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Cardiovascular Risk and Obesity Affect Brain Volume in Middle Age

The strongest influence of cardiovascular risk and obesity on reduced brain volume is seen between 55 and 64 years of age in men and between 65 and 74 years in women, according to a study published online Nov. 26 in the Journal of Neurology, Neurosurgery & Psychiatry.

Joseph Nowell, from Imperial College London, and colleagues recruited 34,425 participants between the ages of 45 and 82 years from the U.K. Biobank database to examine the influence of cardiovascular risk and obesity on brain volume in men and women. T1-weighted structural magnetic resonance images were downloaded for all participants; the volumetric changes of the whole brain were characterized.

The researchers found that cardiovascular risk and obesity had the greatest influence on lower gray matter volume between 55 and 64 years of age among men. The greatest effect on lower gray matter volume occurred between ages 65 and 74 years among women. When evaluated separately, the associations remained significant in APOE ε4 carriers and APOE ε4 noncarriers.

"Mitigating cardiovascular risk represents a promising approach to treat or even prevent the development of Alzheimer's disease," the authors write. "Targeting cardiovascular risk and obesity a decade earlier in males than females may be imperative for potential candidates to achieve a therapeutic benefit in preventing neurodegeneration and cognitive decline."

One author disclosed ties to the pharmaceutical industry.

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Racial Disparities Identified Among Pregnant Women With MS

FRIDAY, Jan. 26, 2024 (HealthDay News) -- Among women with multiple sclerosis (MS), underrepresented women are less often employed and privately insured during pregnancy and they have lower median birth weights compared with White women, according to a study published online Jan. 23 in Neurology.

Anne Marie Radzik, from the University of California San Francisco, and colleagues extracted demographic and clinical data from medical records of nine U.S. MS centers for women with MS/clinically isolated syndrome with live births between 2010 and 2021. Data were analyzed from 294 pregnancies resulting in live births: 81 Black, 67 Hispanic, and 146 White mothers.

The researchers found that White mothers lived in areas of higher median Child Opportunity Index relative to underrepresented women (79 versus 22) and were more often employed (84.9 versus 75 percent; odds ratio, 2.57) and privately insured (93.8 versus 56.8 percent; odds ratio, 11.6); more of them received a 14-week ultrasound (98.6 versus 93.9 percent). The mode of delivery differed significantly between the groups; the rate of emergency cesarean deliveries was highest among Black women, while Hispanic women had the highest rates of uncomplicated vaginal deliveries. Median birth weights were lower for babies born to underrepresented versus White women (3,198 versus 3,275 g), and median breastfeeding duration was shorter (4.5 versus 6.0 months). Underrepresented women had a higher median Expanded Disability Status Scale score (1.5 versus 1) before pregnancy.

"To attenuate some of the disparities identified in the current analyses, collaborative care models may help to increase and optimize access to quality prenatal and neurologic care," the authors write.

Several authors disclosed ties to biopharmaceutical companies, including Genentech, which funded the study.

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Dementia May Occur Less Often, Develop Slower in Parkinson Disease Patients

For patients with Parkinson disease (PD), dementia may occur less often or develop over a longer time period than previously thought, according to a study published online Aug. 7 in Neurology.

Julia Gallagher, from the University of Pennsylvania in Philadelphia, and colleagues determined long-term dementia risk among participants from the Parkinson's Progression Markers Initiative (PPMI) multisite international study and a long-standing PD research cohort at the University of Pennsylvania (Penn). A total of 417 participants with PD were followed for the PPMI cohort, and 389 participants with PD were followed for the Penn cohort.

The researchers found that the estimated probability of dementia at year 10 disease duration was 9, 15, and 12 percent for site investigator diagnosis, according to the Montreal Cognitive Assessment, and according to the Movement Disorder Society-Unified Parkinson's Disease Rating Scale, respectively, in the PPMI cohort; 47 percent of the Penn cohort was eventually diagnosed with dementia. The median time to dementia was 15 years in the interval-censored curve for the Penn cohort, with estimated probabilities of dementia of 27, 50, and 74 percent at 10, 15, and 20 years of disease duration, respectively.

