This week in Neurology® Highlights of the May 19 issue Less Alzheimer disease neuropathology in medicated hypertensive than nonhypertensive persons In the absence of clear prescribing guidelines for antihypertensive medications in the very elderly, this research suggests a potential benefit against Alzheimer disease–associated neuropathology. In this postmortem Longitudinal and cross-sectional analysis of atrophy in pharmacoresistant temporal lobe epilepsy In patients with pharmacoresistant temporal lobe epilepsy, progressive brain atrophy, likely representing seizureinduced damage, occurs over a mean interval of 2.5 years. This paper suggests that as soon as the intractability with medication is established, patients with epilepsy should undergo a comprehensive MRI examination and be evaluated for surgery. See p. 1747; Editorial, p. 1718 study sample with mean age at death of 83.4 years, there was substantially less Alzheimer disease neuropathology in medicated hypertensive than normotensive subjects. See p. 1720; Editorial, p. 1716; see also p. 1727 Duration of antihypertensive drug use and risk of dementia: A prospective cohort study This large, prospective, population-based cohort study investigated the association between duration of antihypertensive drug use and the risk of dementia and Alzheimer disease. The authors found that antihypertensive drug use was associated with 8% risk reduction of dementia per year of use for persons ⱕ75 years. SEPT9 gene sequencing analysis reveals recurrent mutations in hereditary neuralgic amyotrophy Hereditary neuralgic amyotrophy is an autosomal dominant disorder that manifests as recurrent, episodic, painful brachial neuropathies. A recurrent mutation in SEPT9 is a frequent cause of hereditary neuralgic amyotrophy. This paper provides further evidence that this mutation is the molecular basis of some cases of hereditary neuralgic amyotrophy. See p. 1755 Quality of life in multiple sclerosis is associated with lesion burden and brain volume measures The authors conducted a 1H-MRS study in patients with mild Aspects of health-related quality of life (HRQOL), which captures a disease’s impact on well-being, correlate with brain atrophy and lesion load in multiple sclerosis. Since brain atrophy predicts subsequent disability, future studies should evaluate whether HRQOL, easily assessed in the clinical setting, also predicts long-term multiple sclerosis outcomes. dementia and mild cognitive impairment (MCI) to investigate See p. 1760 See p. 1727; Editorial, p. 1716; see also p. 1720 A multicenter 1H-MRS study of the medial temporal lobe in AD and MCI the multicenter feasibility of 1H-MRS. They demonstrate the feasibility of 1H-MRS of the medial temporal lobe in mild dementia and MCI, which should be a prerequisite for the application of 1H-MRS in future clinical trials. See p. 1735 Differences in retinal vessels support a distinct vasculopathy causing lacunar stroke The authors use retinal vessels as a novel method of gaining information about the distinct vasculopathy causing lacunar stroke, which may ultimately lead to different treatments for lacunar stroke. They demonstrate that retinal venules are wider in lacunar stroke as compared to cortical stroke. See p. 1773 Podcasts can be accessed at www.neurology.org Copyright © 2009 by AAN Enterprises, Inc. 1715 EDITORIAL Hypertension and late-life dementia A real link? David S. Knopman, MD Address correspondence and reprint requests to Dr. D.S. Knopman, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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