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CPAP After Stroke May Improve Function
Treating sleep apnea after a stroke or transient ischemic attack (TIA) may improve speech impairment, neurologic symptoms, walking, and physical function, according to a study published August 15 in the Journal of the American Heart Association. To examine whether continuous positive airway pressure (CPAP) improves clinical outcomes among patients with stroke or TIA who have obstructive sleep apnea, researchers analyzed data from a trial that included 252 patients with stroke or TIA. Participants were randomized to intervention groups that received polysomnography soon after the stroke or TIA or to a control group. Among the 81 patients in the intervention groups with sleep apnea, more than 70% used CPAP during approximately one year of follow-up. In intention-to-treat analyses, changes in NIH Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores were similar across groups. In as-treated analyses among patients with sleep apnea, CPAP use was associated with improved NIHSS and mRS scores. In addition, 59% of intervention patients with sleep apnea had a final NIHSS score of 0 or 1 versus 38% of controls with sleep apnea.
Bravata DM, Sico J, Fragoso CAV, et al. Diagnosing and treating sleep apnea in patients with acute cerebrovascular disease. J Am Heart Assoc. 2018;7:e008841.
Intervention Reduces Cognitive Decline in Blacks With MCI
Among black patients with mild cognitive impairment (MCI), a behavioral intervention that aims to increase social, cognitive, and physical activity reduces the risk of memory decline, compared with supportive therapy, according to a study published online ahead of print September 10 in JAMA Neurology. Between June 2011 and October 2014, researchers enrolled 221 black participants with MCI (mean age, 75.8; 79% women) into a clinical trial. Participants were randomized to behavioral activation or supportive therapy (ie, an attention control treatment). The primary outcome was a decline of six or more recalled words on the total recall score of the Hopkins Verbal Learning Test-Revised at six, 12, 18, and 24 months. The two-year incidence of memory decline was lower in the behavioral activation group than in the supportive therapy group (1.2% vs 9.3%). Behavioral activation reduced the risk of cognitive decline by 88%, compared with supportive therapy.
Rovner BW, Casten RJ, Hegel MT, Leiby B. Preventing cognitive decline in black individuals with mild cognitive impairment: a randomized clinical trial. JAMA Neurol. 2018 Sep 10 [Epub ahead of print].
Medical Marijuana May Treat Nerve Pain
Among patients with neuropathic pain, sublingual tetrahydrocannabinol (THC) significantly reduces pain versus placebo, according to a randomized, double-blind study published online ahead of print September 5 in Neurology. The trial included 15 men with chronic radicular nerve pain (average age, 33). Before and one hour after treatment with THC or placebo oil, participants rated their pain levels on a scale from zero to 100. At least one week later, they received the other treatment. The average pain level before treatment was 53. After taking THC, participants’ average pain level was 35, compared with an average pain level of 43 after taking placebo. Functional MRI showed that the drug’s analgesic effect correlated with reduced functional connectivity between brain areas involved in emotion and pain processing.
Weizman L, Dayan L, Brill S, et al. Cannabis analgesia in chronic neuropathic pain is associated with altered brain connectivity. Neurology. 2018 Sep 5 [Epub ahead of print].
For Which Clots Is t-PA Most Effective?
In patients with acute ischemic stroke, a more distal thrombus location, greater thrombus permeability, and longer time to assessment of recanalization are associated with recanalization of an arterial occlusion after administration of IV alteplase, according to a study published in the September 11 issue of JAMA. This multicenter prospective cohort study included 575 patients with acute ischemic stroke and intracranial arterial occlusion demonstrated on CT angiogram (CTA). In all, 275 participants received IV alteplase, 195 participants received IV alteplase plus endovascular thrombectomy, 48 participants received endovascular thrombectomy, and 57 participants received conservative treatment. Median time from baseline CTA to recanalization assessment was 158 minutes. Successful recanalization occurred at an unadjusted rate of 27.3%, including in 30.4% of patients who received IV alteplase and 13.3% who did not.
Menon BK, Al-Ajlan FS, Najm M, et al. Association of clinical, imaging, and thrombus characteristics with recanalization of visible intracranial occlusion in patients with acute ischemic stroke. JAMA. 2018;320(10):1017-1026.