"These results provide updated, and more hopeful, estimates of long-term dementia risk in PD, suggesting a longer window to intervene to prevent or delay cognitive decline," the authors write.

Several authors disclosed ties to the biopharmaceutical industry; the PPMI is partially funded by biopharmaceutical companies.

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Novel Protocol Can Help to Rapidly Diagnose Eye Stroke

WEDNESDAY, Feb. 21, 2024 (HealthDay News) -- A novel protocol can be used to diagnose eye stroke and expedite treatment, according to a study published online Feb. 13 in Ophthalmology.

Gareth M.C. Lema, M.D., Ph.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues conducted a retrospective case series in adults who presented with painless monocular vision loss and were diagnosed with non-arteritic retinal artery occlusion. Optical coherence tomography (OCT) machines were placed in the stroke center or emergency department at three hospitals. Patients were evaluated by the stroke neurology service and underwent OCT; the images were interpreted remotely. Intra-arterial tissue plasminogen activator (IA-tPA) treatment was provided to eligible patients.

Fifty-nine patients were evaluated in the first 18 months since the protocol went live. Based on OCT and follow-up examination, the researchers found that 42 percent of patients had a confirmed retinal artery occlusion. Ten patients were eligible for treatment, and nine received IA-tPA. Within 24 hours after treatment, there was a significant improvement in mean visual acuity from LogMAR 2.14 to LogMAR 0.7; after four weeks, LogMAR was 1.04. Sixty-six percent of patients had clinically significant improvement within 24 hours, which was maintained through one month in 56 percent of treated patients. The mean time to treatment was 543 minutes from last known well and 146 minutes from presentation at the stroke center.

"We reported a novel protocol for the diagnosis of eye strokes that not only can save vision for these patients, but also demonstrates the potential to use remote consultation for time-sensitive ophthalmic emergencies," Lema said in a statement.

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Prenatal Valproate Exposure Tied to Psychiatric Disorders in Late Childhood

WEDNESDAY, May 24, 2023 (HealthDay News) -- Prenatal exposure to the antiepileptic medication valproate is associated with an increased risk for later psychiatric disorders among children of mothers with epilepsy, according to a study published online April 17 in JAMA Neurology.

Julie Werenberg Dreier, Ph.D., from Aarhus University in Denmark, and colleagues examined the association between prenatal exposure to antiseizure medication (ASM) with a spectrum of psychiatric disorders in childhood and adolescence among children of mothers with epilepsy. The analysis included 38,661 children of mothers with epilepsy born in Denmark, Finland, Iceland, Norway, and Sweden between 1996 and 2017.

The researchers found that 42.6 percent of children were prenatally exposed to ASM. Prenatal valproate exposure was associated with an increased risk for the combined psychiatric end point (adjusted hazard ratio [aHR], 1.80; cumulative risk at 18 years in ASM-exposed children, 42.1 versus 31.3 percent in unexposed children), which was driven mainly by disorders within the neurodevelopmental spectrum. There was no increased risk for psychiatric disorders seen with prenatal exposure to lamotrigine, carbamazepine, or oxcarbazepine, while there were associations for prenatal exposure to topiramate with attention-deficit/hyperactivity disorder (aHR, 2.38) and exposure to levetiracetam with anxiety (aHR, 2.17) and attention-deficit/hyperactivity disorder (aHR, 1.78).

"This study provides reassuring evidence that lamotrigine, carbamazepine, and oxcarbazepine are not associated with long-term behavioral or developmental disorders but cannot rule out risks with higher doses," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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Network Reorganization Compensates for Post-COVID Neural Deficits

THURSDAY, May 4, 2023 (HealthDay News) -- Compensatory neural processes with greater usage of alternate brain regions are observed in patients with post-COVID condition (PCC) with neuropsychiatric symptoms, according to a study published online April 26 in Neurology.

