Literature Review

Women who are anxious, jealous, or moody and distressed in middle age may be at a higher risk of developing Alzheimer’s disease later in life, according to a nearly 40-year-long study published in the October 21 issue of Neurology.

“Most Alzheimer’s research has been devoted to factors such as education, heart and blood risk factors, head trauma, family history, and genetics,” said lead author Lena Johansson, PhD, of the University of Gothenburg in Sweden. “Personality may influence the individual’s risk for dementia through its effect on behavior, lifestyle, or reactions to stress.”

For the study, 800 women with an average age of 46 were followed for 38 years and given memory tests and personality tests that examined their levels of neuroticism and extraversion or introversion. Of these participants, 19% developed dementia.

Neuroticism involves a predisposition to distress and personality traits such as worrying, jealousy, or moodiness, according to the researchers. People who are neurotic are more likely to express anger, guilt, envy, anxiety, or depression. Introversion was defined as shyness and reserve, and extraversion was associated with affability.

The investigators also asked the women whether they had experienced any period of stress that lasted one month or longer in their work, health, or family situation. Stress referred to feelings of irritability, tension, nervousness, fear, anxiety, or sleep disturbances. Responses were categorized from 0 to 5, with 0 representing never experiencing any period of stress, and 5 representing an experience of constant stress during the past five years. Women who chose responses from 3 to 5 were considered to have distress.

Women who scored highest on the tests for neuroticism had double the risk of developing dementia, compared with those who scored lowest on the tests. The link depended on long-standing stress, however.

Being either withdrawn or outgoing did not appear to raise dementia risk alone, but women who were easily distressed and withdrawn had the highest risk of Alzheimer’s disease in the study. Sixteen of the 63 women, or 25%, who were easily distressed and withdrawn developed Alzheimer’s disease, compared with eight of the 64 people, or 13%, of those who were not easily distressed and were outgoing. Extraversion was associated with a lower degree of long-standing distress, but had no impact on Alzheimer’s disease dementia.

Women who are anxious, jealous, or moody and distressed in middle age may be at a higher risk of developing Alzheimer’s disease later in life, according to a nearly 40-year-long study published in the October 21 issue of Neurology.

“Most Alzheimer’s research has been devoted to factors such as education, heart and blood risk factors, head trauma, family history, and genetics,” said lead author Lena Johansson, PhD, of the University of Gothenburg in Sweden. “Personality may influence the individual’s risk for dementia through its effect on behavior, lifestyle, or reactions to stress.”

For the study, 800 women with an average age of 46 were followed for 38 years and given memory tests and personality tests that examined their levels of neuroticism and extraversion or introversion. Of these participants, 19% developed dementia.

Neuroticism involves a predisposition to distress and personality traits such as worrying, jealousy, or moodiness, according to the researchers. People who are neurotic are more likely to express anger, guilt, envy, anxiety, or depression. Introversion was defined as shyness and reserve, and extraversion was associated with affability.

The investigators also asked the women whether they had experienced any period of stress that lasted one month or longer in their work, health, or family situation. Stress referred to feelings of irritability, tension, nervousness, fear, anxiety, or sleep disturbances. Responses were categorized from 0 to 5, with 0 representing never experiencing any period of stress, and 5 representing an experience of constant stress during the past five years. Women who chose responses from 3 to 5 were considered to have distress.

Women who scored highest on the tests for neuroticism had double the risk of developing dementia, compared with those who scored lowest on the tests. The link depended on long-standing stress, however.

Being either withdrawn or outgoing did not appear to raise dementia risk alone, but women who were easily distressed and withdrawn had the highest risk of Alzheimer’s disease in the study. Sixteen of the 63 women, or 25%, who were easily distressed and withdrawn developed Alzheimer’s disease, compared with eight of the 64 people, or 13%, of those who were not easily distressed and were outgoing. Extraversion was associated with a lower degree of long-standing distress, but had no impact on Alzheimer’s disease dementia.

Women who are anxious, jealous, or moody and distressed in middle age may be at a higher risk of developing Alzheimer’s disease later in life, according to a nearly 40-year-long study published in the October 21 issue of Neurology.

“Most Alzheimer’s research has been devoted to factors such as education, heart and blood risk factors, head trauma, family history, and genetics,” said lead author Lena Johansson, PhD, of the University of Gothenburg in Sweden. “Personality may influence the individual’s risk for dementia through its effect on behavior, lifestyle, or reactions to stress.”

For the study, 800 women with an average age of 46 were followed for 38 years and given memory tests and personality tests that examined their levels of neuroticism and extraversion or introversion. Of these participants, 19% developed dementia.

Neuroticism involves a predisposition to distress and personality traits such as worrying, jealousy, or moodiness, according to the researchers. People who are neurotic are more likely to express anger, guilt, envy, anxiety, or depression. Introversion was defined as shyness and reserve, and extraversion was associated with affability.

The investigators also asked the women whether they had experienced any period of stress that lasted one month or longer in their work, health, or family situation. Stress referred to feelings of irritability, tension, nervousness, fear, anxiety, or sleep disturbances. Responses were categorized from 0 to 5, with 0 representing never experiencing any period of stress, and 5 representing an experience of constant stress during the past five years. Women who chose responses from 3 to 5 were considered to have distress.

Women who scored highest on the tests for neuroticism had double the risk of developing dementia, compared with those who scored lowest on the tests. The link depended on long-standing stress, however.

Being either withdrawn or outgoing did not appear to raise dementia risk alone, but women who were easily distressed and withdrawn had the highest risk of Alzheimer’s disease in the study. Sixteen of the 63 women, or 25%, who were easily distressed and withdrawn developed Alzheimer’s disease, compared with eight of the 64 people, or 13%, of those who were not easily distressed and were outgoing. Extraversion was associated with a lower degree of long-standing distress, but had no impact on Alzheimer’s disease dementia.

People without dementia who begin reporting memory problems may be more likely to develop dementia later, even if they have no clinical signs of the disease, according to research published in the October 7 issue of Neurology.

“What’s notable about our study is the time it took for this transition to dementia or clinical impairment to occur—about 12 years for dementia and nine years for clinical impairment—after the memory complaints began,” said Richard J. Kryscio, PhD, Chair of Biostatistics at the University of Kentucky in Lexington and lead author of the research. “These findings suggest that there may be a window for intervention before a diagnosable problem shows up.”

