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This Month in Archives of Neurology
January 2010

Inherited Strokes

Arch Neurol. 2010;67(1):13-14. doi:10.1001/archneurol.2009.306

Inherited Strokes

Testai and Gorelick Article provide a rich and important review of strokes associated with specific genetic disorders. Advances in our understanding of molecular genetics and cellular metabolic pathways have led to the detection of strokes caused by inherited metabolic disorders. These genetic disorders underlie the cause of stroke and provide treatment opportunities if properly diagnosed.

The Balance of Dopamine Agonist and Levodopa

Brodsky et al Article examine the effect of a dopamine agonist on the motor response to levodopa in a double-blind, randomized, placebo-controlled crossover trial. Pramipexole augmented the motor response to levodopa beyond a simple additive effect and increased the severity of levodopa-induced dyskinesia. When considering combination of these therapies, an appropriate balance should be maintained regarding gain of motor function vs worsening of dyskinesia.

Do Multiple Chronic Infections Increase the Risk of Stroke?

Elkind et al Article report that common infections may be associated with stroke risk, though no single infection is likely a major independent predictor. A quantitative weighted index of infectious burden was associated with risk of first stroke in this cohort. Editorial perspective is provided by Armin J. Grau, MD, PhD, and Tobias Brandt, MD, PhD. Article

Mean infectious burden index (IBI) by serological status for each of the 5 infections. CMV indicates cytomegalovirus; C pneumoniae, Chlamydia pneumoniae; H pylori, Helicobacter pylori; and HSV, herpes simplex virus.

Mean infectious burden index (IBI) by serological status for each of the 5 infections. CMV indicates cytomegalovirus; C pneumoniae, Chlamydia pneumoniae; H pylori, Helicobacter pylori; and HSV, herpes simplex virus.

Hospital Care for Patients With Stroke on the Weekends vs Weekdays

Kazley et al Article examined the aggressiveness and quality of care for the treatment of acute ischemic stroke on the weekend vs weekdays. Their analysis demonstrates that patients with acute ischemic stroke are more likely to receive tissue plasminogen activator on weekends than weekdays. The dynamics of this process are interesting and have wide implications for implementing necessary acute care.

Proteinuria and Risk of Stroke

Ovbiagele and colleagues Article report that proteinuria is strongly associated with both the frequency and number of cerebral microbleeds in patients with recent cerebral ischemia. Urinary protein excretion may be a cerebral microbleed risk marker or potential therapeutic target for mitigating the untoward clinical sequela linked to cerebral microbleeds.

Multiple Sclerosis Relapse Rates and Pregnancy

Langer-Gould et al Article determined whether fluctuations in functional T-cell subsets can explain why multiple sclerosis relapses decline during pregnancy and increase during the postpartum period. Their findings suggest that a decline in circulating CD4+ interferon-γ–producing cells leads to postpartum multiple sclerosis relapses. Their findings also suggest that the decline in these cells may begin during late pregnancy and that lactational amenorrhea induced by exclusive breastfeeding may be able to interrupt this process.

Dopamine Agonist Withdrawal Syndrome in Parkinson Disease

Rabinak and Nirenberg Article characterize a dopamine agonist withdrawal syndrome in Parkinson disease. Dopamine agonist withdrawal syndrome symptoms resembled those of other drug withdrawal syndromes and included anxiety, panic attacks, agoraphobia, depression, dysphoria, diaphoresis, fatigue, pain, orthostatic hypotension, and drug cravings. Dopamine agonists have a stereotyped withdrawal syndrome that can lead to profound disability in a subset of patients. Physicians should monitor patients closely when tapering these medications.

What Is a Clinically Important Difference on the Unified Parkinson Disease Rating Scale?

Shulman and colleagues Article examine parameters of minimal, moderate, and large clinically important difference for the Unified Parkinson Disease Rating Scale (UPDRS). Concordance among multiple approaches of analysis based on both subjective and objective data shows that reasonable estimates for a clinically important difference on the motor UPDRS are minimal, 2.5 points; moderate, 5 points; and large, 11 points. Estimates for the total UPDRS are minimal, 4.5 points; moderate, 9 points; and large, 17 points. These parameters will assist in determining clinically meaningful changes in Parkinson disease progression and response to therapeutic interventions.

Cognition and Aerobic Exercise for Mild Cognitive Impairment

Baker et al Article have examined the effects of aerobic exercise on cognition and other biomarkers associated with Alzheimer disease pathology for older adults with mild cognitive impairment and assess the role of sex as a predictor of response. For women, aerobic exercise improved performance on multiple tests of executive function, increased glucose disposal during the metabolic clamp, and reduced fasting plasma levels of insulin, cortisol, and brain-derived neurotrophic factor. For men, aerobic exercise increased plasma levels of insulinlike growth factor I and had a favorable effect only on Trails B test performance.

Exercise and Mild Cognitive Impairment

Geda and colleagues Article have studied whether physical exercise is associated with a decreased risk of dementia and Alzheimer disease. They investigated, in addition, whether physical exercise is also associated with mild cognitive impairment. In this population-based case-control study, any frequency of moderate-intensity exercise carried out in either midlife or late life was associated with a reduced odds ratio of mild cognitive impairment.

C-Reactive Protein and Cognitive Impairment

Noble et al Article have explored the association between high-sensitivity C-reactive protein and cognitive impairment in a cross-sectional analysis of a population-based community aging study. They report that high levels of high-sensitivity C-reactive protein may be a marker of memory and visuospatial impairment in elderly persons.

APOE ε4 Genotype and Longitudinal Changes in Cerebral Blood Flow in Normal Aging

Thambisetty and colleagues Article used positron emission tomography to study differences in longitudinal changes in regional cerebral blood flow between apolipoprotein E (APOE) ε4 carriers and noncarriers in older adults without dementia from the Baltimore Longitudinal Study of Aging. Their main goal was to examine whether there are regionally specific longitudinal changes in regional cerebral blood flow in APOE ε4 carriers that might be related to its well-established role as a genetic risk factor for Alzheimer disease. Their findings suggest that APOE ε4–mediated risk of Alzheimer disease is associated with widespread decline in regional cerebral blood flow over time that precedes the onset of dementia.

Donepezil, Changes in Hippocampal Structure, and Early Alzheimer Disease

Wang et al Article compared longitudinal changes in the hippocampal structures of subjects with very mild dementia of the Alzheimer type (DAT) who were treated with donepezil, untreated subjects with very mild DAT, and controls without dementia. They report that treatment with donepezil did not alter the progression of hippocampal deformation in subjects with DAT in this study.