Neurology
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Comparative Study
Secular changes in cognitive predictors of dementia and mortality in 70-year-olds.
Successive elderly birth cohorts improved in cognitive performance during the 20th century. It is not clear whether this influences cognitive predictors of dementia and mortality. ⋯ Secular changes in cognitive performance may influence cognitive predictors of dementia and mortality, despite similar incidence of dementia. The findings should be taken cautiously due to differences between cohorts in refusal rates, quality of education, and dementia recognition in medical records.
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Comparative Study
MRS in presymptomatic MAPT mutation carriers: a potential biomarker for tau-mediated pathology.
To determine the proton magnetic resonance spectroscopy ((1)H MRS) changes in carriers of microtubule-associated protein (MAPT) mutations in a case-control study. ⋯ (1)H MRS metabolite abnormalities characterized by an elevated mI/Cr and decreased NAA/mI are present several years before the onset of symptoms in MAPT mutation carriers. The data suggest an ordered sequencing of the (1)H MRS and MRI biomarkers. MI/Cr, a possible index of glial proliferation, precedes the decrease in neuronal integrity marker NAA/Cr and hippocampal atrophy. (1)H MRS may be a useful inclusion biomarker for preventive trials in presymptomatic carriers of MAPT mutations and possibly other proteinopathies.
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To identify and compare clinical and neuroimaging predictors of primary lobar intracerebral hemorrhage (ICH) recurrence, assessing their relative contributions to recurrent ICH. ⋯ Recurrence of lobar ICH is associated with previous microbleeds or macrobleeds and posterior CT white matter hypodensity, which may be markers of severity for underlying cerebral amyloid angiopathy. Use of an antiplatelet agent following lobar ICH may also increase recurrence risk.
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Webcasts
Health state preferences and decision-making after malignant middle cerebral artery infarctions.
Despite recent trials demonstrating improved functional outcomes in patients with malignant middle cerebral artery ischemic strokes treated with hemicraniectomy, survivors still experience significant stroke-related disability. The value assigned to health states with significant disability varies widely and may influence decisions regarding hemicraniectomy. ⋯ Over a 1-year time horizon, treating patients with malignant middle cerebral artery strokes with hemicraniectomy is associated with more quality-adjusted life-years than medical management alone, except under conditions where patients value possible resultant health states very poorly or surgical mortality is excessively high.