Using positron emission tomography (PET), New York University School of Medicine researchers were able to predict which healthy elderly men and women would develop memory impairment. In the September 11 Proceedings of the National Academy of Sciences, the investigators reported that metabolic changes occurred in particular regions of the brain in study participants years before there were any clinical signs of memory loss. Specifically, a reduction in glucose metabolism in the entorhinal cortex occurred in 12 of 48 subjects studied. Three years later, 11 of these individuals had experienced mild cognitive impairment, and one developed Alzheimer’s disease. The subjects with normal PET scans did not show any signs of mental decline after the three-year follow-up.

The estrogen skin patch given to women with mild to moderate Alzheimer’s disease can improve memory and attention skills, according to a study in the August 28 Neurology. Either the estrogen patch (using estradiol, a type of estrogen that has been shown to have an effect on the brain) or a placebo patch was given to 20 women for eight weeks. Women receiving estrogen improved their performance on an attention test by 20% more than did women receiving placebo. Those receiving estrogen also improved on some tests of recent verbal and visual memory by 35% and 30% more, respectively, than did those receiving placebo. “These results are hopeful, but they need to be confirmed with larger studies with more participants and longer treatment times,” said study author Sanjay Asthana, MD.

Researchers at the University of California, Los Angeles, have identified the small group of brain cells believed to originate breathing in mammals. Reported in the September Nature Neuroscience, their discovery could lead to new approaches to treating serious health problems such as sleep apnea and sudden infant death syndrome. Using a rat model, the researchers identified a small group of roughly 600 neurons within the preBotzinger Complex that are responsible for breathing. When these neurons were destroyed, the rats’ breathing dissolved from a regular, rhythmic pattern into a highly irregular pattern of breathing frequency and depth. The investigators believe that the same portion of the human brain will likely control breathing.

Results of the first human neuroimplantation trial for chronic stroke were published in the September Neurosurgery. University of Pittsburgh researchers reported that positron emission tomography (PET) scans taken six months after implantation of human neuronal cells showed a greater than 10% increase in metabolic activity in the damaged parts of some patients’ brains compared with scans taken a week prior to surgery. The increased metabolism correlated with better performance on standardized stroke tests for behavior and motor function. Although the PET scans taken at 12 months post-surgery showed that metabolism in the implanted area had returned to baseline, the surrounding area in some patients maintained or even improved function.

Pairing an amphetamine with speech/language therapy may help some stroke survivors more quickly recover their ability to communicate, according to a study in the September Stroke. Ten of 12 subjects given dextroamphetamine surpassed the 15-point gain that researchers had specified as a clinically significant change, compared with only two of nine in the placebo group. The investigation was the first to use low doses of dextroamphetamine in a double-blinded, placebo-controlled study of aphasia following non-hemorrhagic stroke. The researchers noted that there were no adverse reactions from the drug and that they are planning to explore other drugs and dosing regimens to determine the optimum timing of drug administration and the amount of behavioral treatment necessary for maximal recovery.

Researchers have identified a new gene mutation that causes episodes of muscle weakness or paralysis, according to a study in the September Annals of Neurology. The investigators believe that this particular mutation is responsible for the paradox that some patients with hypokalemic periodic paralysis actually fare worse on carbonic anhydrase inhibitors, drugs that help many other patients. “If this hypothesis holds up, physicians may be able to use the presence of the mutation to identify patients who should avoid the standard therapy,” said senior author Louis J. Ptacek, MD, a neurologist at the Howard Hughes Medical Institute at the University of Utah. “Knowing the specific molecular alterations in patients,” Dr. Ptacek added, “will allow us to stratify patients in future clinical trials so that we are looking at more homogeneous groups of patients.”

Standard echocardiograms can be used as a screening tool to spot aortic valve abnormalities and to identify people at high risk for stroke and heart valve disease. In a report in the September Journal of the American College of Cardiology, researchers found that more than one third of volunteers ages 45 and older had plaque buildup on their aortic valves and that there was a strong correlation between this aortic valve sclerosis and hardening and narrowing of the aorta. “Everyone who is obese or has high blood pressure should take action to reduce those risk factors, but the echocardiogram now gives us more information about who is most at risk and who should be most urgently concerned,” said Bijoy Khandheria, MD, of the Mayo Clinic, Rochester, Minnesota. He recommended that men ages 40 and older who are more than 25 pounds overweight should have a screening echocardiogram. Women who are obese should have the test done after age 50, he added.

The quality of care in residential and nursing homes in the United Kingdom for patients with dementia is in need of “radical improvement” or “much improvement,”claims a report in the August 25 British Medical Journal. Researchers used dementia care mapping to evaluate the quality of care of over 200 patients with dementia in 10 private sector and seven National Health Service care facilities. Over the six-hour daytime observation period, residents spent 47% of their time either asleep, socially withdrawn, or not actively engaged in any form of constructive activity. Only 50 minutes (14%) were spent communicating with staff or other residents, and less than 12 minutes (3%) were spent engaged in constructive activities other than watching television.

A new study shows that paramedics can safely and effectively treat patients with acute and prolonged seizures with injections of benzodiazepines. A report in the August 30 New England Journal of Medicine states that in 59% of patients who received lorazepam, and in 43% of patients treated with diazepam, seizures stopped before the patients arrived at the emergency department. Conversely, only 21% of patients in the placebo group arrived at the hospital seizure free. The study included 205 patients diagnosed with “status epilepticus,” continuous or repeated seizures lasting five minutes or more without recovery of consciousness.