FDA Approves Ajovy for Adults With Migraine
The FDA has approved Ajovy (fremanezumab-vfrm), a calcitonin gene-related peptide (CGRP) antagonist, for the preventive treatment of migraine in adults. Dosing options include 225 mg monthly administered as one subcutaneous injection or 675 mg quarterly administered as three subcutaneous injections. The injections can be administered by a healthcare professional or by a patient or caregiver. The treatment was evaluated in two phase III, placebo-controlled clinical trials that enrolled patients with migraine. The trials examined the therapy as a stand-alone preventive treatment and in combination with oral preventive treatments. Patients experienced a reduction in monthly migraine days during a 12-week period. The most common adverse reactions were injection site reactions. Ajovy is a humanized monoclonal antibody that binds to CGRP ligand and blocks its binding to the receptor. Teva Pharmaceutical Industries, which markets Ajovy, is headquartered in Jerusalem.
Is Daytime Sleepiness Associated With an Alzheimer’s Disease Biomarker?
Excessive daytime sleepiness (EDS) is associated with more than 2.5 times the odds of β-amyloid (Aβ) deposition an average of 15.7 years later, according to a study published online ahead of print September 5 in Sleep. Researchers studied 124 participants in the Baltimore Longitudinal Study of Aging Neuroimaging Substudy who completed self-reported measures of EDS and napping at baseline and underwent 11C-Pittsburgh compound B-PET scans of the brain an average of 15.7 years later. Participants’ mean age was 60.1 at baseline; 24.4% had EDS, and 28.5% napped. In unadjusted analyses, compared with participants without EDS, people with EDS had more than three times the odds of being Aβ+ (ie, having a cortical distribution volume ratio of greater than 1.06) at follow-up. After adjusting for age, sex, education, and BMI, the odds ratio was 2.75.
Spira AP, An Y, Wu MN, et al. Excessive daytime sleepiness and napping in cognitively normal adults: associations with subsequent amyloid deposition measured by PiB PET. Sleep. 2018 Sep 5 [Epub ahead of print].
Sepsis Heightens Risk of Stroke and Heart Attack
Patients recovering from sepsis have a greater risk of myocardial infarction or stroke in the first four weeks after hospital discharge, compared with population and hospital controls, according to a study published September 10 in the Canadian Medical Association Journal. This retrospective population-based cohort study included 42,316 patients with sepsis identified from the National Health Insurance Research Database in Taiwan. In all, 831 patients with sepsis had a stroke and 184 had a myocardial infarction within 180 days of discharge from the hospital. Compared with population controls, the risk was highest in the first seven days after discharge (hazard ratio, 4.78). Compared with hospital controls, the risk was attenuated but remained elevated before day 36 after discharge (hazard ratio, 1.32).
Lai CC, Lee MG, Lee WC, et al. Susceptible period for cardiovascular complications in patients recovering from sepsis. CMAJ. 2018;190(36):E1062-E1069.
Ten-Year Risk Factors for Dementia
Age, sex, and APOE genotype identify high-risk groups for Alzheimer’s disease and dementia, according to a study published September 4 in the Canadian Medical Association Journal. The study looked at data from 104,537 people in Copenhagen. Participants completed a questionnaire and underwent physical examination and blood sampling at baseline. The researchers obtained diagnoses of dementia and cerebrovascular disease from the Danish National Patient Registry through November 10, 2014. The absolute 10-year risk of Alzheimer’s disease among 3,017 people who were carriers of the APOE ε44 genotype was 7% for women and 6% for men ages 60 to 69, 16% for women and 12% for men ages 70 to 79, and 24% for women and 19% for men ages 80 and older.
Rasmussen KL, Tybjærg-Hansen A, Nordestgaard BG, Frikke-Schmidt R. Absolute 10-year risk of dementia by age, sex and APOE genotype: a population-based cohort study. CMAJ. 2018;190(35):E1033-E1041.
Is Job Stress Associated With Parkinson’s Disease Risk?
Occupational stress may increase Parkinson’s disease risk, according to a study published online ahead of print August 25 in Movement Disorders. Researchers conducted a population-based cohort study of 2,544,748 Swedes whose occupations had been reported in censuses. They identified incident Parkinson’s disease cases using Swedish national health registers and analyzed the data using Cox regression with age as the underlying time scale, adjusting for sex, education, and chronic obstructive pulmonary disease as a proxy for smoking. During a mean follow-up of 21.3 years, 21,544 incident Parkinson’s disease cases were identified. High job demands were associated with increased risk of Parkinson’s disease among men, most evidently in men with high levels of education. High levels of job control were associated with increased risk among people with low levels of education, and this association was stronger in women.
