by Viktoria Papp
Each month the EANpages editorial team reviews the scientific press for recently published papers of outstanding interest to neurologists. Below we present our selection for October 2023 (for our Paper of the Month for October, see here).
1. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial
This multicentre, parallel-group, unmasked, randomised (1:1) controlled trial included older adults (70-84 years) with untreated hearing loss and without cognitive complaints. The goal of the study was to investigate whether hearing intervention could prevent cognitive impairment in this population. Participants were recruited among volunteers and participants of a previous observational study of cardiovascular health (ARIC). They were randomised into two groups and followed up every six months for three years. One group of 490 participants was assigned to hearing intervention including audiological counselling and utilisation of hearing aids while the control group of 489 received health education regarding the prevention of chronic disease. The primary outcome was the change in the global cognition standardised factor score measured after three years obtained from a complex neurocognitive assessment. The results showed no difference between the hearing intervention and health education control groups (0.002 [–0.077 to 0.081]; p=0.96) when volunteers and previous ARIC participants were evaluated as a mixed group. However, prespecified sensitivity analyses found a significant difference between volunteers and previous ARIC participants in favour of the benefit of hearing intervention (pinteraction=0.010). ARIC participants were generally older and had more risk factors for cognitive impairment than the volunteers. These findings indicate that a hearing intervention might reduce cognitive decline over a three-year period in older adults with several risk factors for cognitive impairment.
2. Extracranial-Intracranial Bypass and Risk of Stroke and Death in Patients With Symptomatic Artery Occlusion (The CMOSS Randomized Clinical Trial)
This multicentre, randomised, open-label, outcome assessor–blinded trial from China evaluated the effect of extracranial-intracranial (EC-IC) bypass in patients who experienced transient ischaemic attack (TIA) or nondisabling ischaemic stroke due to occlusion of the arteria carotis interna (ICA) or arteria cerebri media (MCA). Patients were randomised into two treatment arms: (1) EC-IC bypass surgery plus medical treatment (161 patients) versus medical treatment (163 patients). The primary endpoints were new stroke or death within 30 days after randomisation and ipsilateral stroke between 30 days through the two-year follow-up. Further secondary endpoints evaluated at the end of the two-year follow-up were any stroke, disabling stroke, fatal stroke, death, any stroke or death, TIA; National Institutes of Health Stroke Scale (NIHSS) score and modified Rankin Scale (mRS) score, complications related to the surgery; and anastomosis patency. The results did not show any benefit of the bypass surgery in addition to medical treatment compared to medical treatment alone in the risk reduction of the composite outcome of stroke or death within 30 days or ipsilateral ischaemic stroke between 30 days and two-years follow-up (8.6% vs 12.3%, respectively; hazard ratio, 0.71). There was also no significant difference between the treatment arms in the secondary outcomes. This study shows no benefit of EC-IC bypass surgery in addition to medical treatment for the treatment of patients with symptomatic atherosclerotic occlusion of the ICA or MCA.
3. The structured ambulatory post-stroke care program for outpatient aftercare in patients with ischaemic stroke in Germany (SANO): an open-label, cluster-randomised controlled trial
The study goal was to evaluate whether the risk of recurrent stroke could be reduced by a dedicated comprehensive post-stroke follow-up programme including behavioural and organisational elements involving multi-professional care and focusing on the individuals’ needs compared to standard care. A cluster is a region belonging to a participating stroke centre. Thirty clusters were randomly assigned to the intervention group (15 clusters) or control group (15 clusters). Altogether 1203 (86%) of 1396 enrolled patients in the intervention group and 1283 (92%) of 1395 enrolled patients in the control group completed the study. The primary outcomes were a composite of recurrent stroke, myocardial infarction, and all-cause death during the one-year follow-up. The secondary outcomes included transient ischaemic attacks and control of cardiovascular risk factors in the same period. Adverse events were monitored regarding the medical treatment used in secondary stroke prevention. There was no difference in the primary outcome between the intervention and control group (unadjusted odds ratio [OR] 0.80 [95% CI 0.49–1.30]; adjusted OR: 0.95 [95% CI 0.54–1.67]). All-cause deaths were documented in 31 (2.4%) of 1203 patients in the intervention group and 12 (1.0%) of 1283 patients in the control group. The occurrence of severe adverse events was higher in the intervention group (266 [23.1%] of 1151) than in the control group (106 [9.2%] of 1152). The need for hospital readmission was similar in the two groups. In this one-year follow-up period, no significant differences in the rate of recurrent vascular events were registered between the groups. However, the author suggested that the longer-term potentially beneficial effects of such healthcare programmes on post-stroke sequelae and life quality should be evaluated with an extended observation period.