Spotlight on the January 3 Issue

Effects of orthostatic hypotension on cognition in Parkinson disease

This study illustrated that orthostatic hypotension (OH) in Parkinson disease (PD) increases the risk of cognitive impairment. Patients with PD performed more poorly on neuropsychological measures while supine than controls, and had additional impairment during upright tilt. Clinicians should consider postural hemodynamics when assessing cognition in PD.

See p. 17

From editorialists Boylan & Messinis: “It may be appropriate to consider less aggressive blood pressure targets among patients with PD. It is early for a quick reach to the prescription pad in daily practice. Perhaps, however, it may not be early for greater awareness of the range of symptoms of OH and thoughtful consideration of empiric individually tailored intervention.”

See p. 11

Neonatal vitamin D status and risk of multiple sclerosis: A population-based case-control study

This case-control study examined the association between neonatal levels of vitamin D and multiple sclerosis (MS) using dried blood spot samples from the Danish Neonatal Screening Biobank. Low concentrations of neonatal vitamin D were associated with an increased risk of MS, an observation that may contribute to MS prevention.

See p. 44

From editorialists Marrie & Daumer: “Although we still do not fully understand the cause of MS, this collective body of evidence suggests that tackling these modifiable risk factors could prevent a substantial proportion of acquired demyelinating disease at the population level.”

See p. 13

Evolving use of seizure medications after intracerebral hemorrhage: A multicenter study

In this multicenter cohort, clinicians responded rapidly to new information when the best strategy for treatment was uncertain. All institutions studied changed practice based on new data, but with important variations. While clinicians generally respond to data, they do not always follow guidelines strictly for potentially good reasons.

See p. 52, Editorial p. 15

Risk of fractures after stroke: Results from the Ontario Stroke Registry

This study found that the rate of low-trauma fracture, associated with morbidity and mortality, was higher in patients with stroke than in age- and sex-matched controls. These findings showed that the risk of fractures, after stroke, should be considered for targeted screening and treatment for fracture prevention.

See p. 57