Neurology

Suicidality at focal epilepsy diagnosis predicts later treatment resistance

In newly diagnosed focal epilepsy, suicidality at diagnosis strongly predicted subsequent treatment resistance over 6 years of follow-up. Among 347 adults, 24% developed treatment-resistant epilepsy and 55% were treatment sensitive on early antiseizure regimens. Any suicidality more than doubled treatment-resistance risk (relative risk 2.02; 95% CI 1.32-3.09) compared with no suicidality. Suicidality alone increased treatment-resistance probability from 16.3% to 47.1%, whereas mood and anxiety diagnoses alone showed weaker associations. Systematic suicidality screening at diagnosis could help target closer follow-up and earlier consideration of advanced therapies. 1

Minor and major stroke, but not TIA, increase 10-year dementia risk

In the Rotterdam Study, first-ever minor and major stroke increased long-term dementia risk, whereas TIA did not. Compared with matched controls, dementia risk rose after minor stroke (HR 1.60; 95% CI 1.21-2.12) and major stroke (HR 1.72; 95% CI 1.29-2.30). Covert brain infarction conferred intermediate risk between TIA and minor stroke (HR 1.34; 95% CI 0.98-1.83). Accounting for mortality, 10-year dementia risk was 14% after TIA, 21% after minor stroke, and 16% after major stroke. Age, education, baseline cognition, APOE-ε4, hypercholesterolemia, and MRI markers further refined individual dementia risk estimates. 2

TBI, depression, and alcohol use disorder drive 10-year ADRD risk in Veterans

In 245,949 Veterans aged 65 years or older, 4.56% developed Alzheimer disease and related dementias over 10 years. History of traumatic brain injury nearly tripled ADRD risk (HR 2.96; 95% CI 2.76-3.17) after adjustment. Depression (HR 2.93; 95% CI 2.82-3.04) and alcohol use disorder (HR 2.35; 95% CI 2.19-2.53) were similarly strong predictors. Exposures to Agent Orange, chemical or biological agents, and pyridostigmine bromide modestly increased ADRD risk. Aggressive prevention and management of TBI, depression, alcohol misuse, and military environmental exposures may meaningfully lower dementia burden in Veterans. 3

Targeted multidomain rehab adds little over behavioral management after mTBI

In this multisite randomized trial of 162 adults with recent mTBI, targeted multidomain rehabilitation did not improve primary outcomes versus behavioral management. Both groups showed similar 4-week improvements in Neurobehavioral Symptom Inventory scores and Patient Global Impression of Change. Sensitivity analyses suggested modest benefits of targeted therapy on ocular and vestibular symptoms and selected vestibulo-ocular measures. Small gains in cognitive processing speed also favored targeted therapy, but without clear global symptom benefit. Results support reserving intensive multidomain programs for patients with persistent, domain-specific deficits rather than routine use. 4