Intranasal Insulin Therapy for Alzheimer Disease and Amnestic Mild Cognitive Impairment: A Pilot Clinical Trial
Craft and colleagues (SEE ARTICLE) examine the effects of intranasal insulin administration on cognition, function, cerebral glucose metabolism, and cerebrospinal fluid biomarkers in adults with amnestic mild cognitive impairment or Alzheimer disease. They find that treatment with 20 IU of insulin improved delayed memory (P < .05) and that both doses of insulin (20 and 40 IU) preserved caregiver-rated functional ability (P < .01).

Autosomal Recessive Causes Likely in Early-Onset Alzheimer Disease
Wingo and colleagues (SEE ARTICLE) determine the genetic contribution to non–autosomal dominant early-onset Alzheimer disease (EOAD) (onset age 60 years) cases and identify the likely mechanism of inheritance in those cases. The most likely explanation of the data is that approximately 90% of EOAD cases are due to autosomal recessive causes.

Assessing Response to Stroke Thrombolysis: Validation of 24-Hour Multimodal Magnetic Resonance Imaging
Campbell and colleagues (SEE ARTICLE) compare assessment of the effect of reperfusion therapies using 24-hour vs day 90 magnetic resonance imaging. They find that assessment of final infarct volume using diffusion-weighted imaging at 24 hours captures the effect of reperfusion therapies on infarct growth and predicts functional outcome similarly to imaging at day 90.

Statins and Intracerebral Hemorrhage: A Retrospective Cohort Study
Hackam et al (SEE ARTICLE) examine the association between statins and intracerebral hemorrhage (ICH) in patients with recent ischemic stroke in a population-based setting. They report that statin exposure following ischemic stroke was not associated with ICH. Editorial perspective is provided by Philip B. Gorelick, MD, MPH (SEE ARTICLE).

Subgroup analyses. Risk for intracerebral hemorrhage (ICH) in relation to statin exposure in predefined subgroups. Squares indicate hazard ratios (HRs); whiskers, 95% confidence intervals; and SES, socioeconomic status.

Effects of Age and Amyloid Deposition on Aβ Dynamics in the Human Central Nervous System
Huang et al (SEE ARTICLE) investigate whether dynamic changes in Aβ levels in the human central nervous system may be altered by aging or by the pathology of Alzheimer disease (AD) and thus contribute to the risk of AD. They show that a reduction in the linear increase in the Aβ levels in cerebrospinal fluid (CSF) samples that is associated with amyloid deposition and a decreased CSF Aβ diurnal pattern associated with increasing age disrupt the normal physiology of Aβ dynamics and may contribute to AD.

Diffusion Tensor Imaging in Acute Optic Neuropathies: Predictor of Clinical Outcomes
Naismith et al (SEE ARTICLE) evaluate directional diffusivities within the optic nerve in a first event of acute optic neuritis to determine whether decreased axial diffusivity (AD) would predict 6-month visual outcome and optic nerve integrity measures. Decreased AD in acute optic neuritis was associated with a worse 6-month visual outcome and correlated with visual evoked potential and retinal nerve fiber layer measures of axon and myelin injury. Axial diffusivity may serve as a marker of axon injury in acute white matter injury.

¹¹C-PiB Imaging of Human Immunodeficiency Virus–Associated Neurocognitive Disorder
A nces and colleagues (SEE ARTICLE) evaluate whether the amyloid-binding agent carbon 11–labeled Pittsburgh Compound B ([¹¹C]-PiB) could differentiate Alzheimer disease (AD) from human immunodeficiency virus (HIV)–associated neurocognitive disorder (HAND) in middle-aged HIV-positive participants. They show that middle-aged HIV-positive participants, even with HAND, do not exhibit increased ¹¹C-PiB levels, whereas symptomatic AD individuals have increased fibrillar Aβ42 deposition in cortical and subcortical regions.

Daclizumab Use in Patients With Pediatric Multiple Sclerosis
Gorman et al (SEE ARTICLE) report the use of daclizumab in pediatric-onset multiple sclerosis (POMS). They find that daclizumab may be a safe and at least partially effective treatment option for patients with POMS with disease activity despite first-line disease-modifying therapy.

Impact of Inflammation on Brain Volume in Multiple Sclerosis
Cheriyan and colleagues (SEE ARTICLE) study changes in brain volume measured monthly in patients treated for relapsing multiple sclerosis (MS) due to loss of tissue and the appearance of inflammation. They find that 2 major changes in brain volume occur in patients with relapsing MS, a steady decrease likely due to tissue loss with overlapping transient increases due to the appearance of inflammation.

Large, Nonplateauing Relationship Between Clinical Disability and Cerebral White Matter Lesion Load in Patients With Multiple Sclerosis
Caramanos et al (SEE ARTICLE) characterize the relationship between cerebral white matter lesion load (CWM-LL) and clinical disability. They find that a large, nonplateauing relationship exists between CWM-LL and Expanded Disability Status Score–measured clinical disability when patients with multiple sclerosis are studied to examine the entire range of disability, minimize nonbiological sources of variability, and increase pathologic specificity.

Proteomic Changes in Cerebrospinal Fluid of Presymptomatic and Affected Persons Carrying Familial Alzheimer Disease Mutations
Ringman and colleagues (SEE ARTICLE) compared proteomic profiles of cerebrospinal fluid (CSF) from individuals with familial Alzheimer disease (FAD) who were mutation carriers and related noncarriers. They found much overlap in CSF protein changes between individuals with presymptomatic FAD and those with late-onset AD.

Association of Sequence Alterations in the Putative Promoter of RAB7L1 With a Reduced Parkinson Disease Risk
Gan-Or et al (SEE ARTICLE) examine whether PARK16, which was recently identified as a protective locus for Parkinson disease (PD), is also associated with PD in the genetically homogeneous Ashkenazi Jewish population. Their data demonstrate that specific single-nucleotide polymorphism variations and haplotypes in the PARK16 locus are associated with reduced risk for PD.

Fulminant Postpartum Cerebral Vasoconstriction Syndrome
Fugate and colleagues (SEE ARTICLE) raise awareness of the potentially adverse consequences of postpartum cerebral vasoconstriction, which is typically considered benign and self-limited, by describing 4 fulminantly fatal cases. Postpartum vasoconstriction can be fatal, with rapid progression of vasoconstriction, ischemia, and brain edema. Clinicians need to be aware of the potential consequences of this condition.