Sieurin J, Andel R, Tillander A, et al. Occupational stress and risk for Parkinson’s disease: a nationwide cohort study. Mov Disord. 2018 Aug 25 [Epub ahead of print].
FDA Approves Tiglutik for ALS
The FDA has approved Tiglutik (riluzole) oral suspension for the treatment of amyotrophic lateral sclerosis (ALS). Tiglutik is a thickened liquid taken twice daily by oral syringe. The approval of Tiglutik is based on bioavailability studies comparing oral riluzole tablets to Tiglutik oral suspension. The most common side effects of Tiglutik are consistent with the established clinical profile of riluzole and include oral hypoesthesia, asthenia, nausea, decreased lung function, hypertension, and abdominal pain. The recommended dosage is 50 mg/10 mL. The drug should be taken at least one hour before or two hours after a meal. In clinical studies, riluzole modulated glutamate neurotransmission by inhibiting glutamate release and postsynaptic glutamate receptor signaling. ITF Pharma, which markets the drug, is headquartered in Berwyn, Pennsylvania.
—Kimberly Williams
CPAP After Stroke May Improve Function
Treating sleep apnea after a stroke or transient ischemic attack (TIA) may improve speech impairment, neurologic symptoms, walking, and physical function, according to a study published August 15 in the Journal of the American Heart Association. To examine whether continuous positive airway pressure (CPAP) improves clinical outcomes among patients with stroke or TIA who have obstructive sleep apnea, researchers analyzed data from a trial that included 252 patients with stroke or TIA. Participants were randomized to intervention groups that received polysomnography soon after the stroke or TIA or to a control group. Among the 81 patients in the intervention groups with sleep apnea, more than 70% used CPAP during approximately one year of follow-up. In intention-to-treat analyses, changes in NIH Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores were similar across groups. In as-treated analyses among patients with sleep apnea, CPAP use was associated with improved NIHSS and mRS scores. In addition, 59% of intervention patients with sleep apnea had a final NIHSS score of 0 or 1 versus 38% of controls with sleep apnea.
Bravata DM, Sico J, Fragoso CAV, et al. Diagnosing and treating sleep apnea in patients with acute cerebrovascular disease. J Am Heart Assoc. 2018;7:e008841.
Intervention Reduces Cognitive Decline in Blacks With MCI
Among black patients with mild cognitive impairment (MCI), a behavioral intervention that aims to increase social, cognitive, and physical activity reduces the risk of memory decline, compared with supportive therapy, according to a study published online ahead of print September 10 in JAMA Neurology. Between June 2011 and October 2014, researchers enrolled 221 black participants with MCI (mean age, 75.8; 79% women) into a clinical trial. Participants were randomized to behavioral activation or supportive therapy (ie, an attention control treatment). The primary outcome was a decline of six or more recalled words on the total recall score of the Hopkins Verbal Learning Test-Revised at six, 12, 18, and 24 months. The two-year incidence of memory decline was lower in the behavioral activation group than in the supportive therapy group (1.2% vs 9.3%). Behavioral activation reduced the risk of cognitive decline by 88%, compared with supportive therapy.
Rovner BW, Casten RJ, Hegel MT, Leiby B. Preventing cognitive decline in black individuals with mild cognitive impairment: a randomized clinical trial. JAMA Neurol. 2018 Sep 10 [Epub ahead of print].
Medical Marijuana May Treat Nerve Pain
Among patients with neuropathic pain, sublingual tetrahydrocannabinol (THC) significantly reduces pain versus placebo, according to a randomized, double-blind study published online ahead of print September 5 in Neurology. The trial included 15 men with chronic radicular nerve pain (average age, 33). Before and one hour after treatment with THC or placebo oil, participants rated their pain levels on a scale from zero to 100. At least one week later, they received the other treatment. The average pain level before treatment was 53. After taking THC, participants’ average pain level was 35, compared with an average pain level of 43 after taking placebo. Functional MRI showed that the drug’s analgesic effect correlated with reduced functional connectivity between brain areas involved in emotion and pain processing.