For the study, 531 people free of dementia with an average age of 73 were asked yearly if they noticed any changes in their memory. The participants also were given annual memory and thinking tests for an average of 10 years. The investigators examined the brains of 243 participants who died for evidence of Alzheimer’s disease.

Approximately 56% of the participants reported changes in their memory at an average age of 82. People who reported memory complaints were nearly three times more likely to develop memory and thinking problems than were people without memory complaints. About one in six participants developed dementia during the study, and 80% of those participants reported memory changes before developing dementia.

On average, mild cognitive impairment occurred 9.2 years after memory complaints were reported. Participants with subjective memory complaints and an APOE ε4 allele had double the odds of impairment, compared with people with memory complaints alone. Patients with subjective memory complaints who smoked transitioned to mild cognitive impairment more quickly, and women with subjective memory complaints who had undergone hormone replacement transitioned to dementia more slowly. Among participants who died without a diagnosed clinical impairment, subjective memory complaints were associated with elevated neuritic amyloid plaques in the neocortex and medial temporal lobe.

“Our study adds strong evidence to the idea that memory complaints are common among older adults and are sometimes indicators of future memory and thinking problems. Doctors should not minimize these complaints and should take them seriously,” said Dr. Kryscio. “However, memory complaints are not a cause for immediate alarm, since impairment could be many years away. And, unfortunately, we do not yet have preventive therapies for Alzheimer’s disease and other illnesses that cause memory problems.”

People without dementia who begin reporting memory problems may be more likely to develop dementia later, even if they have no clinical signs of the disease, according to research published in the October 7 issue of Neurology.

“What’s notable about our study is the time it took for this transition to dementia or clinical impairment to occur—about 12 years for dementia and nine years for clinical impairment—after the memory complaints began,” said Richard J. Kryscio, PhD, Chair of Biostatistics at the University of Kentucky in Lexington and lead author of the research. “These findings suggest that there may be a window for intervention before a diagnosable problem shows up.”

For the study, 531 people free of dementia with an average age of 73 were asked yearly if they noticed any changes in their memory. The participants also were given annual memory and thinking tests for an average of 10 years. The investigators examined the brains of 243 participants who died for evidence of Alzheimer’s disease.

Approximately 56% of the participants reported changes in their memory at an average age of 82. People who reported memory complaints were nearly three times more likely to develop memory and thinking problems than were people without memory complaints. About one in six participants developed dementia during the study, and 80% of those participants reported memory changes before developing dementia.

On average, mild cognitive impairment occurred 9.2 years after memory complaints were reported. Participants with subjective memory complaints and an APOE ε4 allele had double the odds of impairment, compared with people with memory complaints alone. Patients with subjective memory complaints who smoked transitioned to mild cognitive impairment more quickly, and women with subjective memory complaints who had undergone hormone replacement transitioned to dementia more slowly. Among participants who died without a diagnosed clinical impairment, subjective memory complaints were associated with elevated neuritic amyloid plaques in the neocortex and medial temporal lobe.

“Our study adds strong evidence to the idea that memory complaints are common among older adults and are sometimes indicators of future memory and thinking problems. Doctors should not minimize these complaints and should take them seriously,” said Dr. Kryscio. “However, memory complaints are not a cause for immediate alarm, since impairment could be many years away. And, unfortunately, we do not yet have preventive therapies for Alzheimer’s disease and other illnesses that cause memory problems.”

People without dementia who begin reporting memory problems may be more likely to develop dementia later, even if they have no clinical signs of the disease, according to research published in the October 7 issue of Neurology.

“What’s notable about our study is the time it took for this transition to dementia or clinical impairment to occur—about 12 years for dementia and nine years for clinical impairment—after the memory complaints began,” said Richard J. Kryscio, PhD, Chair of Biostatistics at the University of Kentucky in Lexington and lead author of the research. “These findings suggest that there may be a window for intervention before a diagnosable problem shows up.”

For the study, 531 people free of dementia with an average age of 73 were asked yearly if they noticed any changes in their memory. The participants also were given annual memory and thinking tests for an average of 10 years. The investigators examined the brains of 243 participants who died for evidence of Alzheimer’s disease.

Approximately 56% of the participants reported changes in their memory at an average age of 82. People who reported memory complaints were nearly three times more likely to develop memory and thinking problems than were people without memory complaints. About one in six participants developed dementia during the study, and 80% of those participants reported memory changes before developing dementia.

On average, mild cognitive impairment occurred 9.2 years after memory complaints were reported. Participants with subjective memory complaints and an APOE ε4 allele had double the odds of impairment, compared with people with memory complaints alone. Patients with subjective memory complaints who smoked transitioned to mild cognitive impairment more quickly, and women with subjective memory complaints who had undergone hormone replacement transitioned to dementia more slowly. Among participants who died without a diagnosed clinical impairment, subjective memory complaints were associated with elevated neuritic amyloid plaques in the neocortex and medial temporal lobe.

“Our study adds strong evidence to the idea that memory complaints are common among older adults and are sometimes indicators of future memory and thinking problems. Doctors should not minimize these complaints and should take them seriously,” said Dr. Kryscio. “However, memory complaints are not a cause for immediate alarm, since impairment could be many years away. And, unfortunately, we do not yet have preventive therapies for Alzheimer’s disease and other illnesses that cause memory problems.”

A healthy diet and lifestyle may substantially reduce the risk of stroke in women, according to a study published online ahead of print October 8 in Neurology. Researchers analyzed five factors that make up a healthy lifestyle: healthy diet, moderate alcohol consumption, never smoking, physical activity, and healthy BMI. Compared with women with none of the five healthy factors, women with all five factors had a 54% lower risk of stroke.

“Because the consequences of stroke are usually devastating and irreversible, prevention is of great importance,” said study author Susanna C. Larsson, PhD, Associate Professor of Epidemiology at the Karolinska Institutet in Stockholm. “These results are exciting because they indicate that a healthy diet and lifestyle can substantially reduce the risk of stroke, and these are lifestyle choices that people can make.”

