New and Noteworthy Information for March 2012

Men show higher rates of amnestic mild cognitive impairment (aMCI) and nonamnestic mild cognitive impairment (naMCI) than women, researchers reported in the January 31 Neurology. Starting in 2004, a cohort of Olmsted County, Minnesota, residents ages 70 to 89 underwent baseline and 15-month interval evaluations to assess their cognitive status. Of the 1,450 participants who were cognitively normal at baseline, 296 developed MCI, with an age- and sex-standardized incidence rate of 63.6 (per 1,000 person years) overall. Men (72.4) showed higher rates of MCI than women (57.3), and this trend continued for both aMCI and naMCI. Participants with fewer years of education had higher rates of MCI. “Differences in incidence rates by clinical subtype and by sex suggest that risk factors for MCI should be investigated separately for aMCI and naMCI, and in men and women,” the study authors stated.

Infants who are eventually diagnosed with autism spectrum disorders (ASD) show abnormal development of white matter pathways starting as early as 6 months of age, according to a study published in the February 17 online American Journal of Psychiatry. Researchers analyzed imaging results from 92 high-risk infants who had siblings with autism. The participants underwent diffusion tensor imaging at 6 months, 12 months, and 24 months. After characterizing the white matter fiber tracts of the 28 infants who met criteria for ASD at 24 months and the 64 infants who did not meet the criteria, the investigators found notable differences in the infants’ development. Compared with the 64 infants who did not develop ASD, infants who had ASD had different white matter development for 12 of the 15 brain pathways studied. “These results suggest that aberrant development of white matter pathways may precede the manifestation of autistic symptoms in the first year of life,” the researchers concluded.
Epilepsy surgery has long-term beneficial effects on patients’ seizure control and overall quality of life, according to research published in the February 7 online Epilepsia. Patients who underwent epilepsy surgery by Sidney Goldring, MD, from 1967 to 1990 were followed up for a mean duration of 26 years. Of the 361 patients who had epilepsy surgery, 117 completed follow-up interviews, and 80% reported a higher quality of life on the Quality of Life in Epilepsy (QOLIE-31) questionnaire after surgery. In addition, an association was observed between seizure freedom and better quality of life, and patients who underwent temporal lobe resection showed better seizure outcomes than those who had different procedures. Considering that the positive outcomes of epilepsy surgery from decades ago seem sustainable, the researchers said they are “optimistic that the outcomes from modern epilepsy surgery will be even better and that our present enthusiasm for this treatment modality is not misplaced.”

Elderly nursing home residents show an increased mortality risk with higher doses of antipsychotic drugs, according to a study in the February 23 online BMJ. All 75,445 study participants were age 65 or older, lived in nursing homes from 2001 to 2005, and were new users of antipsychotic drugs (haloperidol, aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone). After comparing 180-day risks of all-cause and cause-specific mortality by individual drug, the researchers found that users of haloperidol had an increased rate of mortality and users of quetiapine had a decreased risk of mortality, compared with users of risperidone. These effects were seen for all causes of mortality examined, remained after adjustment for dose, and were strongest immediately following the start of treatment. “There was no evidence that the treatment effect differed for patients with a diagnosis of dementia or behavioral disturbances,” noted the researchers. They added that although their findings do not prove causality, “….they provide more evidence of the risk of using these drugs in older patients, reinforcing the concept that they should not be used in the absence of clear need.”  

Men show higher rates of amnestic mild cognitive impairment (aMCI) and nonamnestic mild cognitive impairment (naMCI) than women, researchers reported in the January 31 Neurology. Starting in 2004, a cohort of Olmsted County, Minnesota, residents ages 70 to 89 underwent baseline and 15-month interval evaluations to assess their cognitive status. Of the 1,450 participants who were cognitively normal at baseline, 296 developed MCI, with an age- and sex-standardized incidence rate of 63.6 (per 1,000 person years) overall. Men (72.4) showed higher rates of MCI than women (57.3), and this trend continued for both aMCI and naMCI. Participants with fewer years of education had higher rates of MCI. “Differences in incidence rates by clinical subtype and by sex suggest that risk factors for MCI should be investigated separately for aMCI and naMCI, and in men and women,” the study authors stated.

Infants who are eventually diagnosed with autism spectrum disorders (ASD) show abnormal development of white matter pathways starting as early as 6 months of age, according to a study published in the February 17 online American Journal of Psychiatry. Researchers analyzed imaging results from 92 high-risk infants who had siblings with autism. The participants underwent diffusion tensor imaging at 6 months, 12 months, and 24 months. After characterizing the white matter fiber tracts of the 28 infants who met criteria for ASD at 24 months and the 64 infants who did not meet the criteria, the investigators found notable differences in the infants’ development. Compared with the 64 infants who did not develop ASD, infants who had ASD had different white matter development for 12 of the 15 brain pathways studied. “These results suggest that aberrant development of white matter pathways may precede the manifestation of autistic symptoms in the first year of life,” the researchers concluded.
Epilepsy surgery has long-term beneficial effects on patients’ seizure control and overall quality of life, according to research published in the February 7 online Epilepsia. Patients who underwent epilepsy surgery by Sidney Goldring, MD, from 1967 to 1990 were followed up for a mean duration of 26 years. Of the 361 patients who had epilepsy surgery, 117 completed follow-up interviews, and 80% reported a higher quality of life on the Quality of Life in Epilepsy (QOLIE-31) questionnaire after surgery. In addition, an association was observed between seizure freedom and better quality of life, and patients who underwent temporal lobe resection showed better seizure outcomes than those who had different procedures. Considering that the positive outcomes of epilepsy surgery from decades ago seem sustainable, the researchers said they are “optimistic that the outcomes from modern epilepsy surgery will be even better and that our present enthusiasm for this treatment modality is not misplaced.”

