Neurology
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Randomized Controlled Trial Multicenter Study
Vitamins and entacapone in levodopa-induced hyperhomocysteinemia: a randomized controlled study.
Elevated homocysteine is associated with increased risk of heart disease, stroke, and dementia. Therapy of Parkinson disease (PD) with levodopa elevates homocysteine. ⋯ Levodopa initiation caused a small elevation in homocysteine. Vitamin therapy, but not entacapone, resulted in a decrease in homocysteine compared to placebo.
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Multicenter Study Clinical Trial
Neuropathology of older persons without cognitive impairment from two community-based studies.
To examine the relation of National Institute on Aging-Reagan (NIA-Reagan) neuropathologic criteria of Alzheimer disease (AD) to level of cognitive function in persons without dementia or mild cognitive impairment (MCI). ⋯ Alzheimer disease pathology can be found in the brains of older persons without dementia or mild cognitive impairment and is related to subtle changes in episodic memory.
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The authors previously reported a low initial emergency department (ED) blood pressure (BP) to be associated with a significantly increased risk of death at 90 days. In this article, they examine the impact of acute BP variability following onset of ischemic stroke. ⋯ Wide fluctuation of blood pressure in the first 3 hours of the emergency department stay in patients with acute ischemic stroke appears to be associated with an increased risk of death at 90 days.
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To detect white matter abnormalities in patients with mild Alzheimer disease (AD) by diffusion tensor imaging and to determine their topographic relationship with gray matter atrophy. ⋯ Voxel-wise comparison of whole-brain anisotropy revealed widely distributed disintegration of white matter in mild Alzheimer disease (AD). The white matter shows a different pattern of degeneration from gray matter and may be an independent factor in the progress of AD.
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Surgical decompression at the site of anatomic narrowing has been promoted as an alternative treatment for patients with symptomatic diabetic neuropathy. Systematic review of the literature revealed only Class IV studies concerning the utility of this therapeutic approach. Given the current evidence available, this treatment alternative should be considered unproven (Level U). Prospective randomized controlled trials with standard definitions and outcome measures are necessary to determine the value of this therapeutic intervention.