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Medscape
3 days ago
- General
- Medscape
Autism Linked to Fourfold Increase in Parkinson's Disease
Autism spectrum disorder (ASD) is linked to a fourfold increased risk for early-onset Parkinson's disease (PD), results from the largest, population-based cohort study of its kind to date showed. The findings indicated 'that there can be shared biological drivers behind ASD and Parkinson's disease,' study investigator, Weiyao Yin, MD, PhD, of the Karolinska Institutet in Stockholm, Sweden, said in a release. 'One hypothesis is that the brain's dopamine system is affected in both cases, since the neurotransmitter dopamine plays an important part in social behavior and motion control,' Yin added. The study was published online on May 27 in JAMA Neurology . A Plausible Link Recent research pointed to a plausible biological link between ASD and PD. However, large, longitudinal studies investigating the risk for PD following an ASD diagnosis are scarce, the researchers noted. 'Our study is the first population-based study, to our knowledge, using prospectively collected data, longitudinal design, and life-course approach to strengthen the inference,' they wrote. To investigate they used national registry data from more than 2 million individuals born in Sweden between 1974 and 1999 and followed them from age 20 years up to the end of 2022. The median age at study exit was 34 years. Within this cohort, they identified 51,954 individuals with ASD and 2,226,611 individuals without the disorder. PD, defined as a first-ever diagnosis of PD or other idiopathic or degenerative parkinsonian disorders, was identified in 438 individuals without ASD (0.02%; 1.3 cases per 100,000 person-years) and in 24 individuals with ASD (0.05%; 3.9 cases per 100,000 person-years), corresponding to a relative risk (RR) of 4.43. Depression and antidepressant use were present in 46.7% of individuals with ASD, and antipsychotic use, which can cause Parkinson-like symptoms, was present in 31.5%. Adjusting for depression and antipsychotic use reduced but did not eliminate the association between ASD and PD risk (RR, 3.10 and RR, 2.00, respectively). Independent of ASD diagnosis, a history of depression and exposure to antipsychotics were linked to a significantly higher risk for PD (RR, 2.01 and RR, 6.34, respectively). Preterm or early-term birth is a known risk factor for ASD, prompting an examination of its potential association with PD. However, no increased risk for PD was found compared with individuals born at full term. After adjusting for sex, socioeconomic status, and parental mental illness or PD, the investigators found ASD remained consistently associated with an increased risk for PD. There are potential biological explanations for the link, Yin told Medscape Medical News . 'One hypothesis suggests that the brain's dopamine system is impacted in both conditions, as the neurotransmitter dopamine plays a crucial role in social behavior and motor control,' Yin said. There may be a genetic correlation between the two conditions, she added noting that the PARK2 gene may be associated between ASD and early-onset PD. 'ASD is a lifelong condition, and more children with autism now progress into middle and older adulthood. Healthcare services need to provide long-term monitoring for individuals with ASD — a vulnerable group with high comorbidity and a high use of psychotropic medications,' Yin said. Experts Weigh In The study is clinically relevant 'mainly because it shows that neurodevelopmental conditions, like ASD, may be associated with clinical signs and diagnoses that may manifest at different ages, and we as clinicians should be aware of that,' Christos Ganos, MD, a neurologist at the Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada, who was not involved with the study, told Medscape Medical News . 'Although neurodevelopmental disorders are diagnosed early in life, there is a need to assess for neurological symptoms and signs also later in life, including to monitor the effects of prescribed medications on neuromotor control,' added Ganos, who is the wolf chair in neurodevelopmental psychiatry, and associate professor of neurology at the University of Toronto, Toronto, Ontario, Canada. However, he urged caution in linking the specific diagnoses of ASD and PD, as there is a more general link between neurodevelopmental disorders and motor dysfunction. 'Neurodevelopmental disorders are very heterogeneous, and the 'ASD' diagnosis encompasses a lot of different disorders and etiologies. Some of these diagnoses/conditions are linked to motor syndromes that are specifically associated with motor slowing but are not PD, although they could resemble some of its features,' he explained. Strengths of the study include its large sample size and statistical power to provide estimates 'with more meaningful precision than prior studies,' said Connie Marras, MD, PhD, a movement disorders specialist, and professor of neurology at the University of Toronto. However, she noted that investigators did not include smoking in the models, which 'may result in an overestimation of the association between ASD and PD,' she added. 'Smoking is less common among individuals with ASD and may constitute a confounder. Smoking is also less common in individuals with Parkinson's disease and is considered a protective factor against PD.' She also questioned whether the results really have clinical implications for monitoring the emergence of parkinsonism in this population. 'Early detection does not have treatment implications currently, particularly since at present we don't have therapies for PD prevention or slowing of progression. Once we do have such treatments, then monitoring would be justified,' she said. However, the finding 'could have significant clinical and policy-related implications as these individuals age,' Gregory Wallace, PhD, an autism expert and associate professor of speech, language, and hearing sciences at The George Washington University, Washington, DC, who was not part of the study, told Medscape Medical News. 'Given increased rates of autism diagnoses in younger cohorts, if autistic people are at increased risk for developing parkinsonism as they age, the healthcare system and clinicians who provide care for autistic adults need to be prepared,' said Wallace. Wallace recently published research showing that co-occurring parkinsonism in adults with autism is linked with lower subjective quality of life, more memory problems, lower sleep quality, and greater depression symptoms.
