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New Genetic Risk Factors for Stroke Determined
New genetic risk factors for stroke have been identified, thereby tripling the number of gene regions known to affect stroke risk, according to a study published online ahead of print March 12 in Nature Genetics. Researchers conducted a multiancestry genome-wide-association meta-analysis in 521,612 individuals (67,162 with stroke) and discovered 22 new stroke risk loci, bringing the total to 32. In addition, the investigators found shared genetic variation with related vascular traits (eg, blood pressure, cardiac traits, and venous thromboembolism) at individual loci and using genetic risk scores and linkage-disequilibrium-score regression. Several loci had distinct association and pleiotropy patterns for etiological stroke subtypes. Eleven new susceptibility loci indicate mechanisms not previously implicated in stroke pathophysiology. The researchers prioritized risk variants and genes through bioinformatics analyses using functional datasets.
Malik R, Chauhan G, Traylor M, et al. Multiancestry genome-wide association study of 520,000 subjects identifies 32 loci associated with stroke and stroke subtypes. Nat Genet. 2018 Mar 12 [Epub ahead of print].
MS Medication Withdrawn Because of Safety Concerns
Citing concerns about safety, Biogen and AbbVie announced March 2 that they will be withdrawing daclizumab (Zinbryta) from worldwide markets. Daclizumab has known risks, so it was usually prescribed only for people with relapsing multiple sclerosis who had tried two or more other medications that had not worked well enough. Reports of inflammatory encephalitis and meningoencephalitis led the European Medicines Agency to initiate an Article 20 referral procedure. In such referrals, a medicine or class of medicines are scientifically assessed because of concerns over safety or quality. However, Biogen and AbbVie concluded that, because of the complex nature of these reports and how few patients were taking daclizumab, it would be difficult to characterize the nature of the medication’s harms and benefits, so the companies instead have decided to withdraw the medication from the market.
Many Elderly Patients With Epilepsy Receive Interacting Treatments
Many elderly patients with epilepsy receive combinations of nonepilepsy drugs (NEDs) and antiepileptic drugs (AEDs) that could interact, according to a study published February 7 in Epilepsia. Researchers retrospectively analyzed 2008–2010 Medicare claims for a random sample of beneficiaries age 67 and older. Prevalent cases had a diagnosis of epilepsy and took one or more AEDs. Incident cases had no seizure or epilepsy claim codes or AEDs in the preceding 365 days. Interacting pairs of AEDs and NEDs were identified by literature review. Logistic regression models were used to examine factors affecting the likelihood of interaction risk. Interacting drug pairs affected NED efficacy in 24.5% of incident cases and 39% of prevalent cases. Combinations affected AED efficacy in 20.4% of incident cases and 29.3% of prevalent cases.
Faught E, Szaflarski JP, Richman J, et al. Risk of pharmacokinetic interactions between antiepileptic and other drugs in older persons and factors associated with risk. Epilepsia. 2018;59(3):715-723.
Are Physically Fit Women at Reduced Risk for Dementia?
High cardiovascular fitness in midlife is associated with decreased risk of subsequent dementia, according to a study published online ahead of print March 14 in Neurology. Physicians examined a population-based sample of 1,462 women ages 38 to 60 in 1968. A subsample of 191 women with an average age of 50 took a maximal ergometer cycling test to measure their peak cardiovascular capacity. Over the following 44 years, participants were tested for dementia six times. By 2012, 44 of the women developed dementia. Approximately 5% of the highly fit women developed dementia, compared with 25% of moderately fit women, and 32% of the women with low fitness. The highly fit women were 88% less likely to develop dementia than the moderately fit women.
Hörder H, Johansson L, Guo X, et al. Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women. Neurology. 2018 Mar 14 [Epub ahead of print].
Data on Geriatric TBI May Be Inadequate
Many older adults with traumatic brain injury (TBI) respond well to aggressive management and rehabilitation, which suggests that age and TBI severity alone are inadequate prognostic markers, according to a study published online ahead of print February 15 in the Journal of Neurotrauma. Researchers reviewed the literature on incident TBI sustained in older adulthood. They found few geriatric-specific TBI guidelines to assist with complex management decisions and concluded that TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include underrepresentation of older adults in TBI research, lack of systematic measurement of preinjury health that may predict outcome and response to treatment, and lack of geriatric-specific TBI common data elements. Investigators need to develop more age-inclusive TBI research protocols, said the authors.
