New and Noteworthy Information—September 2015

Emergency medical services (EMS) use for stroke differs by race, ethnicity, and sex, according to a study published in the August issue of the Journal of the American Heart Association. Data were analyzed from 398,798 stroke patients who were admitted to 1,613 Get With The Guidelines–Stroke participating hospitals between October 2011 and March 2014. Multivariable logistic regression was used to evaluate the associations between combinations of racial, ethnic, and sex groups with EMS use, adjusting for potential confounders including demographics, medical history, and stroke symptoms. White women were most likely to use EMS to get to the hospital (62%). Hispanic men were least likely to use EMS (52%). Hispanic and Asian men and women had 20% to 29% lower adjusted odds of using EMS compared with their white counterparts. Black women were less likely than white women to use EMS.

For patients who take sleeping pills to treat chronic insomnia, new study findings suggest that they may be able to get relief from as little as half of the drugs, and may even be helped by including placebos in the treatment plan. The study was published online July 7 in Sleep Medicine. In all, 74 subjects with chronic insomnia were treated with 10 mg of zolpidem for four weeks. Treatment responders were then randomized to nightly dosing with 10 mg or 5 mg, intermittent dosing (3 to 5 days weekly) with 10 mg, or partial reinforcement dosing (nightly pills with 50% active meds and 50% placebo) with 10 mg for 12 weeks. In compliant subjects, all of the treatment strategies maintained treatment response. For the subjects that remained in remission, the subjects in the intermittent dosing group exhibited poorer sleep continuity. “Our research found that changing the industry standard for maintenance therapy can maintain treatment responses and lower the incidence of side effects,” said the researchers.

Hospitals often overestimate their ability to deliver timely t-PA to treated patients, according to a study published in the July issue of the Journal of the American Heart Association. Researchers surveyed staff in 141 hospitals that treated 48,201 stroke patients in 2009 and 2010. Data included the onset of stroke symptoms, hospital arrival time, treatments, initiation of t-PA, and complications from the drug. Hospital performance was based on “door-to-needle” time. Only 29% of hospital staff accurately identified their door-to-needle performance; 42% of middle-performing hospitals and 85% of low-performing hospitals overestimated their abilities to quickly administer t-PA and nearly 20% of low-performing hospitals believed their door-to-needle time was above the national average. Hospitals that overestimated their performance had lower volumes of t-PA administration.

Incidence rates for Alzheimer’s disease and other dementias among African Americans age 70 or older have decreased over the last two decades, but the incidence rates for these conditions among Africans has remained unchanged over the same time period. According to a study published online ahead of print July 23 in Alzheimer’s & Dementia, dementia and Alzheimer’s disease incidence rates among African Americans were significantly lower in 2001 than in 1992, except for the oldest group. The cohorts consisted of 1,440 African Americans residing in Indianapolis and 1,774 Yoruba in Ibadan, Nigeria, in 1992, and 1,835 African Americans and 1,895 Yoruba in 2001. The overall dementia incidence rates among the African Americans were 3.6% in the 1992 cohort and 1.4% in the 2001 cohort. “The reason for the significant decline in new cases of Alzheimer’s disease and other dementias in the African Americans we studied is not yet entirely clear but we believe it may be possible that medications for cardiovascular conditions contributed to the decline,” the study authors said.

Lower executive function, but not memory, is associated with higher risk of coronary heart disease and stroke, according to a study published online ahead of print August 5 in Neurology. Included in this study were 3,926 participants with a mean age of 75, who were 44% male, and at risk for cardiovascular diseases. During 3.2 years of follow-up, incidence rates of coronary heart disease and stroke were 30.5 and 12.4 per 1,000 person-years, respectively. In multivariable models, participants in the lowest third of executive function, compared with participants in the highest third, had 1.85-fold higher risk of coronary heart disease and 1.51-fold higher risk of stroke. Participants in the lowest third of memory had no increased risk of coronary heart disease or stroke.

