strength. Researchers found that poor physical performance in all measures was significantly associated with an increased risk of dementia. “Our findings suggest that dementia is a complex neurodegenerative process that may affect physical performance and cognition,” the investigators concluded. “Additional research is necessary to determine the temporal relationship between poor physical activity and cognitive dysfunction.”

Exposure to selective serotonin reuptake inhibitors (SSRI) is associated with an increased risk of intracerebral and intracranial hemorrhage, though the absolute risk of those events is low, according to a study published in the October 30 Neurology. In this meta-analysis, investigators searched for controlled observational studies that compared SSRI users with a control group not receiving SSRIs. The researchers found that intracranial and intracerebral hemorrhage were related to SSRI exposure in unadjusted and adjusted analyses. A subset of five studies showed that SSRI exposure combined with oral anticoagulants was linked with an increased risk of bleeding, compared with use of oral anticoagulants alone. “When all studies were analyzed together, increased risk was seen across cohort studies, case-control studies, and case-crossover studies,” the study authors noted.

The herpes zoster vaccine is effective in preventing herpes zoster in older adults, according to research published in the online October 17 Cochrane Database of Systematic Reviews. The study authors conducted a meta-analysis of eight randomized controlled trials of adults who had a mean age older than 60. The trials had a total of 52,269 participants. Patients who received the vaccine had fewer confirmed cases of herpes zoster than those who received placebo. Analysis of age groups showed that vaccine benefits were greatest for patients ages 60 to 69, as well as for those 70 and older. However, persons ages 60 to 69 experienced more frequent side effects than did persons 70 and older. “In general, zoster vaccine is well tolerated; it produces few systemic adverse events and injection site adverse effects of mild to moderate intensity,” wrote the researchers.

Strokes are increasingly occurring in younger patients, researchers reported in the October 23 Neurology. Between 1993 and 1994 and between 1999 and 2005, strokes were recorded in an estimated population of 1.3 million. The investigators used a mixed-model approach to test for differences in age trends over time, and they found that the mean age at stroke decreased by a significant amount, from 71.2 years in 1993/1994 to 69.2 years in 2005. Furthermore, the proportion of all strokes in persons younger than 55 increased from 12.9% in 1993 to 18.6% in 2005. “This is of great public health significance because strokes in younger patients carry the potential for greater lifetime burden of disability and because some potential contributors identified for this trend are modifiable,” the researchers concluded.

The FDA has approved perampanel (Fycompa), an AMPA receptor agonist, as an adjunctive treatment for partial-onset seizures with or without secondarily generalized seizures in patients ages 12 and older with epilepsy. Perampanel is a novel agent that reduces neuronal hyperexcitation associated with seizures by inhibiting glutamate activity at postsynaptic AMPA receptors, and it is the first antiepileptic agent approved in the US to work in this manner. In three phase III, global, randomized, double-blind, placebo-controlled studies (1,480 patients), researchers concluded that perampanel significantly reduced seizure frequency in patients with partial-onset seizures with or without secondary generalized seizures. Patients experienced adverse events that included dizziness, somnolence, fatigue, irritability, falls, nausea, ataxia, balance disorder, gait disturbance, vertigo, and weight gain.

Persons who survive an ischemic stroke and continue smoking have a greater risk of heart attack, death, or another stroke, compared with those who have never smoked, researchers reported in the online October 25 Stroke. The study included 1,589 patients who experienced a first or recurrent ischemic stroke between 1996 and 1999. The investigators tracked the cohort for 10 years and found that patients who smoked when they had a stroke were 30% more likely to have a poor outcome and that current smokers who survived the first 28 days after a stroke had a 42% higher risk of poor outcome. In addition, former smokers had an 18% higher risk of poor outcomes. The authors also noted that smoking had the greatest effect on younger male patients, particularly those from a disadvantaged background.

For every 400 to 500 persons with an intermediate risk of cardiovascular disease who undergo screening for C-reactive protein or fibrinogen, one additional event in a period of 10 years may be prevented, researchers reported in the October 4 New England Journal of Medicine. In a meta-analysis of 52 prospective studies of persons without a history of cardiovascular disease, the investigators sought to determine whether assessing C-reactive protein or fibrinogen in addition to conventional cardiovascular risk factors leads to better prediction of cardiovascular risk.
Of 100,000 adults ages 40 and older, 15,025 would be classified as intermediate risk using conventional factors, and 13,199 would remain if statin therapy were initiated in accordance with guidelines. “Additional targeted assessment of C-reactive protein or fibrinogen levels in the 13,199 remaining participants at intermediate risk could help prevent approximately 30 additional cardiovascular events over the course of 10 years,” the researchers stated.