Gardner RC, Dams-O’Connor K, Morrissey MR, Manley GT. Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions. J Neurotrauma. 2018 Feb 15 [Epub ahead of print].
TDCS Improves Gait in Parkinson’s Disease
Transcranial direct-current stimulation (TDCS) reduces freezing of gait and improves executive function and mobility, according to a study published online ahead of print February 13 in Movement Disorders. Researchers examined 20 patients with Parkinson’s disease and freezing of gait. The patients received 20 minutes of TDCS or sham treatment during three separate visits. TDCS targeted the primary motor cortex and left dorsolateral prefrontal cortex simultaneously or primary motor cortex only. Participants completed the Timed Up and Go and Stroop tests before and after each stimulation session. Performance on the Timed Up and Go and Stroop tests improved after simultaneous stimulation of the primary motor cortex and left dorsolateral prefrontal cortex, but not after stimulation of the primary motor cortex alone or sham stimulation.
Dagan M, Herman T, Harrison R, et al. Multitarget transcranial direct current stimulation for freezing of gait in Parkinson’s disease. Mov Disord. 2018 Feb 13 [Epub ahead of print].
Patients With Major Stroke Need Realistic Planning
Doctors who care for patients with severe stroke should plan with patients and caregivers and discuss the possibility of death or survival with disability, according to a study published March 5 in the Canadian Medical Association Journal. Researchers recruited a purposive sample of people with total anterior circulation stroke at three stroke services and conducted serial, qualitative interviews with participants and their caregivers at six weeks, six months, and one year. Investigators also conducted a data-linkage study of all patients with anterior circulation stroke admitted to the three services over six months. About 57% of patients died within six months. Patients experienced immediate and persistent emotional distress and poor quality of life. Physicians should practice palliative care for these patients, but avoid using that term, said the authors.
Kendall M, Cowey E, Mead G, et al. Outcomes, experiences and palliative care in major stroke: a multicentre, mixed-method, longitudinal study. CMAJ. 2018;190(9):E238-E246.
Dengue Fever Is Associated With Increased Risk of Stroke
Dengue fever is associated with an increased risk of stroke in the first few months after diagnosis, according to a study published March 12 in Canadian Medical Association Journal. Using data from the Taiwan National Health Insurance Research Database, researchers examined 13,787 patients diagnosed with dengue fever between 2000 and 2012. The control cohort consisted of patients matched by demographic characteristics and stroke-related comorbidities who did not have dengue fever. The overall incidence rate of stroke was 5.33 per 1,000 person-years in the dengue fever cohort and 3.72 per 1,000 person-years in the control cohort. The adjusted hazard ratio of stroke was 1.16 in patients with dengue fever. The risk of stroke was 2.49 times higher in patients with dengue fever during the first two months after diagnosis, compared with controls.
Li HM, Huang YK, Su YC, Kao CH. Risk of stroke in patients with dengue fever: a population-based cohort study. CMAJ. 2018;190(10):E285-E290.
Do Survivors of Stroke Need Additional Help Taking Medication?
More than half of patients with stroke need help taking medication, according to a study published March 11 in BMJ Open. Approximately 600 community-dwelling patients with stroke responded to a five-item questionnaire about practical support that they need and receive. Approximately 56% of respondents got help with taking medication, and 11% needed additional help, including help with prescriptions and collection of medicines, getting medicines out of the packaging, and being reminded to take medicines. Being dependent on others was associated with experiencing more unmet needs with daily medicine taking. About 35% of respondents said that they had missed taking medicine in the previous 30 days. Younger patients with stroke were more likely to miss their medicines, possibly because they were less likely to receive help from a caregiver.
Jamison J, Ayerbe L, Di Tanna GL, et al. Evaluating practical support stroke survivors get with medicines and unmet needs in primary care: a survey. BMJ Open. 2018;8(3):e019874.
Sun Exposure Associated With Reduced Risk of MS
Living in areas with high ambient levels of ultraviolet-B light during childhood and the years before multiple sclerosis (MS) onset is associated with a lower MS risk, according to a study published online ahead of print March 7 in Neurology. Researchers identified 151 women with MS and 235 age-matched controls. The average age at MS onset was 40. All participants completed questionnaires about summer, winter, and lifetime sun exposure. Researchers separated the women into three groups representing low, moderate, and high ultraviolet-B ray exposure, based on their residence. Women who lived in sunnier climates with the highest exposure to ultraviolet-B rays had a 45% reduced risk of developing MS across all pre-MS onset age groups, when compared with participants living in areas with the lowest ultraviolet-B ray exposure.