Linda Chang, M.D., from the University of Maryland School of Medicine in Baltimore, and colleagues used blood-oxygenation-level-dependent functional magnetic resonance imaging to examine whether patients with PCC have abnormal brain activation during working memory. Data were included for 29 participants with PCC and 21 healthy controls. Participants underwent assessment using three National Institutes of Health-Toolbox (NIHTB) batteries for Cognition, Emotion, and Motor function (NIHTB-CB, NIHTB-EB, and NIHTB-MB, respectively), as well as certain tests from the Patient-Reported Outcomes Measurement Information System (PROMIS).

The researchers found that the PCC group had similar and normal performance on the NIHTB-CB as controls, despite the high prevalence of memory and concentration complaints (79 and 93 percent, respectively). Compared with controls, PCC participants had greater brain activation across the network, with greater activation in the right superior frontal gyrus, but lesser deactivation in the default mode regions. Furthermore, PCC participants had poorer dexterity and endurance on the NIHTB-MB, higher T-scores for negative affect and perceived stress, and lower T-scores for psychological well-being on the NIHTB-EB versus controls; they also had more pain symptoms and poorer mental and physical health PROMIS measures. Greater brain activation predicted worse scores on abnormal measures on the NIHTB-MB.

"These findings indicated a reorganized working memory network, with greater or compensatory usage of the nondominant brain regions, but less usage of the parietal default mode resources, to maintain normal performance," the authors write.

Two authors disclosed financial ties to the biopharmaceutical industry.

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Poor Sleep Quality Linked to Incident Motoric Cognitive Risk Syndrome

Poor sleep quality may be associated with incident, but not prevalent, motoric cognitive risk syndrome (MCR), a predementia syndrome characterized by slow gait speed and cognitive complaints, according to a study published online Nov. 6 in Neurology.

Victoire Leroy, M.D., Ph.D., from the Albert Einstein College of Medicine in Bronx, New York, and colleagues examined the association of sleep disturbances with incident and prevalent MCR in older adults. MCR was defined as cognitive complaints reported on standardized questionnaires and slow gait speed as recorded on an electronic treadmill. The 445 participants were categorized as good or poor sleepers based on an estimated Pittsburgh Sleep Quality Index (PSQI) cut score.

The researchers found that 36 of the 403 participants without MCR at baseline developed incident MCR during a mean follow-up of 2.9 years. The risk for incident MCR was higher for poor sleepers than good sleepers (adjusted hazard ratio, 1.6; 95 percent confidence interval, 0.7 to 3.4). Of the seven components of the PSQI, only sleep-related daytime dysfunction (excessive sleepiness and lower enthusiasm) was significantly associated with MCR in fully adjusted models (adjusted hazard ratio, 3.3; 95 percent confidence interval, 1.5 to 7.4). There was no association seen for prevalent MCR with poor sleep quality.

"Excessive day sleepiness is associated with greater risk of incident MCR and needs to be further examined as a potentially modifiable risk factor," the authors write.

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Transition to Standard Time Tied to Short-Term Increase in Sleep Disorders

THURSDAY, May 4, 2023 (HealthDay News) -- The transition from daylight saving time (DST) to standard time (ST) is associated with a transient increase in sleep disorders, according to a study published online May 3 in Neurology.

Sheida Zolfaghari, M.D., from McGill University in Montreal, and colleagues compared sleep symptoms among 30,097 participants aged 45 to 85 years who were interviewed in different seasons and before and after the transition into DST and ST.

The researchers observed no difference in dissatisfaction with sleep, sleep onset, sleep maintenance, and hypersomnolence for participants interviewed in different seasons. Slightly shorter sleep duration was reported by those interviewed in summer versus winter (6.76 ± 1.2 versus 6.84 ± 1.3 hours). No difference in sleep symptoms was reported for participants interviewed one week before versus one week after DST transition, except for a nine-minute decrease in sleep duration a week after transition. Those interviewed a week after versus a week before transition to ST reported more dissatisfaction with sleep (28 versus 22.6 percent), higher sleep-onset insomnia (7.1 versus 3.3 percent), higher sleep-maintenance insomnia (12.9 versus 8.2 percent), and more hypersomnolence with adequate sleep (7.3 versus 3.6 percent; adjusted odds ratios, 1.34, 2.26, 1.64, and 2.08, respectively).

