Mild cognitive impairment (MCI) may affect more men than women. A study published in the September 7 Neurology found that MCI was 1.5 times higher in men, compared with women. For the study, part of the Mayo Clinic Study of Aging, 2,050 people between the ages of 70 and 89 in Olmstead County, Minnesota, were interviewed about memory and tested on memory and thinking skills. Nearly 14% of the participants had MCI, about 10% had dementia, and 76% had normal memory and thinking skills. MCI was detected in 19% of men, compared with 14% of women. Study participants who had a low level of education or were never married also had a higher rate of MCI. “The finding that the frequency of MCI is greater in men was unexpected, since the frequency of Alzheimer’s disease is actually greater in women. It warrants further study,” said study author Ronald Petersen, MD, PhD.
Family members and close friends are more sensitive to early signs of Alzheimer’s dementia than traditional screening tests, according to a study published online September 7 in the journal Brain. Data from the two-minute Ascertain Dementia 8 (AD8) questionnaire, which uses an informant to evaluate cognitive changes and difficulties with activities of daily living, were collected for 257 individuals, who were also tested using the Mini Mental State Examination (MMSE). Study subjects were also evaluated for biomarkers using spinal fluid assays and amyloid imaging. Results showed that the AD8’s results corresponded with biomarker results more consistently than did the MMSE’s results. “The AD8 gives us a brief and very low-cost alternative that takes a few minutes of the informant’s time to screen for dementia and thus identify those individuals who need follow-up evaluations to determine if there truly are signs of Alzheimer’s disease,” said lead investigator John C. Morris, MD.

Mild memory loss is not a part of normal aging, according to a study in the September 15 Neurology. Investigators reported that even the very early, mild changes in memory that are much more common in old age than dementia are caused by the same brain lesions associated with Alzheimer’s disease and other dementias. As part of Rush University’s Religious Orders Study, more than 350 nuns, priests, and brothers completed up to 13 years of annual cognitive testing. Postmortem brains were examined for neurofibrillary tangles, cerebral infarction, and Lewy bodies. The last four to five years of life showed a very rapid decline; preceding years showed a much more gradual decline that would be described as normal aging. Pathologic lesions were related to the rapid decline. Pathology was very strongly predictive of the mild changes in cognitive function. Higher tangle density adversely affected all forms of cognition at all trajectory points. Both Lewy bodies and stroke approximately doubled the rate of gradual memory decline.

Aerobic fitness may relate to the structure and function of the preadolescent brain, according to findings published in the October 28 Brain Research. Among 49 children ages 9 and 10, those who were more physically fit tended to have a bigger hippocampus and perform better on memory tests than their less-fit peers. Researchers used MRI to investigate whether higher- and lower-fit 9- and 10-year-olds showed differences in hippocampal volume and if the differences were related to performance on an item and relational memory task. Higher-fit children showed greater bilateral hippocampal volumes and superior relational memory task performance compared to lower-fit children. Hippocampal volume was positively associated with performance in the relational but not the item memory task. Bilateral hippocampal volume was found to mediate the relationship between fitness level (VO2 max) and relational memory.

The 2009 pandemic influenza A (H1N1) caused a higher rate of neurologic complications in children than the seasonal flu, according to a report in the September Annals of Neurology. Children younger than 19 who were hospitalized with H1N1 and neurologic complications between April 1 and November 20, 2009, were included in a retrospective study. The comparison group comprised records of children hospitalized with seasonal flu and neurologic complications from July 1, 2004, to June 30, 2008. A total of 303 children with 2009 H1N1 were identified, of whom 18 experienced neurologic complications. About 80% of these patients had an underlying medical condition (66% neurologic). The most common neurologic symptoms were seizures (67%) and encephalopathy (50%). The comparison group included 234 children, 16 of whom experienced neurologic complications. Only 25% of the comparison group had underlying medical conditions.

Results of a multicenter, prospective, randomized, blinded feasibility trial indicate that occipital nerve stimulation shows promise for treating medically refractory chronic migraine. In the Occipital Nerve Stimulation for the Treatment of Intractable Migraine (ONSTIM) study, eligible patients received an occipital nerve block. Responders were then randomized to adjustable stimulation, preset stimulation, or medical management. Seventy-five of 110 subjects were assigned to a treatment group. Complete diary data were available for 66. Response was defined as a 50% or greater reduction in the number of headache days per month or a 3-point or greater drop in average overall pain intensity compared with baseline. Three-month responder rates were 39% for adjustable stimulation, 6% for preset stimulation, and 0% for medical management. Study results were published September 29 in an online ahead of print edition of Cephalalgia.

