New and Noteworthy Information—September

Persons who are obese and who also have metabolic abnormalities are likely to have faster cognitive decline, according to a study published in the August 21 Neurology. Researchers gathered data on BMI and metabolic status at the start of the study and then administered four cognitive tests throughout the next decade. Of the 6,401 adults (ages 39 to 63) who provided data on BMI, 31% had metabolic abnormalities, which were defined as having two or more of several risk factors, including high blood pressure. In the metabolically normal group, the 10-year decline in the global cognitive score was similar among the normal weight, overweight, and obese persons. The investigators observed the fastest cognitive decline in those who were both obese and metabolically abnormal.
Patients with atrial fibrillation and chronic kidney disease have an increased risk of stroke or systemic thromboembolism and bleeding, researchers reported in the August 16 New England Journal of Medicine. The study included 132,372 patients who were discharged from the hospital with a diagnosis of nonvalvular atrial fibrillation. Among this group, 3,587 had non–end stage chronic kidney disease and 901 required
renal-replacement therapy at time of inclusion. Compared with patients who did not have renal disease, those with non–end stage chronic kidney disease and those who required renal-replacement therapy had an increased risk of stroke or systemic thromboembolism. Patients in both renal disease groups who took warfarin but not aspirin significantly decreased this risk. However, warfarin and aspirin were associated with an increased risk of bleeding, the researchers noted.
Patients with Alzheimer’s disease who are hospitalized are more likely to experience delirium, which is associated with an increased risk of cognitive decline for up to five years, researchers reported in the online August 20 Archives of Internal Medicine. The investigators prospectively collected data from 263 patients with Alzheimer’s disease between 1991 and 2006 and found that 56% of patients with Alzheimer’s disease developed delirium during hospitalization. Before hospitalization, patients showed no difference in rates of cognitive decline, but patients who developed delirium had greater cognitive deterioration in the year after hospitalization than those who did not. In addition, this increased rate of deterioration was observed throughout the five-year period following hospitalization. “Strategies to prevent delirium may represent a promising avenue to explore for ameliorating cognitive deterioration in Alzheimer’s disease,” the researchers concluded.
Chronic cerebrospinal venous insufficiency (CCSVI) does not have an impact on the neurologic function or disability progression of patients with multiple sclerosis (MS), though it does play a role in cerebral hemodynamic changes, according to a study published in the online August 21 Radiology. Using MRI, researchers assessed cerebral blood volume and flow in 39 patients with MS (25 with CCSVI), and 26 healthy controls (14 with CCSVI). Results showed that persons with CCSVI in both the MS and control groups displayed cerebral hemodynamic anomalies, but no significant relationship was observed between MS and CCSVI for any of the hemodynamic parameters. Furthermore, no correlations were found between cerebral blood flow and volume values in normal-appearing white matter or for severity of disability in patients with MS. “The data support a role of CCSVI in cerebral hemodynamic changes … regardless of the presence of MS,” the researchers concluded.
Relatives of persons who are cognitively intact during late old age and who have high levels of C-reactive protein are more likely to avoid dementia, according to a study published in the August 15 online Neurology. Researchers identified a primary sample of 1,329 patients and siblings of 277 male veteran probands who were cognitively intact and at least 75 years old. The study also included a replication sample of 202 relatives of 51 cognitively intact, community-ascertained probands who were at least 85 years old. Results from both the primary and replication samples showed that relatives with higher levels of C-reactive protein were less likely to develop dementia (hazard ratio, 0.55). “High C-reactive protein in successful cognitive aging individuals may constitute a phenotype for familial—and thus possibly genetic—successful cognitive aging,” the study authors concluded.

More cases of West Nile virus have been documented in the United States thus far in 2012 than in any year since 1999, when the disease was first detected in the US, according to the CDC. As of August 14, 700 cases of West Nile virus had been reported, and 26 people had died from the disease. The increase in cases may be a result of last year’s mild winter and this year’s wet spring, researchers theorize. Among people bitten by an infected mosquito, 20% have symptoms that last from a few days to several weeks, and approximately one in 150 of those infected with West Nile have a severe and potentially fatal illness. Severe symptoms include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness, and paralysis. The neurologic effects from these severe symptoms may be permanent.