Time of India
3 days ago
- Health
- Time of India
Mirrorlights: Autistic patients at high risk of Parkinson's disease: Study
autism spectrum disorder People with autism could be at a higher risk of developing Parkinson's disease early in life, according to a large-scale study that showed similar underlying biological mechanisms of the from the Karolinska Institutet questioned a possible connection between the neuropsychiatric diagnosis of(ASD), which affects an individual's thought processes, behaviour, and interpersonal communication, and early-onset Parkinson's disease -- a condition that affects locomotion and results, published in JAMA Neurology, show that people with an autism diagnosis were four times more likely to develop Parkinson's disease than people without such a diagnosis.'This indicates that there can be shared biological drivers behind ASD and Parkinson's disease,' said Weiyao Yin, researcher at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.'One hypothesis is that the brain's dopamine system is affected in both cases, since the neurotransmitter dopamine plays an important part in social behavior and motion control,' Yin study is based on registry data from over two million people born in Sweden between 1974 and 1999, who were followed from the ageof 20 up to the end of is well-known that dopamine-producing neurons are degraded in Parkinson's studies have also shown that dopamine is possibly implicated in autism, but more research needs to be done to confirm this.'We hope that our results will eventually help to bring greater clarity to the underlying causes of both ASD and Parkinson's disease,' Yin for more studies, the researchers urged healthcare services to keep people with ASD -- a vulnerable group with high co-morbidity and high use of psychotropics -- under long-term observation.
Scientific American
5 days ago
- Health
- Scientific American
Ministrokes Can Be Just as Dangerous for the Brain as Regular Strokes
Kristin Kramer woke up early on a Tuesday morning 10 years ago because one of her dogs needed to go out. Then, a couple of odd things happened. When she tried to call her other dog, 'I couldn't speak,' she said. As she walked downstairs to let them into the yard, 'I noticed that my right hand wasn't working.' But she went back to bed, 'which was totally stupid,' said Kramer, now 54, an office manager in Muncie, Indiana. 'It didn't register that something major was happening,' especially because, reawakening an hour later, 'I was perfectly fine.' On supporting science journalism If you're enjoying this article, consider supporting our award-winning journalism by subscribing. By purchasing a subscription you are helping to ensure the future of impactful stories about the discoveries and ideas shaping our world today. So she 'just kind of blew it off' and went to work. It's a common response to the neurological symptoms that signal a TIA, a transient ischemic attack or ministroke. At least 240,000 Americans experience one each year, with the incidence increasing sharply with age. Because the symptoms disappear quickly, usually within minutes, people don't seek immediate treatment, putting them at high risk for a bigger stroke. Kramer felt some arm tingling over the next couple of days and saw her doctor, who found nothing alarming on a CT scan. But then she started 'jumbling' her words and finally had a relative drive her to an emergency room. By then, she could not sign her name. After an MRI, she recalled, 'my doctor came in and said, 'You've had a small stroke.'' Did those early-morning aberrations constitute a TIA? Might a 911 call and an earlier start on anticlotting drugs have prevented her stroke? 'We don't know,' Kramer said. She's doing well now, but faced with such symptoms again, 'I would seek medical attention.' Now, a large epidemiological study by researchers at the University of Alabama-Birmingham and the University of Cincinnati, published in JAMA Neurology, points to another reason to take TIAs seriously: Over five years, study participants' performance on cognitive tests after a TIA drops as steeply as it does among victims of a full-on stroke. 'If you have one stroke or one TIA, with no other event over time and no other change in your medical status, the rate of cognitive decline is the same,' said Victor Del Bene, a neuropsychologist and lead author of the study. An accompanying editorial by Eric Smith, a neurologist at the University of Calgary, was pointedly headlined 'Transient Ischemic Attack — Not So Transient After All!' The study showed that even if the symptoms resolve — typically within 15 minutes to an hour — TIAs set people on a different cognitive slope later in life, Smith said in an interview: 'a long-lasting change in people's cognitive ability, possibly leading to dementia.' The study, analyzing findings from data on more than 30,000 participants, followed three groups of adults age 45 or older with no history of stroke or TIA. 