Survival continues to improve but long-term neurodevelopmental concerns continue to be prevalent for infants born at extremely early gestational ages, according to a report in the January Pediatrics. Records from 1,036 infants born as young as 23 to 26 weeks’ gestation between the years 1986 and 2000 were analyzed retrospectively for survival; 675 surviving infants were analyzed at a mean age of 47.5 months for developmental outcome; 147 of these were followed through school-age years. Gestational age and recent year of birth correlated highly with survival. Maternal nonwhite race, female gender, inborn status, surfactant therapy, single gestation, and secondary sepsis also correlated positively with survival. Normal cranial ultrasound, absence of chronic lung disease, female gender, cesarean delivery, increased birth weight, and being born at 24 weeks’ gestation or later correlated favorably with long-term outcomes, the investigators reported. However, early outcomes did not reliably predict school-age performance, they noted.

Systematic screening for antiepileptic drug adverse effects may increase identification of toxicity and guide medication changes to reduce adverse effects and possibly improve subjective health status, researchers reported. In a randomized trial comparing the use of a 19-item self-report instrument, the Adverse Events Profile (AEP), with usual care, the investigators found that mean percent improvement in AEP score was greater in the patient group for which clinicians received the AEP compared with the usual care group. Mean change in Quality of Life in Epilepsy Inventory (QOLIE)-89 scores was not different between groups, but for the entire sample QOLIE-89 change was greater for patients having a 15-point improvement in AEP scores than for those with a lesser improvement or worsened score, the investigators reported in the January 13 Neurology. More patients in the AEP group had a greater than 15-point improvement in QOLIE-89 scores, and use of the AEP was associated with a 2.8-fold increase in antiepileptic drug modifications, they noted.

Home-treated elderly patients with ischemic stroke have better depressive scores and lower rates of admission to nursing homes, according to a report in the February Journal of the American Geriatrics Society. Researchers randomized 120 elderly patients admitted to the emergency department of a hospital with acute first ischemic stroke to home treatment from a geriatric home hospitalization service or to a general medical ward. Functional and neurologic parameters were significantly improved in both groups, the investigators reported, but depression scores were significantly better in home-treated patients, “who were more likely to remain at home at six months than hospital-treated patients and had a lower rate of select medical complications.”

Genes play a strong role in how well our memory works, according to a study of families with more than one person with Alzheimer’s disease. Researchers identified 1,036 people from 266 families, mainly in the Dominican Republic and Puerto Rico. All participants were tested for memory, attention, abstract reasoning, language, and visuospatial ability. After analysis, memory performance was found to be strongly influenced by genetics. “We found that about half of the variation in memory performance among individuals is due to genetics,” the investigators reported. “The other half is due to environmental factors such as education. Considering that even with dominant traits—such as a genetic mutation that leads to early-onset Alzheimer’s disease—the genetic influence actually amounts to about 80%. This shows that memory performance has a strong genetic influence.” The influence of genetics was not as strong in the areas of attention, abstract reasoning, language, and visuospatial ability, they noted in the February 10 Neurology.

Neurologists at the University of Michigan Health System and engineers at Altarum Institute, both in Ann Arbor, described for the first time evidence that on average, brain waves in patients with sleep apnea change with each breath, not just the short periods of the night when apneas occur. Using a computer program developed at Altarum, the neurologists measured the extent to which brain wave activity varies with the breathing cycle during sleep in children who had a tonsillectomy to correct sleep apnea. Their first report detailed one child and showed that brain wave activity, as reflected in an EEG, did change with the child’s breathing cycle, even when no pauses in breathing occurred. Their second report presented the results from 10 children. “We looked at the relationship between one EEG signal and the breathing cycle, and in most of the children we found significant correlation between the amount of energy in the EEG signal and different phases in the breathing cycle,” they reported. The strength of that correlation showed promise as a predictor of sleepiness and reduced attention, they said in the February Sleep.

Antibody therapies designed to treat variant Creutzfeldt-Jakob disease (vCJD) could backfire, causing more harm than good, according to a report in the January 30 Nature. Researchers from the Scripps Research Institute in La Jolla, California, found that prion antibodies designed to prevent normal prions from misfolding and aggregating in the brain can kill nerves themselves when injected into the brains of healthy mice. Their report conflicts with research that antibody therapies appear promising for vCJD, but as the investigators noted, in those successful trials, the antibodies did not enter the brain, “so researchers would not see side effects on nerve cells.”