A total of 31,696 Swedish women with an average age of about 60 completed a 350-item questionnaire about their diet and lifestyle. They were then followed for an average of 10 years. A healthy diet was defined as within the top 50% of a recommended food score measuring how often the participants ate healthy foods such as fruits, vegetables, and low-fat dairy products. Moderate alcohol consumption was defined as three to nine drinks per week. Being physically active was defined as walking or biking at least 40 minutes a day, along with more vigorous exercise at least one hour per week. A healthy BMI was considered below 25. Most women had two or three of the healthy factors. A total of 589 women had all five healthy factors, and 1,535 had none. Study participants had a total of 1,554 strokes. The risk of stroke steadily decreased with each additional healthy lifestyle factor.

Women who had a healthier diet were 13% less likely to have a cerebral infarction than were those whose diet was not as healthy. Women with healthier diets had a rate of 28 strokes per 10,000 women per year, compared with 43 strokes per 10,000 women per year among those with a less healthy diet.

Cerebral infarction is the most common cause of stroke, accounting for 80% to 85% of all strokes. Cerebral infarction is caused by a blockage in a blood vessel preventing blood and oxygen from getting to an area of the brain. No relationship was observed between the healthy factors and the risk of hemorrhagic stroke.

A healthy diet and lifestyle may substantially reduce the risk of stroke in women, according to a study published online ahead of print October 8 in Neurology. Researchers analyzed five factors that make up a healthy lifestyle: healthy diet, moderate alcohol consumption, never smoking, physical activity, and healthy BMI. Compared with women with none of the five healthy factors, women with all five factors had a 54% lower risk of stroke.

“Because the consequences of stroke are usually devastating and irreversible, prevention is of great importance,” said study author Susanna C. Larsson, PhD, Associate Professor of Epidemiology at the Karolinska Institutet in Stockholm. “These results are exciting because they indicate that a healthy diet and lifestyle can substantially reduce the risk of stroke, and these are lifestyle choices that people can make.”

A total of 31,696 Swedish women with an average age of about 60 completed a 350-item questionnaire about their diet and lifestyle. They were then followed for an average of 10 years. A healthy diet was defined as within the top 50% of a recommended food score measuring how often the participants ate healthy foods such as fruits, vegetables, and low-fat dairy products. Moderate alcohol consumption was defined as three to nine drinks per week. Being physically active was defined as walking or biking at least 40 minutes a day, along with more vigorous exercise at least one hour per week. A healthy BMI was considered below 25. Most women had two or three of the healthy factors. A total of 589 women had all five healthy factors, and 1,535 had none. Study participants had a total of 1,554 strokes. The risk of stroke steadily decreased with each additional healthy lifestyle factor.

Women who had a healthier diet were 13% less likely to have a cerebral infarction than were those whose diet was not as healthy. Women with healthier diets had a rate of 28 strokes per 10,000 women per year, compared with 43 strokes per 10,000 women per year among those with a less healthy diet.

Cerebral infarction is the most common cause of stroke, accounting for 80% to 85% of all strokes. Cerebral infarction is caused by a blockage in a blood vessel preventing blood and oxygen from getting to an area of the brain. No relationship was observed between the healthy factors and the risk of hemorrhagic stroke.

A healthy diet and lifestyle may substantially reduce the risk of stroke in women, according to a study published online ahead of print October 8 in Neurology. Researchers analyzed five factors that make up a healthy lifestyle: healthy diet, moderate alcohol consumption, never smoking, physical activity, and healthy BMI. Compared with women with none of the five healthy factors, women with all five factors had a 54% lower risk of stroke.

“Because the consequences of stroke are usually devastating and irreversible, prevention is of great importance,” said study author Susanna C. Larsson, PhD, Associate Professor of Epidemiology at the Karolinska Institutet in Stockholm. “These results are exciting because they indicate that a healthy diet and lifestyle can substantially reduce the risk of stroke, and these are lifestyle choices that people can make.”

A total of 31,696 Swedish women with an average age of about 60 completed a 350-item questionnaire about their diet and lifestyle. They were then followed for an average of 10 years. A healthy diet was defined as within the top 50% of a recommended food score measuring how often the participants ate healthy foods such as fruits, vegetables, and low-fat dairy products. Moderate alcohol consumption was defined as three to nine drinks per week. Being physically active was defined as walking or biking at least 40 minutes a day, along with more vigorous exercise at least one hour per week. A healthy BMI was considered below 25. Most women had two or three of the healthy factors. A total of 589 women had all five healthy factors, and 1,535 had none. Study participants had a total of 1,554 strokes. The risk of stroke steadily decreased with each additional healthy lifestyle factor.

Women who had a healthier diet were 13% less likely to have a cerebral infarction than were those whose diet was not as healthy. Women with healthier diets had a rate of 28 strokes per 10,000 women per year, compared with 43 strokes per 10,000 women per year among those with a less healthy diet.

Cerebral infarction is the most common cause of stroke, accounting for 80% to 85% of all strokes. Cerebral infarction is caused by a blockage in a blood vessel preventing blood and oxygen from getting to an area of the brain. No relationship was observed between the healthy factors and the risk of hemorrhagic stroke.

Sleeping seven to eight hours per night is associated with the lowest risk of absence from work due to sickness, according to a study published in the September issue of Sleep.

The risk of an extended absence from work due to sickness increased sharply among those who reported sleeping fewer than six hours or more than nine hours per night, researchers reported. Further analysis found that the optimal sleep duration with the lowest risk of sickness absence from work was between seven and eight hours per night—seven hours, 38 minutes for women and seven hours, 46 minutes for men.

Insomnia-related symptoms, early morning awakenings, feeling more tired than others, and using sleeping pills also were consistently associated with a significant increase in workdays lost due to sickness.

“Optimal sleep duration should be promoted, as very long and very short sleep indicate health problems and subsequent sickness absence,” said principal investigator Tea Lallukka, PhD, specialized researcher at the Finnish Institute of Occupational Health in Helsinki. “Those sleeping five hours or less, or 10 hours or more, were absent from work every year for 4.6 to 8.9 days more, as compared to those with the optimal sleep length.”

“Insufficient sleep due to inadequate or mistimed sleep contributes to the risk for several of today’s public health epidemics, including cardiovascular disease, diabetes, and obesity. Getting at least seven hours of nightly sleep is a key to overall health, which translates to less sick time away from work,” said Timothy Morgenthaler, MD, President of the American Academy of Sleep Medicine.

The study involved a nationally representative survey of 3,760 men and women in Finland who had been working at any time in the prior year. Participants were ages 30 to 64 at baseline. Sleep characteristics were determined by questionnaire, and health measures were derived from physical examination conducted by field physicians. Data for work absences due to sickness were gathered from the Social Insurance Institution of Finland, which tracks all sickness absences lasting more than 10 days. The average follow-up period was seven years.

