The edition · Neurology
A statin after 70 cuts major vascular events but not dementia, and late-onset epilepsy tracks vascular risk
STAREE gives a large placebo-controlled answer on statins for primary prevention in older adults; a pooled analysis of six cohorts ties seizures starting after 65 to smoking, diabetes, kidney disease and stroke; and lecanemab moves plasma biomarkers in more than one direction.
The edition in brief
STAREE randomised 9,971 Australians aged 70 or over without cardiovascular disease, diabetes or dementia to atorvastatin 40 mg or placebo. Over a median 5.9 years, major cardiovascular events, including stroke, fell by 30% (HR 0.70, 0.61–0.82), but the co-primary composite of death, dementia or persistent disability did not change (HR 0.94, 0.84–1.05). In a pooled analysis of six US cohorts (42,257 people), late-onset epilepsy developed in 3.5% over about nine years and was associated with prior stroke (HR 1.99), diabetes (1.42), current smoking (1.39), chronic kidney disease (1.29), hypertension (1.17) and APOE ε4. A cohort of 197 patients on lecanemab found 34 of 130 plasma proteins changed: p-tau217 and GFAP moved towards normal, while TREM2 and synaptic markers moved further away. A meta-analysis of 36 trials found robot-assisted training improved arm motor function and daily activities after stroke, but not balance, with no clear dose–response. The pearl covers the work-up of a first seizure in an older adult.
Late-onset epilepsy behaves like a vascular disease
Treat new-onset epilepsy after 65 as a marker of cerebrovascular burden and review vascular risk factors.
Lecanemab normalises some plasma biomarkers and pushes others the other way
Lecanemab shifts plasma biomarkers in several directions; none is yet a validated treatment monitor.
Robot-assisted stroke rehabilitation helps the arm, not balance, and more is not clearly better
Robot-assisted training modestly helps arm function after stroke, not balance; use it to add to, not replace, therapy.
A first seizure after 65: look for the cause before labelling it epilepsy
Exclude provoking causes and mimics before diagnosing epilepsy in an older adult with a first seizure.
STAREE: atorvastatin after 70 cuts major vascular events, not dementia or disability
In healthy over-70s, atorvastatin reduces major vascular events, a composite including stroke, but does not prevent dementia or disability.
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