Tremlett H, Zhu F, Ascherio A, Munger KL. Sun exposure over the life course and associations with multiple sclerosis. Neurology. 2018 Mar 7 [Epub ahead of print].
The new blood pressure guidelines could harm certain patients, according to a study published online ahead of print March 2 in the Journal of the American College of Cardiology. Investigators examined the effect of 10-year cardiovascular disease (CVD) risk on primary outcome events and serious adverse events in the Systolic Pressure Intervention Trial, which was a basis for the new guidelines. They stratified patients by quartiles of risk and used Cox proportional hazards models to examine associations. From the first to fourth quartiles, the number needed to treat to prevent primary outcomes decreased from 91 to 38. The number needed to harm for all-cause serious adverse events increased from 62 to 250. Classifying patients by future risk could identify patients who would benefit from intensive treatment, said the authors.
Phillips RA, Xu J, Peterson LE, et al. Impact of cardiovascular risk on the relative benefit and harm of intensive treatment of hypertension. J Am Coll Cardiol. 2018 Mar 2 [Epub ahead of print].
—Kimberly Williams
New Genetic Risk Factors for Stroke Determined
New genetic risk factors for stroke have been identified, thereby tripling the number of gene regions known to affect stroke risk, according to a study published online ahead of print March 12 in Nature Genetics. Researchers conducted a multiancestry genome-wide-association meta-analysis in 521,612 individuals (67,162 with stroke) and discovered 22 new stroke risk loci, bringing the total to 32. In addition, the investigators found shared genetic variation with related vascular traits (eg, blood pressure, cardiac traits, and venous thromboembolism) at individual loci and using genetic risk scores and linkage-disequilibrium-score regression. Several loci had distinct association and pleiotropy patterns for etiological stroke subtypes. Eleven new susceptibility loci indicate mechanisms not previously implicated in stroke pathophysiology. The researchers prioritized risk variants and genes through bioinformatics analyses using functional datasets.
Malik R, Chauhan G, Traylor M, et al. Multiancestry genome-wide association study of 520,000 subjects identifies 32 loci associated with stroke and stroke subtypes. Nat Genet. 2018 Mar 12 [Epub ahead of print].
MS Medication Withdrawn Because of Safety Concerns
Citing concerns about safety, Biogen and AbbVie announced March 2 that they will be withdrawing daclizumab (Zinbryta) from worldwide markets. Daclizumab has known risks, so it was usually prescribed only for people with relapsing multiple sclerosis who had tried two or more other medications that had not worked well enough. Reports of inflammatory encephalitis and meningoencephalitis led the European Medicines Agency to initiate an Article 20 referral procedure. In such referrals, a medicine or class of medicines are scientifically assessed because of concerns over safety or quality. However, Biogen and AbbVie concluded that, because of the complex nature of these reports and how few patients were taking daclizumab, it would be difficult to characterize the nature of the medication’s harms and benefits, so the companies instead have decided to withdraw the medication from the market.
Many Elderly Patients With Epilepsy Receive Interacting Treatments
Many elderly patients with epilepsy receive combinations of nonepilepsy drugs (NEDs) and antiepileptic drugs (AEDs) that could interact, according to a study published February 7 in Epilepsia. Researchers retrospectively analyzed 2008–2010 Medicare claims for a random sample of beneficiaries age 67 and older. Prevalent cases had a diagnosis of epilepsy and took one or more AEDs. Incident cases had no seizure or epilepsy claim codes or AEDs in the preceding 365 days. Interacting pairs of AEDs and NEDs were identified by literature review. Logistic regression models were used to examine factors affecting the likelihood of interaction risk. Interacting drug pairs affected NED efficacy in 24.5% of incident cases and 39% of prevalent cases. Combinations affected AED efficacy in 20.4% of incident cases and 29.3% of prevalent cases.
Faught E, Szaflarski JP, Richman J, et al. Risk of pharmacokinetic interactions between antiepileptic and other drugs in older persons and factors associated with risk. Epilepsia. 2018;59(3):715-723.