A novel statistical method developed by study coauthors Tommi Härkänen, PhD, and Risto Kaikkonen was used to predict adjusted average sickness absence days per working year. Additional statistical estimates found that the direct costs of sickness absence to the Finnish government and employers could decrease by 28% if sleep disturbances could be fully addressed.

“Insomnia symptoms should be detected early to help prevent sickness absence and deterioration in health, well-being, and functioning,” said Dr. Lallukka. “Successful prevention of insomnia not only promotes health and work ability among employees, but it can also lead to notable savings in reduced sickness absence costs.”

Sleeping seven to eight hours per night is associated with the lowest risk of absence from work due to sickness, according to a study published in the September issue of Sleep.

The risk of an extended absence from work due to sickness increased sharply among those who reported sleeping fewer than six hours or more than nine hours per night, researchers reported. Further analysis found that the optimal sleep duration with the lowest risk of sickness absence from work was between seven and eight hours per night—seven hours, 38 minutes for women and seven hours, 46 minutes for men.

Insomnia-related symptoms, early morning awakenings, feeling more tired than others, and using sleeping pills also were consistently associated with a significant increase in workdays lost due to sickness.

“Optimal sleep duration should be promoted, as very long and very short sleep indicate health problems and subsequent sickness absence,” said principal investigator Tea Lallukka, PhD, specialized researcher at the Finnish Institute of Occupational Health in Helsinki. “Those sleeping five hours or less, or 10 hours or more, were absent from work every year for 4.6 to 8.9 days more, as compared to those with the optimal sleep length.”

“Insufficient sleep due to inadequate or mistimed sleep contributes to the risk for several of today’s public health epidemics, including cardiovascular disease, diabetes, and obesity. Getting at least seven hours of nightly sleep is a key to overall health, which translates to less sick time away from work,” said Timothy Morgenthaler, MD, President of the American Academy of Sleep Medicine.

The study involved a nationally representative survey of 3,760 men and women in Finland who had been working at any time in the prior year. Participants were ages 30 to 64 at baseline. Sleep characteristics were determined by questionnaire, and health measures were derived from physical examination conducted by field physicians. Data for work absences due to sickness were gathered from the Social Insurance Institution of Finland, which tracks all sickness absences lasting more than 10 days. The average follow-up period was seven years.

A novel statistical method developed by study coauthors Tommi Härkänen, PhD, and Risto Kaikkonen was used to predict adjusted average sickness absence days per working year. Additional statistical estimates found that the direct costs of sickness absence to the Finnish government and employers could decrease by 28% if sleep disturbances could be fully addressed.

“Insomnia symptoms should be detected early to help prevent sickness absence and deterioration in health, well-being, and functioning,” said Dr. Lallukka. “Successful prevention of insomnia not only promotes health and work ability among employees, but it can also lead to notable savings in reduced sickness absence costs.”

Sleeping seven to eight hours per night is associated with the lowest risk of absence from work due to sickness, according to a study published in the September issue of Sleep.

The risk of an extended absence from work due to sickness increased sharply among those who reported sleeping fewer than six hours or more than nine hours per night, researchers reported. Further analysis found that the optimal sleep duration with the lowest risk of sickness absence from work was between seven and eight hours per night—seven hours, 38 minutes for women and seven hours, 46 minutes for men.

Insomnia-related symptoms, early morning awakenings, feeling more tired than others, and using sleeping pills also were consistently associated with a significant increase in workdays lost due to sickness.

“Optimal sleep duration should be promoted, as very long and very short sleep indicate health problems and subsequent sickness absence,” said principal investigator Tea Lallukka, PhD, specialized researcher at the Finnish Institute of Occupational Health in Helsinki. “Those sleeping five hours or less, or 10 hours or more, were absent from work every year for 4.6 to 8.9 days more, as compared to those with the optimal sleep length.”

“Insufficient sleep due to inadequate or mistimed sleep contributes to the risk for several of today’s public health epidemics, including cardiovascular disease, diabetes, and obesity. Getting at least seven hours of nightly sleep is a key to overall health, which translates to less sick time away from work,” said Timothy Morgenthaler, MD, President of the American Academy of Sleep Medicine.

The study involved a nationally representative survey of 3,760 men and women in Finland who had been working at any time in the prior year. Participants were ages 30 to 64 at baseline. Sleep characteristics were determined by questionnaire, and health measures were derived from physical examination conducted by field physicians. Data for work absences due to sickness were gathered from the Social Insurance Institution of Finland, which tracks all sickness absences lasting more than 10 days. The average follow-up period was seven years.

A novel statistical method developed by study coauthors Tommi Härkänen, PhD, and Risto Kaikkonen was used to predict adjusted average sickness absence days per working year. Additional statistical estimates found that the direct costs of sickness absence to the Finnish government and employers could decrease by 28% if sleep disturbances could be fully addressed.

“Insomnia symptoms should be detected early to help prevent sickness absence and deterioration in health, well-being, and functioning,” said Dr. Lallukka. “Successful prevention of insomnia not only promotes health and work ability among employees, but it can also lead to notable savings in reduced sickness absence costs.”

White matter damage caused by severe obstructive sleep apnea can be reversed by continuous positive airway pressure (CPAP) therapy, according to results of a neuroimaging study published in the September issue of Sleep.

Participants with severe, untreated sleep apnea had a significant reduction in white matter fiber integrity in multiple brain areas. This brain damage was accompanied by impairments to cognition, mood, and daytime alertness. Although three months of CPAP therapy produced only limited improvements to damaged brain structures, 12 months of CPAP therapy led to an almost complete reversal of white matter abnormalities. Treatment also produced significant improvements in nearly all cognitive tests, mood, alertness, and quality of life.

“Structural neural injury of the brain of obstructive sleep apnea patients is reversible with effective treatment,” said principal investigator and lead author Vincenza Castronovo, PhD, clinical psychologist at the Sleep Disorders Center at San Raffaele Hospital and Vita-Salute San Raffaele University in Milan. “Treatment with CPAP, if patients are adherent to therapy, is effective for normalizing the brain structure.”


