Tony Bennett Inspires Hope After a Diagnosis of Alzheimer’s In revealing his diagnosis of Alzheimer’s disease in 2021, singer Tony Bennett and his family aim to reduce the stigma around the illness and inspire other patients and their families. In the February issue of Brain & Life®, his wife, Susan, explains how music keeps her husband busy and engaged—and more like his old self, the charming performer. People with myasthenia gravis, a progressive neuromuscular disease, just got new treatment options after the US Food and Drug administration approved two medications. In this feature, Brain & Life describes how the new medications work and advises patients on how to choose the right treatment. Tips are offered for covering the cost of these new drugs. As scientists identify more genes that cause neurologic disorders, they may develop tests that target these genes. The magazine looks at how these advances affect conditions like Parkinson’s,
F E B R UA RY/M A R C H 2 0 2 2 B R A I N A N D LI F E .O R G
In the Genes Genetic Research May Finetune Treatment
epilepsy, Alzheimer’s, and inherited disorders and whether people at risk for them should undergo genetic testing.
Smog Fog How Dirty Air Affects Brain Health
Brain & Life magazine is free for AAN members in the United States to distribute to patients, who also can subscribe for free. If you would like to adjust the number of copies you receive for your patients or update your clinic address, email BeGreen@WasteFreeMail. com. All members have online access to the magazine articles and additional resources at BrainandLife.org. Please share the website with your patients!
Myasthenia Gravis New Drugs Offer More Options
It’s music that saves Tony.” — S U S A N B E N N E T T, W I F E O F TO N Y B E N N E T T
Neurology Today Ranks the Top Stories of 2021 As COVID-19 closes in on its second year, posing new challenges for neurology and other specialties, how does one measure progress? Neurology Today’s annual feature on the best advances of the year, “The News That Mattered in 2021: Neurology Today’s Editorial Board Top Picks,” provides a way forward. Neurology Today editorial Board Top Picks
can memantine improve cognition in down syndrome?
article in brief: The Neurology Today editorial board highlights the advances that occurred in 2021 across multiple subspecialties and areas of practice. every subspecialty. The selections of the most important advances in 2021 by members of the Neurology Today editorial board highlighted below are not all game-changers, but whether incremental or transformational, they have all moved the field forward in practice and the care of patients.
ADvANCED PRACTICE PRACTIONERS
The Pick: Cook CL, Schwarz HB. Advanced practice clinicians-neurology’s underused resource. JAMA Neurol 2021; 78(8):903-904.
julie a. gurwell, phd, pa-c Associate Professor, Director of Advanced Practice Providers University of Kentucky Louisville, KY
Kreimer S. Professionalism: On training and retaining advanced practice clinicians in neurology. Neurol Today 2021;21(15):1,9. The Findings: These two articles provide an important reminder that advanced practice clinicians can be valued team members of neurology care teams in collaboration with physicians when they are supported and mentored. The articles discuss the intrinsic challenges of
CEREBROvASCULAR DISEASE james c. grotta, md, faan Director of Stroke Research at the Clinical Institute for Research and Innovation Memorial Hermann-Texas Medical Center, Houston, TX
The Pick: Ebinger M, Siegerink B, Kunz A, et al. Association between dispatch of mobile stroke units and functional outcomes among patients with acute ischemic stroke in Berlin. JAMA 2021;325:454-466. Grotta JC, Yamal J-M, Parker et al. Prospective, multicenter, controlled trial of mobile stroke units. New Engl J Med 2021;385:971-81. The Findings: Previous studies had shown that mobile stroke units, specialized ambulances with CT imaging, personnel, and drugs, integrated with
emergency medical services systems, can accurately diagnose strokes and speed delivery of tissue plasminogen activator (tPA) treatment into the pre-hospital setting. These two studies from Berlin and seven sites in the US were the first large, controlled trials showing that mobile stroke unit management translates to substantially better clinical outcomes as measured by the modified Rankin scale at 90 days. Better results were driven by more and faster tPA treatment, especially in the first “golden” hour after symptom onset. Why It’s Important: The biggest current challenge in acute stroke treatment is getting appropriate treatment to the patient and getting the patient to the appropriate treatment, and doing this as fast as possible. Mobile stroke units are a way to achieve all this by taking the most widely used effective treatment, intravenous thrombolysis, to the patient immediately following the 911 call, and by triaging patients with large vessel occlusions directly to hospitals that can do thrombectomy. The Pick: LeCouffe ND, Kappelhof M, Treurniet KM, et al. A randomized trial of intravenous alteplase before endovascular treatment for stroke. New Engl J Med 2021;385:1833-44
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the official news source of the a merican academy of neurology | neurology today.com January 20, 2022 | volume 22 | issue 2
direct oral anticoagulants are safe for very elderly Patients with stroke and atrial fibrillation
training and utilizing advanced practice clinicians, as well as offer insights on ways to onboard and engage advanced practice providers to prevent attrition.
