News Roundup

News Roundup: New and Noteworthy Information


Researchers have found that having a transient ischemic attack (TIA) can reduce a person’s life expectancy up to 20%, according to a study published online November 10 in Stroke. “There is a lack of modern-day data quantifying the effect of TIA on survival, and recent data do not take into account expected survival,” the researchers commented. To investigate the impact of a TIA on survival, the investigators analyzed data from 22,157 patients hospitalized with a TIA, then estimated survival relative to the age- and sex-matched general population up to nine years after hospitalization. At one-year follow-up, 91.5% of TIA patients survived, compared with 95.0% expected survival in the general population; by nine-years follow-up, observed survival was 20% lower than expected. Older age, prior hospitalization for stroke (but not TIA), atrial fibrillation, and congestive heart failure significantly increased the risk of excess death in these patients.
Higher levels of urinary sodium excretion were associated with an increased risk of cardiovascular events, while lower levels were associated with cardiovascular death and hospitalization for congestive heart failure, according to a study published in the November 23 JAMA. “[Our objective was] to determine the association between estimated urinary sodium and potassium excretion (surrogates for intake) and cardiovascular events in patients with established cardiovascular disease or diabetes mellitus,” stated the researchers. The results of their observational analyses revealed that “compared with baseline sodium excretion of 4 to 5.99 g per day, sodium excretion of greater than 7 g per day was associated with an increased risk of all cardiovascular events.” In addition, a sodium excretion of less than 3 g per day was associated with increased risk of cardiovascular mortality and hospitalization for congestive heart failure, and a higher estimated potassium excretion was associated with a reduced risk of stroke.
Serum vitamin D levels are significantly lower in patients with recurrent inflammatory spinal cord disease, according to the results of a study published online November 14 in Archives of Neurology. The study authors performed a retrospective analysis evaluating vitamin D levels of 77 patients with monophasic and recurrent inflammatory spinal cord diseases. “Vitamin D levels are significantly lower in patients who developed recurrent spinal cord disease, adjusting for season, age, sex, and race,” the investigators concluded. “This study provides a basis for a prospective trial of measuring 25-hydroxyvitamin D levels in these patient populations and assessing the influence of vitamin D supplementation on the frequency of relapses in those with recurrent inflammatory spinal cord disease.”
The FDA has approved AdaptiveStim with RestoreSensor neurostimulation system for the management of chronic pain. Unlike other implantable neurostimulation devices that require frequent manual adjustments with changes in body positions, the AdaptiveStim system (Medtronic, Inc; Minneapolis) automatically adapts stimulation levels to the needs of people with chronic back and/or leg pain by recognizing and remembering the correlation between a change in body position and the level of stimulation needed. The FDA’s approval was based on data from a clinical trial in which 86.5% of study participants with chronic pain experienced better pain relief and convenience when the system was turned on, compared with a control period when the participants manually adjusted neurostimulation settings; 80.3% of study participants also reported functional improvements, including improved comfort during position changes. The AdaptiveStim system was also approved for use in MRI head scans if recommended by a physician.
Brain overgrowth in boys with autism involves an abnormal excess number of neurons, according to the results of a small preliminary study published in the November 9 JAMA. “Autism often involves early brain overgrowth, including the prefrontal cortex,” the investigators stated. “Although prefrontal abnormality has been theorized to underlie some autistic symptoms, the cellular defects that cause abnormal overgrowth remain unknown.” To investigate whether this overgrowth in children with autism involves excess neuron numbers, the researchers compared postmortem tissue from the prefrontal cortex of seven boys (age range, 2 to 16) who had autism with postmortem tissue of six typically developing boys. They found that children with autism had 67% more neurons in the prefrontal cortex. “Brain weight in the autistic case differed from normative mean weight for age by a mean of 17.6%, while brains in controls differed by a mean of 0.2%,” the researchers reported.
A person’s stroke risk profile may also be helpful in predicting whether a person will develop memory problems and cognitive impairment later in life, according to a study published in the November 8 Neurology. “Participants included subjects without stroke at baseline … with at least two cognitive function assessments during the follow-up,” the researchers explained. “During a mean follow-up of 4.1 years, 1,907 participants met criteria for incident cognitive impairment.” The researchers determined that male sex, black race, less education, older age, and presence of left ventricular hypertrophy were related to the development of cognitive impairment. “Total Framingham Stroke Risk Profile score, elevated blood pressure, and left ventricular hypertrophy predict development of clinically significant cognitive dysfunction,” the investigators concluded. “Prevention and treatment of high blood pressure may be effective in preserving cognitive health.”
The FDA has approved Xarelto (rivaroxaban) to reduce the risk of stroke in people who have nonvalvular atrial fibrillation. Xarelto (Janssen Pharmaceuticals Inc; Titusville, New Jersey) is an oral anti-clotting drug that has also been approved to reduce the risk of blood clots, deep vein thrombosis, and pulmonary embolism following knee or hip replacement surgery. The FDA’s approval was based on the results of a clinical trial with more than 14,000 patients that compared Xarelto with the anti-clotting drug warfarin; Xarelto proved similar to warfarin in its ability to prevent stroke. Bleeding was the most common adverse event reported by patients treated with Xarelto in this clinical trial, and the risk of bleeding was similar to the risk of bleeding associated with warfarin.
Patients with dementia who have a stroke have a higher likelihood of becoming disabled and being institutionalized, compared with patients who did not have dementia at the time of their stroke, according to a report in the November 1 Neurology. Investigators conducted a retrospective cohort study that included 9,304 patients with an acute ischemic stroke, 702 of whom had a history of dementia. “Patients with dementia were older (mean age, 81 vs 70), had more severe strokes, and were more likely to have atrial fibrillation than those without dementia,” the investigators determined. They also found that patients with dementia were slightly less likely to be admitted to a stroke unit, had a higher disability at discharge, and were less likely to be discharged to their prestroke place of residence. “In patients with stroke, preexisting dementia is associated with high rates of disability and institutionalization, representing an increasing challenge for the health care system,” the researchers concluded.


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