News Briefs From the 65th Annual Meeting of the American Academy of Neurology

SAN DIEGO—A new panel of clinical tests introduced at the 65th Annual Meeting of the American Academy of Neurology is intended to help physicians diagnose suspected dementia resulting from treatable forms of cognitive impairment. The test panel, created by Quest Diagnostics, is the first commercial service from a clinical laboratory that combines various guideline-recommended tests for identifying secondary and treatable causes of dementia into a single blood test and report, according to the company.

Using the results of biologic laboratory tests, the service may help primary care physicians examine patients presenting with cognitive impairment for causes of dementia that are reversible, such as vitamin B12 deficiency, hypothyroidism, anemia, and diabetes. Patients with abnormal results on the tests may improve, and the underlying causes of dementia may be reversed if the physician administers appropriate treatment. Patients with dementia whose results are normal may need to be evaluated by a neurologist for other causes of dementia, such as Alzheimer's disease.

The panel of tests is based on the recommendations of the American Academy of Neurology, the American Geriatrics Association, a Consensus Panel of NIH, and the European Federation of Neurological Societies.

In addition, Athena Diagnostics introduced a suite of genetic tests designed to aid the detection of various rare neurologic disorders such as hereditary neuropathy, neuromuscular disease, epilepsy, and several movement disorders. The tests use gene sequencing and bioinformatics to evaluate many clinically relevant genes with one blood draw, potentially simplifying the diagnostic process. Test results may help physicians and genetic counselors confirm diagnoses, develop treatment plans, and manage patient care.

The new service includes expanded testing for Charcot-Marie-Tooth disease and myofibrillar myopathy. Athena Diagnostics is also offering new tests for hereditary sensory and autonomic neuropathy, hereditary neuralgic amyotrophy, hypokalemic periodic paralysis, limb girdle muscular dystrophy, benign familiar infantile epilepsy, and familial paroxysmal kinesigenic dyskinesia.

Heart Attack Patients Who Receive Therapeutic Hypothermia Are Unlikely to Have Cognitive Impairment
The majority of patients treated with therapeutic hypothermia after cardiac arrest had preserved cognitive function and were able to return to work, according to research presented at the 65th Annual Meeting of the American Academy of Neurology. Researchers from the Mayo Clinic in Rochester, Minnesota, and Vanderbilt University in Nashville sought to determine the long-term cognitive abilities of patients surviving out-of-hospital cardiac arrest who were treated with therapeutic hypothermia. They prospectively studied consecutive survivors of cardiac arrest who underwent therapeutic hypothermia from June 2006 to May 2011.

The researchers reviewed the medical records and recorded the results of brain imaging, serum neuron-specific enolase (NSE) measurements, and electroencephalograms of the patients identified for study. They assessed cognitive domains using the Telephone Interview for Cognitive Status (TICS-m). An education-adjusted score of 32 or greater was considered normal.

Of 133 total patients, 77 (58%) were alive at a mean follow-up of 21 months (range two to 59 months). The researchers interviewed 56 patients (73% of those alive). Median age was 67 (range, 24 to 88). Fifty-one patients (91%) were living independently. Median TICS-m score was 33 (range, 16 to 41). Thirty-three (60%) were considered cognitively normal, and 22 (40%) were cognitively impaired. The time-to-assessment did not differ among the cognitive outcomes. Eighteen patients were not working at the time of their cardiac arrest (17 retired, one unemployed). Of the 38 patients who were working up to the time of the cardiac arrest, 30 (79%) returned to work. Cognitive outcome was not associated with age, time to return of spontaneous circulation, brain atrophy, leukoaraiosis, or NSE level.

Three Drugs May Reduce Symptoms Associated With Parkinson's Disease
Various drug treatments may improve the quality of life for patients with Parkinson's disease by alleviating associated problems, according to three studies that were presented at the 65th Annual Meeting of the American Academy of Neurology. The drugs are intended to reduce orthostatic hypotension, decrease off time, and control symptoms, respectively.

Orthostatic hypotension occurs in approximately 18% of patients with Parkinson's disease and can cause dizziness, fainting, and falls. Robert A. Hauser, MD, Professor of Movement Disorders at the University of South Florida in Tampa, and colleagues randomized 225 participants with Parkinson's disease to eight weeks of stable-dose treatment with placebo or droxidopa. After one week of treatment, patients who received droxidopa had a twofold decrease in dizziness and lightheadedness, compared with individuals who received placebo. Over the entire 10-week study duration, patients in the active group had an average of 0.38 falls per patient per week, while subjects who received placebo had an average of 1.73 falls per patient per week.