Extradural motor cortex stimulation for patients with Parkinson’s disease is a safe procedure that leads to moderate improvement of motor symptoms and in quality of life, according to a study published in the October Neurosurgery. Researchers assessed the safety and efficacy of one year of unilateral extradural motor cortex stimulation in nine patients with Parkinson’s disease. At baseline, participants were evaluated with the Unified Parkinson’s Disease Rating Scale and the Parkinson’s Disease Quality of Life Questionnaire. Quality of life scores increased at months three, six, and 12, and disease scores decreased from baseline during the year. Furthermore, bilateral motor effects were observed after three to four weeks. No surgical complications, adverse events, or cognitive and behavioral changes were observed, the study authors said.

The use of beta blockers is not associated with a lower risk of composite cardiovascular events in patients with either coronary artery disease (CAD) risk factors only, known prior myocardial infarction, or known CAD without myocardial infarction, according to an investigation published in the October 3 JAMA. In this longitudinal, observational study, 44,708 patients were categorized into three cohorts— 14,043 patients with known prior myocardial infarction, 12,012 patients with known CAD but without myocardial infarction, and 18,653 patients with CAD risk factors only. The primary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. For all outcomes tested, investigators found that event rates were not significantly different in patients with beta-blocker use, compared with those without beta-blocker use, even among those in the prior myocardial infarction cohort.

Hormone therapy may reduce the risk of Alzheimer’s disease for women who take the treatment at a time near menopause, but if hormone therapy is begun after menopause it may not reduce such risk, according to a study in the October 30 Neurology. Researchers followed 1,768 women who were part of a population-based study and found that 176 women developed Alzheimer’s disease between 1995 and 2006. Women who used any type of hormone therapy within five years of menopause had a 30% less risk of Alzheimer’s disease. However, those who began hormone therapy five or more years after menopause did not have a reduced disease risk. In addition, women who began opposed compounds in the three years prior to the baseline assessment had an increased risk of Alzheimer’s disease. The association of hormone therapy use and risk of Alzheimer’s disease may depend on the timing of use and deserves further study, the investigators concluded.

Engaging in physical activity may protect older adults from brain atrophy and white matter lesions, researchers reported in the October 23 Neurology. The study examined self-reported leisure and physical activity at age 70 among a sample of 691 adults. At age 73, participants were assessed for structural brain biomarkers, and the investigators found that a higher level of physical activity was significantly associated with higher fractional anisotropy, less atrophy, lower white matter load, and larger gray and normal-appearing white matter volumes. These associations remained significant after adjustments for age, social class, and health status. The researchers noted that although their results support the role of physical activity as a potential neuroprotective factor, “the direction of causation is unclear from this observational study.”

Poor physical performance is associated with greater odds of dementia in persons age 90 or older, according to a study published in the online October 22 Archives of Neurology. The 629 participants (72.5% women) were from The 90+ Study, a population-based, longitudinal, epidemiologic study of aging and dementia. Participants’ mean age was 94, and all-cause dementia was the main outcome measure. Measures of physical performance included a 4-m walk, five chair stands, standing balance, and grip strength. Researchers found that poor physical performance in all measures was significantly associated with an increased risk of dementia. “Our findings suggest that dementia is a complex neurodegenerative process that may affect physical performance and cognition,” the investigators concluded. “Additional research is necessary to determine the temporal relationship between poor physical activity and cognitive dysfunction.”

Exposure to selective serotonin reuptake inhibitors (SSRI) is associated with an increased risk of intracerebral and intracranial hemorrhage, though the absolute risk of those events is low, according to a study published in the October 30 Neurology. In this meta-analysis, investigators searched for controlled observational studies that compared SSRI users with a control group not receiving SSRIs. The researchers found that intracranial and intracerebral hemorrhage were related to SSRI exposure in unadjusted and adjusted analyses. A subset of five studies showed that SSRI exposure combined with oral anticoagulants was linked with an increased risk of bleeding, compared with use of oral anticoagulants alone. “When all studies were analyzed together, increased risk was seen across cohort studies, case-control studies, and case-crossover studies,” the study authors noted.

