Mark L. Fuerst

Long-term intake of vegetables and fruits and fruit juices plays a beneficial role in reducing the risk of late-life subjective cognitive function.

of 27,842 men, average age 51 years, average dietary intake was calculated from 5 repeated food frequency questionnaires collected every 4 years until 2002.

 Subjective cognitive function was assessed twice (2008 and 2012) using a 6-item questionnaire; validity was supported by strong associations with 

After controlling for major non-dietary factors and total energy intake, higher intakes of total vegetables, total fruits, and fruit juice were each significantly associated with lower odds of moderate or poor subjective cognitive function.

Higher consumption of vegetables and fruits 18 to 22 years before subjective cognitive function assessment was associated with lower odds of poor subjective cognitive function.

“One of the most important factors in this study is that we were able to research and track such a large group of men over a 20-year period of time, allowing for very telling results,” said lead author Changzheng Yuan, ScD, of Harvard T.H. Chan School of Public Health in Boston, MA. “Our studies provide further evidence dietary choices can be important to maintain your brain health.” 

Long-term intake of vegetables and fruits and subjective cognitive function in US men

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 reveals a quality diet leads to larger brain tissue volumes, suggesting that nutrition has an effect on neurodegeneration via brain structure.

A total of 4213 people without dementia with an average age of 66 years participated in the study. They were asked to complete a questionnaire about how much they ate of nearly 400 items over the past month. The best diet consisted of vegetables, fruit, nuts, whole grains, dairy and fish, but a limited intake of sugary drinks.

All participants had brain scans with magnetic resonance imaging to determine brain volume, the number of brain white matter lesions, and small brain bleeds.

After adjusting for age, sex, education, smoking, and physical activity, a higher diet score was linked to larger total brain volume, when taking into account head size differences. Those who consumed a better diet had an average of 2 milliliters more total brain volume than those who did not. To compare, having a brain volume that is 3.6 milliliters smaller is equivalent to one year of aging.

“People with greater brain volume have been shown in other studies to have better cognitive abilities, so initiatives that help improve diet quality may be a good strategy to maintain thinking skills in older adults,” said senior author Meike W. Vernooij, MD, PhD, of the Erasmus University Medical Center in Rotterdam, the Netherlands. “There are many complex interactions that can occur across different food components and nutrients and according to our research, people who ate a combination of healthier foods had larger brain tissue volumes.”

For the interview with an author of this study, see 

1. Croll PH, Voortman T, Ikram MA, et al. 

Better diet quality relates to larger brain tissue volumes. The Rotterdam Study

A large study reveals a quality diet leads to larger brain tissue volumes, suggesting that nutrition has an effect on neurodegeneration via brain structure.

New Evidence Supports Diet-Brain Connection

The highlights of 3 new clinical studies involving stroke include older adults who take atypical antipsychotics have an increased risk of major cardiovascular events, particularly stroke; thrombectomy may be effective up to 24 hours after stroke onset; and elderly adults can safely undergo endovascular therapy to treat acute ischemic stroke.

Study 1: Antipsychotics Lead to Higher Incidence of Stroke

Long-term use of atypical antipsychotics may lead to major cardiovascular events, including stroke, in older patients.

 included 1008 patients, mean age 72.4 years, who were followed for a median of 36.5 months to evaluate the effect of antipsychotic medications categorized by their metabolic side effect profiles as low, intermediate, or high risk on major cardiovascular events. The primary outcome measure was the time to the composite of acute myocardial infarction, acute coronary syndrome, ischemic stroke, peripheral artery disease, or a new revascularization procedure.

Those taking second-generation antipsychotics who experienced a high level or an intermediate level of metabolic changes had an almost threefold increased risk of experiencing a cardiovascular event, in particular, stroke, as compared to those taking medications associated with a lower risk for metabolic changes.

“Older adult patients under antipsychotic regimens with high or intermediate risk of metabolic side effects may face a higher incidence of major cardiovascular events than those under a low-risk regimen during long-term follow-up,” stated the researchers. The higher risk for major cardiovascular events among those taking intermediate-risk or high-risk agents appears to be mostly driven by the higher risk of stroke, which may be due to high prevalence of patients with dementia or related to potential direct or indirect effects of antipsychotics.

Long-Term Antipsychotic Use and Major Cardiovascular Events: A Retrospective Cohort Study

 2017;78(8):e905–e912.  10.4088/JCP.16m10976

Study 2: Stroke Patients May Benefit from Thrombectomy Up to 24 Hours After Onset 

Time alone should not disqualify stroke patients for thrombectomy-patients from 6 to 24 hours from symptom onset may benefit from treatment.

 enrolled 206 patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery who had last been known to be well 6 to 24 hours earlier and who had a mismatch between the severity of the clinical deficit and the infarct volume; 107 patients were assigned to the thrombectomy group and 99 to the control group.

At 90 days, the rate of functional independence was 49% in the thrombectomy group as compared with 13% in the control group. The rate of symptomatic intracranial hemorrhage did not differ significantly between the two groups.

The findings suggest that physiological criteria as well as time from symptom onset should be considered for endovascular therapy. “Among patients with acute stroke who had last been known to be well 6 to 24 hours earlier and who had a mismatch between clinical deficit and infarct, outcomes for disability at 90 days were better with thrombectomy plus standard care than with standard care alone,” stated the researchers.

Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct

 November 11, 2017DOI: 10.1056/NEJMoa1706442

Study 3: Mechanical Thrombectomy Safe and Effective for Elderly Stroke Patients

Endovascular treatment appears to be safe and effective in elderly adults with large-vessel occlusion stroke.

 of 219 elderly adults treated for acute ischemic stroke divided the patients into two groups based on age-62 patients were age 80 years or older and 157 patients were under age 80. Safety outcomes, such as intracranial hemorrhage (ICH) and mortality, and efficacy outcomes, such as successful reperfusion and 3-month good clinical outcome, were compared in the two groups.

In patients aged 80 and older, intravenous thrombolysis was more frequent (67.7%) and onset to reperfusion time was shorter (318.7) than in younger patients (52.8% and 282, respectively), but no between-group differences were found in terms of successful reperfusion, good clinical outcome, any or symptomatic ICH, or mortality.

A multivariable analysis found that onset National Institute of Health Stroke Scale (NIHSS) score and 24-hour clinical improvement were independent predictors of 3-month functional independence in the older group.

Paying particular attention to onset NIHSS score could speed endovascular procedures and help achieve reperfusion and good clinical outcomes. “For elderly adults showing remarkable clinical improvement in the early period after the procedure, all efforts should be made to prevent or treat post-stroke complications, which are known to strongly affect short-term, intermediate-term, and long-term morbidity and mortality,” stated the researchers.

Efficacy and Safety of Mechanical Thrombectomy in Older Adults With Acute Ischemic Stoke

 2017 Aug;65(8):1816-1820. doi: 10.1111/jgs.14909.

Clinical implications of three new studies on treatments that may increase risk of-or mitigate harm from-stroke in older patients.

Mark L. Fuerst

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