Confounding Outcomes in Alzheimer, AFib and Dementia Risk, Cognitive Issues in Epilepsy, and MRI Imaging

November 10, 2018

Neurology News Network for the week of November 10, 2018.

This week, Neurology News Network covered the findings of an assessment of confounding outcomes in patients with Alzheimer on cholinesterase inhibitors or memantine, a recent trial linking atrial fibrillation and an increased risk of dementia, a conversation with Dr. Kate Davis about cognitive issues in epilepsy, and an interview with Dr. Jeff Waugh about the use of an MRI technique to better understand the brain's anatomy (transcript below).

Jenna:

Welcome to Neurology News Network. I’m Jenna Payesko.

Matt:

And I’m Matt Hoffman. Let’s get into the news from this week.

A recent meta-analysis revealed that participants receiving either cholinesterase inhibitors or memantine showed differences on the Alzheimer Disease Assessment Scale-cognitive subscale compared to those receiving neither medication. This could produce potentially confounding outcomes showing that a treatment is effective when it is not, or vice versa. The difference, which was significant, was also roughly the same size as the expected effect of new therapeutic drugs investigated in clinical trials.

Due to this, lead author Richard Kennedy said that the use of concomitant medications must specifically be accounted for in the design and analysis of trial data to prevent erroneous conclusions that could result from imbalances in the rates of these medications among trial participants.

Jenna:

According to a recent study, atrial fibrillation is associated with a faster global cognitive decline and an increased risk of dementia in elderly adults, however, those taking anticoagulants were less likely to develop dementia than those who did not.

Researchers examined the associations of AFib with dementia, dementia subtypes, and cognitive decline in individuals 60 years and older, and explored the cognitive benefit of antithrombotic treatment in those with AFib. The authors told NeurologyLive that, in addition to the well-known risk of stroke, the increased risk of vascular dementia warrants a more proactive approach in continuously identifying AFib in elderly populations.

Matt:

Epilepsy is most well-known for its seizure-inducing effects, though according to Dr. Kate Davis, an epileptologist from the University of Pennsylvania, one of the most common complaints from patients relates to cognitive issues.

Jenna:

Davis told NeurologyLive that although these cognitive issues can be caused by a number of factors, including seizures themselves, the medications being used, and possible comorbidities, an easy fix is not always available.

Matt:

Davis said that one approach is to make sure that you're treating with the most optimal medications that will minimize the cognitive impacts that the patient is reporting and to possibly refer patients for behavior therapy or cognitive therapy with a speech therapist. If they are stilling still having seizures, and they're not responsive to medication, you should consider whether surgical intervention to potentially cure their epilepsy is a good option for that patient.

Jenna:

Although there are camps within neurology that hold doubts about the abilities of imaging techniques, Dr. Jeff Waugh, is not in those camps. The director of the Pediatric Movement Disorders Program at UT Southwestern has helped develop a magnetic resonance imaging technique for identifying the compartments of the human striatum. While preliminary, Waugh feels that the method holds great potential for increasing the field’s understanding of the brain’s anatomy.

Let’s take a look.

Matt:

For more direct access to expert insight, head to neurologylive.com. This has been Neurology News Network. Thanks for watching.