Articles in 2015

The recent DOMINO-AD trial suggests that continued treatment with donepezil delays nursing home placement for patients with severe Alzheimer disease, but more work is needed to support strong conclusions about whether the benefits outweigh the costs.

Parkinson disease (PD) is now regarded as a mixed motor, nonmotor and multiorgan disorder rather than a pure movement disorder. Nonmotor symptoms (NMS) have underpinned this conceptual change, and new criteria for clinical and prodromal diagnosis of PD, incorporating a range of NMS, have recently been published.

Hepatitis E virus (HEV) is the causative agent of hepatitis E, and extrahepatic manifestations, including various types of neurological injury, have also been reported in individuals with HEV infection. The most common neurological manifestations are Guillain–Barré syndrome (GBS), neuralgic amyotrophy, and encephalitis and/or myelitis. In this article, the authors review the reported cases of HEV-associated neurological injury, discuss the possible pathogenic mechanisms, and outline future directions and research questions.

In Europe, use of intravenous tissue plasminogen activator (tPA) in patients older than 80 years is discouraged because these patients have been excluded from certain past clinical trials. A new retrospective, observational study shows that tPA can substantially improve functional outcome after ischaemic stroke in patients aged 80–89 years.

Whole-exome sequencing is a new tool for neuromuscular clinicians, and recent findings show that it improves the diagnosis of limb-girdle muscular dystrophy. The technique has a dual role as a tool for diagnosis and discovery in genetically heterogeneous neuromuscular diseases.

Many neurological disorders, from traumatic brain injury to Alzheimer disease, affect social cognition, yet deficits in social cognition can be difficult to detect and diagnose effectively. In this Review, Henry and colleagues provide an overview of the clinical contexts in which social cognitive dysfunction arises and consider how tests can be used to detect it. Through examples of four conditions in which social cognitive dysfunction arises, they demonstrate the appropriate tests to use, and consider their clinical application beyond these disorders.

The most-established risk factors for intracerebral haemorrhage (ICH) are lifestyle-related, but several studies have reported familial aggregation of ICH. An understanding of the role of genetic risk factors in ICH could provide insight into ICH aetiopathogenesis, and improve prevention and patient-tailored management of ICH. This Review discusses the evidence for a genetic component in ICH, taking into account the strength of evidence and functional relevance to ICH for each genetic variant.

Rupture of an unruptured intracranial aneurysm (UIA) is the most common cause of subarachnoid haemorrhage (SAH), and at least one in 20–30 adults is estimated to carry an asymptomatic UIA. However, the likelihood and epidemiology of UIA rupture and the associated risk factors are poorly understood. In this Perspectives article, Korja and Kaprio discuss possible misconceptions in the epidemiology of UIAs and SAH, and suggest options to improve the quality of future research.

A randomized, double-blind, phase III trial of generic glatiramer acetate has shown equivalent efficacy and safety compared with the approved formulation, Copaxone. The impact of approval of generic glatiramer acetate, however, will mainly depend on the pricing of the drug.

It is 40 years since the microtubule-associated protein tau was isolated and characterized, and 30 years since this protein was discovered to be abnormally hyperphoshorylated in the brains of patients with Alzheimer disease. To mark these important milestones, Iqbal and colleagues provide an overview of the pivotal discoveries in the tau research field over the past 40 years. They also review the current status of the field, focusing on the molecular biological insights that have established a key role for tau pathology in neurodegenerative disease, and the new therapeutic approaches that are emerging from this research.