Are Physically Fit Women at Reduced Risk for Dementia?
High cardiovascular fitness in midlife is associated with decreased risk of subsequent dementia, according to a study published online ahead of print March 14 in Neurology. Physicians examined a population-based sample of 1,462 women ages 38 to 60 in 1968. A subsample of 191 women with an average age of 50 took a maximal ergometer cycling test to measure their peak cardiovascular capacity. Over the following 44 years, participants were tested for dementia six times. By 2012, 44 of the women developed dementia. Approximately 5% of the highly fit women developed dementia, compared with 25% of moderately fit women, and 32% of the women with low fitness. The highly fit women were 88% less likely to develop dementia than the moderately fit women.
Hörder H, Johansson L, Guo X, et al. Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women. Neurology. 2018 Mar 14 [Epub ahead of print].
Data on Geriatric TBI May Be Inadequate
Many older adults with traumatic brain injury (TBI) respond well to aggressive management and rehabilitation, which suggests that age and TBI severity alone are inadequate prognostic markers, according to a study published online ahead of print February 15 in the Journal of Neurotrauma. Researchers reviewed the literature on incident TBI sustained in older adulthood. They found few geriatric-specific TBI guidelines to assist with complex management decisions and concluded that TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include underrepresentation of older adults in TBI research, lack of systematic measurement of preinjury health that may predict outcome and response to treatment, and lack of geriatric-specific TBI common data elements. Investigators need to develop more age-inclusive TBI research protocols, said the authors.
Gardner RC, Dams-O’Connor K, Morrissey MR, Manley GT. Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions. J Neurotrauma. 2018 Feb 15 [Epub ahead of print].
TDCS Improves Gait in Parkinson’s Disease
Transcranial direct-current stimulation (TDCS) reduces freezing of gait and improves executive function and mobility, according to a study published online ahead of print February 13 in Movement Disorders. Researchers examined 20 patients with Parkinson’s disease and freezing of gait. The patients received 20 minutes of TDCS or sham treatment during three separate visits. TDCS targeted the primary motor cortex and left dorsolateral prefrontal cortex simultaneously or primary motor cortex only. Participants completed the Timed Up and Go and Stroop tests before and after each stimulation session. Performance on the Timed Up and Go and Stroop tests improved after simultaneous stimulation of the primary motor cortex and left dorsolateral prefrontal cortex, but not after stimulation of the primary motor cortex alone or sham stimulation.
Dagan M, Herman T, Harrison R, et al. Multitarget transcranial direct current stimulation for freezing of gait in Parkinson’s disease. Mov Disord. 2018 Feb 13 [Epub ahead of print].
Patients With Major Stroke Need Realistic Planning
Doctors who care for patients with severe stroke should plan with patients and caregivers and discuss the possibility of death or survival with disability, according to a study published March 5 in the Canadian Medical Association Journal. Researchers recruited a purposive sample of people with total anterior circulation stroke at three stroke services and conducted serial, qualitative interviews with participants and their caregivers at six weeks, six months, and one year. Investigators also conducted a data-linkage study of all patients with anterior circulation stroke admitted to the three services over six months. About 57% of patients died within six months. Patients experienced immediate and persistent emotional distress and poor quality of life. Physicians should practice palliative care for these patients, but avoid using that term, said the authors.
Kendall M, Cowey E, Mead G, et al. Outcomes, experiences and palliative care in major stroke: a multicentre, mixed-method, longitudinal study. CMAJ. 2018;190(9):E238-E246.
Dengue Fever Is Associated With Increased Risk of Stroke
Dengue fever is associated with an increased risk of stroke in the first few months after diagnosis, according to a study published March 12 in Canadian Medical Association Journal. Using data from the Taiwan National Health Insurance Research Database, researchers examined 13,787 patients diagnosed with dengue fever between 2000 and 2012. The control cohort consisted of patients matched by demographic characteristics and stroke-related comorbidities who did not have dengue fever. The overall incidence rate of stroke was 5.33 per 1,000 person-years in the dengue fever cohort and 3.72 per 1,000 person-years in the control cohort. The adjusted hazard ratio of stroke was 1.16 in patients with dengue fever. The risk of stroke was 2.49 times higher in patients with dengue fever during the first two months after diagnosis, compared with controls.
