Patients with Alzheimer’s disease may experience fewer behavioral and psychological symptoms of dementia when treated with collaborative care as opposed to usual care, according to a report in the May 10 JAMA. A total of 153 patients with Alzheimer’s disease and their caregivers were randomized to receive collaborative care management or augmented usual care. There were significant improvements in the quality of patient care, as well as caregiver distress and depression, at 12 and 18 months in the collaborative care group.

Certain caregiver characteristics are associated with neuropsychiatric symptoms of dementia independent of patient characteristics, according to a study in the May Journal of the American Geriatrics Society. Caregivers reported data about 12 neuropsychiatric symptoms of dementia in their care recipients. Caregivers who were younger, less educated, more depressed, or more burdened or who spent more hours a week giving care reported more neuropsychiatric symptoms of dementia in patients.

Survival in patients with brain metastases may not improve after up-front whole-brain radiation therapy plus stereotactic radiosurgery, according to findings reported in the June 7 JAMA. A total of 132 patients with one to four brain metastases were randomized to receive whole-brain radiation therapy plus stereotactic radiosurgery or stereotactic radiosurgery alone. Results showed median survival times of 7.5 and 8.0 months, respectively; however, one-year brain tumor recurrence rates were 46.8% and 76.4%, respectively.

Lowering blood pressure may not prevent cognitive impairment and dementia, according to a review of recent studies published in the April Cochrane Database of Systematic Reviews. Investigators assessed three clinical trials and found no significant differences between placebo and treatment with a calcium channel blocker, a diuretic, or an angiotensin receptor blocker. Although not statistically significant, an 11% relative risk decrease of dementia was shown in treated patients with no prior cerebrovascular disease.

Sodium para-aminosalicylic acid, a drug used in tuberculosis treatment, appears to be effective in reversing the Parkinson-like symptoms of severe chronic manganese intoxication, according to a report published in the June Journal of Occupational and Environmental Medicine. A patient exposed to airborne manganese for 21 years received 15 courses of para-aminosalicylic acid (6 g/day) for four days, accompanied by three days of rest. Symptoms were significantly improved at the end of treatment, as well as at 17-year follow-up.

Poor awareness and insufficient medical follow-up are related to inadequate control of cerebrovascular risk factors in stroke patients, as reported in the June Journal of Neurology, Neurosurgery, and Psychiatry. Results of a questionnaire completed by 164 patients three months after stroke showed that 13% of respondents demonstrated relevance of cerebrovascular risk factors to their stroke; 27% of patients had not visited a general practitioner and two thirds had not visited a specialist since their stroke.

Treatment with antidepressants or lithium may be associated with an increased likelihood of subsequent treatment with antiparkinsonian drugs, according to a report published in the Journal of Neurology, Neurosurgery, and Psychiatry. Data on antidepressant, lithium, or antidiabetic use were assessed in the first control group, while a general population sample served as the second control group, for a combined total of 1,293,789 participants. After treatment with antidepressants, the ratio rate of treatment with antiparkinsonian drugs was 2.27 for men and 1.50 for women. These results were nearly parallel to those for men and women taking lithium. The findings show "an association between anxiety/affective disorder and Parkinson’s disease," concluded the investigators.

Pesticide use may be associated with Parkinson’s disease in men, as reported online in the June 13 Movement Disorders. Researchers matched 149 persons who developed Parkinson’s disease from 1976 to 1995 with 129 controls, by age and gender. Chemical exposure was assessed via telephone interview. An association between Parkinson’s disease and pesticide use—both related and unrelated to farming—was found; this remained significant after adjustments were made for education and smoking status. Data on six other categories of industrial and household chemicals did not show a significant association with Parkinson’s disease. "Pesticides may interact with other genetic and nongenetic factors that are different in men and women," stated the researchers.

In nondiabetic patients with transient ischemic attack or minor ischemic stroke, impaired glucose tolerance may be an independent risk factor for future stroke, according to the June Stroke. A total of 3,127 patients with transient ischemic attack or minor ischemic stroke were included in the study. During a follow-up period of 2.6 years, results showed that 272 patients had a stroke and 200 patients experienced a myocardial infarction or cardiac death. Compared to patients with normal glucose levels, risk of stroke was nearly twofold in patients with an impaired glucose tolerance of 7.8 to 11.0 mmol/L. In addition, a 50% increase in stroke risk was found in patients with low glucose levels. However, no association was found between glucose levels and the risk of myocardial infarction or cardiac death.

The use of rosuvastatin and ezetimibe resulted in a 70% reduction in LDL-cholesterol, according to a report presented at the 14th International Symposium on Atherosclerosis. In a 12-week trial of 469 patients with LDL cholesterol levels between 160 and 250 mg/dL, participants were randomized to receive rosuvastatin (40 mg) in combination with ezetimibe (10 mg) or rosuvastatin monotherapy. In addition to the 70% reduction of LDL cholesterol, 94% of high-risk patients achieved their target cholesterol level with rosuvastatin and ezetimibe at the end of the study, as opposed to 79% of high-risk patients treated with rosuvastatin alone. Both statin drugs were well tolerated.

The septum appears to have a regulatory effect on epileptic seizures, as reported in the June Journal of Neurophysiology. Researchers injected rats with pilocarpine to induce chronic epilepsy and found that the septum’s theta rhythm had 20% less amplitude in rats with chronic epilepsy than in controls, and a frequency of 4.25 Hz, compared to a frequency of 3.38 Hz in controls. In addition, epileptic discharges were reduced 86% to 97% when theta rhythm was induced in rats by anesthesia regulation, carbachol injection, or tail pinching. "The understanding of the theta rhythm ‘anti-epileptic’ effect at the cellular and molecular levels may result in novel therapeutic approaches dedicated to protect the brain against abnormal excitability states," the researchers concluded.

Statin use may be associated with a reduction in stroke risk but not in stroke severity or mortality, according to the June Stroke. Data from three trials of oral glycoprotein IIb/IIIa were pooled; out of 217 patients who had strokes, statin users had a lower risk of stroke than nonusers. One hundred six patients with neurologic examinations that were scorable according to the Canadian Neurological Scale showed no difference in stroke severity or mortality between statin users and nonusers. Women were found to have more severe strokes than men, "a difference that was not explained by baseline characteristics or statin use," the researchers noted.

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