"As disruptive as these transitions may feel in the short term, there may be few long-term implications of the repeated switch back and forth from daylight saving time to standard time," a coauthor said in a statement.

Several authors disclosed financial ties to the pharmaceutical industry.

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Risk for Incident Dementia Increased With Diagnosed Depression

MONDAY, July 24, 2023 (HealthDay News) -- Men and women with diagnosed depression have an increased risk for dementia, according to a study published online July 24 in JAMA Neurology.

Holly Elser, M.D., Ph.D., from Aarhus University in Denmark, and colleagues examined the associations between early-, middle-, and late-life depression and incident dementia in a nationwide cohort study involving Danish individuals. Data were included from 246,499 individuals with diagnosed depression and 1,190,302 without depression.

The researchers found that 67.7 percent of those diagnosed with depression were diagnosed before the age of 60 years. Relative to the comparison cohort, those diagnosed with depression had a 2.41 times higher hazard of dementia. When the time elapsed from the index date was longer than 20 to 39 years (hazard ratio, 1.79) and among those diagnosed with depression in early, middle, or late life, the association persisted (hazard ratios, 3.08, 2.95, and 2.31 for 18 to 44 years, 45 to 59 years, and 60 years and older, respectively). Men had a greater hazard ratio for dementia than women (2.98 versus 2.21).

"Findings support our hypothesis that associations would persist regardless of time since depression diagnosis or the age at which depression was diagnosed," the authors write. "Our results therefore suggest that depression is not only an early symptom of dementia but also that depression is associated with an increase in dementia risk."

One author disclosed receiving fees from Peabody Arnold and having a patent for use of glecaprevir/pibrentasvir; a second author disclosed ties to Amgen.

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Self-, Partner-Reported Cognitive Decline Linked to Tau

Individuals who self-report and whose partners report cognitive decline have greater tau, which is driven by elevated beta-amyloid (Aβ), according to a study published online May 29 in Neurology.

Michalina F. Jadick, from Massachusetts General Hospital in Boston, and colleagues conducted a cross-sectional study to examine associations of self-reported and study partner-reported cognitive decline with tau deposition, especially among those with preclinical Alzheimer disease. Flortaucipir positron emission tomography (PET) uptake was averaged in the medial temporal lobe (MTL) and neocortex (NEO) to derive two regional tau composites. Associations between tau PET and the Cognitive Function Index (CFI) were examined among 675 cognitively unimpaired individuals.

The researchers found that greater tau was associated with greater self-reported CFI (β = 0.28 and 0.26 for MTL and NEO, respectively) and study partner-reported CFI (β = 0.28 and 0.31 for MTL and NEO, respectively). Elevated Aβ was the driver of the significant associations between both CFI measures and MTL/NEO tau PET. For both self- and study partner-reported CFI, continuous Aβ showed an independent effect on CFI in addition to MTL and NEO tau. Independent associations were seen for self-reported CFI, study partner-reported CFI, and the Preclinical Alzheimer Cognitive Composite (PACC) with MTL tau; independent associations were seen for study partner-reported CFI and PACC, but not self-reported CFI, with NEO tau.

"Our study found early suspicions of memory problems by both participants and the people who knew them well were linked to higher levels of tau tangles in the brain," coauthor Rebecca E. Amariglio, Ph.D., from Harvard Medical School in Boston, said in a statement.

Several authors disclosed ties to the biopharmaceutical industry.

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Ubrogepant Administered During Prodrome Beneficial for Migraine

For adults experiencing migraine attacks with moderate-to-severe headache pain, ubrogepant administered during prodrome is beneficial for patient-reported outcomes, according to a study published online Aug. 28 in Neurology.

