In a survey of 3,681 stroke survivors, researchers found that patients younger than 65 have reduced access to a physician’s care and medication compared with their older counterparts. An article slated for publication in the January issue of Archives of Neurology reports that 14% of stroke survivors ages 45 to 64 reported no general doctor visit, and 8% reported no visit to a general doctor or medical specialist. Only 10% and 5% of those 65 or older reported not seeing a general doctor and not seeing a general doctor or specialist, respectively. After adjusting for sex, race, income, neurologic disability, health status, comorbidity, and health insurance, investigators found younger age was independently associated with the inability to afford medication; the association between lack of doctor visits and age was rendered insignificant when investigators adjusted for health insurance.

Drivers with Parkinson’s disease may be more likely to make mistakes that jeopardize their safety while distracted than are those with no neurologic disorders, according to a study published in the November 28 issue of Neurology. A total of 218 current driv-ers participated in a driving test. Midway through the test course, the participants were given a verbal addition task, which researchers said simulates the amount of distraction created by a conversation with a passenger or while talking on a cell phone. Twenty eight percent of subjects with Parkinson’s disease made more safety driving mistakes while distracted, compared with 16% of those with no disorders. Researchers noted well-known motor problems associated with Parkinson’s disease did not affect subjects as much as lesser-known aspects of the disease, such as effects on mental functioning, vision, and sleep.

The protein Par-3 is a key organizing component for the recruitment of Schwann and must be properly recruited for nerve cells to be coated with myelin, according to a report in the November 3 Science. Investigators found that Par-3 is "enriched asymmetrically at the membrane of premyelinating Schwann cells," and that without cell-cell contact, the localization of Par-3 was "diffuse and uniform." The team then overexpressed Par-3, disrupting its polarized asymmetric localization, and knocked down Par-3 expression. Both experiments prevented Schwann cells from myelinating the axons of nerve cells properly, "suggesting that asymmetric localization of Par-3 may be necessary for myelination." The researchers recommend that further studies examine whether cell polarity mechanisms are involved with nerve regeneration and remyelination, as "this will largely impact the design of therapies for various peripheral neuropathies and nerve injuries."

Migraine headaches in adolescents have a favorable long-term prognosis, though family history and lack of an aura predict a poorer outcome, reported investigators in the October 24 issue of Neurology. Ten-year follow-up interviews were conducted with 55 Italian patients with migraine headaches; migraines persisted in 41.8% of patients, while 38.2% experienced remission, and 20.0% had transformed to tension-type headache. Only migraine without aura persisted in the same International Headache Society code after 10 years. The researchers also reported a sevenfold increased risk of migraine persistence in those subjects who have a first-degree relative with migraine. The team recommended further population-based studies be conducted on larger samples of adolescents.

Risk of dementia in Alzheimer’s disease may be reduced for those with higher levels docosahexaenoic acid (DHA) in their blood, as reported in the November Archives of Neurology. Researchers conducted follow-up interviews of men and women free of dementia at baseline interview and found that those in the upper quartile of baseline plasma phosphatidylcholine DHA levels had a relative risk of 0.53 for developing dementia and 0.61 for developing Alzheimer’s compared with the lower three quartiles. After adjusting for demographic and biological variation, the investigators found an overall reduction of developing all-cause dementia of 47%. Those subjects in the top quartile reported eating an average of 0.18 grams of DHA per day and an average of three servings of fish per week, substantially more than the other subjects.

Sibling history of stroke may be the only family history characteristic that independently predicts the likelihood of a severe stroke, according to a report in the October 24 issue of Neurology. After assessing 505 subjects from the Ischemic Stroke Genetics Study and recording a history of stroke in first-degree relatives, researchers found case subjects with sibling history of stroke "tended to have more severe strokes." NIH Stroke Scale scores of 5 or higher occurred in 43% of subjects with sibling history of stroke, compared with 28% of subjects without sibling history. The investigators found no increased risk of stroke associated with multiple affected siblings, and history of stroke in parents or children did not affect stroke severity.

People without a history of cardiovascular disease may reduce their risk of major heart attack and cerebrovascular events by regularly taking statins, as reported in the November 27 issue of Archives of Internal Medicine. Investigators compiled data from seven previously published clinical trials comprising 42,848 subjects between the ages of 55 and 75, 90% of whom had no history of cardiovascular disease. Subjects receiving statin therapy experienced a 29.2% risk reduction in major coronary events compared with placebo-controlled subjects. Risk of major cerebrovascular events, including stroke, was also reduced by 14.4% in those on statin therapy. Statins were associated with a 31.7% reduction in nonfatal heart attacks, though reduction of fatal cardiovascular disease and death from all causes did not reach statistical significance.

Chemotherapy drugs may cause more damage to normal, healthy brain cells than to the cancerous cells they are supposed to target, according to a study published online in the Journal of Biology on November 30. In mice, researchers demonstrated that very low concentrations of three chemotherapeutic drugs were toxic to dividing neural stem cells and nondividing cells. A 60% to 90% reduction in the viability of oligodendrocyte precursor cells and neuron precursor cells was also observed, while the same dosage had little effect on most of the cancer cell lines examined. The authors reported that doses required to kill 40% to 80% of cancer cells were strong enough to kill 70% to 100% of neural cells. The neural cells of the mice continued to die for at least six weeks after the end of treatment. The authors concluded that the drugs cause long-lasting reductions in cell division and proliferation in the CNS.

Ethnicity may contribute to the recurrence of stroke, according to a study published in the October issue of Annals of Neurology. Researchers analyzed the data of 1,345 first-ever ischemic stroke patients with a median age of 72. During the time interval, 126 recurrent strokes occurred, with cumulative risks for recurrence at 30 days and one year of 2.6% and 7.5%, respectively. Fifty-three percent of the subjects were Mexican American, and investigators determined that the group had a risk ratio for stroke recurrence of 1.57, significantly higher than non-Hispanic white patients after adjustment for demographics, stroke risk factors, and stroke severity. They also observed recurrence was related to mortality "to a similar extent across ethnic groups." The team concluded that efforts to reduce stroke recurrence in Mexican Americans are needed.

Dementia caregivers’ quality of life can be improved with a multifaceted, personalized intervention, reported researchers. The study, including 642 caregivers from different ethnic groups, was published in the November 21 Annals of Internal Medicine. Baseline interviews were performed, and follow-up interviews were performed six months after services began. Those receiving intervention were visited by and received phone calls from trained staff members. They offered support in the form of instruction, role playing, problem solving, skills training, stress-management techniques, and telephone support groups. Those in the control group received a packet on dementia education and two brief "check in" telephone calls. In the intervention group, 45% of Hispanic, 40% of white, and 28% of African-American caregivers experienced "large and clinically important quality of life improvements," compared with 7%, 13%, and 11% of the respective ethnic groups in the control group. The rate of clinical depression was found to be significantly lower in the intervention group (12.6%) than in the control group (22.7%).

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