The study involved 17 men with severe, untreated obstructive sleep apnea who had an average age of 43. They were evaluated at baseline and after three and 12 months of treatment with CPAP therapy. At each time, they underwent a neuropsychologic evaluation and a diffusion tensor imaging examination. DTI is a form of magnetic resonance imaging that measures the flow of water through brain tissue. Participants were compared with 15 age-matched, healthy controls who were evaluated only at baseline.

A previous study by Dr. Castronovo’s group found similar damage to gray matter volume in multiple brain regions of people with severe sleep apnea. Improvements in gray matter volume appeared after three months of CPAP therapy. According to the authors, the two studies suggest that the white matter of the brain takes longer to respond to treatment than the gray matter.

“We are seeing a consistent message that the brain can improve with treatment,” said co-principal investigator Mark Aloia, PhD, Associate Professor of Medicine at National Jewish Health in Denver, and Senior Director of Global Clinical Research for Philips Respironics in Thornton, Colorado. “We know that PAP therapy keeps people breathing at night, but demonstrating effects on secondary outcomes is critical, and brain function and structure are strong secondary outcomes.”

White matter damage caused by severe obstructive sleep apnea can be reversed by continuous positive airway pressure (CPAP) therapy, according to results of a neuroimaging study published in the September issue of Sleep.

Participants with severe, untreated sleep apnea had a significant reduction in white matter fiber integrity in multiple brain areas. This brain damage was accompanied by impairments to cognition, mood, and daytime alertness. Although three months of CPAP therapy produced only limited improvements to damaged brain structures, 12 months of CPAP therapy led to an almost complete reversal of white matter abnormalities. Treatment also produced significant improvements in nearly all cognitive tests, mood, alertness, and quality of life.

“Structural neural injury of the brain of obstructive sleep apnea patients is reversible with effective treatment,” said principal investigator and lead author Vincenza Castronovo, PhD, clinical psychologist at the Sleep Disorders Center at San Raffaele Hospital and Vita-Salute San Raffaele University in Milan. “Treatment with CPAP, if patients are adherent to therapy, is effective for normalizing the brain structure.”


The study involved 17 men with severe, untreated obstructive sleep apnea who had an average age of 43. They were evaluated at baseline and after three and 12 months of treatment with CPAP therapy. At each time, they underwent a neuropsychologic evaluation and a diffusion tensor imaging examination. DTI is a form of magnetic resonance imaging that measures the flow of water through brain tissue. Participants were compared with 15 age-matched, healthy controls who were evaluated only at baseline.

A previous study by Dr. Castronovo’s group found similar damage to gray matter volume in multiple brain regions of people with severe sleep apnea. Improvements in gray matter volume appeared after three months of CPAP therapy. According to the authors, the two studies suggest that the white matter of the brain takes longer to respond to treatment than the gray matter.

“We are seeing a consistent message that the brain can improve with treatment,” said co-principal investigator Mark Aloia, PhD, Associate Professor of Medicine at National Jewish Health in Denver, and Senior Director of Global Clinical Research for Philips Respironics in Thornton, Colorado. “We know that PAP therapy keeps people breathing at night, but demonstrating effects on secondary outcomes is critical, and brain function and structure are strong secondary outcomes.”

White matter damage caused by severe obstructive sleep apnea can be reversed by continuous positive airway pressure (CPAP) therapy, according to results of a neuroimaging study published in the September issue of Sleep.

Participants with severe, untreated sleep apnea had a significant reduction in white matter fiber integrity in multiple brain areas. This brain damage was accompanied by impairments to cognition, mood, and daytime alertness. Although three months of CPAP therapy produced only limited improvements to damaged brain structures, 12 months of CPAP therapy led to an almost complete reversal of white matter abnormalities. Treatment also produced significant improvements in nearly all cognitive tests, mood, alertness, and quality of life.

“Structural neural injury of the brain of obstructive sleep apnea patients is reversible with effective treatment,” said principal investigator and lead author Vincenza Castronovo, PhD, clinical psychologist at the Sleep Disorders Center at San Raffaele Hospital and Vita-Salute San Raffaele University in Milan. “Treatment with CPAP, if patients are adherent to therapy, is effective for normalizing the brain structure.”


The study involved 17 men with severe, untreated obstructive sleep apnea who had an average age of 43. They were evaluated at baseline and after three and 12 months of treatment with CPAP therapy. At each time, they underwent a neuropsychologic evaluation and a diffusion tensor imaging examination. DTI is a form of magnetic resonance imaging that measures the flow of water through brain tissue. Participants were compared with 15 age-matched, healthy controls who were evaluated only at baseline.

A previous study by Dr. Castronovo’s group found similar damage to gray matter volume in multiple brain regions of people with severe sleep apnea. Improvements in gray matter volume appeared after three months of CPAP therapy. According to the authors, the two studies suggest that the white matter of the brain takes longer to respond to treatment than the gray matter.

“We are seeing a consistent message that the brain can improve with treatment,” said co-principal investigator Mark Aloia, PhD, Associate Professor of Medicine at National Jewish Health in Denver, and Senior Director of Global Clinical Research for Philips Respironics in Thornton, Colorado. “We know that PAP therapy keeps people breathing at night, but demonstrating effects on secondary outcomes is critical, and brain function and structure are strong secondary outcomes.”

Patients with hemorrhagic stroke who are treated with a statin in the hospital may be significantly more likely to survive than those who are not, according to a study published online ahead of print September 22 in JAMA Neurology. In a previous study, the researchers found that cholesterol-lowering statins can improve survival in patients with ischemic stroke.

“Previous research has suggested that treating patients with statins after they suffer hemorrhagic stroke may increase their long-term risk of continued bleeding,” said lead author Alexander Flint, MD, PhD, a neurologist at the Kaiser Permanente Department of Neuroscience in Redwood City, California. “Yet the findings of our study suggest that stopping statin treatments for these patients may carry substantial risks.”

Statins and Intracerebral Hemorrhage
The study included 3,481 individuals older than 50 who were admitted to any of 20 Kaiser Permanente hospitals in northern California with a hemorrhagic stroke between January 2002 and December 2011. Patients with prior qualifying intracerebral hemorrhage during the study period and those whose prestroke outpatient statin use could not be determined accurately were excluded from the study.

The study’s main outcomes were 30-day survival and discharge to home or inpatient rehabilitation facility. Patients were observed for 30 days from the date of admission or until death. No patients were lost to follow-up.

