DOES MIGRAINE WITH AURA PROTECT AGAINST MEMORY DECLINE?

Migraine patients with aura may show less decline in cognitive function over time compared with people without migraine, according to Amanda Kalaydjian, PhD, and colleagues. The investigators’ results, published in the April 24 Neurology, showed that this association was limited to persons older than 50.

Data from Waves III (1993-1996) and IV (2004-2005) of the Baltimore Epidemiologic Catchment Area Study were analyzed. At baseline, 1,448 persons were eligible for the study; 812 of these were evaluated at both Waves III and IV. Scores on immediate and delayed recall tests and the Mini-Mental State Examination (MMSE) were compared. Two hundred and four patients (14%) received a diagnosis of migraine; 95 of these had migraine with aura.

Although migraineurs had lower scores on immediate and delayed memory tests at baseline, their scores declined less over time than did scores provided by nonmigraineurs. Specifically, scores of migraineurs with aura declined by 1.26 and 1.47 words less than those of nonmigraineurs on the immediate and delayed recall tests over a 12-year follow up period. In addition, among participants younger than 50, both migraineurs with aura and nonmigraineurs declined on the MMSE at the same rate, but in migraineurs with aura who were older than 50, the decline was 0.99 point lower than that of nonmigraineurs.

Due to previous evidence of a neuroprotective effect of nonaspirin NSAIDs and the fact that migraineurs often use this treatment, the investigators considered NSAIDs as a potential confounder of the association between migraine and cognitive functioning. However, “[a]lthough it is possible ... that the increased use of nonaspirin NSAIDs among migraineurs might be at least partially responsible for the observed reduction in cognitive decline, it is unlikely that nonaspirin NSAIDs underlie the reduction in decline given that it was adjusted for in the model and showed no indication of a significant protective effect,” Dr. Kalaydjian and colleagues stated. “Alternatively, other medications that are prescribed for migraine headaches, such as b-blockers, calcium channel blockers, and anticonvulsants, may also be partially responsible for the reduction in cognitive decline.” The researchers also posited that a change in diet or behavior could improve cognitive function among migraineurs.

“However, it seems more likely that there may be some underlying biologic mechanism associated with migraine headaches, such as changes in vasculature or underlying differences in neuronal activation, which results in decreased cognitive decline over time,” Dr. Kalaydjian’s team pointed out.

Suggested Reading
Kalaydjian A, Zandi PP, Swartz KL, et al. How migraines impact cognitive function: findings from the Baltimore ECA. Neurology. 2007;68:1417-1424.

INCREASED RISK OF CARDIOVASCULAR DISEASE LINKED TO MIGRAINE IN MEN

Migraine may be associated with a significantly increased risk of major cardiovascular disease in men, which may in turn be driven by an increased risk of myocardial infarction, as reported in the April 23 Archives of Internal Medicine.

Tobias Kurth, MD, ScD, and colleagues analyzed yearly questionnaires submitted by a prospective cohort of 20,084 initially healthy men, ages 40 to 84, who were participating in the Physicians’ Health Study. The investigators followed up with the participants for a mean of 15.7 years. A total of 1,449 (7.2%) participants reported migraine until 60 months, while 434 reported migraine four or more times, which qualified these men as having frequent migraine. There were 2,236 major ischemic cardiovascular disease events, 1,046 myocardial infarctions, 866 ischemic cardiovascular disease deaths, and 750 ischemic strokes. There were also 2,257 coronary revascularizations and 2,625 cases of angina reported.

Compared with participants who did not have migraine, men who did had multivariable-adjusted hazard ratios of 1.42 for myocardial infarction, 1.24 for major cardiovascular disease, 1.15 for angina, 1.12 for ischemic stroke, 1.07 for ischemic cardiovascular death, and 1.05 for coronary revascularization. Those with migraine were also younger, reported hypertension more frequently, were less likely to smoke cigarettes or consume alcohol on a regular basis, and were more likely to report a history of 240 mg/dL of cholesterol or greater. After adjustment for cardiovascular risk factors, men who reported migraine by the five-year questionnaire had a 24% increased risk of major cardiovascular disease and a 42% increased risk of myo­cardial infarction, compared with men who did not report migraine by that time point.

