Optimal Teneceplase Dosing for Elders Identified, BMI Associated With Worse Cognitive Decline, Slight Improvements in Migraine Preventive Use

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This week Neurology News Network covered a study comparing the effects of tenecteplase doses and alteplase in elders with stroke, how body mass index plays a role into long-term cognitive decline, and the slow but steady improvements in the use of migraine preventatives.

Pooled analyses from the EXTEND-IA TNK randomized controlled trial showed that treatment with tenecteplase 0.25 mg/kg before endovascular therapy improved 90-day functional outcome and mortality better than 0.40 mg/kg doses in elders aged at least 80 years with large vessel occlusion (LVO) stroke. At the time of randomization and treatment, 137 (27%) of the 502 originally enrolled patients were older than 80 years of age. After adjusting for relevant covariates, tenecteplase 0.25 mg/kg was associated with improved modified Rankin Scale (mRS) scores at 90 days compared with tenecteplase 0.40 mg/kg and alteplase. Notably, there was no difference between the alteplase and tenecteplase 0.40 mg/kg groups. Overall, only one-third of those older than 80 years of age achieved disability freedom or were functionally independent at 90 days, with the highest proportion of patients observed in the tenecteplase 0.25-mg/kg group. This difference was found to be statistically significant when compared with patients treated with alteplase.

Pooled data from more than 15,000 initially nondemented elderly individuals showed that significant changes in body mass index (BMI), along with greater variability in BMI, were associated with worsened cognitive decline. Furthermore, the stability of BMI may confer protection against cognitive decline, irrespective of the initial BMI of the individual.Lead author Michal Schnaider-Beeri, PhD, professor of psychiatry, Mount Sinai Icahn School of Medicine, and colleagues followed the cognitive trajectories of individuals aged at least 60 years from the Alzheimer’s Disease Centers for 5 years on average. At baseline, 36% (n = 5747) of participants had normal weight, 39.4% (n = 6302) were overweight, and 24.6% were obese. Up to the last BMI measure, 26.7% of the total sample decreased by 5% or more, 55.8% remained stable in BMI over time, and 17.5% had BMI increase more than 5%. Schnaider-Beeri et al wrote, “These results suggest a potential clinical value in tracking BMI in annual medical visits, which is simple, nonexpensive, noninvasive, and quick to measure, as it may point to individuals whose cognition is declining and allow for early intervention. Disentangling the biological pathways underlying different trajectories of BMI in old age, and their contribution to brain health and disease, is necessary to develop potential therapies.”

Data from the longitudinal OVERCOME study’s 2018 migraine cohort showed that relative to previous population-based findings, consultation for migraine may now be more likely to include ambulatory clinics, diagnosis rates have shown slow and consistent improvement over time, and the use of preventive medication may be slowly improving.1 Notably, though, the subgroups of patients with the highest disability reported some of the lowest use of preventative medications. Led by Richard B. Lipton, MD, director, Montefiore Headache Center, the data also suggest that episodic migraine (EM) is a condition with substantial heterogeneity and should not be approached with the same mentality for each individual. In the analysis, Lipton and colleagues identified several opportunities for optimizing migraine care, including patients seeking care in primary care, more people getting diagnosed with migraine and being prescribed potentially beneficial acute and preventive medication. When observing treatment patterns, investigators found that 97.1% of the cohort had used an acute treatment for migraine in their lifetime. Although 76.8% reported having used a prescription medication in their lifetime, only 40.0% currently used prescription medication. Lifetime use of triptans was reported by 35.0% whereas 22.7% reported current use.

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