'It's been a hard group to study because you lack the baseline data of how they were functioning prior to the TIA or stroke,' Del Bene said. With this longitudinal study, however, researchers could separate those who went on to have a TIA from a group who went on to suffer a stroke and also from an asymptomatic control group. The team adjusted their findings for a host of demographic variables and health conditions. Immediately after a TIA, 'we don't see an abrupt change in cognition,' as measured by cognitive tests administered every other year, Del Bene said. The stroke group showed a steep decline, but the TIA and control group participants 'were more or less neck and neck.' Five years later, the picture was different. People who had experienced TIAs were cognitively better off than those who had suffered strokes. But both groups were experiencing cognitive decline, and at equally steep rates. After accounting for various possible causes, the researchers concluded that the cognitive drop reflected not demographic factors, chronic illnesses, or normal aging, but the TIA itself. 'It's not dementia,' Del Bene said of the decline after a TIA. 'It may not even be mild cognitive impairment. But it's an altered trajectory.' Of course, most older adults do have other illnesses and risk factors, like heart disease, diabetes, or smoking. 'These things together work synergistically to increase the risk for cognitive decline and dementia over time,' he said. The findings reinforce long-standing concerns that people experiencing TIAs don't respond quickly enough to the incident. 'These events are serious, acute, and dangerous,' said Claiborne Johnston, a neurologist and chief medical officer of Harbor Health in Austin, Texas. After a TIA, neurologists put the risk of a subsequent stroke within 90 days at 5% to 20%, with half that risk occurring in the first 48 hours. 'Feeling back to normal doesn't mean you can ignore this, or delay and discuss it with your primary care doctor at your next visit,' Johnston said. The symptoms should prompt a 911 call and an emergency room evaluation. How to recognize a TIA? Tracy Madsen, an epidemiologist and emergency medicine specialist at the University of Vermont, promotes the BE FAST acronym: balance loss, eyesight changes, facial drooping, arm weakness, speech problems. The 'T' is for time, as in don't waste any. 'We know a lot more about how to prevent a stroke, as long as people get to a hospital,' said Madsen, vice chair of an American Heart Association committee that, in 2023, revised recommendations for TIAs. The statement called for more comprehensive and aggressive testing and treatment, including imaging, risk assessment, anticlotting and other drugs, and counseling about lifestyle changes that reduce stroke risk. Unlike other urgent conditions, a TIA may not look dramatic or even be visible; patients themselves have to figure out how to respond. Karen Howze, 74, a retired lawyer and journalist in Reno, Nevada, didn't realize that she'd had several TIAs until after a doctor noticed weakness on her right side and ordered an MRI. Years later, she still notices some effect on 'my ability to recall words.' Perhaps 'transient ischemic attack' is too reassuring a label, Johnston and a co-author argued in a 2022 editorial in JAMA. They suggested that giving a TIA a scarier name, like 'minor ischemic stroke,' would more likely prompt a 911 call. The experts interviewed for this column all endorsed the idea of a name that includes the word 'stroke.' Changing medical practice is 'frustratingly slow,' Johnston acknowledged. But whatever the nomenclature, keeping BE FAST in mind could lead to more examples like Wanda Mercer, who shared her experience in a previous column. In 2018, she donated at the bloodmobile outside her office in Austin, where she was a systems administrator for the University of Texas, then walked two blocks to a restaurant for lunch. 'Waiting in line, I remember feeling a little lightheaded,' she said. 'I woke up on the floor.' Reviving, she assured the worried restaurant manager that she had merely fainted after giving blood. But the manager had already called an ambulance — this was smart move No. 1. The ER doctors ran tests, saw no problems, gave Mercer intravenous fluids, and discharged her. 'I began to tell my colleagues, 'Guess what happened to me at lunch!'' she recalled. But, she said, she had lost her words: 'I couldn't articulate what I wanted to say.' Smart move No. 2: Co-workers, suspecting a stroke, called the EMTs for the second time. 'I was reluctant to go,' Mercer said. 'But they were right.' This time, emergency room doctors diagnosed a minor stroke. Mercer has had no recurrences. She takes a statin and a baby aspirin daily and sees her primary care doctor annually. Otherwise, at 73, she has retired to an active life of travel, pickleball, running, weightlifting, and book groups. 'I'm very grateful,' she said, 'that I have a happy story to tell.'