Weizman L, Dayan L, Brill S, et al. Cannabis analgesia in chronic neuropathic pain is associated with altered brain connectivity. Neurology. 2018 Sep 5 [Epub ahead of print].
For Which Clots Is t-PA Most Effective?
In patients with acute ischemic stroke, a more distal thrombus location, greater thrombus permeability, and longer time to assessment of recanalization are associated with recanalization of an arterial occlusion after administration of IV alteplase, according to a study published in the September 11 issue of JAMA. This multicenter prospective cohort study included 575 patients with acute ischemic stroke and intracranial arterial occlusion demonstrated on CT angiogram (CTA). In all, 275 participants received IV alteplase, 195 participants received IV alteplase plus endovascular thrombectomy, 48 participants received endovascular thrombectomy, and 57 participants received conservative treatment. Median time from baseline CTA to recanalization assessment was 158 minutes. Successful recanalization occurred at an unadjusted rate of 27.3%, including in 30.4% of patients who received IV alteplase and 13.3% who did not.
Menon BK, Al-Ajlan FS, Najm M, et al. Association of clinical, imaging, and thrombus characteristics with recanalization of visible intracranial occlusion in patients with acute ischemic stroke. JAMA. 2018;320(10):1017-1026.
FDA Approves Ajovy for Adults With Migraine
The FDA has approved Ajovy (fremanezumab-vfrm), a calcitonin gene-related peptide (CGRP) antagonist, for the preventive treatment of migraine in adults. Dosing options include 225 mg monthly administered as one subcutaneous injection or 675 mg quarterly administered as three subcutaneous injections. The injections can be administered by a healthcare professional or by a patient or caregiver. The treatment was evaluated in two phase III, placebo-controlled clinical trials that enrolled patients with migraine. The trials examined the therapy as a stand-alone preventive treatment and in combination with oral preventive treatments. Patients experienced a reduction in monthly migraine days during a 12-week period. The most common adverse reactions were injection site reactions. Ajovy is a humanized monoclonal antibody that binds to CGRP ligand and blocks its binding to the receptor. Teva Pharmaceutical Industries, which markets Ajovy, is headquartered in Jerusalem.
Is Daytime Sleepiness Associated With an Alzheimer’s Disease Biomarker?
Excessive daytime sleepiness (EDS) is associated with more than 2.5 times the odds of β-amyloid (Aβ) deposition an average of 15.7 years later, according to a study published online ahead of print September 5 in Sleep. Researchers studied 124 participants in the Baltimore Longitudinal Study of Aging Neuroimaging Substudy who completed self-reported measures of EDS and napping at baseline and underwent 11C-Pittsburgh compound B-PET scans of the brain an average of 15.7 years later. Participants’ mean age was 60.1 at baseline; 24.4% had EDS, and 28.5% napped. In unadjusted analyses, compared with participants without EDS, people with EDS had more than three times the odds of being Aβ+ (ie, having a cortical distribution volume ratio of greater than 1.06) at follow-up. After adjusting for age, sex, education, and BMI, the odds ratio was 2.75.
Spira AP, An Y, Wu MN, et al. Excessive daytime sleepiness and napping in cognitively normal adults: associations with subsequent amyloid deposition measured by PiB PET. Sleep. 2018 Sep 5 [Epub ahead of print].
Sepsis Heightens Risk of Stroke and Heart Attack
Patients recovering from sepsis have a greater risk of myocardial infarction or stroke in the first four weeks after hospital discharge, compared with population and hospital controls, according to a study published September 10 in the Canadian Medical Association Journal. This retrospective population-based cohort study included 42,316 patients with sepsis identified from the National Health Insurance Research Database in Taiwan. In all, 831 patients with sepsis had a stroke and 184 had a myocardial infarction within 180 days of discharge from the hospital. Compared with population controls, the risk was highest in the first seven days after discharge (hazard ratio, 4.78). Compared with hospital controls, the risk was attenuated but remained elevated before day 36 after discharge (hazard ratio, 1.32).
Lai CC, Lee MG, Lee WC, et al. Susceptible period for cardiovascular complications in patients recovering from sepsis. CMAJ. 2018;190(36):E1062-E1069.