Advanced practice clinicians can help increase access to neurologic care. Although hiring advanced practice clinician requires a significant financial
investment, if integrated falls strategically, and bleeding, instead placing them fitzgerald Why It’s Important: Thesusan demand for that investment will lead to onbetter older provitamin K antagonists (VKA), neurologic care continues to outpace vider retention, and subsequent continuaspirin or perhaps nothing at all. the availability of neurology clinicians. ity for access to neurology. The new study, published online
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new study of patients older November 8 in Annals of Neurology, than 85 who had a recent used real-world data from stroke cenSuzuki K, Matsumaru Y, Takeuchi M, et Japan. The Zi study, along with similar the safety and efficacy of stroke along with atrial ters toa compare al. The effect of mechanical thrombecstudy reported last year, conducted fibrillation (AF) found that both DOAC to VKA by measuring outcomes tomy without vs with intravenous in China, demonstrated the already known benefits non-inferiority such as recurrent stroke and intracranial thrombolysis on functional outcome for skipping. (DOACs) bleeding. of direct oral anticoagulants among patients with acute ischemic compared with vitamin K antagonists “Our data are reassuring in that direct It’s Important: The preponderance stroke. JAMA 2021;325(3):244-253. held true even forWhy this very old and often oral anticoagulants maintain their favorbeprofile given as frail population. of evidence is that tPA should able in the oldest old with recent Zi W, Qiu Z, Li F, et al. Effect ofSome endovassoonare as possible patients whoindicating qualphysicians hesitant in toall prestroke, that reluctance to use cular treatment alone vsscribe intravenous including those who are candidates the newerify, direct oral anticoaguthem in these patients is not justified,” alteplase plus endovascularlants treatment on prevention for endovascular thrombectomy. for stroke in their very said the study’s lead author, Alexandros functional independence inelderly patientsAF with patients because of fears of Polymeris, MD, a neurology resident and a c u t e i s c h e m i c s t r o k e . JA M A The Pick: Halliday A, Bulbulia R, Bonati L, et al. Second asymptomatic carotid 2021;325(3):234-243. surgery trial (ACST-2): A randomised The Findings: Among patients who comparison of carotid artery stenting qualify for systemic thrombolysis with versus carotid endarterectomy. Lancet tPA, about 25 percent harbor clots in the 2021; 398:1065–1073. large vessels or large vessel occlusions studies had does this model prepare (LVOs). Endovascular thrombectomy is The Findings: Previousbut how well olgafor rukovets was a powerfully effective treatment these suggested that carotid stenting trainees for the disorders they will see in than endartpatients, but tPA usually cannot dissolve associated with more risk routine neurologic practice? the these large clots. Consequently, there erectomy. In asymptomatic patients, In a Viewpoint published in JAMA benefit of either procedure over mediis uncertainty if tPA should be given or eurology residents currently Neurology on December 6, Daniel Shalev, cal therapy is still in question, so any skipped in LVO patients. The LeCouffe complete one month of full- MD, an instructor in medicine and psyrisk would the balance. study tested non-inferiority and could timeincreased clinical training in psy-tip chiatry at Weill Cornell Medicine in New In this large international randomized not exclude that skipping tPA was infechiatry, as required by the York, and Nuri Jacoby, MD, an associate study of 3,265 patients, serious comrior to giving it. In fact, patients receivAccreditation Council for professor of clinical neurology at SUNY plications similarlyDownstate uncommon ing tPA on average had better outcomes Graduate Medical Educationwere (ACGME), Health Sciences University than those in whom it was skipped. This after carotid artery stenting and carotid was confirmed in a Swiss study, pre- endarterectomy, and the long-term sented but not yet published (SWIFT- effects on fatal or disabling stroke were Continued on page 20 DIRECT), and in the Suzuki study from comparable.
