New and Noteworthy Information—July 2013
In patients with arterial disease, low baseline diastolic blood pressure may correspond with increased progression of subcortical atrophy, researchers reported online ahead of print June 10 in JAMA Neurology. The association may not depend on subsequent change in blood pressure. Researchers measured blood pressure for 663 participants at baseline and at a mean of 3.9 years later. Change in brain parenchymal fraction, cortical gray matter fraction, and ventricular fraction were quantified as indicators of progression of global, cortical, and subcortical brain atrophy. Patients with lower baseline diastolic blood pressure or mean arterial pressure had more progression of subcortical atrophy. Of patients with higher baseline blood pressure, those with declining blood pressure over time had less progression of subcortical atrophy, compared with those with increasing blood pressure.
Diffusion tensor imaging (DTI) of the basal ganglia and cerebellum may accurately diagnose Parkinson’s disease and other movement disorders, according to a study published online ahead of print May 14 in Movement Disorders. Investigators studied 72 subjects with DTI at 3 T. The technique distinguished between controls and patients with movement disorder with 92% sensitivity and 88% specificity. DTI also distinguished between controls and patients with parkinsonism (93% sensitivity, 91% specificity), Parkinson’s disease and atypical parkinsonism (90% sensitivity, 100% specificity), Parkinson’s disease and multiple system atrophy (94% sensitivity, 100% specificity), Parkinson’s disease and progressive supranuclear palsy (87% sensitivity, 100% specificity), multiple system atrophy and progressive supranuclear palsy (90% sensitivity, 100% specificity), and Parkinson’s disease and essential tremor (92% sensitivity, 87% specificity).
Heading a soccer ball may be associated with abnormal white matter microstructure and poor neurocognitive performance, according to research published online ahead of print June 11 in Radiology. Thirty-seven amateur soccer players answered a questionnaire about heading in the previous 12 months and lifetime history of concussions. Investigators performed diffusion-tensor MRI on the players and evaluated their cognitive function. The players had headed a median of 432 times during the previous year. Heading was associated with lower fractional anisotropy (FA) at three locations in temporo-occipital white matter with a threshold that varied according to location. Heading more than 1,800 times per year was associated with lower levels of FA and poorer memory scores. Concussion history and demographic features were not significantly associated with FA or cognitive performance.
Restless legs syndrome (RLS) may entail an increased risk of mortality, independent of known risk factors, according to a study published online ahead of print June 12 in Neurology. Researchers conducted a prospective cohort study of 18,425 American men without diabetes, arthritis, or renal failure. RLS was assessed using standardized questions. During eight years of follow-up, 2,765 deaths occurred. In an age-adjusted model, RLS was associated with a 39% increased risk of mortality. The association between RLS and mortality was slightly attenuated after further adjustment for BMI, lifestyle factors, chronic conditions, sleep duration, and other sleep-related disorders. When patients with major chronic conditions (eg, cancer, high blood pressure, cardiovascular disease, and other comorbidities) were excluded, the adjusted hazard ratio for RLS was 1.92.
Patients with stroke who are about to undergo surgery can safely continue to take aspirin or warfarin in many instances, according to a guideline published in the May 28 Neurology. Researchers systematically reviewed the literature to assess evidence about the periprocedural management of antithrombotic drugs in patients with ischemic cerebrovascular disease. Stroke patients undergoing dental procedures should routinely continue aspirin, according to the guideline. Stroke patients undergoing invasive ocular anesthesia, cataract surgery, dermatologic procedures, transrectal ultrasound–guided prostate biopsy, spinal or epidural procedures, and carpal tunnel surgery should probably continue aspirin. Stroke patients requiring warfarin should routinely continue it when undergoing dental procedures and probably continue it for dermatologic procedures. Some patients undergoing EMG, prostate procedures, inguinal herniorrhaphy, and endothermal ablation of the great saphenous vein should possibly continue warfarin.
Exposure to pesticides or solvents could be a risk factor for Parkinson’s disease, investigators concluded in the May 28 Neurology. Researchers performed a meta-analysis of prospective cohort and case-control studies that estimated the risk of Parkinson’s disease associated with exposure to pesticides or solvents. Parkinson’s disease was associated with farming, and the association between the disease and pesticides was highly significant in the studies in which Parkinson’s disease diagnosis was self-reported. In high-quality case-control studies, exposure to any pesticides, herbicides, and solvents increased the risk of Parkinson’s disease. Exposure to paraquat or maneb/mancozeb was associated with about a twofold increase in risk. Study quality was not a source of heterogeneity among prospective studies. In case-control studies, study quality was a source of heterogeneity in risk estimates for some exposures.
