News Roundup

New and Noteworthy Information—January 2015



Diabetes prevention and glucose control in midlife may protect against late-life cognitive decline, according to a study published December 2 in Annals of Internal Medicine. Researchers analyzed data from the Atherosclerosis Risk in Communities Study (ARIC). The investigators compared the amount of cognitive decline associated with aging with the amount of decline found in the ARIC participants. The study authors determined that participants with poorly controlled diabetes had 19% more cognitive decline than expected. They also observed declines for participants with controlled diabetes and prediabetes. “Knowing that the risk for cognitive impairments begins with diabetes and other risk factors in midlife can be a strong motivator for patients and their doctors to adopt and maintain long-term healthy practices,” stated the researchers.

The likelihood of receiving a clinical cognitive evaluation in elderly individuals with dementia depends on patient-specific factors such as severity of cognitive impairment and current marital status, according to a study published online ahead of print November 26 in Neurology. The investigation was part of the Health and Retirement Study. Eight hundred forty-five people age 70 and older were evaluated for dementia, and 297 met the criteria for dementia. Of those people, 45% had seen a doctor about their memory problems, compared with 5% of those with memory and thinking problems that did not meet the criteria for dementia, and 1% of those with normal memory and thinking skills. People who were married were more than twice as likely to undergo screening as people who were not married.

Stimwave Technologies (Miami Beach, Florida) has received FDA clearance to market the Stimwave Freedom Spinal Cord Stimulator System, a wireless, microtechnology neuromodulation device for the relief of chronic back pain and leg pain. The device, a long-term implant, is between 2 and 11 cm long and can be inserted through a standard needle. The Stimwave Freedom Spinal Cord Stimulator System also eliminates the need for long wires to be tunneled through the body and connected to the battery source. Patients who receive the system can undergo whole-body 3-T or 1.5-T MRI without removing the implant. The Stimwave technology is also fixed in place by an anchor that allows it to move only when the body moves. The device contains no internal batteries or toxic materials.

Chronic impairment of glymphatic pathway function after traumatic brain injury (TBI) may be a key factor that renders the post-traumatic brain vulnerable to tau aggregation and the onset of neurodegeneration, according to a study published December 3 in Journal of Neuroscience. Previously, investigators defined a network of paravascular channels called the glymphatic pathway that facilitates the clearance of solutes such as amyloid-β from the brain. The researchers demonstrated that extracellular tau in mice is cleared from the brain along the paravascular pathways. After TBI, glymphatic pathway function was reduced by 60%, and this impairment persisted for at least one month after injury. Knockout of the gene encoding the astroglial water channel aquaporin-4 exacerbated glymphatic pathway dysfunction after TBI and promoted the development of neurofibrillary pathology and neurodegeneration in the post-traumatic brain.

In patients with transient ischemic attack (TIA), CT evidence of acute ischemia alone or acute ischemia with chronic ischemia is associated with increased subsequent stroke risk within 90 days, according to a study published online ahead of print December 4 in Stroke. Of 2,028 patients who received CT scans within 24 hours of a TIA, 814 (40.1%) had brain damage resulting from ischemia. In addition, 3.4% of the people in the study group had a subsequent stroke within 90 days, and 25% of patients with CT scans showing three types of damage to their brain had strokes. “These findings should prompt physicians to be more aggressive in managing patients with TIA or nondisabling stroke who are diagnosed with acute ischemia, especially if there is additional chronic ischemia and microangiopathy,” the researchers said.

People who have sleep apnea or spend less time in deep sleep may be more likely to have changes in the brain that are associated with dementia, according to a study published December 10 in Neurology. A total of 167 Japanese–American men had sleep tests in their homes at an average age of 84. All men were followed until they died at an average of six years later. Autopsies were conducted on their brains to look for microinfarcts. Of the 41 men who spent the least sleep time with low blood oxygen levels, four had microinfarcts in the brain. Fourteen of the 42 men with the most sleep time with low blood oxygen levels had the abnormalities; thus, they were nearly four times more likely to develop brain damage.

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