Yahoo
6 days ago
- Health
- Yahoo
A Ministroke Can Have Major Consequences
Kristin Kramer woke up early on a Tuesday morning 10 years ago because one of her dogs needed to go out. Then, a couple of odd things happened. When she tried to call her other dog, 'I couldn't speak,' she said. As she walked downstairs to let them into the yard, 'I noticed that my right hand wasn't working.' But she went back to bed, 'which was totally stupid,' said Kramer, now 54, an office manager in Muncie, Indiana. 'It didn't register that something major was happening,' especially because, reawakening an hour later, 'I was perfectly fine.' So she 'just kind of blew it off' and went to work. It's a common response to the neurological symptoms that signal a TIA, a transient ischemic attack or ministroke. At least 240,000 Americans experience one each year, with the incidence increasing sharply with age. Because the symptoms disappear quickly, usually within minutes, people don't seek immediate treatment, putting them at high risk for a bigger stroke. Kramer felt some arm tingling over the next couple of days and saw her doctor, who found nothing alarming on a CT scan. But then she started 'jumbling' her words and finally had a relative drive her to an emergency room. By then, she could not sign her name. After an MRI, she recalled, 'my doctor came in and said, 'You've had a small stroke.'' Did those early-morning aberrations constitute a TIA? Might a 911 call and an earlier start on anticlotting drugs have prevented her stroke? 'We don't know,' Kramer said. She's doing well now, but faced with such symptoms again, 'I would seek medical attention.' Now, a large epidemiological study by researchers at the University of Alabama-Birmingham and the University of Cincinnati, published in JAMA Neurology, points to another reason to take TIAs seriously: Over five years, study participants' performance on cognitive tests after a TIA drops as steeply as it does among victims of a full-on stroke. 'If you have one stroke or one TIA, with no other event over time and no other change in your medical status, the rate of cognitive decline is the same,' said Victor Del Bene, a neuropsychologist and lead author of the study. An accompanying editorial by Eric Smith, a neurologist at the University of Calgary, was pointedly headlined 'Transient Ischemic Attack — Not So Transient After All!' The study showed that even if the symptoms resolve — typically within 15 minutes to an hour — TIAs set people on a different cognitive slope later in life, Smith said in an interview: 'a long-lasting change in people's cognitive ability, possibly leading to dementia.' The study, analyzing findings from data on more than 30,000 participants, followed three groups of adults age 45 or older with no history of stroke or TIA. 'It's been a hard group to study because you lack the baseline data of how they were functioning prior to the TIA or stroke,' Del Bene said. With this longitudinal study, however, researchers could separate those who went on to have a TIA from a group who went on to suffer a stroke and also from an asymptomatic control group. The team adjusted their findings for a host of demographic variables and health conditions. Immediately after a TIA, 'we don't see an abrupt change in cognition,' as measured by cognitive tests administered every other year, Del Bene said. The stroke group showed a steep decline, but the TIA and control group participants 'were more or less neck and neck.' Five years later, the picture was different. People who had experienced TIAs were cognitively better off than those who had suffered strokes. But both groups were experiencing cognitive decline, and at equally steep rates. After accounting for various possible causes, the researchers concluded that the cognitive drop reflected not demographic factors, chronic illnesses, or normal aging, but the TIA itself. 'It's not dementia,' Del Bene said of the decline after a TIA. 