Richard B. Lipton, M.D., from the Albert Einstein College of Medicine in Bronx, New York, and colleagues conducted a multicenter, randomized, crossover trial involving adults who experienced two to eight migraine attacks per month with moderate-to-severe headache pain. Eligible participants were randomly assigned to treatment sequence A (placebo then ubrogepant 100 mg) or sequence B (ubrogepant 100 mg then placebo) for treatment of two qualifying prodrome events, defined as a migraine attack with prodromal symptoms when the participant was confident a headache would follow within one to six hours. The modified intent-to-treat population included 477 participants.

The researchers found that after treatment of qualifying prodrome events, participants after ubrogepant treatment had a significantly greater ability to function normally over 24 hours than those treated with placebo (odds ratio, 1.66). The proportion reporting "no disability, able to function normally" as early as two hours after a dose was higher with ubrogepant versus placebo treatment (odds ratio, 1.76). A greater reduction in activity limitations was seen over 24 hours after dose for ubrogepant administered during the prodrome (odds ratio, 2.07). The rates of being "satisfied" or "extremely satisfied" were greater for ubrogepant than placebo at eight and 24 hours after dose (odds ratios, 2.37 and 2.32, respectively).

"These results demonstrate the functional benefits of ubrogepant for the treatment of acute migraine when administered during the prodrome," the authors write.

Several authors disclosed ties to pharmaceutical companies, including AbbVie, which manufactures ubrogepant and funded the study.

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Ofatumumab Effective for MS Across Racial, Ethnic Subgroups

For patients with relapsing multiple sclerosis (RMS), ofatumumab is more effective than teriflunomide across racial and ethnic subgroups, according to a study published online July 17 in Neurology.

Mitzi J. Williams, M.D., from the Joi Life Wellness MS Center in Atlanta, and colleagues conducted a post-hoc analysis to compare the proportion of patients with RMS achieving three-parameter no evidence of disease activity (NEDA-3) with ofatumumab versus teriflunomide. A total of 1,882 participants were randomly allocated to receive ofatumumab 20 mg every four weeks or teriflunomide 14 mg once daily for up to 30 months.

The researchers found that from months 0 to 24, the proportion of ofatumumab- versus teriflunomide-treated patients achieving NEDA-3 was 33.3 versus 3.4 percent for non-Hispanic Black patients; 42.9 versus 21.9 percent for non-Hispanic Asian patients; 36.6 versus 18.6 percent for Hispanic/Latino patients; and 37.4 versus 16.6 percent for non-Hispanic White patients. Between treatment group and across race/ethnicity subgroups, the rates of adverse events were generally similar; no new or unexpected safety signals were seen.

"Our study examined the efficacy and safety of ofatumumab in diverse populations," Williams said in a statement. "We found overall the drug was effective and safe across racial and ethnic groups."

Several authors disclosed ties to pharmaceutical companies, including Novartis, which manufactures ofatumumab and funded the study.

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Most With Intractable Meniere Disease Experience Symptom Relief

Most patients with intractable Meniere disease (MD) experience symptom relief over time, according to a study published online Oct. 23 in Frontiers in Neurology.

F.R. Gerritsen, from Haga Hospital in The Hague, Netherlands, and colleagues described the evolution of vertigo attacks among patients with intractable MD in whom surgery was considered in a retrospective cohort study. Patients with definite unilateral MD and persisting vertigo attacks despite intratympanic steroid injection treatment were included in the study. All patients had been wait-listed for participation in a trial examining nonablative surgery; they were wait-listed between June 2016 and June 2021. To assess the evolution of the vertigo attacks, their data were collected in September 2022.

The analysis included 35 patients; 25 (71 percent) declined surgery. The researchers found that 21 of the 33 patients (64 percent) with complete information on vertigo attacks were free of vertigo attacks on data collection after a median disease duration of 5.3 years. The duration of disease was longer for patients who did versus those who did not undergo surgery.

"The current population was thought to suffer intractable disease, and yet most patients experienced relieve of symptoms in just over one year," the authors write. "Knowledge of the generally benign evolution of MD may be of value for patients and clinicians when weighing treatment options."