The herpes zoster vaccine is effective in preventing herpes zoster in older adults, according to research published in the online October 17 Cochrane Database of Systematic Reviews. The study authors conducted a meta-analysis of eight randomized controlled trials of adults who had a mean age older than 60. The trials had a total of 52,269 participants. Patients who received the vaccine had fewer confirmed cases of herpes zoster than those who received placebo. Analysis of age groups showed that vaccine benefits were greatest for patients ages 60 to 69, as well as for those 70 and older. However, persons ages 60 to 69 experienced more frequent side effects than did persons 70 and older. “In general, zoster vaccine is well tolerated; it produces few systemic adverse events and injection site adverse effects of mild to moderate intensity,” wrote the researchers.

Strokes are increasingly occurring in younger patients, researchers reported in the October 23 Neurology. Between 1993 and 1994 and between 1999 and 2005, strokes were recorded in an estimated population of 1.3 million. The investigators used a mixed-model approach to test for differences in age trends over time, and they found that the mean age at stroke decreased by a significant amount, from 71.2 years in 1993/1994 to 69.2 years in 2005. Furthermore, the proportion of all strokes in persons younger than 55 increased from 12.9% in 1993 to 18.6% in 2005. “This is of great public health significance because strokes in younger patients carry the potential for greater lifetime burden of disability and because some potential contributors identified for this trend are modifiable,” the researchers concluded.

The FDA has approved perampanel (Fycompa), an AMPA receptor agonist, as an adjunctive treatment for partial-onset seizures with or without secondarily generalized seizures in patients ages 12 and older with epilepsy. Perampanel is a novel agent that reduces neuronal hyperexcitation associated with seizures by inhibiting glutamate activity at postsynaptic AMPA receptors, and it is the first antiepileptic agent approved in the US to work in this manner. In three phase III, global, randomized, double-blind, placebo-controlled studies (1,480 patients), researchers concluded that perampanel significantly reduced seizure frequency in patients with partial-onset seizures with or without secondary generalized seizures. Patients experienced adverse events that included dizziness, somnolence, fatigue, irritability, falls, nausea, ataxia, balance disorder, gait disturbance, vertigo, and weight gain.

Persons who survive an ischemic stroke and continue smoking have a greater risk of heart attack, death, or another stroke, compared with those who have never smoked, researchers reported in the online October 25 Stroke. The study included 1,589 patients who experienced a first or recurrent ischemic stroke between 1996 and 1999. The investigators tracked the cohort for 10 years and found that patients who smoked when they had a stroke were 30% more likely to have a poor outcome and that current smokers who survived the first 28 days after a stroke had a 42% higher risk of poor outcome. In addition, former smokers had an 18% higher risk of poor outcomes. The authors also noted that smoking had the greatest effect on younger male patients, particularly those from a disadvantaged background.

For every 400 to 500 persons with an intermediate risk of cardiovascular disease who undergo screening for C-reactive protein or fibrinogen, one additional event in a period of 10 years may be prevented, researchers reported in the October 4 New England Journal of Medicine. In a meta-analysis of 52 prospective studies of persons without a history of cardiovascular disease, the investigators sought to determine whether assessing C-reactive protein or fibrinogen in addition to conventional cardiovascular risk factors leads to better prediction of cardiovascular risk.
Of 100,000 adults ages 40 and older, 15,025 would be classified as intermediate risk using conventional factors, and 13,199 would remain if statin therapy were initiated in accordance with guidelines. “Additional targeted assessment of C-reactive protein or fibrinogen levels in the 13,199 remaining participants at intermediate risk could help prevent approximately 30 additional cardiovascular events over the course of 10 years,” the researchers stated.

Extradural motor cortex stimulation for patients with Parkinson’s disease is a safe procedure that leads to moderate improvement of motor symptoms and in quality of life, according to a study published in the October Neurosurgery. Researchers assessed the safety and efficacy of one year of unilateral extradural motor cortex stimulation in nine patients with Parkinson’s disease. At baseline, participants were evaluated with the Unified Parkinson’s Disease Rating Scale and the Parkinson’s Disease Quality of Life Questionnaire. Quality of life scores increased at months three, six, and 12, and disease scores decreased from baseline during the year. Furthermore, bilateral motor effects were observed after three to four weeks. No surgical complications, adverse events, or cognitive and behavioral changes were observed, the study authors said.