Speech therapy reorganizes the brains of patients with persistent developmental stuttering, according to a study published in the August 14 Neurology. Researchers examined resting-state functional connectivity (RSFC) and cortical thickness before and after therapy in 15 patients with stuttering who received the intervention, 13 patients with stuttering who did not receive the intervention, and 13 fluent controls. Before the therapeutic intervention, both groups of patients who stuttered had significant reductions in RSFC in the left pars opercularis as well as RSFC increases in the cerebellum. After the intervention, patients who stuttered showed decreases in stuttering and displayed RSFC levels in the cerebellum that matched those of fluent controls, though there was no change in the RSFC levels or cortical thickness of the left pars opercularis. This research suggests that the left pars opercularis and the cerebellum may play a role in stuttering, the study authors said.

Daily caffeine use provides only borderline improvement in excessive sleepiness in patients with Parkinson’s disease, but it does show benefits for motor function, researchers reported in the August 14 Neurology. In this six-week, randomized controlled clinical trial, 31 patients received placebo and 61 patients received 100 mg of caffeine supplements twice a day for three weeks, followed by 200 mg of caffeine supplements twice a day for three weeks. Analysis showed that caffeine led to a nonsignificant reduction in Epworth Sleepiness Scale score on the primary intention-to-treat analysis and a significant reduction in the Epworth Sleepiness Scale score on per-protocol analysis. In addition, use of caffeine reduced the total Unified Parkinson’s Disease Rating Scale score as well as the objective motor component. “These potential benefits suggest that a larger, long-term trial of caffeine is warranted,” the researchers concluded.

Black survivors of intracerebral hemorrhage are more likely than whites to have high blood pressure a year after stroke, which puts them at higher risk of another stroke, researchers reported in the August 16 online Stroke. The study included 162 patients (mean age, 59) with spontaneous intracerebral hemorrhage—77% of patients were black and 53% were male. At presentation, the mean arterial blood pressure in blacks was 9.6 mm Hg higher than in whites, even after adjusting for confounders. Furthermore, blacks were more likely than whites to have stage I/II hypertension one year following stroke, though there was no difference between blacks and whites at 30 days. Fewer than 20% of the overall patient group had normal blood pressure at 30 days or one year, leading researchers to conclude that “long-term blood pressure control is inadequate in patients after intracerebral hemorrhage, particularly in blacks.”                     