However, migraine was not significantly associated with an increased risk of ischemic stroke, death from ischemic cardiovascular disease, or coronary revascularization. There was a marginal association between migraine and angina. “The association between migraine and ischemic stroke, however, was significantly modified by age, indicating an increased risk of ischemic stroke for men with migraine who were [ages 40 to 54] but not for older age groups,” Dr. Kurth and colleagues noted. “Men who indicated migraine four or more times during the five-year exposure window did not have further increased risk of cardiovascular disease.”

The investigators noted several limitations to their study, including the inability to determine whether migraine with aura increases the risk of cardiovascular disease in men; another limitation was the lack of vascular event risk associated with nonmigraine headache events.

Suggested Reading
Kurth T, Gaziano JM, Cook NR, et al. Migraine and risk of cardiovascular disease in men. Arch Intern Med. 2007;167:795-801.

PARKINSON'S DISEASE PATIENTS MAY HAVE HIGH RATES OF INSOMNIA

Insomnia may be highly prevalent among patients with Parkinson’s disease, according to a report in the May Journal of Neurology, Neurosurgery, and Psychiatry. However, the frequency of insomnia fluctuated among individual patients in the study conducted by Michaela D. Gjerstad, MD, and colleagues, and there was no consistent increase of insomnia over time.

The investigators studied the development of nighttime sleeping problems in patients with Parkinson’s disease during an eight-year period. From the initial cohort of 231 Parkinson’s disease patients available in a 1993 population-based prevalence study, 142 patients were available for reevaluation in 1997, and 89 were available for a second reevaluation in 2001. The investigators utilized semistructured interviews to gain clinical data. They found that the prevalence of insomnia ranged from 54% to 60% at each study evaluation. The prevalence of sleep initiation problems ranged from 23% to 30%, and the prevalence of frequent awakenings ranged from 23% to 44%, while 19% to 24% of patients reported early-morning awakenings. Of the 89 patients who were examined at all three study visits, 29 patients reported insomnia at all three visits, 27 reported insomnia only at baseline or at baseline and at one additional visit, while 18 did not have insomnia at baseline but developed the disorder at later evaluations.

While the frequency of insomnia was high among the participants, self-reports of insomnia, as in the general population and among older people, varied significantly among individual patients, and was most likely a result of treatment-related effects, Dr. Gjerstad and colleagues stated. Prevalence of sleep initiation problems in the study was not more common than among older people without Parkinson’s disease.

The investigators posited that sleep disorders could be caused by pathologic lesions of the Parkinson’s disease process in the upper brain stem and lower midbrain. In addition, nocturnal sleep could be disrupted by the use of such treatments as levo­dopa and other dopaminergic agents, due to a direct effect on sleep/wake regulation or end of dose symptoms. Motor symptoms, parasomnias, nocturia, and depression could also have an effect on sleep in patients with Parkinson’s disease.

“Physicians should be aware of the high prevalence of insomnia in patients with Parkinson’s disease and should examine their patients for a possible coexisting depression,” Dr. Gjerstad’s team noted.

Suggested Reading
Gjerstad MD, Wentzel-Larsen T, Aarsland D, Larsen, JP. Insomnia in Parkinson’s disease: frequency and progression over time. J Neurol Neurosurg Psychiatry. 2007;78:476-479.

DIABETES AND INCREASED RISK OF MILD COGNITIVE IMPAIRMENT—IS THERE A LINK?

Diabetes may be associated with an elevated risk of mild cognitive impairment (MCI), according to a study in the April Archives of Neurology. José A. Luchsinger, MD, and colleagues examined 918 Medicare recipients 65 and older; 334 of these had incident MCI. Among this subgroup, 160 (47.9%) had amnestic MCI, and 174 (52.1%) had nonamnestic MCI.

After adjustment for socioeconomic variables and vascular risk factors, the researchers found that an association between diabetes and a higher risk of nonamnestic MCI was “appreciably attenuated.” However, diabetes was related to a significantly elevated risk of all-cause MCI and amnestic MCI after adjustment for all covariates, including vascular risk factors, heart disease, and stroke. There was an 8.8% risk of MCI attributable to diabetes for the entire cohort, an 8.4% risk for African-Americans, an 11% risk for Hispanic persons, and a 4.6% risk for non-Hispanic white persons.     

Suggested Reading
Luchsinger JA, Reitz C, Patel B, et al. Relation of diabetes to mild cognitive impairment. Arch Neurol. 2007;64:570-575.

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