Donepezil appears to slow the progression from mild cognitive impairment to Alzheimer’s disease. At the Ninth International Conference on Alzheimer’s Disease and Related Disorders, researchers presented data from a study in which 769 patients with mild cognitive impairment were randomized to receive donepezil, vitamin E, or placebo. Patients who received donepezil were given 5 mg/day during the first six weeks and 10 mg/day thereafter, while those who received vitamin E were given 1,000 IU/day during the first six weeks and 2,000 IU/day thereafter. Over the first 18 months of the three-year trial, patients treated with donepezil had a reduced risk of progressing to Alzheimer’s disease. However, by the end of the study, the risk of progression to Alzheimer’s disease was the same among the three treatment groups.

Although use of the drug selegiline has decreased in recent years, a new study indicates that it could be one of the most effective and inexpensive treatments available for early Parkinson’s disease. In the August 14 online edition of BMJ, researchers reported findings from their study of 17 randomized trials involving 3,525 patients. The trials compared monoamine oxidase type B inhibitors, a group of drugs that includes selegiline, with levodopa or placebo. Results of the study indicated that monoamine oxidase type B inhibitors reduced disability, the need for levodopa, and problems with movement, without serious side effects or increased risk of death.

Blood oxygen level–dependent fMRI may be able to measure brain activity associated with deception. Ten healthy adults were asked to tell the truth or to lie while undergoing fMRI. Patients were shown pictures of several objects and were told to indicate, truthfully and deceptively, whether fifty-dollar bills were hidden beneath them. Results revealed significant activation of five brain regions—the right inferior frontal, right orbitofrontal, right middle frontal, left middle temporal, and right anterior cingulate areas—during lying compared with truth telling. While their findings are intriguing, the researchers caution that the effectiveness of fMRI in distinguishing deceptive responses from truthful responses has not yet been established. Results of this study were published in the August Behavioral Neuroscience and were also presented at the 112th Annual Convention of the American Psychological Association in Honolulu.

Brain tumors may be easier to diagnose due to an innovative spectroscopic instrument that is currently being developed by researchers at Cedars- Sinai Medical Center and the University of Southern California. According to an article in the July/August Photochemistry and Photobiology, fluorescence spectroscopy can more clearly delineate the borders of tumors. The spectroscopic system consists of an optical instrument the size of a ballpoint pen that is connected to a computer. Light from a nitrogen laser stimulates molecules within cells, and the light emitted from the cells is sent back to the computer. Researchers found that high-grade gliomas are characterized by fluorescence emissions of longer duration than those of normal tissue are.

Researchers at the University of Toronto are urging physicians to be on the lookout for common manifestations of West Nile virus, according to the May Journal of Neuroscience. “It is important to keep West Nile virus in mind in the summer and early fall when faced with unexplained neurologic presentations such as encephalitis and paralysis … to identify those who may benefit from available therapies,” researchers said. More than 50% of the 26 West Nile virus patients in Toronto during August and September 2002 had neurologic diseases. Researchers recommend that physicians follow the currently accepted West Nile virus testing regimen. Electrodiagnostic testing should also be performed in patients with unexplained weakness and in those who are critically ill to rule out acute flaccid paralysis syndrome.

The UK meningitis C vaccine program has been successful in controlling the incidence of meningitis C, except in infants initially vaccinated younger than 5 months. According to the July 24 Lancet, researchers assessed surveillance data from the four years since the introduction of the vaccination program. Vaccine effectiveness remained high (around 90%) in children ages 5 months to 18 years. Effectiveness in early infancy, however, was only 66%. Though the vaccine offered high levels of protection for one year in all children, this protection rapidly diminished for those who were vaccinated in early infancy. Researchers recommend that “alternative routine immunization schedules should be considered to ensure high levels of protection are sustained.”

Researchers are focusing on dendroaspis natriuretic peptide and the role it may play in developing cerebral vasospasm. In a pilot study, published in the July Neurosurgery, investigators discovered a 29% increase in dendroaspis natriuretic peptide levels in aneurysm patients who later developed complications of cerebral vasospasm. Among six patients who were monitored for seven days after initial aneurysm, four displayed evidence of cerebral vasospasm. Of these four, three had increased dendroaspis natriuretic peptide levels. Though the sample of patients was small, researchers say the results justify a larger case-controlled formal study. They hope to pursue the possibility that dendroaspis natriuretic peptide may provide a target for new therapies to stop cerebral vasospasm.

Early clinical treatment of brain lesions may prevent the progression of Alzheimer’s disease, researchers reported in the August 5 Neuron. They found that inserting anti–beta-amyloid antibodies into the hippocampus of mice helped clear amyloid plaques within three days, as well as neurofibrillary tangles several days later. It is believed that accumulation of beta-amyloid plaques and neurofibrillary tangles contributes to the destruction of brain cells and the eventual loss of memory. Researchers found that removing the plaques lessened and even removed the consequences of Alzheimer’s disease, if it had not progressed to an advanced state. They are now investigating if a combined therapy—aimed at clearing both the beta-amyloid plaques and the neurofibrillary tangles—will be effective in preventing Alzheimer’s disease.