Persons who are obese and who also have metabolic abnormalities are likely to have faster cognitive decline, according to a study published in the August 21 Neurology. Researchers gathered data on BMI and metabolic status at the start of the study and then administered four cognitive tests throughout the next decade. Of the 6,401 adults (ages 39 to 63) who provided data on BMI, 31% had metabolic abnormalities, which were defined as having two or more of several risk factors, including high blood pressure. In the metabolically normal group, the 10-year decline in the global cognitive score was similar among the normal weight, overweight, and obese persons. The investigators observed the fastest cognitive decline in those who were both obese and metabolically abnormal.
Patients with atrial fibrillation and chronic kidney disease have an increased risk of stroke or systemic thromboembolism and bleeding, researchers reported in the August 16 New England Journal of Medicine. The study included 132,372 patients who were discharged from the hospital with a diagnosis of nonvalvular atrial fibrillation. Among this group, 3,587 had non–end stage chronic kidney disease and 901 required
renal-replacement therapy at time of inclusion. Compared with patients who did not have renal disease, those with non–end stage chronic kidney disease and those who required renal-replacement therapy had an increased risk of stroke or systemic thromboembolism. Patients in both renal disease groups who took warfarin but not aspirin significantly decreased this risk. However, warfarin and aspirin were associated with an increased risk of bleeding, the researchers noted.
Patients with Alzheimer’s disease who are hospitalized are more likely to experience delirium, which is associated with an increased risk of cognitive decline for up to five years, researchers reported in the online August 20 Archives of Internal Medicine. The investigators prospectively collected data from 263 patients with Alzheimer’s disease between 1991 and 2006 and found that 56% of patients with Alzheimer’s disease developed delirium during hospitalization. Before hospitalization, patients showed no difference in rates of cognitive decline, but patients who developed delirium had greater cognitive deterioration in the year after hospitalization than those who did not. In addition, this increased rate of deterioration was observed throughout the five-year period following hospitalization. “Strategies to prevent delirium may represent a promising avenue to explore for ameliorating cognitive deterioration in Alzheimer’s disease,” the researchers concluded.
Chronic cerebrospinal venous insufficiency (CCSVI) does not have an impact on the neurologic function or disability progression of patients with multiple sclerosis (MS), though it does play a role in cerebral hemodynamic changes, according to a study published in the online August 21 Radiology. Using MRI, researchers assessed cerebral blood volume and flow in 39 patients with MS (25 with CCSVI), and 26 healthy controls (14 with CCSVI). Results showed that persons with CCSVI in both the MS and control groups displayed cerebral hemodynamic anomalies, but no significant relationship was observed between MS and CCSVI for any of the hemodynamic parameters. Furthermore, no correlations were found between cerebral blood flow and volume values in normal-appearing white matter or for severity of disability in patients with MS. “The data support a role of CCSVI in cerebral hemodynamic changes … regardless of the presence of MS,” the researchers concluded.
Relatives of persons who are cognitively intact during late old age and who have high levels of C-reactive protein are more likely to avoid dementia, according to a study published in the August 15 online Neurology. Researchers identified a primary sample of 1,329 patients and siblings of 277 male veteran probands who were cognitively intact and at least 75 years old. The study also included a replication sample of 202 relatives of 51 cognitively intact, community-ascertained probands who were at least 85 years old. Results from both the primary and replication samples showed that relatives with higher levels of C-reactive protein were less likely to develop dementia (hazard ratio, 0.55). “High C-reactive protein in successful cognitive aging individuals may constitute a phenotype for familial—and thus possibly genetic—successful cognitive aging,” the study authors concluded.

More cases of West Nile virus have been documented in the United States thus far in 2012 than in any year since 1999, when the disease was first detected in the US, according to the CDC. As of August 14, 700 cases of West Nile virus had been reported, and 26 people had died from the disease. The increase in cases may be a result of last year’s mild winter and this year’s wet spring, researchers theorize. Among people bitten by an infected mosquito, 20% have symptoms that last from a few days to several weeks, and approximately one in 150 of those infected with West Nile have a severe and potentially fatal illness. Severe symptoms include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness, and paralysis. The neurologic effects from these severe symptoms may be permanent.

Speech therapy reorganizes the brains of patients with persistent developmental stuttering, according to a study published in the August 14 Neurology. Researchers examined resting-state functional connectivity (RSFC) and cortical thickness before and after therapy in 15 patients with stuttering who received the intervention, 13 patients with stuttering who did not receive the intervention, and 13 fluent controls. Before the therapeutic intervention, both groups of patients who stuttered had significant reductions in RSFC in the left pars opercularis as well as RSFC increases in the cerebellum. After the intervention, patients who stuttered showed decreases in stuttering and displayed RSFC levels in the cerebellum that matched those of fluent controls, though there was no change in the RSFC levels or cortical thickness of the left pars opercularis. This research suggests that the left pars opercularis and the cerebellum may play a role in stuttering, the study authors said.