Li HM, Huang YK, Su YC, Kao CH. Risk of stroke in patients with dengue fever: a population-based cohort study. CMAJ. 2018;190(10):E285-E290.
Do Survivors of Stroke Need Additional Help Taking Medication?
More than half of patients with stroke need help taking medication, according to a study published March 11 in BMJ Open. Approximately 600 community-dwelling patients with stroke responded to a five-item questionnaire about practical support that they need and receive. Approximately 56% of respondents got help with taking medication, and 11% needed additional help, including help with prescriptions and collection of medicines, getting medicines out of the packaging, and being reminded to take medicines. Being dependent on others was associated with experiencing more unmet needs with daily medicine taking. About 35% of respondents said that they had missed taking medicine in the previous 30 days. Younger patients with stroke were more likely to miss their medicines, possibly because they were less likely to receive help from a caregiver.
Jamison J, Ayerbe L, Di Tanna GL, et al. Evaluating practical support stroke survivors get with medicines and unmet needs in primary care: a survey. BMJ Open. 2018;8(3):e019874.
Sun Exposure Associated With Reduced Risk of MS
Living in areas with high ambient levels of ultraviolet-B light during childhood and the years before multiple sclerosis (MS) onset is associated with a lower MS risk, according to a study published online ahead of print March 7 in Neurology. Researchers identified 151 women with MS and 235 age-matched controls. The average age at MS onset was 40. All participants completed questionnaires about summer, winter, and lifetime sun exposure. Researchers separated the women into three groups representing low, moderate, and high ultraviolet-B ray exposure, based on their residence. Women who lived in sunnier climates with the highest exposure to ultraviolet-B rays had a 45% reduced risk of developing MS across all pre-MS onset age groups, when compared with participants living in areas with the lowest ultraviolet-B ray exposure.
Tremlett H, Zhu F, Ascherio A, Munger KL. Sun exposure over the life course and associations with multiple sclerosis. Neurology. 2018 Mar 7 [Epub ahead of print].
The new blood pressure guidelines could harm certain patients, according to a study published online ahead of print March 2 in the Journal of the American College of Cardiology. Investigators examined the effect of 10-year cardiovascular disease (CVD) risk on primary outcome events and serious adverse events in the Systolic Pressure Intervention Trial, which was a basis for the new guidelines. They stratified patients by quartiles of risk and used Cox proportional hazards models to examine associations. From the first to fourth quartiles, the number needed to treat to prevent primary outcomes decreased from 91 to 38. The number needed to harm for all-cause serious adverse events increased from 62 to 250. Classifying patients by future risk could identify patients who would benefit from intensive treatment, said the authors.
Phillips RA, Xu J, Peterson LE, et al. Impact of cardiovascular risk on the relative benefit and harm of intensive treatment of hypertension. J Am Coll Cardiol. 2018 Mar 2 [Epub ahead of print].
—Kimberly Williams
New Genetic Risk Factors for Stroke Determined
New genetic risk factors for stroke have been identified, thereby tripling the number of gene regions known to affect stroke risk, according to a study published online ahead of print March 12 in Nature Genetics. Researchers conducted a multiancestry genome-wide-association meta-analysis in 521,612 individuals (67,162 with stroke) and discovered 22 new stroke risk loci, bringing the total to 32. In addition, the investigators found shared genetic variation with related vascular traits (eg, blood pressure, cardiac traits, and venous thromboembolism) at individual loci and using genetic risk scores and linkage-disequilibrium-score regression. Several loci had distinct association and pleiotropy patterns for etiological stroke subtypes. Eleven new susceptibility loci indicate mechanisms not previously implicated in stroke pathophysiology. The researchers prioritized risk variants and genes through bioinformatics analyses using functional datasets.
Malik R, Chauhan G, Traylor M, et al. Multiancestry genome-wide association study of 520,000 subjects identifies 32 loci associated with stroke and stroke subtypes. Nat Genet. 2018 Mar 12 [Epub ahead of print].
MS Medication Withdrawn Because of Safety Concerns
Citing concerns about safety, Biogen and AbbVie announced March 2 that they will be withdrawing daclizumab (Zinbryta) from worldwide markets. Daclizumab has known risks, so it was usually prescribed only for people with relapsing multiple sclerosis who had tried two or more other medications that had not worked well enough. Reports of inflammatory encephalitis and meningoencephalitis led the European Medicines Agency to initiate an Article 20 referral procedure. In such referrals, a medicine or class of medicines are scientifically assessed because of concerns over safety or quality. However, Biogen and AbbVie concluded that, because of the complex nature of these reports and how few patients were taking daclizumab, it would be difficult to characterize the nature of the medication’s harms and benefits, so the companies instead have decided to withdraw the medication from the market.