The Quick Dementia Rating System (QDRS) differentiates between individuals with and without dementia, accurately stages dementia without extensive tester training or clinician input, and is highly correlated with gold standard measures, according to a study published in the June issue of Alzheimer’s & Dementia. The QDRS was used in 267 patient-caregiver dyads compared with Clinical Dementia Ratings (CDR), neuropsychologic testing, and gold standard measures of function, mood, and behavior. The QDRS scores increased with higher CDR staging and poorer neuropsychologic performance. The QDRS demonstrated low floor and ceiling effects; excellent known-groups validity across CDR stages; construct validity against cognitive, behavioral, and functional measures; and reliability. The QDRS demonstrated differential scores across different dementia etiologies. The QDRS is copyrighted and permission is required to use it. The QDRS is available at no cost to clinicians, researchers, and not-for-profit organizations.

A drug used to treat diabetes may also reduce the risk of Parkinson’s disease, according to a study published July 21 in PLOS Medicine. Researchers conducted a retrospective cohort study in which individuals with diabetes who were prescribed glitazone antidiabetes drugs (rosiglitazone or pioglitazone) were matched by age, sex, practice, and diabetes treatment stage with up to five people who were taking other diabetes treatments. Patients were followed up from 1999 until the first recording of a Parkinson’s disease diagnosis, end of observation in the database, or the end of the study (August 1, 2013). In all, 44,597 glitazone-exposed individuals were matched to 120,373 other antidiabetic users. The incidence rate of Parkinson’s disease in the glitazone-exposed group was 6.4 per 10,000 patient years compared with 8.8 per 10,000 years in those prescribed other antidiabetic treatments.

Day-of-injury serum brain-derived neurotrophic factor (BDNF) is associated with traumatic brain injury (TBI) diagnosis and provides six-month prognostic information regarding recovery, according to a study published online ahead of print July 10 in the Journal of Neurotrauma. Researchers examined BDNF in 300 patients drawn from two independent cohorts of TBI cases presenting to two emergency departments and 150 patients without brain injuries. Among Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) pilot study subjects, median BDNF concentrations were higher in mild than in moderate or severe TBI. In the TRACK-TBI cohort, the subjects with very low BDNF values had higher odds of incomplete recovery than those without very low values. According to the researchers, their results suggest that a test for BDNF levels, administered in the emergency department, could help stratify patients.

Children with multiple sclerosis (MS) are less physically active than children with monophasic acquired demyelinating syndrome, according to a study published online ahead of print August 12 in Neurology. In this cross-sectional study of consecutive patients attending a specialized pediatric MS clinic, researchers administered the PedsQL Multidimensional Fatigue Scale, Center for Epidemiological Studies Depression Scale, and Godin Leisure-Time Exercise Questionnaire. A total of 110 patients were included. Patients with MS reported less strenuous and total physical activity than those with monophasic acquired demyelinating syndrome. Patients with MS who reported greater amounts of moderate physical activity metabolic equivalents had fewer sleep/rest fatigue symptoms. Participation in strenuous physical activity was associated with smaller T2 lesion volumes and lower annualized relapse rate.

—Kimberly Williams

Emergency medical services (EMS) use for stroke differs by race, ethnicity, and sex, according to a study published in the August issue of the Journal of the American Heart Association. Data were analyzed from 398,798 stroke patients who were admitted to 1,613 Get With The Guidelines–Stroke participating hospitals between October 2011 and March 2014. Multivariable logistic regression was used to evaluate the associations between combinations of racial, ethnic, and sex groups with EMS use, adjusting for potential confounders including demographics, medical history, and stroke symptoms. White women were most likely to use EMS to get to the hospital (62%). Hispanic men were least likely to use EMS (52%). Hispanic and Asian men and women had 20% to 29% lower adjusted odds of using EMS compared with their white counterparts. Black women were less likely than white women to use EMS.

For patients who take sleeping pills to treat chronic insomnia, new study findings suggest that they may be able to get relief from as little as half of the drugs, and may even be helped by including placebos in the treatment plan. The study was published online July 7 in Sleep Medicine. In all, 74 subjects with chronic insomnia were treated with 10 mg of zolpidem for four weeks. Treatment responders were then randomized to nightly dosing with 10 mg or 5 mg, intermittent dosing (3 to 5 days weekly) with 10 mg, or partial reinforcement dosing (nightly pills with 50% active meds and 50% placebo) with 10 mg for 12 weeks. In compliant subjects, all of the treatment strategies maintained treatment response. For the subjects that remained in remission, the subjects in the intermittent dosing group exhibited poorer sleep continuity. “Our research found that changing the industry standard for maintenance therapy can maintain treatment responses and lower the incidence of side effects,” said the researchers.

