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March 28 Highlights

Yip et al. found that cerebral CD62p expression was more enhanced prior to internal carotid artery (ICA) stenting and was less enhanced after ICA stenting in patients with severe ICA stenosis relative to systemic CD62p expression.

see page 804

The editorial by Goldstein and Kaplan notes that the difference in platelet activation between the baseline and the 90-day post-stenting levels is consistent with there having been platelet activation during flow through the stenotic carotid artery at baseline. Stenotic lesions in the carotid artery lead to increased shear stress in the vessel at the site of narrowing, and high shear stress is associated with platelet activation. However, it cannot be determined from the Yip et al. study whether the difference between baseline and 90 days was due to an effect of the stenting procedure, changes in medical therapy, or unmeasured factors. A prospective outcome study with appropriate controls will be needed to determine this as well as whether the reduction is associated with fewer cerebrovascular events.

see page 792

Leisure activities and MCI

Verghese et al. examined association of leisure activity participation and risk of MCI in a cohort of 437 older adults, initially free of dementia or MCI. Cognitive but not physical activities were associated with lower risk of MCI, even after excluding individuals at early stages of dementia.

see page 821

Leisure activity and risk of cognitive impairment

Wang et al. studied the association between leisure activities and risk of cognitive impairment in 5,437 Chinese older people and found that cognitive activities were associated with reduced risk of cognitive impairment.

see page 911

The editorial by Rundek and Bennett about these two articles notes that together these studies add support to data suggesting that a modification to lifestyle, namely the frequency with which persons engage in cognitively stimulating activities, may lower risk of cognitive impairment in old age. The study of Chinese urban community residents found benefit associated with playing board games (primarily mahjong, a traditional Chinese board game), and reading. Interestingly, watching television was associated with 20% increased risk of developing cognitive impairment. These observational studies cannot establish causal relationships between engagement in cognitively stimulating leisure activities and the development of cognitive impairment. Intervention trials may be needed to prove a causal relation.

see page 794

Malignant infarction in middle cerebral artery (MCA) territory strokes

In 192 consecutive autopsies on patients with non-lacunar MCA territory cerebral infarction, Jaramillo et al. studied associations with malignant infarction of the MCA. Malignant infarction typically developed in young patients with carotid occlusion, abnormal ipsilateral circle of Willis, and first-ever large hemispheric stroke including the superficial territory.

see page 815

Presymptomatic identification of PD

Approximately half of patients with REM sleep behavior disorder (RBD) will develop PD. In this study by Postuma et al., potential early PD markers such as olfaction and color vision loss were abnormal in half of the patients with idiopathic RBD, suggesting that presymptomatic identification of PD may be possible.

see page 845

The editorial by Boeve and Saper notes that RBD typically manifests dream enactment behavior. RBD is associated with the synucleinopathies and can occur in non-synucleinopathy disorders. RBD can present years/decades before parkinsonism and cognitive impairment become manifest in the synucleinopathies. When occurring in isolation and without any clear underlying cause, the term "idiopathic RBD" is typically used, yet there is growing evidence that idiopathic RBD may evolve with PD, DLB, or MSA. If RBD is one of the earliest clinical manifestations of an evolving synucleinopathy, other features that occur early in these disorders might coexist with RBD. This is precisely what Postuma et al. have demonstrated, with impairment in color discrimination and olfactory functioning, and more subtle abnormalities on measures of autonomic, motor, and gait functioning, in addition to RBD—all of which occur in patients with presymptomatic or early symptomatic PD. This study suggests a very early window of opportunity to delay or prevent these features from ever developing in LBD.

see page 796

Localization of a gene for ALS-FTD

Morita et al. describe a locus for a gene defect predisposing to amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Affected individuals in the reported family had either ALS or FTD.

see page 839

Risk factors for mild cognitive impairment and dementia

In a study by Kryscio et al., annual cognitive assessments of 554 initially cognitively normal subjects showed they usually exhibited a transient mild cognitive impairment (MCI) before converting to dementia. Aside from age, presence of an apolipoprotein 4 allele and low education increase risk for MCI transitions.

see page 828

Basilar-type migraine in patients with familial migraine

Kirchmann et al. studied the clinical, epidemiologic, and genetic features of basilar-type migraine in 362 patients with familial migraine with aura. Basilar-type aura occurred in 10% of patients and vertigo was the most common symptom. There was no familial aggregation of basilar-type migraine and the underlying genes were not identified.

see page 880

Figure. Brain swelling with transtentorial herniation and Duret hemorrhages in the upper brainstem.

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What does cerebral platelet activation mean in the setting of carotid stenosis?

Karen L. Kaplan and Larry B. Goldstein
Neurology 2006 66: 792-793. [Full Text] [PDF]

This Article Full Text (PDF) Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Related Articles