Many Elderly Patients With Epilepsy Receive Interacting Treatments
Many elderly patients with epilepsy receive combinations of nonepilepsy drugs (NEDs) and antiepileptic drugs (AEDs) that could interact, according to a study published February 7 in Epilepsia. Researchers retrospectively analyzed 2008–2010 Medicare claims for a random sample of beneficiaries age 67 and older. Prevalent cases had a diagnosis of epilepsy and took one or more AEDs. Incident cases had no seizure or epilepsy claim codes or AEDs in the preceding 365 days. Interacting pairs of AEDs and NEDs were identified by literature review. Logistic regression models were used to examine factors affecting the likelihood of interaction risk. Interacting drug pairs affected NED efficacy in 24.5% of incident cases and 39% of prevalent cases. Combinations affected AED efficacy in 20.4% of incident cases and 29.3% of prevalent cases.
Faught E, Szaflarski JP, Richman J, et al. Risk of pharmacokinetic interactions between antiepileptic and other drugs in older persons and factors associated with risk. Epilepsia. 2018;59(3):715-723.
Are Physically Fit Women at Reduced Risk for Dementia?
High cardiovascular fitness in midlife is associated with decreased risk of subsequent dementia, according to a study published online ahead of print March 14 in Neurology. Physicians examined a population-based sample of 1,462 women ages 38 to 60 in 1968. A subsample of 191 women with an average age of 50 took a maximal ergometer cycling test to measure their peak cardiovascular capacity. Over the following 44 years, participants were tested for dementia six times. By 2012, 44 of the women developed dementia. Approximately 5% of the highly fit women developed dementia, compared with 25% of moderately fit women, and 32% of the women with low fitness. The highly fit women were 88% less likely to develop dementia than the moderately fit women.
Hörder H, Johansson L, Guo X, et al. Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women. Neurology. 2018 Mar 14 [Epub ahead of print].
Data on Geriatric TBI May Be Inadequate
Many older adults with traumatic brain injury (TBI) respond well to aggressive management and rehabilitation, which suggests that age and TBI severity alone are inadequate prognostic markers, according to a study published online ahead of print February 15 in the Journal of Neurotrauma. Researchers reviewed the literature on incident TBI sustained in older adulthood. They found few geriatric-specific TBI guidelines to assist with complex management decisions and concluded that TBI prognostic models do not perform optimally in this population. Major barriers in management of geriatric TBI include underrepresentation of older adults in TBI research, lack of systematic measurement of preinjury health that may predict outcome and response to treatment, and lack of geriatric-specific TBI common data elements. Investigators need to develop more age-inclusive TBI research protocols, said the authors.
Gardner RC, Dams-O’Connor K, Morrissey MR, Manley GT. Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions. J Neurotrauma. 2018 Feb 15 [Epub ahead of print].
TDCS Improves Gait in Parkinson’s Disease
Transcranial direct-current stimulation (TDCS) reduces freezing of gait and improves executive function and mobility, according to a study published online ahead of print February 13 in Movement Disorders. Researchers examined 20 patients with Parkinson’s disease and freezing of gait. The patients received 20 minutes of TDCS or sham treatment during three separate visits. TDCS targeted the primary motor cortex and left dorsolateral prefrontal cortex simultaneously or primary motor cortex only. Participants completed the Timed Up and Go and Stroop tests before and after each stimulation session. Performance on the Timed Up and Go and Stroop tests improved after simultaneous stimulation of the primary motor cortex and left dorsolateral prefrontal cortex, but not after stimulation of the primary motor cortex alone or sham stimulation.
Dagan M, Herman T, Harrison R, et al. Multitarget transcranial direct current stimulation for freezing of gait in Parkinson’s disease. Mov Disord. 2018 Feb 13 [Epub ahead of print].