Hospitals often overestimate their ability to deliver timely t-PA to treated patients, according to a study published in the July issue of the Journal of the American Heart Association. Researchers surveyed staff in 141 hospitals that treated 48,201 stroke patients in 2009 and 2010. Data included the onset of stroke symptoms, hospital arrival time, treatments, initiation of t-PA, and complications from the drug. Hospital performance was based on “door-to-needle” time. Only 29% of hospital staff accurately identified their door-to-needle performance; 42% of middle-performing hospitals and 85% of low-performing hospitals overestimated their abilities to quickly administer t-PA and nearly 20% of low-performing hospitals believed their door-to-needle time was above the national average. Hospitals that overestimated their performance had lower volumes of t-PA administration.

Incidence rates for Alzheimer’s disease and other dementias among African Americans age 70 or older have decreased over the last two decades, but the incidence rates for these conditions among Africans has remained unchanged over the same time period. According to a study published online ahead of print July 23 in Alzheimer’s & Dementia, dementia and Alzheimer’s disease incidence rates among African Americans were significantly lower in 2001 than in 1992, except for the oldest group. The cohorts consisted of 1,440 African Americans residing in Indianapolis and 1,774 Yoruba in Ibadan, Nigeria, in 1992, and 1,835 African Americans and 1,895 Yoruba in 2001. The overall dementia incidence rates among the African Americans were 3.6% in the 1992 cohort and 1.4% in the 2001 cohort. “The reason for the significant decline in new cases of Alzheimer’s disease and other dementias in the African Americans we studied is not yet entirely clear but we believe it may be possible that medications for cardiovascular conditions contributed to the decline,” the study authors said.

Lower executive function, but not memory, is associated with higher risk of coronary heart disease and stroke, according to a study published online ahead of print August 5 in Neurology. Included in this study were 3,926 participants with a mean age of 75, who were 44% male, and at risk for cardiovascular diseases. During 3.2 years of follow-up, incidence rates of coronary heart disease and stroke were 30.5 and 12.4 per 1,000 person-years, respectively. In multivariable models, participants in the lowest third of executive function, compared with participants in the highest third, had 1.85-fold higher risk of coronary heart disease and 1.51-fold higher risk of stroke. Participants in the lowest third of memory had no increased risk of coronary heart disease or stroke.

The Quick Dementia Rating System (QDRS) differentiates between individuals with and without dementia, accurately stages dementia without extensive tester training or clinician input, and is highly correlated with gold standard measures, according to a study published in the June issue of Alzheimer’s & Dementia. The QDRS was used in 267 patient-caregiver dyads compared with Clinical Dementia Ratings (CDR), neuropsychologic testing, and gold standard measures of function, mood, and behavior. The QDRS scores increased with higher CDR staging and poorer neuropsychologic performance. The QDRS demonstrated low floor and ceiling effects; excellent known-groups validity across CDR stages; construct validity against cognitive, behavioral, and functional measures; and reliability. The QDRS demonstrated differential scores across different dementia etiologies. The QDRS is copyrighted and permission is required to use it. The QDRS is available at no cost to clinicians, researchers, and not-for-profit organizations.

A drug used to treat diabetes may also reduce the risk of Parkinson’s disease, according to a study published July 21 in PLOS Medicine. Researchers conducted a retrospective cohort study in which individuals with diabetes who were prescribed glitazone antidiabetes drugs (rosiglitazone or pioglitazone) were matched by age, sex, practice, and diabetes treatment stage with up to five people who were taking other diabetes treatments. Patients were followed up from 1999 until the first recording of a Parkinson’s disease diagnosis, end of observation in the database, or the end of the study (August 1, 2013). In all, 44,597 glitazone-exposed individuals were matched to 120,373 other antidiabetic users. The incidence rate of Parkinson’s disease in the glitazone-exposed group was 6.4 per 10,000 patient years compared with 8.8 per 10,000 years in those prescribed other antidiabetic treatments.