One author was employed by The Novo Nordisk Foundation Center for Stem Cell Medicine.

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Disparities in Post-Acute Stroke Care Depend on Insurance Status

Insurance-dependent racial and ethnic disparities and regional variations are seen in post-acute service utilization after stroke, according to a study published online July 17 in Neurology: Clinical Practice.

Shumei Man, M.D., Ph.D., from the Neurological Institute at the Cleveland Clinic, and colleagues conducted a retrospective cross-sectional study involving patients hospitalized for ischemic stroke and intracerebral hemorrhage in 2017 to 2018 using the National Inpatient Sample. Data were included for 1,000,980 weighted ischemic stroke admissions.

The researchers found that uninsured patients had the lowest adjusted odds of facility over home discharge and home health care (HHC) discharge over home without HHC (odds ratios, 0.44 and 0.79, respectively) compared with patients with private insurance. Only Hispanic patients with Medicare/Medicaid insurance or self-pay had lower odds of facility over home discharge compared with White patients (adjusted odds ratios, 0.80 and 0.75, respectively). Lower odds of HHC discharge over home without HHC discharge were seen for uninsured Hispanic patients versus White patients (adjusted odds ratio, 0.74). The HHC discharge rate was highest in the East North Central region and lowest in the Pacific region (39.2 and 31.2 percent, respectively). The HHC discharge rate was highest in New England and lowest in the West North Central region (20.2 and 10.3 percent, respectively).

"These findings indicate that targeted efforts are needed to improve access to care after stroke for people without insurance, especially Hispanic people, as well as those in specific regions to ensure optimal recovery and successful community transition for all people across the country," Man said in a statement.

One author disclosed ties to the pharmaceutical industry.

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Lithium Aspartate Not Effective for Neurologic Long COVID Fatigue

Lithium aspartate is not effective for neurologic post-COVID-19 condition (PCC) symptoms of fatigue and cognitive dysfunction, according to a study published online Oct. 2 in JAMA Network Open.

Thomas Guttuso Jr., M.D., from the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo in Williamsville, New York, and colleagues conducted a randomized, placebo-controlled trial involving participants in a neurology clinic to examine the effects of lithium aspartate therapy on PCC fatigue and cognitive dysfunction. Fifty-two participants were randomly assigned to receive lithium aspartate 10 to 15 mg/day or identically appearing placebo for three weeks (26 patients in each group), followed by two weeks of open-label lithium aspartate 10 to 15 mg/day. The main outcome measures were the changes in sum of Fatigue Severity Scale-7 or Brain Fog Severity Scale scores.

The researchers observed no adverse events attributable to lithium therapy. No significant intergroup differences were seen for the primary outcome or any secondary outcomes, including changes from baseline in the scores of additional questionnaires. Three patients completed a subsequent dose-finding study; open-label lithium aspartate 40 to 45 mg/day versus 15 mg/day was associated with numerically greater reductions in fatigue and cognitive dysfunction scores.

"Another randomized controlled trial is required to assess the potential benefits of higher lithium dosages for treating neurologic PCC," the authors write.

One author disclosed ties to e3 Pharmaceuticals.

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Lower Risk for MCI, Dementia Seen With Cognitively Stimulating Occupations

WEDNESDAY, April 17, 2024 (HealthDay News) -- Individuals with a history of cognitively stimulating occupations from ages 30 to 65 years have lower risk for mild cognitive impairment (MCI) and dementia in later life, according to a study published online April 17 in Neurology.

Trine H. Edwin, M.D., Ph.D., from Oslo University Hospital in Norway, and colleagues examined the association between registry-based trajectories of occupational cognitive demands from ages 30 to 65 years and clinically diagnosed MCI and dementia at age 70 years and older. Occupational cognitive demands were measured by routine task intensity (RTI), with lower RTI indicating a more cognitively demanding occupation. The relative risk ratios (RRRs) of MCI and dementia were estimated after adjustment for multiple confounding variables.

