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Concussions affect more than 1 million Americans each year but are sometimes dismissed in medical care if the patient recovers quickly. Redelmeier and coauthors conducted a population-based double cohort study including 28 815 patients 66 years and older who were free of dementia and diagnosed as having a concussion, with a mean follow-up of 3.9 years. Their results suggest the average concussion doubles the relative risk of subsequent dementia. The study also highlights a potential modest benefit from statins for neurological recovery and the importance of preventing concussions at all ages. Editorial perspective is provided by Whitmer.
Author Audio Interview
Although the diagnostic criteria for status epilepticus (SE) have become more refined and treatment has become more aggressive since the late 1990s, it is unclear if there have been any effects on mortality rates. In a systematic review and meta-analysis of mortality in generalized convulsive SE, Neligan and coauthors identified 61 studies published between 1990 and 2017 with a high degree of heterogeneity. There was no convincing evidence that the mortality of SE had changed over time in individual subgroups using a meta-regression model nor a significant reduction in study subgroup heterogeneity despite use of a multivariate mega-regression model. Failure to demonstrate evidence of improved prognosis of SE over time is concerning, and further work is needed to help improve outcomes. Editorial perspective is provided by Guterman and Betjemann.
The benefits of low-dose aspirin for the secondary prevention of myocardial infarction and ischemic stroke are clear; however, the unintended consequence of increasing the risk of intracranial hemorrhage in the general population taking low-dose aspirin regimen is unknown. In a systematic review and meta-analysis, Huang and coauthors identified 13 randomized clinical trials of low-dose aspirin use and found that in patients without symptomatic cardiovascular disease, the use of low-dose aspirin was associated with an overall increased risk of intracranial hemorrhage compared with controls, particularly increasing the risk of intracerebral hemorrhage for patients of Asian race/ethnicity and people with low body mass index. Low-dose aspirin should not be recommended for primary prevention of cardiovascular events in part because of the risks of intracranial bleeding.
Continuing Medical Education
Late-onset Alzheimer disease (LOAD) is the most common form of dementia, but genetic causes of LOAD are not completely explained by known genetic loci. The frequency of LOAD varies across populations, and rare variants identified tend to be ethnicity specific; consequently, lack of diversity in genetic studies can be a source of bias. In a meta-analysis, Tosto and coauthors examined whole-exome and whole-genome sequencing data from 15 030 participants in the Alzheimer Disease Sequencing Project; the Religious Orders Study and Memory and Aging Project; and the Washington Heights, Hamilton Heights, Inwood Community Aging Project, representing different ethnic groups. They identified an association of PINX1, a gene involved in telomere integrity, and TREM2, involved in the innate immune system, with LOAD. Both genes have well-established roles in aging and neurodegeneration and could serve to generate new, biologically testable hypotheses.
Highlights. JAMA Neurol. 2019;76(8):877. doi:10.1001/jamaneurol.2018.3001
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