Day-of-injury serum brain-derived neurotrophic factor (BDNF) is associated with traumatic brain injury (TBI) diagnosis and provides six-month prognostic information regarding recovery, according to a study published online ahead of print July 10 in the Journal of Neurotrauma. Researchers examined BDNF in 300 patients drawn from two independent cohorts of TBI cases presenting to two emergency departments and 150 patients without brain injuries. Among Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) pilot study subjects, median BDNF concentrations were higher in mild than in moderate or severe TBI. In the TRACK-TBI cohort, the subjects with very low BDNF values had higher odds of incomplete recovery than those without very low values. According to the researchers, their results suggest that a test for BDNF levels, administered in the emergency department, could help stratify patients.

Children with multiple sclerosis (MS) are less physically active than children with monophasic acquired demyelinating syndrome, according to a study published online ahead of print August 12 in Neurology. In this cross-sectional study of consecutive patients attending a specialized pediatric MS clinic, researchers administered the PedsQL Multidimensional Fatigue Scale, Center for Epidemiological Studies Depression Scale, and Godin Leisure-Time Exercise Questionnaire. A total of 110 patients were included. Patients with MS reported less strenuous and total physical activity than those with monophasic acquired demyelinating syndrome. Patients with MS who reported greater amounts of moderate physical activity metabolic equivalents had fewer sleep/rest fatigue symptoms. Participation in strenuous physical activity was associated with smaller T2 lesion volumes and lower annualized relapse rate.

—Kimberly Williams

Emergency medical services (EMS) use for stroke differs by race, ethnicity, and sex, according to a study published in the August issue of the Journal of the American Heart Association. Data were analyzed from 398,798 stroke patients who were admitted to 1,613 Get With The Guidelines–Stroke participating hospitals between October 2011 and March 2014. Multivariable logistic regression was used to evaluate the associations between combinations of racial, ethnic, and sex groups with EMS use, adjusting for potential confounders including demographics, medical history, and stroke symptoms. White women were most likely to use EMS to get to the hospital (62%). Hispanic men were least likely to use EMS (52%). Hispanic and Asian men and women had 20% to 29% lower adjusted odds of using EMS compared with their white counterparts. Black women were less likely than white women to use EMS.

For patients who take sleeping pills to treat chronic insomnia, new study findings suggest that they may be able to get relief from as little as half of the drugs, and may even be helped by including placebos in the treatment plan. The study was published online July 7 in Sleep Medicine. In all, 74 subjects with chronic insomnia were treated with 10 mg of zolpidem for four weeks. Treatment responders were then randomized to nightly dosing with 10 mg or 5 mg, intermittent dosing (3 to 5 days weekly) with 10 mg, or partial reinforcement dosing (nightly pills with 50% active meds and 50% placebo) with 10 mg for 12 weeks. In compliant subjects, all of the treatment strategies maintained treatment response. For the subjects that remained in remission, the subjects in the intermittent dosing group exhibited poorer sleep continuity. “Our research found that changing the industry standard for maintenance therapy can maintain treatment responses and lower the incidence of side effects,” said the researchers.

Hospitals often overestimate their ability to deliver timely t-PA to treated patients, according to a study published in the July issue of the Journal of the American Heart Association. Researchers surveyed staff in 141 hospitals that treated 48,201 stroke patients in 2009 and 2010. Data included the onset of stroke symptoms, hospital arrival time, treatments, initiation of t-PA, and complications from the drug. Hospital performance was based on “door-to-needle” time. Only 29% of hospital staff accurately identified their door-to-needle performance; 42% of middle-performing hospitals and 85% of low-performing hospitals overestimated their abilities to quickly administer t-PA and nearly 20% of low-performing hospitals believed their door-to-needle time was above the national average. Hospitals that overestimated their performance had lower volumes of t-PA administration.

Incidence rates for Alzheimer’s disease and other dementias among African Americans age 70 or older have decreased over the last two decades, but the incidence rates for these conditions among Africans has remained unchanged over the same time period. According to a study published online ahead of print July 23 in Alzheimer’s & Dementia, dementia and Alzheimer’s disease incidence rates among African Americans were significantly lower in 2001 than in 1992, except for the oldest group. The cohorts consisted of 1,440 African Americans residing in Indianapolis and 1,774 Yoruba in Ibadan, Nigeria, in 1992, and 1,835 African Americans and 1,895 Yoruba in 2001. The overall dementia incidence rates among the African Americans were 3.6% in the 1992 cohort and 1.4% in the 2001 cohort. “The reason for the significant decline in new cases of Alzheimer’s disease and other dementias in the African Americans we studied is not yet entirely clear but we believe it may be possible that medications for cardiovascular conditions contributed to the decline,” the study authors said.