A low sense of well-being is an independent predictor for stroke in elderly patients with diabetes, investigators reported in the February Journal of the American Geriatrics Society. Investigators followed 376 outpatients with diabetes (mean age, 75) who were free of stroke at baseline for three years. Well-being and diabetes-specific burden were assessed at baseline. Twenty-five patients had strokes during the follow-up. The researchers reported that low scores on the morale scale were significant predictors for stroke after adjustment for covariables including socioeconomic factors and microalbuminuria. Increased symptom burden and social burden were also significant predictors for stroke, although the causal relationship remains unknown, the investigators said.

There is new evidence that blocking acetylcholine receptors significantly impairs memory, according to a report in the February Behavioral Neuroscience. Investigators tested 28 healthy young adults, injecting 12 of the participants with scopolamine, an anticholinergic drug, then measured how well this group compared to an untreated group in learning new word pairs. The researchers found that “memory for word pairs learned after scopolamine administration suffered significantly but memory for word pairs learned immediately before injection was spared.” The acetylcholine blocker also made it more difficult to learn when stimuli overlapped, creating proactive interference. The findings may help to explain why Alzheimer’s disease, Parkinson’s disease, poststroke dementia, and other conditions characterized by lower levels of acetylcholine in the brain cause problems with memory function, as well as hallucinations and delusions.

Subcortical cerebrovascular load is a predicting factor of successful rehabilitation in patients with levodopa-refractory parkinsonism, according to a report in the February Journal of the American Geriatrics Society. Researchers examined 38 patients with gait disturbances and levodopa-refractory parkinsonism (mean age, 78.9). Subjects received an intensive rehabilitation program; the outcome measure of the program was gain on the Unified Parkinson Disease Rating Scale (UPDRS). Among the potential predictors assessed by the investigators, only subcortical cerebrovascular load (four classes of increasing severity based on leukoariosis, patchy lesions of white matter, and lacunas on CT scan) predicted functional recovery at discharge (odds ratio, 2.3). The adjusted proportion of patients with high functional recovery decreased with increasing cerebrovascular load: 83%, 61%, 44%, and 27%, respectively, for the four classes of severity, the investigators reported.

There is new evidence that blocking acetylcholine receptors significantly impairs memory, according to a report in the February Behavioral Neuroscience. Investigators tested 28 healthy young adults, injecting 12 of the participants with scopolamine, an anticholinergic drug, then measured how well this group compared to an untreated group in learning new word pairs. The researchers found that “memory for word pairs learned after scopolamine administration suffered significantly but memory for word pairs learned immediately before injection was spared.” The acetylcholine blocker also made it more difficult to learn when stimuli overlapped, creating proactive interference. The findings may help to explain why Alzheimer’s disease, Parkinson’s disease, poststroke dementia, and other conditions characterized by lower levels of acetylcholine in the brain cause problems with memory function, as well as hallucinations and delusions.

The creation of a self-renewing cell line of spinal cord neurons was reported in the March Nature Biotechnology. Researchers from the University of Rochester Medical Center in New York introduced telomerase, the gene responsible for the ability of stem cells to live indefinitely, into progenitor cells that differentiate into spinal neurons. With the newly added telomerase gene, the normally short-lived progenitor cells were able to continuously divide while still producing only their specific type of neuron, the investigators reported. After propagating the cell line for more than two years, the researchers used the cells to partially repair damaged spinal cords in laboratory animals. Their hope is that the new progenitor cells might provide treatment for diseases where only a specific cell type is at risk, such as Parkinson’s disease or multiple sclerosis. “The progenitor cells are immortalized at a stage when they only give rise to the type of neuron we want,” the researchers said, “thus becoming an ongoing source of these neurons.”

A spontaneous dominant mutation has a protective effect on axons in a mouse model of Parkinson’s disease. Researchers found that mice with the mutation exhibited strong protection of dopaminergic axons in face of a dopamine toxin in the brain. The discovery may lead to the understanding of mechanisms underlying axonal loss and to the development of new therapeutic approaches for Parkinson’s disease, they reported in the February Current Biology.

Treatment of depression may be inadequately prioritized in the management of intractable epilepsy, researchers reported in the January 27 Neurology. A prospective evaluation of patients with refractory epilepsy admitted to an inpatient video-EEG monitoring unit assessed the impact of clinical variables (age, gender, marital status, seizure frequency, duration and type of seizure disorder, seizure localization, number of antiepileptic drugs, and depression) on quality of life. “Depression was a powerful predictor of quality of life,” the investigators reported, and no other variable predicted quality of life. Depression was common (54%), severe (19% with suicidal thoughts), underdiagnosed (37%), and largely untreated (17% on antidepressants), they noted.

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