Ten-Year Risk Factors for Dementia
Age, sex, and APOE genotype identify high-risk groups for Alzheimer’s disease and dementia, according to a study published September 4 in the Canadian Medical Association Journal. The study looked at data from 104,537 people in Copenhagen. Participants completed a questionnaire and underwent physical examination and blood sampling at baseline. The researchers obtained diagnoses of dementia and cerebrovascular disease from the Danish National Patient Registry through November 10, 2014. The absolute 10-year risk of Alzheimer’s disease among 3,017 people who were carriers of the APOE ε44 genotype was 7% for women and 6% for men ages 60 to 69, 16% for women and 12% for men ages 70 to 79, and 24% for women and 19% for men ages 80 and older.
Rasmussen KL, Tybjærg-Hansen A, Nordestgaard BG, Frikke-Schmidt R. Absolute 10-year risk of dementia by age, sex and APOE genotype: a population-based cohort study. CMAJ. 2018;190(35):E1033-E1041.
Is Job Stress Associated With Parkinson’s Disease Risk?
Occupational stress may increase Parkinson’s disease risk, according to a study published online ahead of print August 25 in Movement Disorders. Researchers conducted a population-based cohort study of 2,544,748 Swedes whose occupations had been reported in censuses. They identified incident Parkinson’s disease cases using Swedish national health registers and analyzed the data using Cox regression with age as the underlying time scale, adjusting for sex, education, and chronic obstructive pulmonary disease as a proxy for smoking. During a mean follow-up of 21.3 years, 21,544 incident Parkinson’s disease cases were identified. High job demands were associated with increased risk of Parkinson’s disease among men, most evidently in men with high levels of education. High levels of job control were associated with increased risk among people with low levels of education, and this association was stronger in women.
Sieurin J, Andel R, Tillander A, et al. Occupational stress and risk for Parkinson’s disease: a nationwide cohort study. Mov Disord. 2018 Aug 25 [Epub ahead of print].
FDA Approves Tiglutik for ALS
The FDA has approved Tiglutik (riluzole) oral suspension for the treatment of amyotrophic lateral sclerosis (ALS). Tiglutik is a thickened liquid taken twice daily by oral syringe. The approval of Tiglutik is based on bioavailability studies comparing oral riluzole tablets to Tiglutik oral suspension. The most common side effects of Tiglutik are consistent with the established clinical profile of riluzole and include oral hypoesthesia, asthenia, nausea, decreased lung function, hypertension, and abdominal pain. The recommended dosage is 50 mg/10 mL. The drug should be taken at least one hour before or two hours after a meal. In clinical studies, riluzole modulated glutamate neurotransmission by inhibiting glutamate release and postsynaptic glutamate receptor signaling. ITF Pharma, which markets the drug, is headquartered in Berwyn, Pennsylvania.
—Kimberly Williams
CPAP After Stroke May Improve Function
Treating sleep apnea after a stroke or transient ischemic attack (TIA) may improve speech impairment, neurologic symptoms, walking, and physical function, according to a study published August 15 in the Journal of the American Heart Association. To examine whether continuous positive airway pressure (CPAP) improves clinical outcomes among patients with stroke or TIA who have obstructive sleep apnea, researchers analyzed data from a trial that included 252 patients with stroke or TIA. Participants were randomized to intervention groups that received polysomnography soon after the stroke or TIA or to a control group. Among the 81 patients in the intervention groups with sleep apnea, more than 70% used CPAP during approximately one year of follow-up. In intention-to-treat analyses, changes in NIH Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores were similar across groups. In as-treated analyses among patients with sleep apnea, CPAP use was associated with improved NIHSS and mRS scores. In addition, 59% of intervention patients with sleep apnea had a final NIHSS score of 0 or 1 versus 38% of controls with sleep apnea.
Bravata DM, Sico J, Fragoso CAV, et al. Diagnosing and treating sleep apnea in patients with acute cerebrovascular disease. J Am Heart Assoc. 2018;7:e008841.