Patients With Major Stroke Need Realistic Planning
Doctors who care for patients with severe stroke should plan with patients and caregivers and discuss the possibility of death or survival with disability, according to a study published March 5 in the Canadian Medical Association Journal. Researchers recruited a purposive sample of people with total anterior circulation stroke at three stroke services and conducted serial, qualitative interviews with participants and their caregivers at six weeks, six months, and one year. Investigators also conducted a data-linkage study of all patients with anterior circulation stroke admitted to the three services over six months. About 57% of patients died within six months. Patients experienced immediate and persistent emotional distress and poor quality of life. Physicians should practice palliative care for these patients, but avoid using that term, said the authors.
Kendall M, Cowey E, Mead G, et al. Outcomes, experiences and palliative care in major stroke: a multicentre, mixed-method, longitudinal study. CMAJ. 2018;190(9):E238-E246.
Dengue Fever Is Associated With Increased Risk of Stroke
Dengue fever is associated with an increased risk of stroke in the first few months after diagnosis, according to a study published March 12 in Canadian Medical Association Journal. Using data from the Taiwan National Health Insurance Research Database, researchers examined 13,787 patients diagnosed with dengue fever between 2000 and 2012. The control cohort consisted of patients matched by demographic characteristics and stroke-related comorbidities who did not have dengue fever. The overall incidence rate of stroke was 5.33 per 1,000 person-years in the dengue fever cohort and 3.72 per 1,000 person-years in the control cohort. The adjusted hazard ratio of stroke was 1.16 in patients with dengue fever. The risk of stroke was 2.49 times higher in patients with dengue fever during the first two months after diagnosis, compared with controls.
Li HM, Huang YK, Su YC, Kao CH. Risk of stroke in patients with dengue fever: a population-based cohort study. CMAJ. 2018;190(10):E285-E290.
Do Survivors of Stroke Need Additional Help Taking Medication?
More than half of patients with stroke need help taking medication, according to a study published March 11 in BMJ Open. Approximately 600 community-dwelling patients with stroke responded to a five-item questionnaire about practical support that they need and receive. Approximately 56% of respondents got help with taking medication, and 11% needed additional help, including help with prescriptions and collection of medicines, getting medicines out of the packaging, and being reminded to take medicines. Being dependent on others was associated with experiencing more unmet needs with daily medicine taking. About 35% of respondents said that they had missed taking medicine in the previous 30 days. Younger patients with stroke were more likely to miss their medicines, possibly because they were less likely to receive help from a caregiver.
Jamison J, Ayerbe L, Di Tanna GL, et al. Evaluating practical support stroke survivors get with medicines and unmet needs in primary care: a survey. BMJ Open. 2018;8(3):e019874.
Sun Exposure Associated With Reduced Risk of MS
Living in areas with high ambient levels of ultraviolet-B light during childhood and the years before multiple sclerosis (MS) onset is associated with a lower MS risk, according to a study published online ahead of print March 7 in Neurology. Researchers identified 151 women with MS and 235 age-matched controls. The average age at MS onset was 40. All participants completed questionnaires about summer, winter, and lifetime sun exposure. Researchers separated the women into three groups representing low, moderate, and high ultraviolet-B ray exposure, based on their residence. Women who lived in sunnier climates with the highest exposure to ultraviolet-B rays had a 45% reduced risk of developing MS across all pre-MS onset age groups, when compared with participants living in areas with the lowest ultraviolet-B ray exposure.
Tremlett H, Zhu F, Ascherio A, Munger KL. Sun exposure over the life course and associations with multiple sclerosis. Neurology. 2018 Mar 7 [Epub ahead of print].
The new blood pressure guidelines could harm certain patients, according to a study published online ahead of print March 2 in the Journal of the American College of Cardiology. Investigators examined the effect of 10-year cardiovascular disease (CVD) risk on primary outcome events and serious adverse events in the Systolic Pressure Intervention Trial, which was a basis for the new guidelines. They stratified patients by quartiles of risk and used Cox proportional hazards models to examine associations. From the first to fourth quartiles, the number needed to treat to prevent primary outcomes decreased from 91 to 38. The number needed to harm for all-cause serious adverse events increased from 62 to 250. Classifying patients by future risk could identify patients who would benefit from intensive treatment, said the authors.
Phillips RA, Xu J, Peterson LE, et al. Impact of cardiovascular risk on the relative benefit and harm of intensive treatment of hypertension. J Am Coll Cardiol. 2018 Mar 2 [Epub ahead of print].
—Kimberly Williams
