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In This Issue of JAMA Neurology
February 2018


JAMA Neurol. 2018;75(2):139. doi:10.1001/jamaneurol.2017.2621


Exposure in utero to antiepileptic drugs is associated with increased risk of autistic traits in childhood. In this population-based cohort and Norwegian biobank study, Bjørk and coauthors found that the risk of autistic traits in children exposed to antiepileptic drugs in utero (n = 335) was significantly higher at 18 months of age when their mothers had not used folic acid supplements compared with children of mothers who had used supplements. Degree of autistic traits was inversely associated with maternal plasma folate concentrations and folic acid doses. Meador provides editorial perspective.


Author Audio Interview

Parkinson disease dementia affects 75% to 90% of patients who have had Parkinson disease for more than 10 years, but current treatments have only been modestly successful. Following the publication of encouraging findings in a single case report, Gratwicke and coauthors sought to further explore the potential of nucleus basalis of Meynert deep brain stimulation in patients with Parkinson disease dementia. In this double-blind crossover trial, 6 men (mean [SD] age, 65.2 [10.7] years) with Parkinson disease dementia underwent low-frequency stimulation to the nucleus basalis of Meynert bilaterally. While there were no consistent objective improvements in cognitive performance, there was a marked reduction in visual hallucinations in 2 participants, supporting the further exploration of nucleus basalis of Meynert deep brain stimulation in patients with disabling, treatment-refractory visual hallucinations. Deeb et al provide editorial perspective.


Intracranial aneurysm (IA) is prevalent in 2% to 5% of the adult population. While most of these lesions will remain asymptomatic, the results of ruptured aneurysms may be devastating, and therefore, identifying potentially modifiable risk factors for aneurysm formation is important. In a cross-sectional study conducted at Seoul National University Hospital between December 2004 and November 2015, Shin and coauthors reviewed the results of brain magnetic resonance angiography and bone mineral densitometry as well as other clinical information from health checkup program records of 12 785 patients (7242 women [56.6%]; mean [SD] age, 54.8 [10.1] years); they identified IAs in 472 patients (3.7%). Lower bone mineral density was associated with increased risk of IA, and the lowest bone mineral density tertile was associated with multiple and larger IAs, especially in at-risk populations. This provocative finding may further link risks between bone fragility and aneurysm formation.

Multiple disease processes are possibly associated with cognitive impairment in Parkinson disease (PD), including Lewy body accumulation, cerebrovascular disease, and Alzheimer disease. To determine whether tau and β-amyloid contribute to cognitive impairment in PD, Winer and coauthors conducted a cross-sectional study using positron emission tomography to evaluate 15 cognitively normal patients with PD, 14 patients with PD with mild cognitive impairment, and 49 healthy control participants (47 women [60%]; mean [SD] age, 71.1 [6.6] years). Tau and β-amyloid were not associated with cognitive functioning in PD. Alzheimer disease–related pathology does not seem to be a primary contributor to cognitive decline in patients with PD without dementia.