The use of beta blockers is not associated with a lower risk of composite cardiovascular events in patients with either coronary artery disease (CAD) risk factors only, known prior myocardial infarction, or known CAD without myocardial infarction, according to an investigation published in the October 3 JAMA. In this longitudinal, observational study, 44,708 patients were categorized into three cohorts— 14,043 patients with known prior myocardial infarction, 12,012 patients with known CAD but without myocardial infarction, and 18,653 patients with CAD risk factors only. The primary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. For all outcomes tested, investigators found that event rates were not significantly different in patients with beta-blocker use, compared with those without beta-blocker use, even among those in the prior myocardial infarction cohort.

Hormone therapy may reduce the risk of Alzheimer’s disease for women who take the treatment at a time near menopause, but if hormone therapy is begun after menopause it may not reduce such risk, according to a study in the October 30 Neurology. Researchers followed 1,768 women who were part of a population-based study and found that 176 women developed Alzheimer’s disease between 1995 and 2006. Women who used any type of hormone therapy within five years of menopause had a 30% less risk of Alzheimer’s disease. However, those who began hormone therapy five or more years after menopause did not have a reduced disease risk. In addition, women who began opposed compounds in the three years prior to the baseline assessment had an increased risk of Alzheimer’s disease. The association of hormone therapy use and risk of Alzheimer’s disease may depend on the timing of use and deserves further study, the investigators concluded.

Engaging in physical activity may protect older adults from brain atrophy and white matter lesions, researchers reported in the October 23 Neurology. The study examined self-reported leisure and physical activity at age 70 among a sample of 691 adults. At age 73, participants were assessed for structural brain biomarkers, and the investigators found that a higher level of physical activity was significantly associated with higher fractional anisotropy, less atrophy, lower white matter load, and larger gray and normal-appearing white matter volumes. These associations remained significant after adjustments for age, social class, and health status. The researchers noted that although their results support the role of physical activity as a potential neuroprotective factor, “the direction of causation is unclear from this observational study.”

Poor physical performance is associated with greater odds of dementia in persons age 90 or older, according to a study published in the online October 22 Archives of Neurology. The 629 participants (72.5% women) were from The 90+ Study, a population-based, longitudinal, epidemiologic study of aging and dementia. Participants’ mean age was 94, and all-cause dementia was the main outcome measure. Measures of physical performance included a 4-m walk, five chair stands, standing balance, and grip strength. Researchers found that poor physical performance in all measures was significantly associated with an increased risk of dementia. “Our findings suggest that dementia is a complex neurodegenerative process that may affect physical performance and cognition,” the investigators concluded. “Additional research is necessary to determine the temporal relationship between poor physical activity and cognitive dysfunction.”

Exposure to selective serotonin reuptake inhibitors (SSRI) is associated with an increased risk of intracerebral and intracranial hemorrhage, though the absolute risk of those events is low, according to a study published in the October 30 Neurology. In this meta-analysis, investigators searched for controlled observational studies that compared SSRI users with a control group not receiving SSRIs. The researchers found that intracranial and intracerebral hemorrhage were related to SSRI exposure in unadjusted and adjusted analyses. A subset of five studies showed that SSRI exposure combined with oral anticoagulants was linked with an increased risk of bleeding, compared with use of oral anticoagulants alone. “When all studies were analyzed together, increased risk was seen across cohort studies, case-control studies, and case-crossover studies,” the study authors noted.

The herpes zoster vaccine is effective in preventing herpes zoster in older adults, according to research published in the online October 17 Cochrane Database of Systematic Reviews. The study authors conducted a meta-analysis of eight randomized controlled trials of adults who had a mean age older than 60. The trials had a total of 52,269 participants. Patients who received the vaccine had fewer confirmed cases of herpes zoster than those who received placebo. Analysis of age groups showed that vaccine benefits were greatest for patients ages 60 to 69, as well as for those 70 and older. However, persons ages 60 to 69 experienced more frequent side effects than did persons 70 and older. “In general, zoster vaccine is well tolerated; it produces few systemic adverse events and injection site adverse effects of mild to moderate intensity,” wrote the researchers.