The researchers identified four RTI trajectory groups based on longitudinal RTI scores for 305 unique occupations: low, intermediate-low, intermediate-high, and high RTI (20.4, 22.5, 37.1, and 19.9 percent, respectively). After adjusting for age, sex, and education, participants in the high versus the low RTI group had a higher risk for MCI and dementia (RRRs [95 percent confidence intervals], 1.74 [1.41 to 2.14] and 1.37 [1.01 to 1.86], respectively). The point estimates were not appreciably changed in a sensitivity analysis controlling for income and baseline health-related factors (RRRs [95 percent confidence intervals], 1.66 [1.35 to 2.06] and 1.31 [0.96 to 1.78], respectively).

"These results indicate that both education and occupational cognitive demands play a crucial role in lowering the risk of later-life cognitive impairment, consistent with the cognitive reserve hypothesis," the authors write.

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Harmful Association Identified Between Traffic Pollution, Amyloid Plaques

THURSDAY, Feb. 22, 2024 (HealthDay News) -- Traffic-related fine particulate matter (PM2.5) affects the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) score, according to a study published online Feb. 21 in Neurology.

Grace M. Christensen, Ph.D., from the Emory University School of Medicine in Atlanta, and colleagues conducted a cross-sectional study using 224 brain tissue donors who died before 2020. Alzheimer disease (AD) pathology was assessed among donors using the Braak stage, CERAD score, and combined AD neuropathologic change (ABC) score. The association between traffic-related PM2.5 (based on measurements of one-, three-, and five-year average PM2.5 concentrations before death matched to home addresses) and AD hallmark pathology was examined.

Of the participants, 57 percent had at least one APOE ε4 copy. The researchers observed a significant association for traffic-related PM2.5 with the CERAD score for the one- and three-year exposure windows (odds ratios, 1.92 and 1.87, respectively). Nonsignificant associations were seen for PM2.5 with Braak stage and ABC score. Those without APOE ε4 markers had the strongest associations between PM2.5 and neuropathology markers (e.g., odds ratio, 2.31 for the CERAD score and one-year exposure window); however, the interaction between PM2.5 and APOE genotype was not significant.

"Our study found traffic-related PM2.5 exposure was associated with the CERAD score at autopsy, contributing to a growing body of evidence that PM2.5 affects β-amyloid deposition in the brain," the authors write. "More research is needed to establish causality for the association between PM2.5 and AD, including epidemiologic and mechanistic studies."

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Variability in Total Cholesterol, LDL Cholesterol Linked to Dementia

Variability in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) is associated with dementia and cognitive impairment, according to a study published online Jan. 27 in Neurology.

Zhen Zhou, Ph.D., from Monash University in Melbourne, Australia, and colleagues examined the association between year-to-year intraindividual lipid variability and the subsequent risk for cognitive decline and dementia in community-dwelling older adults in the ASPirin in Reducing Events in the Elderly randomized trial of aspirin. This post-hoc analysis included participants with lipid levels measured at baseline and in years 1, 2, and 3 and quantified year-to-year variability in TC, LDL-C, high-density lipoprotein cholesterol (HDL-C), and triglycerides.

The analysis included 9,846 individuals. The researchers identified 509 incident dementia events and 1,790 cognitive impairment with no dementia (CIND) events during a median follow-up of 5.8 and 5.4 years after assessment of variability. Comparing the highest and lowest quartiles of TC and LDL-C variability, respectively, the hazard ratios were 1.60 and 1.48 for dementia and 1.23 and 1.27 for CIND. Associations were also seen for higher TC and LDL-C variability with faster decline in global cognition, episodic memory, psychomotor speed, and the composite score for changes in four cognitive function domains. There was no strong evidence for an association of HDL-C and triglyceride variability with dementia and cognitive change.

"These results suggest that fluctuating cholesterol, measured annually, may be a new biomarker for identifying people at risk of dementia, providing more information than the actual cholesterol levels measured at a single time point," Zhou said in a statement.

Several authors disclosed ties to the biopharmaceutical industry.

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