Intervention Reduces Cognitive Decline in Blacks With MCI
Among black patients with mild cognitive impairment (MCI), a behavioral intervention that aims to increase social, cognitive, and physical activity reduces the risk of memory decline, compared with supportive therapy, according to a study published online ahead of print September 10 in JAMA Neurology. Between June 2011 and October 2014, researchers enrolled 221 black participants with MCI (mean age, 75.8; 79% women) into a clinical trial. Participants were randomized to behavioral activation or supportive therapy (ie, an attention control treatment). The primary outcome was a decline of six or more recalled words on the total recall score of the Hopkins Verbal Learning Test-Revised at six, 12, 18, and 24 months. The two-year incidence of memory decline was lower in the behavioral activation group than in the supportive therapy group (1.2% vs 9.3%). Behavioral activation reduced the risk of cognitive decline by 88%, compared with supportive therapy.
Rovner BW, Casten RJ, Hegel MT, Leiby B. Preventing cognitive decline in black individuals with mild cognitive impairment: a randomized clinical trial. JAMA Neurol. 2018 Sep 10 [Epub ahead of print].
Medical Marijuana May Treat Nerve Pain
Among patients with neuropathic pain, sublingual tetrahydrocannabinol (THC) significantly reduces pain versus placebo, according to a randomized, double-blind study published online ahead of print September 5 in Neurology. The trial included 15 men with chronic radicular nerve pain (average age, 33). Before and one hour after treatment with THC or placebo oil, participants rated their pain levels on a scale from zero to 100. At least one week later, they received the other treatment. The average pain level before treatment was 53. After taking THC, participants’ average pain level was 35, compared with an average pain level of 43 after taking placebo. Functional MRI showed that the drug’s analgesic effect correlated with reduced functional connectivity between brain areas involved in emotion and pain processing.
Weizman L, Dayan L, Brill S, et al. Cannabis analgesia in chronic neuropathic pain is associated with altered brain connectivity. Neurology. 2018 Sep 5 [Epub ahead of print].
For Which Clots Is t-PA Most Effective?
In patients with acute ischemic stroke, a more distal thrombus location, greater thrombus permeability, and longer time to assessment of recanalization are associated with recanalization of an arterial occlusion after administration of IV alteplase, according to a study published in the September 11 issue of JAMA. This multicenter prospective cohort study included 575 patients with acute ischemic stroke and intracranial arterial occlusion demonstrated on CT angiogram (CTA). In all, 275 participants received IV alteplase, 195 participants received IV alteplase plus endovascular thrombectomy, 48 participants received endovascular thrombectomy, and 57 participants received conservative treatment. Median time from baseline CTA to recanalization assessment was 158 minutes. Successful recanalization occurred at an unadjusted rate of 27.3%, including in 30.4% of patients who received IV alteplase and 13.3% who did not.
Menon BK, Al-Ajlan FS, Najm M, et al. Association of clinical, imaging, and thrombus characteristics with recanalization of visible intracranial occlusion in patients with acute ischemic stroke. JAMA. 2018;320(10):1017-1026.
FDA Approves Ajovy for Adults With Migraine
The FDA has approved Ajovy (fremanezumab-vfrm), a calcitonin gene-related peptide (CGRP) antagonist, for the preventive treatment of migraine in adults. Dosing options include 225 mg monthly administered as one subcutaneous injection or 675 mg quarterly administered as three subcutaneous injections. The injections can be administered by a healthcare professional or by a patient or caregiver. The treatment was evaluated in two phase III, placebo-controlled clinical trials that enrolled patients with migraine. The trials examined the therapy as a stand-alone preventive treatment and in combination with oral preventive treatments. Patients experienced a reduction in monthly migraine days during a 12-week period. The most common adverse reactions were injection site reactions. Ajovy is a humanized monoclonal antibody that binds to CGRP ligand and blocks its binding to the receptor. Teva Pharmaceutical Industries, which markets Ajovy, is headquartered in Jerusalem.
Is Daytime Sleepiness Associated With an Alzheimer’s Disease Biomarker?
Excessive daytime sleepiness (EDS) is associated with more than 2.5 times the odds of β-amyloid (Aβ) deposition an average of 15.7 years later, according to a study published online ahead of print September 5 in Sleep. Researchers studied 124 participants in the Baltimore Longitudinal Study of Aging Neuroimaging Substudy who completed self-reported measures of EDS and napping at baseline and underwent 11C-Pittsburgh compound B-PET scans of the brain an average of 15.7 years later. Participants’ mean age was 60.1 at baseline; 24.4% had EDS, and 28.5% napped. In unadjusted analyses, compared with participants without EDS, people with EDS had more than three times the odds of being Aβ+ (ie, having a cortical distribution volume ratio of greater than 1.06) at follow-up. After adjusting for age, sex, education, and BMI, the odds ratio was 2.75.