Strokes are increasingly occurring in younger patients, researchers reported in the October 23 Neurology. Between 1993 and 1994 and between 1999 and 2005, strokes were recorded in an estimated population of 1.3 million. The investigators used a mixed-model approach to test for differences in age trends over time, and they found that the mean age at stroke decreased by a significant amount, from 71.2 years in 1993/1994 to 69.2 years in 2005. Furthermore, the proportion of all strokes in persons younger than 55 increased from 12.9% in 1993 to 18.6% in 2005. “This is of great public health significance because strokes in younger patients carry the potential for greater lifetime burden of disability and because some potential contributors identified for this trend are modifiable,” the researchers concluded.

The FDA has approved perampanel (Fycompa), an AMPA receptor agonist, as an adjunctive treatment for partial-onset seizures with or without secondarily generalized seizures in patients ages 12 and older with epilepsy. Perampanel is a novel agent that reduces neuronal hyperexcitation associated with seizures by inhibiting glutamate activity at postsynaptic AMPA receptors, and it is the first antiepileptic agent approved in the US to work in this manner. In three phase III, global, randomized, double-blind, placebo-controlled studies (1,480 patients), researchers concluded that perampanel significantly reduced seizure frequency in patients with partial-onset seizures with or without secondary generalized seizures. Patients experienced adverse events that included dizziness, somnolence, fatigue, irritability, falls, nausea, ataxia, balance disorder, gait disturbance, vertigo, and weight gain.

Persons who survive an ischemic stroke and continue smoking have a greater risk of heart attack, death, or another stroke, compared with those who have never smoked, researchers reported in the online October 25 Stroke. The study included 1,589 patients who experienced a first or recurrent ischemic stroke between 1996 and 1999. The investigators tracked the cohort for 10 years and found that patients who smoked when they had a stroke were 30% more likely to have a poor outcome and that current smokers who survived the first 28 days after a stroke had a 42% higher risk of poor outcome. In addition, former smokers had an 18% higher risk of poor outcomes. The authors also noted that smoking had the greatest effect on younger male patients, particularly those from a disadvantaged background.

For every 400 to 500 persons with an intermediate risk of cardiovascular disease who undergo screening for C-reactive protein or fibrinogen, one additional event in a period of 10 years may be prevented, researchers reported in the October 4 New England Journal of Medicine. In a meta-analysis of 52 prospective studies of persons without a history of cardiovascular disease, the investigators sought to determine whether assessing C-reactive protein or fibrinogen in addition to conventional cardiovascular risk factors leads to better prediction of cardiovascular risk.
Of 100,000 adults ages 40 and older, 15,025 would be classified as intermediate risk using conventional factors, and 13,199 would remain if statin therapy were initiated in accordance with guidelines. “Additional targeted assessment of C-reactive protein or fibrinogen levels in the 13,199 remaining participants at intermediate risk could help prevent approximately 30 additional cardiovascular events over the course of 10 years,” the researchers stated.

Extradural motor cortex stimulation for patients with Parkinson’s disease is a safe procedure that leads to moderate improvement of motor symptoms and in quality of life, according to a study published in the October Neurosurgery. Researchers assessed the safety and efficacy of one year of unilateral extradural motor cortex stimulation in nine patients with Parkinson’s disease. At baseline, participants were evaluated with the Unified Parkinson’s Disease Rating Scale and the Parkinson’s Disease Quality of Life Questionnaire. Quality of life scores increased at months three, six, and 12, and disease scores decreased from baseline during the year. Furthermore, bilateral motor effects were observed after three to four weeks. No surgical complications, adverse events, or cognitive and behavioral changes were observed, the study authors said.

The use of beta blockers is not associated with a lower risk of composite cardiovascular events in patients with either coronary artery disease (CAD) risk factors only, known prior myocardial infarction, or known CAD without myocardial infarction, according to an investigation published in the October 3 JAMA. In this longitudinal, observational study, 44,708 patients were categorized into three cohorts— 14,043 patients with known prior myocardial infarction, 12,012 patients with known CAD but without myocardial infarction, and 18,653 patients with CAD risk factors only. The primary outcome was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. For all outcomes tested, investigators found that event rates were not significantly different in patients with beta-blocker use, compared with those without beta-blocker use, even among those in the prior myocardial infarction cohort.