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By Nancy Lapid, Health Science Editor

Hello Health Rounds readers! Today we highlight two studies that will be presented at next week’s big stroke meeting, including one that carries a warning of a significant increase in stroke risk for young Black women with hypertension. The second found that vagus nerve stimulation can lead to lasting functional improvements after a serious stroke. (More about what’s coming at the meeting can be found online here.)

We also report on findings that dementia in military veterans may be linked to a treatable liver disease condition.

In breaking news, see these stories from our Reuters journalists: Growing cancer burden masks inequity among rich and poor nations- WHO; U.S. government sends initial offers for Medicare drug price cuts; U.S. receives thousands of reports of AI-generated child abuse content in growing risk; EU pushes for higher uptake of two key cancer-preventing vaccines; and pharma companies lose fight over venue for states’ price-fixing lawsuits.

Stimulating a major nerve in stroke patients led to lasting improvements in arm and hand function long after such progress would be expected, researchers say. REUTERS/Yves Herman

In a large study of Black women, those treated for high blood pressure before age 35 had triple the odds of having a stroke, and those treated for the condition before age 45 had twice the stroke risk, compared to women without a diagnosis of hypertension, researchers found.

Participants treated for hypertension between ages 45 and 64 faced 69% higher odds of a stroke in the Black Women’s Health Study, which has been tracking 59,000 Black women since 1995 via questionnaires once every two years.

Study investigators plan to present their findings on Feb. 6, in a pre-conference symposium at the American Heart Association’s International Stroke Conference 2024 in Phoenix.

Their calculations took participants’ other risk health, lifestyle and demographic risk factors into account, they said.

Overall, stroke occurred in 3.2% of participants during up to 23 years of follow-up.

Study leader Dr. Hugo Aparicio of Boston University Chobanian & Avedisian School of Medicine urged healthcare professionals to pay particular attention to blood pressure screening of Black women particularly before middle age.

“Healthcare policy changes are needed so that primary prevention is promoted and funded because by the time a Black woman has a stroke at middle age, it is often too late,” Aparicio said.

Stimulating a nerve in the neck led to lasting improvements in arm and hand function after a stroke, long after such progress would be expected, researchers plan to report next week at the International Stroke Conference 2024  in Phoenix.

In patients left with moderate to severe upper limb impairment after recovering from a stroke, treatment with Texas-based MicroTransponder’s implantable device for vagus nerve stimulation improved arm and hand function by 2 to 3 times more than intense rehabilitation alone after three months of use. That improvement was maintained in patients still using the device a year later, researchers found.

Some measures of hand and arm function, such as control and coordination of muscle movements, continued to improve over the year, they also found.

Typically, beyond the first three months after a stroke, recovery often stalls or even declines.

“As a clinician, it is surprising to see someone with chronic stroke – stroke that in many ways is a progressive disease – continue to improve and not show a decline,” study leader Teresa Kimberley of MGH Institute of Health Professions in Boston said in a statement.

“The pairing of rehabilitation therapy with vagus nerve stimulation likely helps the brain strengthen new neural pathways, like building a bridge to bypass a damaged area,” she said.

The implantable device, placed just under the skin of the chest, was approved for use in stroke patients by the U.S. Food and Drug Administration in 2021, based on a trial that followed 108 patients for 90 days. Participants had experienced their strokes nine months to 10 years prior to enrolling in the study.

The new study tracked 74 of those patients for a year. All had also completed six weeks of in-clinic, intense rehabilitation followed by a one-year home exercise program with continued use of the nerve stimulator.

Data for the remaining 34 participants was unavailable primarily due to disruptions from the COVID-19 pandemic, researchers said.

Dr. Joel Stein, chair of the department of rehabilitation and regenerative medicine at Columbia University’s Vagelos College of Physicians and Surgeons who was not involved in the study, called the results “an important finding that supports the use of this modality to enhance recovery post-stroke.”

What appears to be dementia in military veterans may instead be a reversible cognitive decline related to advanced liver disease, data from a large study suggests.

The authors of the report, published on Wednesday in JAMA Network Open, say physicians treating veterans with dementia should consider assessing their patients for liver disease.

Their review of medical records of 177,422 U.S. veterans with dementia found that roughly 30% had some form of liver disease, based on biomarkers available from routinely performed blood tests.

Based on those tests, 10.3% of veterans with dementia were very likely to have cirrhosis severe enough to cause so-called hepatic encephalopathy.

A follow-up study at the Richmond VA Medical Center in Virginia found similar results, with as many as 11.2% of dementia patients having a high Fibrosis-4 (FIB-4) score, a measure of advanced liver disease.

While the researchers estimated the likelihood of dementia patients having liver disease severe enough to cause cognitive dysfunction, they did not track down those patients to confirm that diagnosis or attempt to treat it.

Still, “routinely using the FIB-4 index to evaluate dementia could help a significant number of patients, families and physicians by providing an opportunity to treat and potentially reverse cognitive impairment brought on by liver disease,” study leader Dr. Jasmohan Bajaj of Virginia Commonwealth University School of Medicine and the Richmond VA Medical Center said in a statement.

“The next step is to ensure that healthcare providers taking care of patients with cirrhosis and well as those with dementia are made aware of a potential overlap with hepatic encephalopathy, which is treatable,” Bajaj said.

This newsletter was edited by Bill Berkrot.

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