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In This Issue of JAMA Neurology
March 2019


JAMA Neurol. 2019;76(3):243. doi:10.1001/jamaneurol.2018.2976


Although migraine is more common in women of reproductive age and has been associated with increased risk of cardiovascular events and hypertension, data are unclear regarding an association between migraine and type 2 diabetes in women. Using data from a prospective cohort of 74 247 women from the large French E3N study, Fagherazzi and coauthors observed a lower risk of type 2 diabetes in women with active migraine over 10-year follow-up. A linear decrease of migraine prevalence long before and a plateau long after type 2 diabetes diagnosis suggest a potential role of both hyperglycemia and hyperinsulinism on migraine occurrence. Editorial perspective is provided by Gelfand and Loder.


Author Audio Interview Continuing Medical Education

There is conflicting evidence for racial differences in Alzheimer disease (AD), which is compounded by the lack of inclusion of nonwhite participants in AD research. In a research cohort of cognitively normal older adults and older adults with AD, Morris and coauthors compared biomarker results in 173 African American participants with results in 1082 non-Hispanic white participants. There were no racial differences in amyloid burden measured either by positron emission tomography or by cerebrospinal fluid assay. However, African American participants had lower concentrations of total tau and phosphorylated tau181 compared with white participants; these differences were largely in individuals who were carriers of an apolipoprotein E (APOE) ε4 allele. Racial disparities in AD biomarkers may be a function of the interaction of APOE ε4 with tau. Editorial perspective is provided by Barnes.


Because higher-quality brain imaging is becoming more available, the number of incidentally discovered saccular unruptured intracranial aneurysms is on the rise. Algra and coauthors performed a systematic review and meta-analysis of 114 studies (106 433 patients with 108 263 aneurysms) and identified factors associated with complications from preventive endovascular treatment and preventive neurosurgical treatment. Among the 74 studies of endovascular treatment, the risk of procedural clinical complications was 4.96% and the case-fatality rate was 0.30%; in the 54 studies of neurosurgical treatment, the pooled complication risk was 8.34% and the case-fatality rate was 0.10%. As more standardized and detailed recording of clinical complications from treatment of unruptured intracranial aneurysms become available, more accurate risk scores for individual patients can be developed to determine treatment choice.

Cerebral palsy (CP) is a lifelong condition, but most mental health research on individuals with CP is focused on childhood. In this retrospective longitudinal cohort study of 1705 adults with CP and a matched group of 5115 adults without CP, Smith and coauthors analyzed primary care data in the United Kingdom. Adults with CP had an increased adjusted hazard of depression and anxiety compared with the matched reference group. There were 1342 individuals with CP and no comorbid intellectual disability who had a higher risk of incident depression and anxiety than matched controls, suggesting that targeted interventions should be developed for adults with CP.