IV aspirin is safe, effective, and useful for the treatment of severe headache, per a report in the September 21 Neurology. “IV lysine acetylsalicylate (aspirin) has been shown to be effective in the treatment of acute migraine attacks, but little is known about its effectiveness and safety in patients hospitalized for management of severe headache, typically arising from abrupt withdrawal of other acute attack medications,” researchers wrote. The study of 168 patients in a tertiary referral setting found improvements in pain scores, with a decrease of three or more points on a 10-point scale in more than 25% of cases. Side effect rates were also low (5.9%), and there were no serious adverse events.

Men who experience insomnia with short sleep duration have an increased risk of death, according to research in the September 1 Sleep. The longitudinal study of 1,741 men and women from central Pennsylvania found that men with insomnia who sleep for less than six hours have a fourfold increased risk of death when compared with those with normal sleep, “a risk that has been underestimated,” investigators reported. Insomnia was determined by complaint of sleep difficulty lasting one year or more, and short sleep duration was defined as less than six hours. Patients were seen in the sleep laboratory, and researchers tracked participants for 10 years (males) or 14 years (female). Mortality rates were 21% for men and 5% for women. Men with diabetes or hypertension had an even greater risk than men without these comorbidities. However, in women, mortality was not associated with insomnia or sleep duration.

IV dexamethasone reduces the number of unfavorable outcomes in patients with pneumococcal meningitis, researchers reported in the September 29 Neurology. The Dutch study compared outcomes of 357 episodes of the illness between 2006 and 2009, when 84% of patients received dexamethasone with or before the first dose of antibiotics, to 352 similar cases between 1998 and 2002, when 3% received dexamethasone. Outcomes were based on the 5-point Glasgow Outcome Scale, where a discharge score of 1 to 4 points was deemed unfavorable. Unfavorable outcomes decreased from 50% in the earlier cohort to 39%; rates of hearing loss dropped from 22% to 12%; and death rates declined from 30% to 20%. “The prognosis of pneumococcal meningitis on a national level has substantially improved after the introduction of adjunctive dexamethasone therapy,” the investigators reported.

The FDA approved Gilenya (fingolimod) 0.5 mg daily as a first-line treatment for relapsing forms of multiple sclerosis (MS). The approval makes Gilenya the first oral treatment for relapsing forms of MS. In clinical studies, fingolimod reduced relapses by 52% at one year, compared with interferon beta-1a. A two-year, placebo-controlled study showed that fingolimod significantly reduced the risk of disability progression. The oral therapy, which is marketed by Novartis Pharmaceuticals Corporation, is the first in a new class of drugs called sphingosine 1-phosphate receptor modulators. While fingolimod’s exact mechanism of action is unknown, it is thought to work by reducing the immune system’s attack on the CNS by retaining lymphocytes in the lymph nodes.

Age at disease onset is one of many clues to life expectancy for patients with Parkinson’s disease, according to a report that was published in the October 5 Neurology. Results of a 12-year study that included 230 patients indicate that the average time from symptom onset to death was 16 years. The average age at death was 81. The risk of earlier death was increased about 1.4 times for every 10-year increase in age at symptom onset. Patients with psychotic symptoms were also 1.5 times more likely to die sooner, compared with those without such symptoms. For patients with dementia symptoms, odds of dying earlier were nearly two times higher compared with patients with no memory problems. Men were 1.6 times more likely to die earlier, compared with women. Patients who scored worst on movement tests also had a higher risk of earlier death, compared with those with the highest scores.

A new understanding of the interaction between c-Abl and parkin offers a new target for neuroprotective therapies in Parkinson’s disease, according to research published in the September 7 online issue of theProceedings of the National Academy of Sciences. The over-activation of the c-Abl protein may shut down the brain-protective effects of parkin’s ubiquitin E3 ligase and contribute to a buildup of toxic proteins in the brain that enables the progression of sporadic Parkinson’s disease. The cancer drug imatinib is a c-Abl family kinase inhibitor, and investigators hope that it may help to maintain parkin’s normal protective functions. “The testing of these already approved, well-tolerated drugs for a new use—as a neuroprotective treatment for Parkinson’s disease—is a potentially exciting therapeutic arc that should be pursued,” the investigators reported.

—Glenn S. Williams and Rebecca K. Abma

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