Progranulin Level Predicts Frontotemporal Lobar Degeneration
NEW YORK, March 6 (Reuters Health) — Reduced serum levels of progranulin can identify people who are at risk for frontotemporal lobar degeneration (FTLD), the term for a number of dementia-inducing diseases involving atrophy of the frontal cortex, temporal cortex, or both.
Mutations resulting in loss of progranulin have been implicated in FTLD, but until now there have been no biomarkers to rapidly detect progranulin loss, Dr. Christine Van Broeckhoven, from the University of Antwerp-CDE, Belgium, and colleagues explained in the March Annals of Neurology.
In the present study, the researchers used an enzyme-linked immunosorbent assay (ELISA) to measure serum levels of progranulin in 14 subjects with null mutations in the gene for progranulin. Six of the subjects had FTLD and eight did not.
Serum progranulin levels were also measured in two patients with a different null mutation, four with a predicted pathogenic missense mutation, five with a benign missense polymorphism, nine unaffected carrier relatives, and 22 community controls.
Affected and unaffected null mutation carriers had significantly lower progranulin levels than did their noncarrier relatives (P
The subjects with missense mutations had progranulin levels that were lower than controls but not as low as those seen in null mutation carriers. No significant difference in levels was observed between carriers of benign missense polymorphisms and controls.
“Further studies, including larger samples and different progranulin gene mutations, are needed to appraise (the progranulin ELISA assay) as a diagnostic or predictive test, and to accurately define a diagnostic threshold value,” the authors wrote.
Ann Neurol. 2009 Mar 13; [Epub ahead of print].
Elderly Patients With Recent Stroke or TIA Benefit From Statins
NEW YORK, March 6 (Reuters Health) — Elderly patients with a recent stroke or transient ischemic attack (TIA) benefit from statin treatment to a similar degree as their younger counterparts, according to a secondary analysis of data from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study.
In the analysis, researchers investigated the relative benefit and risk of atorvastatin compared with placebo in 2,249 patients 65 and older and 2,482 younger patients with recent stroke or TIA.
The baseline LDL (133 mg/dL) and total cholesterol levels were similar in the two groups. During the study, the elderly and younger groups experienced a similar mean decrease in LDL cholesterol (-61.4 mg/dL and -58.7 mg/dL, respectively).
Moreover, according to the investigators, “there was no heterogeneity in the stroke reduction seen with atorvastatin in the elderly and younger groups,” although younger patients tended to have greater event reductions than elderly patients.
The primary end point of fatal or nonfatal stroke was reduced by 26% in younger subjects (hazard ratio [HR], 0.74) and by 10% in elderly subjects (HR, 0.90), Dr. Seemant Chaturvedi, of the Wayne State University/Detroit Medical Center Stroke Program, and colleagues reported in the February 24 issue of Neurology.
Cardiac events and revascularization procedures were also lower in both the elderly and younger subgroups treated with atorvastatin. The high-dose atorvastatin regimen was well tolerated by the younger and older subjects.
“Clinicians should strongly consider using statins post stroke or TIA, regardless of patient age,” Dr. Chaturvedi concluded in comments to Reuters Health.
The authors of a commentary published with the study noted that clinicians currently start statins less often in the elderly, “even when the indication is proven, reflecting a broad perception that it is too late for such a treatment to make a difference.”
The message from this SPARCL post hoc analysis “is clear,” concluded Drs. Bruce M. Coull of the University of Arizona, Tucson and S. Claiborne Johnston of the University of California, San Francisco. “Whenever possible, stroke and TIA patients, even the elderly ones, should be given a high-potency, high-dose statin.”
Neurology. 2009;72(8):684-685, 688-694.
Late-Life Obesity Inversely Associated With Dementia Risk
NEW YORK, March 10 (Reuters Health) — In contrast to midlife obesity, late-life obesity is associated with a reduced risk of dementia, results of a study published in the March issue of the Archives of Neurology indicated.
“High adiposity predicts hyperinsulinemia and diabetes mellitus, both risk factors for dementia,” Dr. Annette L. Fitzpatrick, of the University of Washington, Seattle, and colleagues wrote. “Although high adiposity in middle age seems to be related to greater dementia risk, studies that explore this association in the elderly are conflicting.”
The researchers used data from the Cardiovascular Health Study to retrospectively examine associations between mid- and late-life obesity and the risk of dementia. The current study included 2,798 subjects without dementia (mean age, 74.7 years) who underwent MRI and who were measured for height and weight at baseline (1992 to 1994) and at age 65 or older. Midlife weight relied on self-report of weight at age 50.