Lower executive function, but not memory, is associated with higher risk of coronary heart disease and stroke, according to a study published online ahead of print August 5 in Neurology. Included in this study were 3,926 participants with a mean age of 75, who were 44% male, and at risk for cardiovascular diseases. During 3.2 years of follow-up, incidence rates of coronary heart disease and stroke were 30.5 and 12.4 per 1,000 person-years, respectively. In multivariable models, participants in the lowest third of executive function, compared with participants in the highest third, had 1.85-fold higher risk of coronary heart disease and 1.51-fold higher risk of stroke. Participants in the lowest third of memory had no increased risk of coronary heart disease or stroke.

The Quick Dementia Rating System (QDRS) differentiates between individuals with and without dementia, accurately stages dementia without extensive tester training or clinician input, and is highly correlated with gold standard measures, according to a study published in the June issue of Alzheimer’s & Dementia. The QDRS was used in 267 patient-caregiver dyads compared with Clinical Dementia Ratings (CDR), neuropsychologic testing, and gold standard measures of function, mood, and behavior. The QDRS scores increased with higher CDR staging and poorer neuropsychologic performance. The QDRS demonstrated low floor and ceiling effects; excellent known-groups validity across CDR stages; construct validity against cognitive, behavioral, and functional measures; and reliability. The QDRS demonstrated differential scores across different dementia etiologies. The QDRS is copyrighted and permission is required to use it. The QDRS is available at no cost to clinicians, researchers, and not-for-profit organizations.

A drug used to treat diabetes may also reduce the risk of Parkinson’s disease, according to a study published July 21 in PLOS Medicine. Researchers conducted a retrospective cohort study in which individuals with diabetes who were prescribed glitazone antidiabetes drugs (rosiglitazone or pioglitazone) were matched by age, sex, practice, and diabetes treatment stage with up to five people who were taking other diabetes treatments. Patients were followed up from 1999 until the first recording of a Parkinson’s disease diagnosis, end of observation in the database, or the end of the study (August 1, 2013). In all, 44,597 glitazone-exposed individuals were matched to 120,373 other antidiabetic users. The incidence rate of Parkinson’s disease in the glitazone-exposed group was 6.4 per 10,000 patient years compared with 8.8 per 10,000 years in those prescribed other antidiabetic treatments.

Day-of-injury serum brain-derived neurotrophic factor (BDNF) is associated with traumatic brain injury (TBI) diagnosis and provides six-month prognostic information regarding recovery, according to a study published online ahead of print July 10 in the Journal of Neurotrauma. Researchers examined BDNF in 300 patients drawn from two independent cohorts of TBI cases presenting to two emergency departments and 150 patients without brain injuries. Among Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) pilot study subjects, median BDNF concentrations were higher in mild than in moderate or severe TBI. In the TRACK-TBI cohort, the subjects with very low BDNF values had higher odds of incomplete recovery than those without very low values. According to the researchers, their results suggest that a test for BDNF levels, administered in the emergency department, could help stratify patients.

Children with multiple sclerosis (MS) are less physically active than children with monophasic acquired demyelinating syndrome, according to a study published online ahead of print August 12 in Neurology. In this cross-sectional study of consecutive patients attending a specialized pediatric MS clinic, researchers administered the PedsQL Multidimensional Fatigue Scale, Center for Epidemiological Studies Depression Scale, and Godin Leisure-Time Exercise Questionnaire. A total of 110 patients were included. Patients with MS reported less strenuous and total physical activity than those with monophasic acquired demyelinating syndrome. Patients with MS who reported greater amounts of moderate physical activity metabolic equivalents had fewer sleep/rest fatigue symptoms. Participation in strenuous physical activity was associated with smaller T2 lesion volumes and lower annualized relapse rate.

—Kimberly Williams