Daily caffeine use provides only borderline improvement in excessive sleepiness in patients with Parkinson’s disease, but it does show benefits for motor function, researchers reported in the August 14 Neurology. In this six-week, randomized controlled clinical trial, 31 patients received placebo and 61 patients received 100 mg of caffeine supplements twice a day for three weeks, followed by 200 mg of caffeine supplements twice a day for three weeks. Analysis showed that caffeine led to a nonsignificant reduction in Epworth Sleepiness Scale score on the primary intention-to-treat analysis and a significant reduction in the Epworth Sleepiness Scale score on per-protocol analysis. In addition, use of caffeine reduced the total Unified Parkinson’s Disease Rating Scale score as well as the objective motor component. “These potential benefits suggest that a larger, long-term trial of caffeine is warranted,” the researchers concluded.

Black survivors of intracerebral hemorrhage are more likely than whites to have high blood pressure a year after stroke, which puts them at higher risk of another stroke, researchers reported in the August 16 online Stroke. The study included 162 patients (mean age, 59) with spontaneous intracerebral hemorrhage—77% of patients were black and 53% were male. At presentation, the mean arterial blood pressure in blacks was 9.6 mm Hg higher than in whites, even after adjusting for confounders. Furthermore, blacks were more likely than whites to have stage I/II hypertension one year following stroke, though there was no difference between blacks and whites at 30 days. Fewer than 20% of the overall patient group had normal blood pressure at 30 days or one year, leading researchers to conclude that “long-term blood pressure control is inadequate in patients after intracerebral hemorrhage, particularly in blacks.”                     

Persons who are obese and who also have metabolic abnormalities are likely to have faster cognitive decline, according to a study published in the August 21 Neurology. Researchers gathered data on BMI and metabolic status at the start of the study and then administered four cognitive tests throughout the next decade. Of the 6,401 adults (ages 39 to 63) who provided data on BMI, 31% had metabolic abnormalities, which were defined as having two or more of several risk factors, including high blood pressure. In the metabolically normal group, the 10-year decline in the global cognitive score was similar among the normal weight, overweight, and obese persons. The investigators observed the fastest cognitive decline in those who were both obese and metabolically abnormal.
Patients with atrial fibrillation and chronic kidney disease have an increased risk of stroke or systemic thromboembolism and bleeding, researchers reported in the August 16 New England Journal of Medicine. The study included 132,372 patients who were discharged from the hospital with a diagnosis of nonvalvular atrial fibrillation. Among this group, 3,587 had non–end stage chronic kidney disease and 901 required
renal-replacement therapy at time of inclusion. Compared with patients who did not have renal disease, those with non–end stage chronic kidney disease and those who required renal-replacement therapy had an increased risk of stroke or systemic thromboembolism. Patients in both renal disease groups who took warfarin but not aspirin significantly decreased this risk. However, warfarin and aspirin were associated with an increased risk of bleeding, the researchers noted.
Patients with Alzheimer’s disease who are hospitalized are more likely to experience delirium, which is associated with an increased risk of cognitive decline for up to five years, researchers reported in the online August 20 Archives of Internal Medicine. The investigators prospectively collected data from 263 patients with Alzheimer’s disease between 1991 and 2006 and found that 56% of patients with Alzheimer’s disease developed delirium during hospitalization. Before hospitalization, patients showed no difference in rates of cognitive decline, but patients who developed delirium had greater cognitive deterioration in the year after hospitalization than those who did not. In addition, this increased rate of deterioration was observed throughout the five-year period following hospitalization. “Strategies to prevent delirium may represent a promising avenue to explore for ameliorating cognitive deterioration in Alzheimer’s disease,” the researchers concluded.
Chronic cerebrospinal venous insufficiency (CCSVI) does not have an impact on the neurologic function or disability progression of patients with multiple sclerosis (MS), though it does play a role in cerebral hemodynamic changes, according to a study published in the online August 21 Radiology. Using MRI, researchers assessed cerebral blood volume and flow in 39 patients with MS (25 with CCSVI), and 26 healthy controls (14 with CCSVI). Results showed that persons with CCSVI in both the MS and control groups displayed cerebral hemodynamic anomalies, but no significant relationship was observed between MS and CCSVI for any of the hemodynamic parameters. Furthermore, no correlations were found between cerebral blood flow and volume values in normal-appearing white matter or for severity of disability in patients with MS. “The data support a role of CCSVI in cerebral hemodynamic changes … regardless of the presence of MS,” the researchers concluded.
Relatives of persons who are cognitively intact during late old age and who have high levels of C-reactive protein are more likely to avoid dementia, according to a study published in the August 15 online Neurology. Researchers identified a primary sample of 1,329 patients and siblings of 277 male veteran probands who were cognitively intact and at least 75 years old. The study also included a replication sample of 202 relatives of 51 cognitively intact, community-ascertained probands who were at least 85 years old. Results from both the primary and replication samples showed that relatives with higher levels of C-reactive protein were less likely to develop dementia (hazard ratio, 0.55). “High C-reactive protein in successful cognitive aging individuals may constitute a phenotype for familial—and thus possibly genetic—successful cognitive aging,” the study authors concluded.