'It may not even be mild cognitive impairment. But it's an altered trajectory.' Of course, most older adults do have other illnesses and risk factors, like heart disease, diabetes, or smoking. 'These things together work synergistically to increase the risk for cognitive decline and dementia over time,' he said. The findings reinforce long-standing concerns that people experiencing TIAs don't respond quickly enough to the incident. 'These events are serious, acute, and dangerous,' said Claiborne Johnston, a neurologist and chief medical officer of Harbor Health in Austin, Texas. After a TIA, neurologists put the risk of a subsequent stroke within 90 days at 5% to 20%, with half that risk occurring in the first 48 hours. 'Feeling back to normal doesn't mean you can ignore this, or delay and discuss it with your primary care doctor at your next visit,' Johnston said. The symptoms should prompt a 911 call and an emergency room evaluation. How to recognize a TIA? Tracy Madsen, an epidemiologist and emergency medicine specialist at the University of Vermont, promotes the BE FAST acronym: balance loss, eyesight changes, facial drooping, arm weakness, speech problems. The 'T' is for time, as in don't waste any. 'We know a lot more about how to prevent a stroke, as long as people get to a hospital,' said Madsen, vice chair of an American Heart Association committee that, in 2023, revised recommendations for TIAs. The statement called for more comprehensive and aggressive testing and treatment, including imaging, risk assessment, anticlotting and other drugs, and counseling about lifestyle changes that reduce stroke risk. Unlike other urgent conditions, a TIA may not look dramatic or even be visible; patients themselves have to figure out how to respond. Karen Howze, 74, a retired lawyer and journalist in Reno, Nevada, didn't realize that she'd had several TIAs until after a doctor noticed weakness on her right side and ordered an MRI. Years later, she still notices some effect on 'my ability to recall words.' Perhaps 'transient ischemic attack' is too reassuring a label, Johnston and a co-author argued in a 2022 editorial in JAMA. They suggested that giving a TIA a scarier name, like 'minor ischemic stroke,' would more likely prompt a 911 call. The experts interviewed for this column all endorsed the idea of a name that includes the word 'stroke.' Changing medical practice is 'frustratingly slow,' Johnston acknowledged. But whatever the nomenclature, keeping BE FAST in mind could lead to more examples like Wanda Mercer, who shared her experience in a previous column. In 2018, she donated at the bloodmobile outside her office in Austin, where she was a systems administrator for the University of Texas, then walked two blocks to a restaurant for lunch. 'Waiting in line, I remember feeling a little lightheaded,' she said. 'I woke up on the floor.' Reviving, she assured the worried restaurant manager that she had merely fainted after giving blood. But the manager had already called an ambulance — this was smart move No. 1. The ER doctors ran tests, saw no problems, gave Mercer intravenous fluids, and discharged her. 'I began to tell my colleagues, 'Guess what happened to me at lunch!'' she recalled. But, she said, she had lost her words: 'I couldn't articulate what I wanted to say.' Smart move No. 2: Co-workers, suspecting a stroke, called the EMTs for the second time. 'I was reluctant to go,' Mercer said. 'But they were right.' This time, emergency room doctors diagnosed a minor stroke. Mercer has had no recurrences. She takes a statin and a baby aspirin daily and sees her primary care doctor annually. Otherwise, at 73, she has retired to an active life of travel, pickleball, running, weightlifting, and book groups. 'I'm very grateful,' she said, 'that I have a happy story to tell.' KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF. Subscribe to KFF Health News' free Morning Briefing. This article first appeared on KFF Health News and is republished here under a Creative Commons license. The post A Ministroke Can Have Major Consequences appeared first on Katie Couric Media.
