Neurology

Intensive lifestyle counseling buffered cognition against tau-related decline without changing imaging biomarkers

In the POINTER Imaging ancillary trial, structured versus self-guided multidomain lifestyle intervention showed no group differences in longitudinal cognition or primary imaging outcomes. Primary imaging measures were global β-amyloid, entorhinal cortex tau, hippocampal volume, and white matter hyperintensity volume. Amyloid status and accumulation did not modify intervention effects on cognition or imaging trajectories. Rising entorhinal tau was negatively associated with global cognition in the self-guided group, but this association was attenuated in the structured group, suggesting enhanced cognitive resilience. 1

EVT for distal and medium-vessel stroke preserved more threatened tissue than medical therapy alone

This post hoc DISTAL analysis compared EVT plus best medical treatment with best medical treatment alone in medium or distal vessel occlusion stroke. EVT increased the odds of a good imaging outcome, defined as preserving at least 80% of initially at-risk tissue (adjusted OR 1.6; 95% CI 1.1-2.3). Successful reperfusion further improved tissue preservation (adjusted OR 2.5; 95% CI 1.3-4.8). Patients with greater preserved at-risk tissue had better 90-day clinical outcomes, linking tissue salvage to functional benefit in selected distal EVT candidates. 2

Valproate carried the highest mortality risk in dementia patients treated for epilepsy

This Swedish nationwide cohort included 5,764 individuals with both dementia and epilepsy starting a first antiseizure medication after 2006. Valproate users had higher all-cause mortality (adjusted HR 1.34; 95% CI 1.20-1.48) compared with other common agents. Lamotrigine was associated with lower mortality (adjusted HR 0.84; 95% CI 0.75-0.93), while levetiracetam showed a near-neutral association (adjusted HR 0.93; 95% CI 0.85-1.03). Cardiovascular deaths were more frequent with valproate and carbamazepine; valproate increased cardiovascular mortality versus carbamazepine (adjusted HR 1.30; 95% CI 1.11-1.52). Lamotrigine reduced cardiovascular death versus carbamazepine (adjusted HR 0.79; 95% CI 0.66-0.94), supporting preferential use of newer ASMs in this population. 3

In low-NIHSS basilar occlusion, EVT increased in-hospital mortality without improving routine discharge

Using the US Nationwide Readmissions Database, this study analyzed 9,461 adults with basilar artery occlusion and NIHSS 1-9 between 2016 and 2022. After propensity matching, 1,632 EVT and 2,888 medically managed patients had identical routine home discharge rates (34.0% vs 34.0%). EVT was associated with higher in-hospital mortality compared with medical management (16.0% vs 7.1%; P < .001). Subgroup analyses suggested possible discharge benefit in NIHSS 6-9 and no mortality excess in embolic strokes or patients ≥75 years. These findings argue for highly selective EVT use rather than routine intervention in low-NIHSS basilar occlusion. 4