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Proton Pump Inhibitors and Dementia Incidence
To the Editor I read with interest the article by Gomm and colleagues, which examined the association between the use of proton pump inhibitors (PPIs) and incident dementia in elderly individuals in a prospective study. The authors adopted time-dependent Cox regression analysis, and the time-dependent covariates were polypharmacy and the comorbidities of depression, diabetes, ischemic heart disease, and stroke. Age and sex were also used as confounding factors. The hazard ratio of PPIs for incident dementia was 1.44 (95% CI, 1.36-1.52), and the authors recommended randomized clinical trials to confirm the causal associatio...
Source: JAMA Neurology - June 20, 2016 Category: Neurology Source Type: research

Dementia After Intracerebral Hemorrhage
As acute management of intracerebral hemorrhage (ICH) has improved, more patients survive ICH but are left with significant deficits. In the past, primary evaluations of outcomes after ICH have focused on mortality and levels of functional dependence, with a relatively modest number of patients experiencing true functional independence after ICH or returning to their previous level of functioning. Cognitive outcomes after ICH have thus not been a primary focus of either treatment or natural history studies of ICH, despite their known importance after ischemic stroke and their importance in predicting return to previous functioning.
Source: JAMA Neurology - June 13, 2016 Category: Neurology Source Type: research

Cerebral Microbleeds, Cognition and Therapeutic Implications
A recent major clinical advance in magnetic resonance imaging (MRI) of the brain is the development of paramagnetic-sensitive sequences such as T2-weighted gradient-recalled echo and susceptibility-weighted images for the detection of cerebral microbleeds (CMBs). On brain MRI, CMBs are small (≤5 to 10 mm in diameter), round, dark-signaled lesions that consist of extravasation of blood components through fragile microvascular walls that neuropathologically represent hemosiderin-laden macrophages. Magnetic resonance imaging–detected CMBs are common in elderly individuals, coexist with ischemic stroke and intracerebral he...
Source: JAMA Neurology - June 6, 2016 Category: Neurology Source Type: research

Vital Sign and Glucose Abnormalities and Outcome in Childhood Stroke
Childhood stroke studies often cite differences in risk factors between adult and pediatric patients, namely that traditional adult stroke risk factors, such as hypertension and hyperglycemia, are not common causes of childhood stroke. In a study of 83 children from the United Kingdom, only 8 children (10%) with available blood pressure data at admission were classified as having hypertension. The authors stated that this could be an overestimate because follow-up blood pressure data were not available, but they acknowledged that elevated blood pressure could be important in some children. In a multinational cohort of 676 ...
Source: JAMA Neurology - May 23, 2016 Category: Neurology Source Type: research

Blood Pressure, Blood Glucose, and Temperature After Childhood Stroke
This cohort study aims to determine the prevalence of abnormal blood pressure, blood glucose levels, and temperature in pediatric patients with acute arterial ischemic stroke and to explore any association between these measures and neurological outcome.
Source: JAMA Neurology - May 23, 2016 Category: Neurology Source Type: research

Factors Affecting Preventability of Stroke
In Reply We appreciate the interest of Kawada in our work. Our study was designed to analyze the association between ischemic stroke prevention and treatment; we defined our variables and conducted our data analysis accordingly. We disagree with Kawada’s statement that the “empirical method is not suitable for scientific research.” We look forward to further investigations of how stroke prevention and treatment are associated.
Source: JAMA Neurology - May 2, 2016 Category: Neurology Source Type: research

Precision Medicine for Ischemic Stroke
This Viewpoint discusses the future of precision medicine in the field of ischemic stroke, first looking at the current status of genetic approaches and then exploring the status of phenotype-based delineations.
Source: JAMA Neurology - May 2, 2016 Category: Neurology Source Type: research

Cerebral Microbleeds and Thrombolysis
Using intravenous thrombolysis in a stroke patient with cerebral microbleeds represents one of the most challenging clinical decisions in acute stroke neurology. In this setting, the implications of coexisting ischemic and hemorrhagic cerebrovascular disease (mixed cerebrovascular disease) must be confronted and urgently addressed. The clinical consequences of intervening or not intervening are profound.
Source: JAMA Neurology - April 18, 2016 Category: Neurology Source Type: research

Hemodynamics in Atherosclerotic Vertebrobasilar Occlusive Disease
In Reply We read with interest the letter by Walcott et al and thank them for their insightful comments. They note that whereas in carotid stenosis, artery-to-artery embolism is a common culprit, hypoperfusion as determined by the Vertebrobasilar Flow Evaluation and Risk of Transient Ischemic Attack and Stroke protocol is the main pathological mechanism in patients with vertebrobasilar disease and low-flow status. In their experience, a number of patients with medically refractory vertebrobasilar disease symptoms were successfully treated with surgical revascularization in the form of a microsurgical bypass and they make t...
Source: JAMA Neurology - April 18, 2016 Category: Neurology Source Type: research

Symptomatic Intracerebral Hemorrhage After IV Thrombolysis in Acute Stroke
This meta-analysis investigates the association of high cerebral microbleed burden with the risk of symptomatic intracerebral hemorrhage in patients with acute ischemic stroke treated with intravenous thrombolysis.
Source: JAMA Neurology - April 18, 2016 Category: Neurology Source Type: research

The Challenges of Stroke Prediction Scores
Transient ischemic attack (TIA) and stroke prediction scores have been a topic of both clinical and research interest for decades. The goal of these scores is to identify high-risk patients for both prognostic and clinical management purposes. There are several TIA and stroke prediction scores that aim to prognosticate recurrence or worsening of cerebrovascular events (CVEs). Some are purely clinical scales (eg, California, ABCD, ABCD2, and ABCD3), while others incorporate cerebral parenchyma and/or vascular imaging (eg, Clinical and Imaging-based Predictive model, Recurrence Risk Estimator at 90 Days, ABCDE+, ABCD-I, ABCD...
Source: JAMA Neurology - March 21, 2016 Category: Neurology Source Type: research

Imaging and Recurrent Cerebrovascular Events in Patients After Stroke
This cohort study seeks to determine predictors of early recurrent cerebrovascular events among patients with transient ischemic attacks and minor strokes and National Institutes of Health Stroke Scale scores of 0 to 3.
Source: JAMA Neurology - March 21, 2016 Category: Neurology Source Type: research

Early Recurrent Stroke Prediction With the Recurrence Risk Estimator
Acute ischemic stroke is a medical emergency. Early reperfusion therapy can reduce functional disability, and early secondary prevention therapy can reduce early recurrent stroke. The rate of recurrent stroke in the first month is approximately 9.4% (95% CI, 6%-14%) among patients with ischemic stroke caused by large-artery atherosclerosis and approximately 1.2% (95% CI, 0.4%-3.0%) among patients with ischemic stroke caused by intracranial small vessel disease. Because some effective early prevention therapies may be risky or costly (eg, carotid revascularization or dual antiplatelet therapy) and some patients have a low r...
Source: JAMA Neurology - February 29, 2016 Category: Neurology Source Type: research

Prediction of Early Recurrence After Acute Ischemic Stroke
This study tests the validity of a prognostic score that was exclusively developed to predict early risk of recurrence in a multicenter setting.
Source: JAMA Neurology - February 29, 2016 Category: Neurology Source Type: research

Omitted Author Affiliation
This article was corrected online.
Source: JAMA Neurology - February 22, 2016 Category: Neurology Source Type: research

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