The apolipoprotein E (APOE) gene differentially affects the risks of developing mild cognitive impairment (MCI) and Alzheimer disease (AD). In 3 case-control analyses in this meta-analysis of 27 independent research studies with a total of 57 979 non-Hispanic white participants from the Global Alzheimer Association Interactive Network, Neu and coauthors found that 31 340 men and women with 1 copy of the APOE ε4 allele shared the same risks for MCI and AD between ages 55 and 85 years, contrary to long-standing views. However, women in this group were found to have increased risks for MCI (at 55 to 75 years) and AD (at 65 to 75 years) at younger ages compared with men. Conversely, the APOE ε2 allele conferred a protective effect on women and decreased their risk of AD compared with men. Editorial perspective is provided by Dubal and Rogine.
Audio Author Interview
Zika virus (ZIKV) is associated with life-threatening neurological syndromes, but most current evidence is derived from case series. In this prospective cohort study from a tertiary neurological disease referral center in Brazil between December 2015 and May 2016, da Silva and coauthors show that an increased incidence of hospital admissions for acute neurological syndromes was observed compared with the pre-ZIKV era for Guillain-Barré syndrome, encephalitis, and transverse myelitis, with most patients showing evidence of recent ZIKV infection. Of 40 patients with a diverse spectrum of neurologic syndromes (25 men; mean [range] age, 44 [22-72] years), 35 (88%) had molecular and/or serologic evidence of recent ZIKV infection. Editorial perspective is provided by Tyler and Roos.
Continuing Medical Education
Neurological complications are an increasingly recognized consequence of anti–programmed death 1 (PD-1) therapies, commonly used in solid malignancies. In a retrospective cohort study using the Mayo Cancer Pharmacy database, Kao and coauthors found that of 347 patients receiving anti–PD1 therapies, 10 patients (2.9%; 8 men; median [range] age, 71 [31-78] years) experienced neurological complications (eg, myopathy, various neuropathies, cerebellar ataxia, necrotizing myopathy, internuclear ophthalmoplegia, retinopathy, and headache) within 12 months of treatment with these checkpoint therapies for stage IV metastatic disease. Editorial perspective is provided by Strowd.
Continuing Medical Education
Fundoscopic examination is required by the American Council of Graduate Medical Education to be learned by neurology residents; however, the skill has been historically difficult to teach and assess owing to the impossibility of simultaneous confirmation of a resident’s findings and a teacher’s assessment. In a single-blind education study of 48 neurology residents (30 men), Gupta and coauthors provided both control (n = 24) and intervention (n = 24) groups with lecture-based training videos that covered fundoscopy and fundoscopic examination, and the intervention group also participated in a 1-hour workshop with faculty that included practice with a fundoscopic simulator. The intervention group had greater increases in skills and self-reported fundoscopy examination confidence compared with the control group.