More cases of West Nile virus have been documented in the United States thus far in 2012 than in any year since 1999, when the disease was first detected in the US, according to the CDC. As of August 14, 700 cases of West Nile virus had been reported, and 26 people had died from the disease. The increase in cases may be a result of last year’s mild winter and this year’s wet spring, researchers theorize. Among people bitten by an infected mosquito, 20% have symptoms that last from a few days to several weeks, and approximately one in 150 of those infected with West Nile have a severe and potentially fatal illness. Severe symptoms include high fever, headache, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, vision loss, numbness, and paralysis. The neurologic effects from these severe symptoms may be permanent.

Speech therapy reorganizes the brains of patients with persistent developmental stuttering, according to a study published in the August 14 Neurology. Researchers examined resting-state functional connectivity (RSFC) and cortical thickness before and after therapy in 15 patients with stuttering who received the intervention, 13 patients with stuttering who did not receive the intervention, and 13 fluent controls. Before the therapeutic intervention, both groups of patients who stuttered had significant reductions in RSFC in the left pars opercularis as well as RSFC increases in the cerebellum. After the intervention, patients who stuttered showed decreases in stuttering and displayed RSFC levels in the cerebellum that matched those of fluent controls, though there was no change in the RSFC levels or cortical thickness of the left pars opercularis. This research suggests that the left pars opercularis and the cerebellum may play a role in stuttering, the study authors said.

Daily caffeine use provides only borderline improvement in excessive sleepiness in patients with Parkinson’s disease, but it does show benefits for motor function, researchers reported in the August 14 Neurology. In this six-week, randomized controlled clinical trial, 31 patients received placebo and 61 patients received 100 mg of caffeine supplements twice a day for three weeks, followed by 200 mg of caffeine supplements twice a day for three weeks. Analysis showed that caffeine led to a nonsignificant reduction in Epworth Sleepiness Scale score on the primary intention-to-treat analysis and a significant reduction in the Epworth Sleepiness Scale score on per-protocol analysis. In addition, use of caffeine reduced the total Unified Parkinson’s Disease Rating Scale score as well as the objective motor component. “These potential benefits suggest that a larger, long-term trial of caffeine is warranted,” the researchers concluded.

Black survivors of intracerebral hemorrhage are more likely than whites to have high blood pressure a year after stroke, which puts them at higher risk of another stroke, researchers reported in the August 16 online Stroke. The study included 162 patients (mean age, 59) with spontaneous intracerebral hemorrhage—77% of patients were black and 53% were male. At presentation, the mean arterial blood pressure in blacks was 9.6 mm Hg higher than in whites, even after adjusting for confounders. Furthermore, blacks were more likely than whites to have stage I/II hypertension one year following stroke, though there was no difference between blacks and whites at 30 days. Fewer than 20% of the overall patient group had normal blood pressure at 30 days or one year, leading researchers to conclude that “long-term blood pressure control is inadequate in patients after intracerebral hemorrhage, particularly in blacks.”