HLA-DRB1*1501, adolescent summer sun habits, and BMI at the age of 20 independently affect age of multiple sclerosis (MS) onset, according to a study published online ahead of print October 7 in Neurology. This cross-sectional study included 1,161 Danish patients with MS. Lifestyle questionnaires and blood samples for genotyping were collected from all participants from 2009 to 2012. Information on age at onset was obtained from the Danish MS Treatment Registry. Younger age at onset was significantly associated with low exposure to summer sun in adolescence, higher BMI at age 20, and the HLA-DRB1*1501 risk allele in both univariate analyses and in a multivariable regression analysis. No association was found between age at onset and other single-nucleotide polymorphisms studied or vitamin D-associated environmental factors.
Treatment responses for autoimmune ataxia are more likely in patients with nonparaneoplastic disorders and those with exclusively plasma membrane protein (PMP) antibodies, according to a study published online ahead of print September 28 in JAMA Neurology. Investigators examined 118 patients with ataxia who were 18 or older, were seropositive for at least one neural autoantibody, had received at least one immunotherapy or cancer therapy, and had neurologist-reported outcomes documented from January 1, 1989, through December 31, 2013. Fifty-four patients had neurologic improvements. Kaplan-Meier analyses revealed that progression to wheelchair dependence occurred significantly faster among patients with neuronal nuclear or cytoplasmic antibody positivity only, although those with glutamic acid decarboxylase 65-kDa isoform autoimmunity progressed to wheelchair dependence at a rate similar to those with PMP autoimmunity.
Patients with celiac disease are not at increased risk for dementia overall, though they may be at increased risk for vascular dementia, according to a study published online ahead of print September 29 in Journal of Alzheimer’s Disease. Researchers compared the incidence of a subsequent dementia diagnosis among 8,846 older adults with celiac disease to that among 43,474 age- and gender-matched controls. The median age of the study population was 63, and 56% of participants were female. During a median follow-up time of 8.4 years, dementia was diagnosed in 4.3% of patients with celiac disease and 4.4% of controls. The researchers observed an increased risk of dementia in the first year following a diagnosis of celiac disease, but the increased risk was restricted to vascular dementia and was not present for Alzheimer’s dementia.
Infection may trigger childhood arterial ischemic stroke, while routine vaccinations appear to protect against it, according to a study published online ahead of print September 30 in Neurology. This international case–control study included 355 children with confirmed cases of arterial ischemic stroke and 354 controls without stroke. Median age was 7.6 for cases and 9.3 for controls. Infection in the week prior to stroke, or interview date for controls, was reported in 18% of cases versus 3% of controls. Infection thus conferred a 6.3-fold increased risk of arterial ischemic stroke. Children with some, few, or no routine vaccinations were at higher stroke risk than those receiving all or most vaccinations. Risk factors for arterial ischemic stroke included infection in the prior week, undervaccination, black race, and rural residence.
Amyloid PET and CSF biomarkers identify early Alzheimer’s disease with equal accuracy, according to a study published October 6 in Neurology. Researchers examined 122 healthy elderly people and 34 patients with mild cognitive impairment who developed Alzheimer’s disease dementia within three years (MCI-AD). They examined β-amyloid deposition in nine brain regions with [18F]-flutemetamol PET. CSF was analyzed with INNOTEST and EUROIMMUN ELISAs. CSF samples and PET scans each identified approximately 90% of patients who later received a diagnosis of Alzheimer’s disease. The best CSF measures for identifying MCI-AD were Aβ42/total tau and Aβ42/hyperphosphorylated tau, which performed better than CSF Aβ42 and Aβ42/40. CSF Aβ42/total tau had the highest accuracy of all CSF and PET biomarkers. The combination of CSF and PET was not better than either individual biomarker.
A combination of dextromethorphan and quinidine demonstrated clinically relevant efficacy for agitation in patients with probable Alzheimer’s disease and was generally well tolerated, according to a study published September 22 in JAMA. A total of 194 patients completed a preliminary 10-week phase II randomized clinical trial. In the sequential parallel comparison design, 152 patients received dextromethorphan–quinidine, and 127 received placebo. Analysis combining all patients and rerandomized placebo nonresponders showed significantly reduced agitation and aggression scores for dextromethorphan–quinidine versus placebo. Among all patients, mean agitation and aggression scores were reduced from 7.1 to 3.8 with dextromethorphan–quinidine and from 7.0 to 5.3 with placebo. Between-group treatment differences were significant. Among rerandomized placebo nonresponders, agitation and aggression scores were reduced from 5.8 to 3.8 with dextromethorphan–quinidine and from 6.7 to 5.8 with placebo.