Spira AP, An Y, Wu MN, et al. Excessive daytime sleepiness and napping in cognitively normal adults: associations with subsequent amyloid deposition measured by PiB PET. Sleep. 2018 Sep 5 [Epub ahead of print].
Sepsis Heightens Risk of Stroke and Heart Attack
Patients recovering from sepsis have a greater risk of myocardial infarction or stroke in the first four weeks after hospital discharge, compared with population and hospital controls, according to a study published September 10 in the Canadian Medical Association Journal. This retrospective population-based cohort study included 42,316 patients with sepsis identified from the National Health Insurance Research Database in Taiwan. In all, 831 patients with sepsis had a stroke and 184 had a myocardial infarction within 180 days of discharge from the hospital. Compared with population controls, the risk was highest in the first seven days after discharge (hazard ratio, 4.78). Compared with hospital controls, the risk was attenuated but remained elevated before day 36 after discharge (hazard ratio, 1.32).
Lai CC, Lee MG, Lee WC, et al. Susceptible period for cardiovascular complications in patients recovering from sepsis. CMAJ. 2018;190(36):E1062-E1069.
Ten-Year Risk Factors for Dementia
Age, sex, and APOE genotype identify high-risk groups for Alzheimer’s disease and dementia, according to a study published September 4 in the Canadian Medical Association Journal. The study looked at data from 104,537 people in Copenhagen. Participants completed a questionnaire and underwent physical examination and blood sampling at baseline. The researchers obtained diagnoses of dementia and cerebrovascular disease from the Danish National Patient Registry through November 10, 2014. The absolute 10-year risk of Alzheimer’s disease among 3,017 people who were carriers of the APOE ε44 genotype was 7% for women and 6% for men ages 60 to 69, 16% for women and 12% for men ages 70 to 79, and 24% for women and 19% for men ages 80 and older.
Rasmussen KL, Tybjærg-Hansen A, Nordestgaard BG, Frikke-Schmidt R. Absolute 10-year risk of dementia by age, sex and APOE genotype: a population-based cohort study. CMAJ. 2018;190(35):E1033-E1041.
Is Job Stress Associated With Parkinson’s Disease Risk?
Occupational stress may increase Parkinson’s disease risk, according to a study published online ahead of print August 25 in Movement Disorders. Researchers conducted a population-based cohort study of 2,544,748 Swedes whose occupations had been reported in censuses. They identified incident Parkinson’s disease cases using Swedish national health registers and analyzed the data using Cox regression with age as the underlying time scale, adjusting for sex, education, and chronic obstructive pulmonary disease as a proxy for smoking. During a mean follow-up of 21.3 years, 21,544 incident Parkinson’s disease cases were identified. High job demands were associated with increased risk of Parkinson’s disease among men, most evidently in men with high levels of education. High levels of job control were associated with increased risk among people with low levels of education, and this association was stronger in women.
Sieurin J, Andel R, Tillander A, et al. Occupational stress and risk for Parkinson’s disease: a nationwide cohort study. Mov Disord. 2018 Aug 25 [Epub ahead of print].
FDA Approves Tiglutik for ALS
The FDA has approved Tiglutik (riluzole) oral suspension for the treatment of amyotrophic lateral sclerosis (ALS). Tiglutik is a thickened liquid taken twice daily by oral syringe. The approval of Tiglutik is based on bioavailability studies comparing oral riluzole tablets to Tiglutik oral suspension. The most common side effects of Tiglutik are consistent with the established clinical profile of riluzole and include oral hypoesthesia, asthenia, nausea, decreased lung function, hypertension, and abdominal pain. The recommended dosage is 50 mg/10 mL. The drug should be taken at least one hour before or two hours after a meal. In clinical studies, riluzole modulated glutamate neurotransmission by inhibiting glutamate release and postsynaptic glutamate receptor signaling. ITF Pharma, which markets the drug, is headquartered in Berwyn, Pennsylvania.
—Kimberly Williams