The investigators gathered information about statin use before and during hospitalization from electronic pharmacy records and inpatient order information included in electronic medical records. Inpatient statin use was defined as occurring when a physician ordered statins for inpatient administration. Patients were identified as outpatient statin users or nonusers according to whether statin prescriptions were filled at a Kaiser Permanente pharmacy.

Statin Treatment, Survival, and Discharge Disposition
Mean age of the participants was 73.5. Approximately 50% of participants were female, 85% had hypertension, 36% had atrial fibrillation, and 25% had a history of coronary artery disease. A total of 1,194 patients were considered statin users, and 2,287 were considered nonusers.

Of the 2,321 patients who did not receive a statin as an outpatient, 425 (18.3%) received a statin as an inpatient. A total of 1,160 patients received a statin as an outpatient, and 391 (33.7%) did not receive a statin as an inpatient. The statins used by the 1,194 inpatients included lovastatin (58.3%), simvastatin (37.9%), atorvastatin (3.2%), and pravastatin sodium (0.6%). The median inpatient statin dose (in atorvastatin-equivalent dose) was 10 mg/day.

Patients treated with a statin while in the hospital were more likely to be alive 30 days after a hemorrhagic stroke than were those who were not treated with a statin (81.6% vs 61.3%, odds ratio [OR], 4.25). Patients treated with a statin while in the hospital also were more likely to be discharged to home or an acute rehabilitation facility than those who were not (51.1% vs 35.0%, OR, 2.57).

Patients whose statin therapy was discontinued (ie, patients who took a statin as an outpatient before having a hemorrhagic stroke, and who did not receive a statin as an inpatient) had a mortality rate of 57.8%, compared with a mortality rate of 18.9% for patients using a statin before and during hospitalization. Patients whose statin therapy was discontinued were less likely than statin users to survive to 30 days (OR, 0.16) and were less likely than statin users to be discharged to their home or an acute rehabilitation facility (OR, 0.26).

A small proportion of patients in the cohort were treated with high-dose statins. A total of 113 patients received 40 to 80 mg/day of atorvastatin equivalent dose. This group represented 9.5% of statin users and 3.3% of the total cohort. When the researchers conducted a formal analysis of the dose–response relationship, they found increased point estimates for improved survival and discharge disposition. The observed differences were not statistically significant, however.

Statins May Modulate Secondary Brain Injury
“Several mechanisms have been implicated in secondary brain injury in both ischemic stroke and intracerebral hemorrhage, including excitotoxicity, oxidative stress, and inflammation, and many of these mechanisms can be modulated by statin use,” said Dr. Flint. “In addition, statin use has been associated with a reduction in the volume of perihematomal edema after intracerebral hemorrhage.”

The researchers concluded that statin use is strongly associated with improved outcomes after hemorrhagic stroke, and that discontinuing statin use is strongly associated with worsened outcomes after hemorrhagic stroke. “Given the association between statin cessation and substantially worsened outcomes, the risk–benefit balance of discontinuing statin therapy in the acute setting of ICH should be carefully considered,” concluded Dr. Flint.

Patients with hemorrhagic stroke who are treated with a statin in the hospital may be significantly more likely to survive than those who are not, according to a study published online ahead of print September 22 in JAMA Neurology. In a previous study, the researchers found that cholesterol-lowering statins can improve survival in patients with ischemic stroke.

“Previous research has suggested that treating patients with statins after they suffer hemorrhagic stroke may increase their long-term risk of continued bleeding,” said lead author Alexander Flint, MD, PhD, a neurologist at the Kaiser Permanente Department of Neuroscience in Redwood City, California. “Yet the findings of our study suggest that stopping statin treatments for these patients may carry substantial risks.”

Statins and Intracerebral Hemorrhage
The study included 3,481 individuals older than 50 who were admitted to any of 20 Kaiser Permanente hospitals in northern California with a hemorrhagic stroke between January 2002 and December 2011. Patients with prior qualifying intracerebral hemorrhage during the study period and those whose prestroke outpatient statin use could not be determined accurately were excluded from the study.

The study’s main outcomes were 30-day survival and discharge to home or inpatient rehabilitation facility. Patients were observed for 30 days from the date of admission or until death. No patients were lost to follow-up.

The investigators gathered information about statin use before and during hospitalization from electronic pharmacy records and inpatient order information included in electronic medical records. Inpatient statin use was defined as occurring when a physician ordered statins for inpatient administration. Patients were identified as outpatient statin users or nonusers according to whether statin prescriptions were filled at a Kaiser Permanente pharmacy.

Statin Treatment, Survival, and Discharge Disposition
Mean age of the participants was 73.5. Approximately 50% of participants were female, 85% had hypertension, 36% had atrial fibrillation, and 25% had a history of coronary artery disease. A total of 1,194 patients were considered statin users, and 2,287 were considered nonusers.

Of the 2,321 patients who did not receive a statin as an outpatient, 425 (18.3%) received a statin as an inpatient. A total of 1,160 patients received a statin as an outpatient, and 391 (33.7%) did not receive a statin as an inpatient. The statins used by the 1,194 inpatients included lovastatin (58.3%), simvastatin (37.9%), atorvastatin (3.2%), and pravastatin sodium (0.6%). The median inpatient statin dose (in atorvastatin-equivalent dose) was 10 mg/day.

Patients treated with a statin while in the hospital were more likely to be alive 30 days after a hemorrhagic stroke than were those who were not treated with a statin (81.6% vs 61.3%, odds ratio [OR], 4.25). Patients treated with a statin while in the hospital also were more likely to be discharged to home or an acute rehabilitation facility than those who were not (51.1% vs 35.0%, OR, 2.57).

Patients whose statin therapy was discontinued (ie, patients who took a statin as an outpatient before having a hemorrhagic stroke, and who did not receive a statin as an inpatient) had a mortality rate of 57.8%, compared with a mortality rate of 18.9% for patients using a statin before and during hospitalization. Patients whose statin therapy was discontinued were less likely than statin users to survive to 30 days (OR, 0.16) and were less likely than statin users to be discharged to their home or an acute rehabilitation facility (OR, 0.26).

A small proportion of patients in the cohort were treated with high-dose statins. A total of 113 patients received 40 to 80 mg/day of atorvastatin equivalent dose. This group represented 9.5% of statin users and 3.3% of the total cohort. When the researchers conducted a formal analysis of the dose–response relationship, they found increased point estimates for improved survival and discharge disposition. The observed differences were not statistically significant, however.