PhD candidate in the neurology department and stroke center at University Hospital Basel in Switzerland. “Based on these findings, more stroke patients could benefit from treatment with direct anticoagulants in the future,” Dr. Polymeris said. Background information in the new report noted that current guidelines from the American Heart Association/ American Stroke Association recommend DOACs in patients with AF for recurrent stroke prevention in preference to VKAs, based on the results of randomized-controlled trials. But whether that recommendation should apply to the very old is often questioned by doctors
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s 2021 came to a close, studies about COVID-19 continued to dominate across major journals and institutions. But even with another year of the coronavirus and a troubling variant, neurology witnessed the expansion of developments across
because persons 85 or older were barely represented in the clinical trials and neither were those with very recent ischemic stroke. Settling that uncertainty is important, especially given Continued on page 30
is it time to update Psychiatry training for neurologists? Proposals for How to Get It Done
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and Maimonides Medical Center in Brooklyn, pointed to gaps in both the format and content of psychiatry training for neurologists and called for both to be modernized. “A large number of disorders, including dementia, fall at the intersection of neurology and psychiatry,” Dr. Jacoby told Neurology Today. “Many disorders that are traditionally the purview of one field or the
other such as Parkinson’s disease, epilepsy, psychotic disorders, and stroke have neuropsychiatric manifestations. And there are workforce challenges in both specialties that can make referral and consultation difficult. It’s critical that neurologists receive psychiatry training that empowers them to provide care to patients with psychiatric comorbidities,” he said. “Current Continued on page 16 training in
the Best neurology advances of 2021
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“2021 has proven to be a year when the engines of neurology research and innovation continued to move forward, despite great challenges,” said Neurology Today Editor-in-Chief Joseph E. Safdieh, MD, FAAN, the Gertrude Feil Associate Dean of Curricular Affairs, vice chair of education, and professor of neurology at Weill Cornell Medical College. “The advances highlighted by our editorial board, all leaders in the field, offer up hope for the future of our specialty and for our patients.”
the news that mattered in 2021
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This past year’s selections, published in print and online on NeurologyToday.com on January 20, highlight the most noteworthy achievements across subspecialties— from dementia and genetics, sleep and epilepsy, neuromuscular disorders and stroke, movement disorders and neuro-oncology, neurocritical care and ethics, to legislative and wellness initiatives, and more. Look for the studies, initiatives, and developments that moved the field forward and led to important changes in practice—and why they matter.
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Best advances
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NeurologyToday (ISSN 1533-7006), an official publication of the American Academy of Neurology, is published Semi Monthly for the Academy by Wolters Kluwer Health, Inc, at 1800 Dual Highway, Suite 201, Hagerstown, MD 21740-6636. Periodicals Postage Paid at Hagerstown, MD and at additional mailing offices. POSTMASTER: Send address changes to Neurology Today, PO Box 1610, Hagerstown, MD 21740.
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