The edition · Neurology
Atorvastatin in over-70s cut cardiovascular events by 30% but did not extend disability-free survival
STAREE settles one half of the statin question in older adults; a Korean registry shows recurrence after artery dissection is concentrated in the first week; and higher p-tau217 went with worse cognition in late-onset epilepsy.
The edition in brief
In STAREE, 9,971 community-dwelling adults aged 70 or over without cardiovascular disease, diabetes or dementia were randomised to atorvastatin 40 mg or placebo for a median 5.9 years. Major cardiovascular events (a composite that includes stroke) fell (HR 0.70, 0.61 to 0.82), but the composite of death, dementia or persistent disability did not (HR 0.94, 0.84 to 1.05). In a Korean national registry of 711 patients with craniocervical artery dissection presenting within seven days, recurrent ischaemic stroke was 8.7% on day 1, 17.4% by one week and 19.9% at one year; a double lumen and stenosis without dilatation predicted recurrence, while intracranial versus extracranial location did not. In 85 patients with late-onset unexplained epilepsy, higher plasma p-tau217 was associated with worse cognition, especially with drug-refractory seizures, with about a quarter of the association statistically accounted for by sleep spindle coupling. A Brain review warns that the 2024 McDonald criteria, with more routes to a multiple sclerosis diagnosis, raise the risk of misdiagnosis outside expert centres.
After craniocervical dissection, one in five had a recurrent stroke within a year, mostly in the first week
Treat the first week after craniocervical dissection as the high-risk period, and read the vessel imaging for double lumen and stenosis.
In late-onset unexplained epilepsy, higher p-tau217 went with worse cognition and disrupted sleep
Treat late-onset unexplained epilepsy as a possible early sign of Alzheimer disease: test cognition and consider biomarkers.
More routes to an MS diagnosis under 2024 McDonald criteria bring more room for misdiagnosis
Use the 2024 McDonald criteria with a typical clinical picture and good-quality MRI, and seek an expert opinion before starting treatment when either is missing.
New seizures after 55 with a clean MRI deserve a cognitive baseline
In late-onset non-lesional epilepsy, a cognitive screen at diagnosis is the baseline you will need later.
Atorvastatin in healthy over-70s cut cardiovascular events but not death, dementia or disability
Consider a statin for vascular prevention in healthy older adults after discussing benefits and side effects; do not present it as protection against dementia or disability.
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