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Left Atrial Enlargement Could Be Detected on Extended Computed Tomography Angiography —Reply
In Reply We agree with Popkirov that left atrial volume is a better marker of incident atrial fibrillation than atrial diameter; however, we did not have these data available at all of the sites participating in the New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS) trial. Recently completed and ongoing studies will help determine if our observation has a clinical role and may provide additional data on left atrial size and function. Once all of these data are available, guidelines committees will likely make recommendat...
Source: JAMA Neurology - November 11, 2019 Category: Neurology Source Type: research

Prevention of Dementia —Thinking Beyond the Age and Amyloid Boxes
It is increasingly recognized that the declines in brain structure and function in persons with no clinical brain disease that we call brain aging and the 2 brain diseases that most frequently affect older adults (dementia and stroke) are the theoretically predictable consequences of a lifetime of injury that overcomes genetically and environmentally determined reserve and resilience, a concept encapsulated in the shorthand phrase life-course illness. Despite this insight, details of the various factors that adversely affect the brain health of older adults (and clarity on which times during life have the greatest effect a...
Source: JAMA Neurology - November 4, 2019 Category: Neurology Source Type: research

Association of Endovascular Treatment With Ischemic Stroke and Clinical Outcome in Pediatric Patients
This cohort study examines the use of endovascular recanalization in pediatric patients with arterial ischemic stroke and clinical outcomes.
Source: JAMA Neurology - October 14, 2019 Category: Neurology Source Type: research

Endovascular Therapy for Childhood Stroke —Working Together to Reach Prime Time
The standard of care for stroke treatment in adults changed rapidly in 2015 after results from 5 major clinical trials each showed efficacy of endovascular treatment of anterior circulation large-vessel occlusion within 6 hours of stroke onset. The positive results of these studies have since raised questions about whether endovascular therapy should be used for children who present with stroke due to large-vessel occlusion and, other than age, fit adult criteria for thrombectomy. Compared with the occurrence in adults, ischemic stroke in children is uncommon, but remains important to address because the resulting disabili...
Source: JAMA Neurology - October 14, 2019 Category: Neurology Source Type: research

Trends in Stroke Incidence Rates in Older US Adults
This cohort study evaluates whether stroke incidence declined among older adults from 1987 to 2011 vs 2011 to 2017 in the Atherosclerosis Risk in Communities study.
Source: JAMA Neurology - September 30, 2019 Category: Neurology Source Type: research

Realizing Benefits From More Intensive Blood Pressure Control for Preventing Recurrent Stroke
Blood pressure (BP) targets below 140/90 mm Hg in high-risk patients, such as those who have had a stroke, remain a controversial topic. A pivotal meta-analysis of 61 prospective observational studies involving 1 million adults without previous cardiovascular (CV) disease showed a linear association between usual BP levels and deaths from ischemic heart disease and stroke, down to BP levels as low as 115/75 mm Hg. These data prompted the “lower the better” hypothesis and challenged the long-standing argument of a J-curve or U-curve association of BP levels in such patients. Before the pivotal Systolic Blood Pressure In...
Source: JAMA Neurology - July 29, 2019 Category: Neurology Source Type: research

Inclusivity of Diverse Patient Groups —Reply
In Reply We thank Reddy for his commendation of our report examining risk factors for incident stroke in black and white men and women in the US National Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study. His comments align with our call for more epidemiologic studies to report sex-specific and race/ethnicity-specific research findings. Other epidemiologic studies, including the Cardiovascular Health Study and the Atherosclerosis Risk in Communities study, examined sex differences in the association of risk factors with cardiovascular outcomes (but not stroke alone) in blacks and white individu...
Source: JAMA Neurology - June 3, 2019 Category: Neurology Source Type: research

External Validation of a Scoring System for Predicting Fracture Risk After Ischemic Stroke
This prognostic study evaluated medical records of survivors of ischemic stroke from a national Canadian database to develop and validate a scoring system to predict low-trauma fractures within 1 year of hospital discharge.
Source: JAMA Neurology - May 13, 2019 Category: Neurology Source Type: research

Variations in Modeling for Treating All Patients With Stroke With Suspected Large Vessel Occlusion
To the Editor We read the article by Holodinsky et al, who reported the results of a modeling study to identify the optimal triage and transport strategy for patients suspected of having large-vessel occlusion, with interest.
Source: JAMA Neurology - March 25, 2019 Category: Neurology Source Type: research

Prognostic Model of Swallowing Recovery and Enteral Tube Feeding After Ischemic Stroke
This validation study describes the development of a prognostic model to predict swallowing recovery and guide the decision for enteral tube feeding in people with dysphagia after ischemic stroke.
Source: JAMA Neurology - February 11, 2019 Category: Neurology Source Type: research

Potential New Horizons for the Prevention of Cerebrovascular Diseases and Dementia
In this issue ofJAMA Neurology, Spence et al discuss the effect of pioglitazone, an insulin-sensitizing agent that has been shown to reduce the risk of recurrent stroke and myocardial infarction in patients with insulin resistance, in patients with prediabetes. Prediabetes was defined according to the American Diabetes Association criteria, ie, a hemoglobin A1c level of 5.7% to 6.4% or a fasting plasma glucose level of 100 to 125 mg/dL. Data were taken from the Insulin Resistance Intervention after Stroke (IRIS) study, an international randomized clinical trial performed in patients with previous stroke or transient ischem...
Source: JAMA Neurology - February 7, 2019 Category: Neurology Source Type: research

Sex and Race Differences in the Association of Incident Ischemic Stroke With Risk Factors
This cohort study of 25  789 black and white individuals in the United States examines the incidence and risk factors for ischemic stroke by sex and race.
Source: JAMA Neurology - December 10, 2018 Category: Neurology Source Type: research

Modeling Stroke Patient Transport for All Suspected Large-Vessel Occlusion Patients
This modeling study examines strategies for optimal triage and transport of patients with suspected large-vessel occlusion stroke to the appropriate center to achieve optimal care.
Source: JAMA Neurology - September 4, 2018 Category: Neurology Source Type: research

Association of Medication Nonadherence Among Survivors of Stroke After Affordable Care Act Implementation
This study investigates whether the US Affordable Care Act is associated with medication affordability and adherence among middle-aged to older adults who have had a stroke.
Source: JAMA Neurology - August 27, 2018 Category: Neurology Source Type: research

Advances in Understanding the Pathophysiology of Lacunar Stroke
This narrative review of studies of cerebral small vessel disease published since 2012 investigates progress in understanding the pathogenesis, imaging characteristics, and genetic basis of lacunar stroke.
Source: JAMA Neurology - August 27, 2018 Category: Neurology Source Type: research

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