Patients with Parkinson’s disease who use alternative treatments such as vitamins and acupuncture are more likely to be younger, more educated, and have higher incomes than patients who do not use alternative therapy, as reported in the September 11 Neurology. Those using alternative therapy are also more likely to be married and to have developed the disease at a younger age. Forty percent of the 201 patients studied used alternative treatment, and of those, 58% did not consult their physician before starting the alternative treatment. “While the public generally assumes that vitamins and herbs are safe, a rapidly growing number of studies show that they can have potentially harmful effects and interactions with other drugs,” said Stephen Reich, MD, of the Johns Hopkins University School of Medicine.

Wearing a cooling vest can help multiple sclerosis patients with muscle strength, fatigue, and balance, according to a report in the September 11 Neurology. “It’s a relatively easy treatment that brings an immediate benefit,” said Jacques De Keyser, MD, PhD, of the University Hospital in Groningen, the Netherlands. Balance improved by an average of 20% for patients receiving active cooling, and muscle strength improved by an average of 10%. The level of fatigue also improved significantly, said Dr. De Keyser. In addition, the researchers found that levels of nitric oxide decreased by 41% in patients who wore the vests. “The beneficial effects of the cooling garment can’t be explained simply by a direct cooling of the central nervous system,” Dr. De Keyser said. “These results raise the intriguing possibility that lowering of nitric oxide production may play an important role in this.”

In the evaluation of syncope, “neurologic testing, which is rarely diagnostic, remains a common practice, whereas more useful cardiovascular tests are used infrequently,” reported researchers in the August 13/27 Archives of Internal Medicine. Researchers from St. John Hospital and Medical Center in Detroit evaluated the work-up of 649 patients who were admitted to the hospital with a principal diagnosis of syncope. More than half underwent at least one neurologic test. In patients with a history consistent with seizure or stroke, only brain computed tomography and electroencephalography provided diagnoses but only for 11 patients. Cardiovascular tests provided more diagnoses than did neurologic tests, yet postural blood pressure check, the highest-yield test, was used only in 27% of patients.

A cognitive tool that can keep older drivers on the road longer and more safely by measuring and even improving their visual information processing abilities was touted by researchers at the 109th Annual Convention of the American Psychological Association. Based on a meta-analysis of studies on risk factors for unsafe driving—scores on measures of visual acuity, contrast sensitivity and visual fields, visuospatial function and cognitive flexibility, mental status, and visual information processing ability (UFOV)—researchers found the UFOV test to be more accurate than any other currently in use. Not only does UFOV predict impaired driving, but the speed of processing training that improves UFOV performance also improves actual driving ability, the investigators reported.

Topamax® (topiramate) tablets and sprinkle capsules have been approved by the Food and Drug Administration as adjunctive treatment for adults and children (ages 2 and older) who have seizures associated with Lennox-Gastaut syndrome. A study showed that topiramate, when used in combination with one or two other anti-epileptic drugs, can significantly reduce both the severity of seizures and the number of “drop attacks” (serious seizures characterized by complete loss of muscle tone and sudden falls). “Until now, anti-epileptic drugs have either not been effective for Lennox-Gastaut, or have had significant side effects, so topiramate offers hope for children and adults with this disease,” said Tracy Glauser, MD, director of the Children’s Comprehensive Epilepsy Program at Cincinnati Hospital Medical Center. Topamax is marketed by Ortho-McNeil.

A study in the September 8 Lancet suggested that levodopa used in combination with physiotherapy could improve motor recovery in patients with hemiplegia due to stroke. Researchers in Germany determined that motor recovery was substantially improved after three weeks of drug intervention in patients given levodopa compared with placebo. Fifty-three patients were assessed. For the first three weeks, patients received single doses of 100 mg levodopa or placebo daily in combination with physiotherapy. For the second three weeks, patients had only physiotherapy. The advantage of the levodopa group was maintained three weeks after it was stopped. The investigators said that because of levodopa’s minimal side effects, it will be a “possible add-on during stroke rehabilitation.”

A new technique for the evaluation of acute stroke may allow physicians to more quickly administer treatment as well as better predict a patient’s clinical outcome, according to a report in the September Stroke. Investigators from the Massachusetts General Hospital (MGH) found that a special procedure using a computed tomography (CT) scan could be performed instead of the more expensive magnetic resonance imaging. The procedure involves perfusion-weighted CT scanning, which allows physicians to simultaneously look at blood vessels and blood flow to tissues in the brain. According to Lee Schwamm, MD, associate director of MGH’s Acute Stroke Service, “We’ve demonstrated here that, with subtle changes to current methods, the sensitivity of CT can be increased, and we can anticipate the minimum size of the final stroke.”

Transcranial Doppler ultrasonography (TCD) is much less sensitive than xenon-enhanced computed tomography cerebral blood flow (Xe/CT CBF) in identifying patients with compromised cerebrovascular reserve (CVR), according to researchers from the University of Pittsburgh Medical Center. As reported in the August Stroke, investigators concluded that this may be a result of TCD’s inability to identify patients with compromised reserves when their middle cerebral artery (MCA) blood flow comes from collateral sources. A key finding, said the researchers, was that changes in velocity measured within the initial portion of the MCA do not reliably predict the changes in tissue perfusion that accompany a vasodilatory stress induced by intravenous acetazolamide. Furthermore, the team recommends that the lack of correlation between TCD and Xe/CT CBF for identifying patients with compromised CVR should be considered when stroke risk assessments are made by TCD.

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