Statins May Modulate Secondary Brain Injury
“Several mechanisms have been implicated in secondary brain injury in both ischemic stroke and intracerebral hemorrhage, including excitotoxicity, oxidative stress, and inflammation, and many of these mechanisms can be modulated by statin use,” said Dr. Flint. “In addition, statin use has been associated with a reduction in the volume of perihematomal edema after intracerebral hemorrhage.”

The researchers concluded that statin use is strongly associated with improved outcomes after hemorrhagic stroke, and that discontinuing statin use is strongly associated with worsened outcomes after hemorrhagic stroke. “Given the association between statin cessation and substantially worsened outcomes, the risk–benefit balance of discontinuing statin therapy in the acute setting of ICH should be carefully considered,” concluded Dr. Flint.

Patients with hemorrhagic stroke who are treated with a statin in the hospital may be significantly more likely to survive than those who are not, according to a study published online ahead of print September 22 in JAMA Neurology. In a previous study, the researchers found that cholesterol-lowering statins can improve survival in patients with ischemic stroke.

“Previous research has suggested that treating patients with statins after they suffer hemorrhagic stroke may increase their long-term risk of continued bleeding,” said lead author Alexander Flint, MD, PhD, a neurologist at the Kaiser Permanente Department of Neuroscience in Redwood City, California. “Yet the findings of our study suggest that stopping statin treatments for these patients may carry substantial risks.”

Statins and Intracerebral Hemorrhage
The study included 3,481 individuals older than 50 who were admitted to any of 20 Kaiser Permanente hospitals in northern California with a hemorrhagic stroke between January 2002 and December 2011. Patients with prior qualifying intracerebral hemorrhage during the study period and those whose prestroke outpatient statin use could not be determined accurately were excluded from the study.

The study’s main outcomes were 30-day survival and discharge to home or inpatient rehabilitation facility. Patients were observed for 30 days from the date of admission or until death. No patients were lost to follow-up.

The investigators gathered information about statin use before and during hospitalization from electronic pharmacy records and inpatient order information included in electronic medical records. Inpatient statin use was defined as occurring when a physician ordered statins for inpatient administration. Patients were identified as outpatient statin users or nonusers according to whether statin prescriptions were filled at a Kaiser Permanente pharmacy.

Statin Treatment, Survival, and Discharge Disposition
Mean age of the participants was 73.5. Approximately 50% of participants were female, 85% had hypertension, 36% had atrial fibrillation, and 25% had a history of coronary artery disease. A total of 1,194 patients were considered statin users, and 2,287 were considered nonusers.

Of the 2,321 patients who did not receive a statin as an outpatient, 425 (18.3%) received a statin as an inpatient. A total of 1,160 patients received a statin as an outpatient, and 391 (33.7%) did not receive a statin as an inpatient. The statins used by the 1,194 inpatients included lovastatin (58.3%), simvastatin (37.9%), atorvastatin (3.2%), and pravastatin sodium (0.6%). The median inpatient statin dose (in atorvastatin-equivalent dose) was 10 mg/day.

Patients treated with a statin while in the hospital were more likely to be alive 30 days after a hemorrhagic stroke than were those who were not treated with a statin (81.6% vs 61.3%, odds ratio [OR], 4.25). Patients treated with a statin while in the hospital also were more likely to be discharged to home or an acute rehabilitation facility than those who were not (51.1% vs 35.0%, OR, 2.57).

Patients whose statin therapy was discontinued (ie, patients who took a statin as an outpatient before having a hemorrhagic stroke, and who did not receive a statin as an inpatient) had a mortality rate of 57.8%, compared with a mortality rate of 18.9% for patients using a statin before and during hospitalization. Patients whose statin therapy was discontinued were less likely than statin users to survive to 30 days (OR, 0.16) and were less likely than statin users to be discharged to their home or an acute rehabilitation facility (OR, 0.26).

A small proportion of patients in the cohort were treated with high-dose statins. A total of 113 patients received 40 to 80 mg/day of atorvastatin equivalent dose. This group represented 9.5% of statin users and 3.3% of the total cohort. When the researchers conducted a formal analysis of the dose–response relationship, they found increased point estimates for improved survival and discharge disposition. The observed differences were not statistically significant, however.

Statins May Modulate Secondary Brain Injury
“Several mechanisms have been implicated in secondary brain injury in both ischemic stroke and intracerebral hemorrhage, including excitotoxicity, oxidative stress, and inflammation, and many of these mechanisms can be modulated by statin use,” said Dr. Flint. “In addition, statin use has been associated with a reduction in the volume of perihematomal edema after intracerebral hemorrhage.”

The researchers concluded that statin use is strongly associated with improved outcomes after hemorrhagic stroke, and that discontinuing statin use is strongly associated with worsened outcomes after hemorrhagic stroke. “Given the association between statin cessation and substantially worsened outcomes, the risk–benefit balance of discontinuing statin therapy in the acute setting of ICH should be carefully considered,” concluded Dr. Flint.

A new guideline from the American Academy of Neurology (AAN) and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) provides recommendations about how physicians should evaluate a patient to determine which genetic tests may best diagnose his or her subtype of limb-girdle or distal muscular dystrophy. Factors to consider include symptoms, family history, ethnicity, physical examination, and laboratory test results, according to the guideline, which was published in the October 14 issue of Neurology.

To develop the guideline, researchers reviewed all of the available studies on the disorders, which cause muscles to waste away. “These are rare muscle diseases that can be difficult to diagnose,” said lead author Pushpa Narayanaswami, MB, Assistant Professor of Neurology at Harvard Medical School in Boston and a fellow of the AAN and AANEM. “With an accurate diagnosis, unnecessary tests or treatments may be avoided. Knowing the specific subtype is important for getting the best possible care.”

Clinical Features May Aid Diagnosis
Certain clinical features and other information such as family history can help doctors determine a person’s subtype. “Looking at a range of clinical signs and symptoms—such as which muscles are weak and if there is muscle wasting or enlargement, winging out of the shoulder blades, early signs of contracted limbs, rigidity of the neck or back, or heart or lung involvement—can help doctors determine which genetic test to order,” said senior author Anthony A. Amato, MD, Professor of Neurology at Harvard Medical School and a fellow of the AAN and AANEM. “This [technique], in turn, can shorten the time to diagnosis and start of treatment while helping avoid more extensive and expensive testing.”

