News Roundup: New and Noteworthy Information

First-ever stroke patients who are prescribed statin therapy after hospital discharge have a lower risk of 10-year stroke recurrence and improved survival, according to a study in the May 26 Neurology. Investigators observed a cohort of 794 consecutive, first-ever acute stroke patients from the Athenian Stroke Registry who were admitted since January 1997 and for whom information covering a 10-year follow-up period was available. The recurrence rate among patients who did not receive statins after hospital discharge was 16.3%, compared with 7.5% among those who did receive statins. “Cox regression analyses revealed only statin therapy postdischarge to be a significant independent predictor of stroke recurrence (adjusted hazard ratio, 0.65),” the researchers stated. “Similarly, patients receiving a statin had a significantly lower mortality during the 10-year period after the acute cerebrovascular event.”

The trajectory of cognitive decline is accelerated by delirium in patients with Alzheimer’s disease, according to a report in the May 5 Neurology. A secondary analysis of data from the Massachusetts Alzheimer’s Disease Research Center examined cognitive performance over time for patients who developed (n = 72) and did not develop (n = 336) delirium. “Among patients who developed delirium, the average decline at baseline for performance on the Information-Memory-Concentration was 2.5 points per year, but after an episode of delirium there was a further decline to an average of 4.9 points per year,” investigators stated. The rate of change occurred approximately three times faster in those who had delirium across groups.

The specificity and sensitivity of self-reported stroke is inaccurate among adults of varying ethnicities, according to a report in the May 11 online Archives of Neurology. High-resolution MRIs were conducted in a community-based cohort study of 717 persons without dementia. “In analyses of the whole sample, sensitivity of stroke self-report for a diagnosis of stroke on MRI was 32.4%, and specificity was 78.9%,” the investigators commented. “In analyses stratified by median age (80.1), the validity between reported stroke and detection of stroke on MRI was significantly better in the younger than the older age group (for all vascular territories: P = .02).” False-negative results were associated with impaired memory, cognitive skills, language ability, hypertension, and myocardial infarction.

The late-life dementia risk index accurately stratifies older adults into categories of low, moderate, and high risk for dementia, according to a study in the May 13 onlineNeurology. Researchers developed a point system based on logistic regression coefficients to identify predictive factors of developing incident dementia within six years. Within that time, 14% of subjects (mean age, 76) developed dementia. The final index included older age (1 to 2 points), poor cognitive performance (2 to 4 points), and BMI less than 18.5 (2 points), as well as one or more apolipoprotein E ┖ alleles, cerebral MRI findings of white matter disease, ventricular enlargement, and other factors (1 point each). “Four percent of subjects with low scores developed dementia over six years compared with 23% of subjects with moderate scores and 56% of subjects with high scores,” the researchers stated.

Lamictal (lamotrigine) ODT (orally disintegrating tablets) has been approved by the FDA for long-term treatment of bipolar 1 disorder to lengthen the time between mood episodes in patients 18 and older who have been treated with other medication. Lamotrigine ODT demonstrated bioequivalence to lamotrigine and can also be used as monotherapy for patients 16 and older who are switching from other drugs used to treat partial seizures, or in combination with other drugs to treat certain types of seizures in patients 2 and older. The new formulation offers an option to patients who have difficulty swalling tablets. Lamictal ODT is expected to be available in 25-mg, 50-mg, 100-mg, and 200-mg doses in early July. Lamictal ODT is marketed by GlaxoSmithKline.

Patients with peripheral artery disease who took aspirin alone or with dipyridamole had a significant reduction in nonfatal stroke, as well as a statistically nonsignificant decrease in the primary end point of cardiovascular events, according to a study in the May 13 JAMA. Investigators identified 18 prospective, randomized controlled trials (5,269 individuals) of aspirin therapy with and without dipyridamole that reported cardiovascular event rates. Nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death were primary endpoints. A total of 251 (8.9%) of 2,823 patients taking aspirin, either alone or with dipyridamole, experienced cardiovascular events, compared with 269 (11%) of 2,446 controls. A reduction in nonfatal stroke was associated with aspirin therapy (52 of 2,823 vs 76 of 2,446; relative risk, 0.66). “Additional randomized controlled trials of aspirin therapy are needed to establish the net benefit and bleeding risks in peripheral artery disease,” researchers stated.