Hospitalization of patients with stroke in primary stroke centers, compared with noncertified hospitals, is associated with decreased seven-day and 30-day case fatality, according to a study published online ahead of print July 25 in JAMA Internal Medicine. Among 865,184 elderly patients with stroke (mean age, 78.9; 55.5% female), 53.9% were treated in primary stroke centers. Admission to primary stroke centers was associated with 1.8% lower seven-day and 1.8% lower 30-day case fatality. Fifty-six patients with stroke needed to be treated in primary stroke centers to save one life at 30 days. Overall, receiving treatment in primary stroke centers was associated with a 30-day survival benefit for patients traveling less than 90 minutes, but traveling at least 90 minutes offset any benefit of care in primary stroke centers.
Obesity may increase the risk of neurodegeneration, according to a study published online ahead of print July 27 in Neurobiology of Aging. Participants were a population-based cohort of cognitively healthy adults recruited over a five-year period. In all, 527 subjects with an age range of 20 to 87 were included. Researchers performed a cross-sectional analysis of MRI-based brain structure and found a statistically significant interaction between age and BMI. Cortical reconstruction techniques were used to generate measures of whole brain cerebral white matter volume, cortical thickness, and surface area. Cerebral white matter volume in overweight and obese individuals was associated with a greater degree of atrophy, with maximal effects in middle age corresponding to an estimated increase in brain age of 10 years.
Thymectomy improves clinical outcomes over a three-year period in patients with nonthymomatous myasthenia gravis, according to a study published August 11 in the New England Journal of Medicine. Researchers randomized 126 patients to thymectomy plus alternate-day prednisone or alternate-day prednisone alone. Patients who underwent thymectomy had a lower time-weighted average Quantitative Myasthenia Gravis score over a three-year period than those who received prednisone alone. Patients in the thymectomy group also had a lower average requirement for alternate-day prednisone. Fewer patients in the thymectomy group than in the prednisone-only group required immunosuppression with azathioprine or were hospitalized for exacerbations. The number of patients with treatment-associated complications did not differ significantly between groups. However, patients in the thymectomy group had fewer treatment-associated symptoms related to immunosuppressive medications.
Calcium supplementation may increase the risk of developing dementia in elderly women with cerebrovascular disease, according to a study published online ahead of print August 17 in Neurology. This longitudinal population-based study included 700 women without dementia between ages 70 and 92. At baseline and at five-year follow-up, the women underwent comprehensive neuropsychiatric and somatic examinations. A CT scan also was performed in 447 participants at baseline. Information on the use and dosage of calcium supplements was collected. Women treated with calcium supplements had a higher risk of developing dementia and the subtype of stroke-related dementia. Calcium supplementation was associated with the development of dementia in groups with a history of stroke or presence of white matter lesions, but not in groups without these conditions.
Exposure to bright light during the day may help combat sleep disturbances associated with the evening use of electronic devices emitting blue light, according to a study published online ahead of print June 16 in Sleep Medicine. Following a constant bright light exposure over 6.5 hours, 14 participants read a novel either on a tablet or as a physical book for two hours. Evening concentrations of saliva melatonin were measured repeatedly. Sleepiness was assessed before and after nocturnal sleep. About one week later, experiments were repeated. Participants who had read the novel on a tablet in the first experimental session continued reading the same novel as a physical book, and vice versa. There were no differences in sleep parameters and presleep saliva melatonin levels between the tablet reading and physical book reading conditions.
Treatment immediately after clinically isolated syndrome (CIS) is more beneficial than delayed treatment, according to a study published online ahead of print August 10 in Neurology. Researchers randomized 278 people with CIS to interferon beta-1b or placebo. After two years or a diagnosis of multiple sclerosis (MS), patients receiving placebo could receive treatment. After 11 years, risk of clinically definite MS remained lower in the early-treatment arm, compared with the delayed-treatment arm, with longer time to first relapse and lower overall annualized relapse rate. Twenty-five patients converted to secondary progressive MS. Expanded Disability Status Scale scores remained low and stable, with no difference between treatment arms. The early-treatment group had better Paced Auditory Serial Addition Task-3 total scores. Health resource utilization was low in both groups.