Thrombolysis Benefits Patients With Stroke
In patients with acute stroke with an unknown time of onset, IV alteplase guided by a mismatch between diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR) in the region of ischemia results in a significantly better functional outcome and more intracranial hemorrhages at 90 days, compared with placebo, according to a study published August 16 in the New England Journal of Medicine. Researchers randomly assigned 254 participants to receive IV alteplase and 249 participants to receive placebo. Participants had an ischemic lesion on MRI diffusion-weighted imaging, but no parenchymal hyperintensity on FLAIR. A favorable outcome (ie, a score of 0 or 1 on the modified Rankin Scale at 90 days) occurred in 53.3% of the alteplase group versus 41.8% of the placebo group.
Thomalla G, Simonsen CZ, Boutitie F, et al. MRI-guided thrombolysis for stroke with unknown time of onset. N Engl J Med. 2018;379(7):611-622.
High Levels of Cortisol Linked to Impaired Memory
Middle-aged people with high levels of cortisol in their blood have impaired memory, compared with people with average levels of cortisol, according to a study published online ahead of print October 24 in Neurology. Researchers identified 2,231 people with an average age of 49 who did not have dementia. At the start of the study, each participant underwent a psychologic exam and assessments of memory and thinking skills. Participants’ memory and thinking skills were tested again at an average of eight years later. Participants also provided a blood sample. After adjusting for age, sex, smoking, and BMI, researchers found that people with high levels of cortisol had lower scores on tests of memory and thinking skills, compared with people with normal levels of cortisol.
Echouffo-Tcheugui JB, Conner SC, Himali JJ, et al. Circulating cortisol and cognitive and structural brain measures: The Framingham Heart Study. Neurology. 2018 Oct 24 [Epub ahead of print].
Is Nusinersen Effective If Initiated Later?
Patients with spinal muscular atrophy type 1 (SMA1) may benefit from nusinersen when the therapy is initiated after age 7 months, according to a study published online ahead of print August 29 in Neurology. In this study, 33 patients with SMA1 received intrathecal nusinersen injections. Researchers evaluated patients before treatment and at two months and six months after treatment. All patients were alive and continuing treatment at six months. Median progress on the modified Hammersmith Infant Neurologic Examination Part 2 score was 1.5 points after six months of treatment. The need for respiratory support significantly increased over time. The results are consistent with those of a phase III trial in which patients with SMA1 received nusinersen before age 7 months, the researchers said.
Aragon-Gawinska K, Seferian AM, Daron A, et al. Nusinersen in spinal muscular atrophy type 1 patients older than 7 months: a cohort study. Neurology. 2018 Aug 29 [Epub ahead of print].
Pre-Eclampsia Linked to Dementia in Late Life
Pre-eclampsia is associated with an increased risk of dementia, particularly vascular dementia, according to a study published October 17 in BMJ. The study cohort consisted of 1,178,005 Danish women with at least one live birth or stillbirth between 1978 and 2015. Women with a history of pre-eclampsia had more than three times the risk of vascular dementia later in life, compared with women with no history of pre-eclampsia. The association with vascular dementia seemed to be stronger for late-onset disease than for early-onset disease. Adjustment for diabetes, hypertension, and cardiovascular disease attenuated the hazard ratios moderately. Sensitivity analyses suggested that BMI was unlikely to explain the association with vascular dementia. In contrast, modest associations were observed for Alzheimer’s disease and other or unspecified dementia.
Basit S, Wohlfahrt J, Boyd HA. Pre-eclampsia and risk of dementia later in life: nationwide cohort study. BMJ. 2018;363:k4109.