Elderly nursing home residents show an increased mortality risk with higher doses of antipsychotic drugs, according to a study in the February 23 online BMJ. All 75,445 study participants were age 65 or older, lived in nursing homes from 2001 to 2005, and were new users of antipsychotic drugs (haloperidol, aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone). After comparing 180-day risks of all-cause and cause-specific mortality by individual drug, the researchers found that users of haloperidol had an increased rate of mortality and users of quetiapine had a decreased risk of mortality, compared with users of risperidone. These effects were seen for all causes of mortality examined, remained after adjustment for dose, and were strongest immediately following the start of treatment. “There was no evidence that the treatment effect differed for patients with a diagnosis of dementia or behavioral disturbances,” noted the researchers. They added that although their findings do not prove causality, “….they provide more evidence of the risk of using these drugs in older patients, reinforcing the concept that they should not be used in the absence of clear need.”  

Men show higher rates of amnestic mild cognitive impairment (aMCI) and nonamnestic mild cognitive impairment (naMCI) than women, researchers reported in the January 31 Neurology. Starting in 2004, a cohort of Olmsted County, Minnesota, residents ages 70 to 89 underwent baseline and 15-month interval evaluations to assess their cognitive status. Of the 1,450 participants who were cognitively normal at baseline, 296 developed MCI, with an age- and sex-standardized incidence rate of 63.6 (per 1,000 person years) overall. Men (72.4) showed higher rates of MCI than women (57.3), and this trend continued for both aMCI and naMCI. Participants with fewer years of education had higher rates of MCI. “Differences in incidence rates by clinical subtype and by sex suggest that risk factors for MCI should be investigated separately for aMCI and naMCI, and in men and women,” the study authors stated.

Infants who are eventually diagnosed with autism spectrum disorders (ASD) show abnormal development of white matter pathways starting as early as 6 months of age, according to a study published in the February 17 online American Journal of Psychiatry. Researchers analyzed imaging results from 92 high-risk infants who had siblings with autism. The participants underwent diffusion tensor imaging at 6 months, 12 months, and 24 months. After characterizing the white matter fiber tracts of the 28 infants who met criteria for ASD at 24 months and the 64 infants who did not meet the criteria, the investigators found notable differences in the infants’ development. Compared with the 64 infants who did not develop ASD, infants who had ASD had different white matter development for 12 of the 15 brain pathways studied. “These results suggest that aberrant development of white matter pathways may precede the manifestation of autistic symptoms in the first year of life,” the researchers concluded.
Epilepsy surgery has long-term beneficial effects on patients’ seizure control and overall quality of life, according to research published in the February 7 online Epilepsia. Patients who underwent epilepsy surgery by Sidney Goldring, MD, from 1967 to 1990 were followed up for a mean duration of 26 years. Of the 361 patients who had epilepsy surgery, 117 completed follow-up interviews, and 80% reported a higher quality of life on the Quality of Life in Epilepsy (QOLIE-31) questionnaire after surgery. In addition, an association was observed between seizure freedom and better quality of life, and patients who underwent temporal lobe resection showed better seizure outcomes than those who had different procedures. Considering that the positive outcomes of epilepsy surgery from decades ago seem sustainable, the researchers said they are “optimistic that the outcomes from modern epilepsy surgery will be even better and that our present enthusiasm for this treatment modality is not misplaced.”

Elderly nursing home residents show an increased mortality risk with higher doses of antipsychotic drugs, according to a study in the February 23 online BMJ. All 75,445 study participants were age 65 or older, lived in nursing homes from 2001 to 2005, and were new users of antipsychotic drugs (haloperidol, aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone). After comparing 180-day risks of all-cause and cause-specific mortality by individual drug, the researchers found that users of haloperidol had an increased rate of mortality and users of quetiapine had a decreased risk of mortality, compared with users of risperidone. These effects were seen for all causes of mortality examined, remained after adjustment for dose, and were strongest immediately following the start of treatment. “There was no evidence that the treatment effect differed for patients with a diagnosis of dementia or behavioral disturbances,” noted the researchers. They added that although their findings do not prove causality, “….they provide more evidence of the risk of using these drugs in older patients, reinforcing the concept that they should not be used in the absence of clear need.”