Medscape
16-05-2025
- Health
- Medscape
New ‘Real World' Data on Lecanemab Side Effects
Patients with early Alzheimer's disease (AD) who initiated lecanemab treatment at a specialty memory clinic showed an expected and manageable side-effect profile, new research showed. 'The findings are very reassuring,' Barbara Joy Snider, MD, PhD, professor of neurology, and director of the Memory Diagnostic Center and Knight ADRC Clinical Trials Unit, Washington University School of Medicine, St. Louis, Missouri, told Medscape Medical News . 'We found similar rates of side effects in our patient population as were found in the phase 3 studies of lecanemab. Clinical trial volunteer participants tend to be very healthy, so it is not always a given that side effects will be similar in the clinical population, especially in older adults,' Snider explained. The study was published online on May 12 in JAMA Neurology. Real World Data Lecanemab was the first disease-modifying treatment for AD to receive traditional approval from the US Food and Drug Administration (FDA) in July 2023. However, side effects, including brain swelling and bleeding, which emerged during clinical trials, left some patients and clinicians hesitant to initiate treatment in appropriate patients. In this real-world analysis, Snider and colleagues took a look back at 234 patients with early symptomatic AD who initiated lecanemab infusions (10 mg/kg intravenous every 2 weeks) in the memory clinic at WashU Medicine over 14 months. Infusion-related reactions occurred in 87 (37%) study participants and were typically mild. During an average treatment period of 6.5 months, amyloid-related imaging abnormalities (ARIA) were observed in 42 of 194 patients (22%) who received at least four lecanemab infusions and underwent at least one monitoring MRI scan. Overall, 29 (15%) patients developed ARIA with edema/effusion, with or without ARIA with hemorrhage/hemosiderin deposition (ARIA-H) and 13 (6.7%) developed isolated ARIA-H. The majority of ARIA was asymptomatic and radiographically mild and most patients who developed ARIA stayed on treatment. Eleven patients (5.7%) developed symptomatic ARIA; only two patients (1.0%) had clinically severe ARIA. No deaths or microhemorrhages were observed. 'Importantly,' wrote the investigators, patients with mild dementia at baseline (Clinical Dementia Rating [CDR], 1) had a 15-fold higher rate of symptomatic ARIA than patients with mild cognitive impairment or very mild dementia (CDR, 0.5) at baseline (27% vs 1.8%, P < .001). 'We do not know for sure why people with very mild dementia had fewer side effects than people with mild dementia,' Snider told Medscape Medical News . 'Some findings published based on the clinical trials have shown that people with very mild dementia likely get more benefit from these medications, so this emphasizes the importance of diagnosing Alzheimer's disease when symptoms are very mild. We have a discussion with each patient and their family about the potential risks and benefits of these medications, so this will be part of that discussion,' Snider said. 'We need to gather more information and follow more patients, not only at our site but more broadly through efforts like ALZ-NET [Alzheimer's Network for Treatment and Diagnostics] to better understand what factors affect the risks and benefits of these medications,' Snider added. Summing up, Snider said this real-world analysis showed that 'recently approved antibodies against amyloid can be used in an outpatient clinical practice, side effects are as expected and can be managed, and only 1%-2% of patients had clinically concerning side effects.' 'Valuable' Evidence Commenting on this study for Medscape Medical News , Ozama Ismail, PhD, director of scientific programs at Alzheimer's Association, said the findings of this study 'support using approved amyloid-targeting treatments in clinical practice.' Ismail, who wasn't involved in the study, said this research contributes 'valuable evidence' about the side effects of lecanemab and their management and the findings 'align with what was seen during clinical trials.' 'That said, this is just one demonstration of how these treatments are being effectively implemented, administered, and managed within a regional population. Every clinic may have a different perspective and will be serving a different patient population,' Ismail cautioned. He noted that new FDA-approved treatments offer 'real hope for people living with early Alzheimer's, and they are redefining how Alzheimer's is addressed. Understanding how these therapies work in real-world settings is essential to improving treatment for everyone — this requires robust data collection beyond controlled clinical trials,' Ismail said. He also noted that Washington University Memory Diagnostic Center, where this work was done, is part of the ALZ-NET — a nationwide network where healthcare providers collect real-world data from patients who are being evaluated for treatment or are receiving treatment with new FDA-approved AD therapies. ALZ-NET now has more than 2000 patients enrolled in nearly 100 locations across the United States.