Clinicians should refer newly diagnosed patients with a subtype of limb-girdle muscular dystrophy and high risk of cardiac complications for cardiology evaluation, even if they are asymptomatic, according to the guideline. Although no cure for these disorders is available, patients and physicians can manage their complications. The guideline makes recommendations about treating and managing complications, which may include muscle symptoms, heart problems, and breathing problems.

A Role for Specialized Treatment Centers
“Before this publication, there were no care guidelines that covered both limb-girdle muscular dystrophy and distal muscular dystrophy and were based on the evidence,” said Julie Bolen, PhD, MPH, Team Lead and Epidemiologist at the National Center on Birth Defects and Developmental Disabilities within the Centers for Disease Control and Prevention in Atlanta. “We hope that this guideline will fill that gap for both the people who live with these rare disorders and the health care professionals who treat them.”

The guideline recommends that care for people with these disorders be coordinated through treatment centers specializing in muscular dystrophy. People with these disorders should tell their doctors about any symptoms such as tachycardia, premature heartbeats, shortness of breath, pain, or difficulty in swallowing, according to the authors. Treatments for these symptoms may be available. People should also talk to their doctors about exercises that are safe.

A new guideline from the American Academy of Neurology (AAN) and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) provides recommendations about how physicians should evaluate a patient to determine which genetic tests may best diagnose his or her subtype of limb-girdle or distal muscular dystrophy. Factors to consider include symptoms, family history, ethnicity, physical examination, and laboratory test results, according to the guideline, which was published in the October 14 issue of Neurology.

To develop the guideline, researchers reviewed all of the available studies on the disorders, which cause muscles to waste away. “These are rare muscle diseases that can be difficult to diagnose,” said lead author Pushpa Narayanaswami, MB, Assistant Professor of Neurology at Harvard Medical School in Boston and a fellow of the AAN and AANEM. “With an accurate diagnosis, unnecessary tests or treatments may be avoided. Knowing the specific subtype is important for getting the best possible care.”

Clinical Features May Aid Diagnosis
Certain clinical features and other information such as family history can help doctors determine a person’s subtype. “Looking at a range of clinical signs and symptoms—such as which muscles are weak and if there is muscle wasting or enlargement, winging out of the shoulder blades, early signs of contracted limbs, rigidity of the neck or back, or heart or lung involvement—can help doctors determine which genetic test to order,” said senior author Anthony A. Amato, MD, Professor of Neurology at Harvard Medical School and a fellow of the AAN and AANEM. “This [technique], in turn, can shorten the time to diagnosis and start of treatment while helping avoid more extensive and expensive testing.”

Clinicians should refer newly diagnosed patients with a subtype of limb-girdle muscular dystrophy and high risk of cardiac complications for cardiology evaluation, even if they are asymptomatic, according to the guideline. Although no cure for these disorders is available, patients and physicians can manage their complications. The guideline makes recommendations about treating and managing complications, which may include muscle symptoms, heart problems, and breathing problems.

A Role for Specialized Treatment Centers
“Before this publication, there were no care guidelines that covered both limb-girdle muscular dystrophy and distal muscular dystrophy and were based on the evidence,” said Julie Bolen, PhD, MPH, Team Lead and Epidemiologist at the National Center on Birth Defects and Developmental Disabilities within the Centers for Disease Control and Prevention in Atlanta. “We hope that this guideline will fill that gap for both the people who live with these rare disorders and the health care professionals who treat them.”

The guideline recommends that care for people with these disorders be coordinated through treatment centers specializing in muscular dystrophy. People with these disorders should tell their doctors about any symptoms such as tachycardia, premature heartbeats, shortness of breath, pain, or difficulty in swallowing, according to the authors. Treatments for these symptoms may be available. People should also talk to their doctors about exercises that are safe.

A new guideline from the American Academy of Neurology (AAN) and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) provides recommendations about how physicians should evaluate a patient to determine which genetic tests may best diagnose his or her subtype of limb-girdle or distal muscular dystrophy. Factors to consider include symptoms, family history, ethnicity, physical examination, and laboratory test results, according to the guideline, which was published in the October 14 issue of Neurology.

To develop the guideline, researchers reviewed all of the available studies on the disorders, which cause muscles to waste away. “These are rare muscle diseases that can be difficult to diagnose,” said lead author Pushpa Narayanaswami, MB, Assistant Professor of Neurology at Harvard Medical School in Boston and a fellow of the AAN and AANEM. “With an accurate diagnosis, unnecessary tests or treatments may be avoided. Knowing the specific subtype is important for getting the best possible care.”

Clinical Features May Aid Diagnosis
Certain clinical features and other information such as family history can help doctors determine a person’s subtype. “Looking at a range of clinical signs and symptoms—such as which muscles are weak and if there is muscle wasting or enlargement, winging out of the shoulder blades, early signs of contracted limbs, rigidity of the neck or back, or heart or lung involvement—can help doctors determine which genetic test to order,” said senior author Anthony A. Amato, MD, Professor of Neurology at Harvard Medical School and a fellow of the AAN and AANEM. “This [technique], in turn, can shorten the time to diagnosis and start of treatment while helping avoid more extensive and expensive testing.”

Clinicians should refer newly diagnosed patients with a subtype of limb-girdle muscular dystrophy and high risk of cardiac complications for cardiology evaluation, even if they are asymptomatic, according to the guideline. Although no cure for these disorders is available, patients and physicians can manage their complications. The guideline makes recommendations about treating and managing complications, which may include muscle symptoms, heart problems, and breathing problems.

A Role for Specialized Treatment Centers
“Before this publication, there were no care guidelines that covered both limb-girdle muscular dystrophy and distal muscular dystrophy and were based on the evidence,” said Julie Bolen, PhD, MPH, Team Lead and Epidemiologist at the National Center on Birth Defects and Developmental Disabilities within the Centers for Disease Control and Prevention in Atlanta. “We hope that this guideline will fill that gap for both the people who live with these rare disorders and the health care professionals who treat them.”

The guideline recommends that care for people with these disorders be coordinated through treatment centers specializing in muscular dystrophy. People with these disorders should tell their doctors about any symptoms such as tachycardia, premature heartbeats, shortness of breath, pain, or difficulty in swallowing, according to the authors. Treatments for these symptoms may be available. People should also talk to their doctors about exercises that are safe.