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In This Issue of JAMA
May 19, 2015


JAMA. 2015;313(19):1883-1885. doi:10.1001/jama.2014.11749

In a randomized trial that enrolled 269 patients with acute radiculopathy due to a herniated lumbar disk, Goldberg and colleagues assessed the effect of a tapering 15-day course of oral prednisone (total cumulative dose, 600 mg) on physical function and pain. The authors report that compared with placebo, short-course oral steroids resulted in modest improvement in function but no improvement in pain.

Author Video Interview and Continuing Medical Education

Cerebral amyloid-β aggregation is an early neuropathological event in Alzheimer disease. In a meta-analysis of individual participant data from 55 studies (involving 2914 persons with normal cognition, 697 persons with subjective cognitive impairment, and 3972 persons with mild cognitive impairment), Jansen and colleagues estimated the prevalence of amyloid pathology from positron emission tomography imaging or cerebral spinal fluid findings. Among their findings was that the prevalence of cerebral amyloid pathology was associated with age, apolipoprotein E genotype, and the presence of cognitive impairment. In an Editorial, Rosenberg discusses the potential clinical use of amyloid imaging in the diagnosis of dementia and, perhaps, eventual treatment of persons at risk.

Related Article

Amyloid-β positron emission tomography (PET) imaging allows in vivo detection of amyloid plaques—a key, but not defining, feature of Alzheimer disease. In an analysis of data from 1359 patients with Alzheimer disease, 538 patients with non–Alzheimer dementia, 1849 healthy controls, and an independent sample of 1359 patients with an autopsy diagnosis of Alzheimer disease, Ossenkoppele and colleagues found that the prevalence of amyloid positivity was associated with clinical diagnosis, age, and apolipoprotein E genotype—suggesting potential clinical utility of amyloid imaging in the diagnosis of some forms of dementia.

Editorial and Related Article

Clinical Review & Education

Atrial fibrillation is associated with a substantial increase in the risk of stroke. Based on a systematic review of studies relating to atrial fibrillation, stroke risk, and stroke prevention, Lip and Lane summarize current concepts and recent developments in stroke prevention for patients with atrial fibrillation. The authors review stroke and bleeding risk prediction scores and conclude that patients with atrial fibrillation and 1 or more stroke risk factor should be offered oral anticoagulant therapy.

Author Audio Interview and Continuing Medical Education

An article in JAMA Neurology reported data from a prospective cohort study of middle-aged adults, which found that compared with normal blood pressure, midlife hypertension and elevated systolic blood pressure in midlife but not late life were associated with more cognitive decline during 20 years’ follow-up. In this From The JAMA Network article, DeCarli discusses the importance of early diagnosis and appropriate treatment of hypertension.

This JAMA Clinical Evidence Synopsis by Molyneaux and colleagues summarizes findings from an updated Cochrane review of antidepressants for postnatal depression. Based on the available evidence (6 studies; 596 patients), selective serotonin reuptake inhibitors are associated with higher rates of response and remission than placebo. Whether antidepressant medications have greater efficacy than psychological treatments and whether outcomes vary by depression severity could not be determined.

An 87-year-old woman with a history of open-angle glaucoma reported a gradual darkening of her right iris and right-side eyelash lengthening during the prior year, without changes in vision or foreign-body sensation. Her medications included bimatoprost, atenolol, atorvastatin, and clopidogrel. What would you do next?