A new delivery method for gene therapy reaches all the voluntary muscles of a mouse—including heart, diaphragm, and limbs—and reverses the process of muscle-wasting found in muscular dystrophy. The delivery system includes a type of an adeno-associated virus and the use of a growth factor, VEGF, that appears to increase penetration into muscles, said researchers in the August Nature Medicine. A single injection of the adeno-associated virus delivers therapeutic levels of dystrophin to skeletal and cardiac muscles of adult, dystrophic mice. Researchers are currently gathering data to seek regulatory approval to determine the safety of a small amount of the adeno-associated virus in human muscle. They suggest that it may be possible someday to introduce other genes into adult muscle to address conditions other than muscular dystrophy.

Lithium therapy may help slow the progress of degenerative brain disorders such as Huntington’s disease and Alzheimer’s disease. At the Ninth International Conference on Alzheimer’s Disease and Related Disorders, investigators from the University of São Paulo, Brazil, presented data from their study of 74 elderly people with bipolar disorder. They found that patients taking lithium were less likely to have Alzheimer’s disease than those not taking the drug. Researchers concluded that lithium therapy might lower the risk of Alzheimer’s disease by clearing the brain of tangles and plaques. However, long-term lithium treatment may cause nausea, vomiting, diarrhea, and tremors in elderly patients. Therefore, drug companies are working on developing lithium-like drugs that are free of serious side effects.

Mexican-Americans are at a higher risk of stroke than are non-Hispanic whites and, in contrast to previous thought, this risk does not seem to be associated with Mexican-Americans’ higher incidence of diabetes. These findings were published in the August 15 American Journal of Epidemiology and the August 10 Neurology. After examining medical records of stroke patients in Nueces County, Texas, researchers found that Mexican-Americans ages 45 to 59 are twice as likely as non-Hispanic whites to have a stroke; those in their 60s and 70s are 60% more likely to have a stroke. Researchers found no significant difference in the risk of stroke between Mexican-Americans and non-Hispanic whites with respect to high blood sugar and its effect on narrowing blood vessels in the brain.

The second reported case of variant Creutzfeldt-Jakob disease infection that was probably caused by a blood transfusion was announced in the August 7 Lancet. The protease-resistant prion protein, which is responsible for the disease, was found in the spleen and cervical lymph node of an elderly person who died five years after having received a blood transfusion from a donor who subsequently developed variant Creutzfeldt-Jakob disease. The current case is the first of its kind to identify a heterozygous genotype for the prion, suggesting that a larger population of people could become infected. In an accompanying article, researchers identified new sterilizing procedures for medical and surgical instruments, such as alkaline agents or an original vaporized hydrogen peroxide treatment, and recommended they be implemented immediately to reduce risk of prion transmission.

Reductions of gray matter volume in areas of the brain associated with language processing have been observed among people with a family history of dyslexia, according to a report in the August 24 Neurology. Ten people with familial dyslexia and 11 controls without reading problems participated in a study that used a testing method known as voxel-based morphometry. Researchers found significant gray matter abnormalities in the planum temporale, inferior temporale cortex, cerebellar nuclei, left superior and inferior temporal gyrus, and right middle temporal gyrus in subjects with a family history of dyslexia in comparison to controls. These results add “further support to the effectiveness of intensive reading remediation therapy to correct the reading problems associated with dyslexia,” the researchers said.

A combination of dendritic cell immunotherapy and chemotherapy seems to significantly slow tumor progression and extend survival in patients with glioblastoma multiforme, according to a study in the August 15 Clinical Cancer Research. Researchers began the immunotherapy process by culturing tumor cells with dendritic cells. This enabled the immune cells to recognize targets for attack. When the dendritic cells were injected back into patients they signaled for T lymphocytes to kill the remaining tumor cells. Researchers believe immunotherapy delivers an initial blow to the tumor cells, which increases their vulnerability to subsequent chemotherapy. They found that the average length of survival in patients who received the combination therapy was 26 months, compared with 18 months for those who received immunotherapy alone and 16 months for those who received chemotherapy alone.

Dronabinol, a cannabis extract, reduces pain in patients with multiple sclerosis, researchers reported in the July 31 BMJ. They studied 24 patients with multiple sclerosis and central pain. Pain intensity was assessed and patients were asked to complete a quality-of-life questionnaire. The researchers found that pain intensity was significantly lower during dronabinol treatment than during placebo treatment. Pressure-evoked pain tended to decrease as well. Furthermore, the researchers found that patients reported better quality of life with dronabinol than with placebo. They concluded that dronabinol should be available for patients whose central pain is not sufficiently treated with alternative drugs.

Isoflurane and desflurane, two inhalational anesthesia agents, adequately suppress refractory status epilepticus, according to a study published in the August Archives of Neurology. Researchers studied the medical records of seven patients with refractory status epilepticus who were treated with isoflurane and/or desflurane during a four-year period. They found that “isoflurane and desflurane consistently stopped epileptic discharges with adequate, sustained electroencephalographic burst suppression within minutes of initiating inhalational anesthesia therapy.” Common complications that occurred during inhalational anesthesia therapy included hypotension, atelectasis, infections, paralytic ileus, and deep venous thrombosis. Researchers recommend that “isoflurane and desflurane be used as a single agent for management of patients with refractory status epilepticus while their standard anticonvulsants are being adjusted.”

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