Archives of Neurology

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Insidious Cerebrovascular Disease—the Uncool Iceberg

This Viewpoint describes the clinical and public health implications of emerging information on subclinical cases of cerebrovascular disease.

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The Patient I Didn’t Like

This essay describes lessons the author learned through treating a difficult patient.

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Survival and Prognostic Factors in C9orf72 Repeat Expansion Carriers

This systematic review and meta-analysis examines prognostic factors in c9 amyotrophic lateral sclerosis, c9 frontotemporal dementia, c9 amyotrophic lateral sclerosis and frontotemporal dementia, and atypical phenotypes.

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Minocycline vs Placebo for Patients With Mild Alzheimer Disease

This randomized clinical trial examines whether 24 months of minocycline treatment can modify cognitive and functional decline in patients with mild Alzheimer disease.

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Pragmatic Trials and Repurposed Drugs for Alzheimer Disease

Howard and colleagues report a randomized clinical trial in which 554 patients clinically diagnosed with early Alzheimer disease were randomized to 200 mg/d or 400 mg/d of the broad-spectrum antibiotic minocycline or to placebo and followed up for 24 months. Clinical outcomes were a structured Mini-Mental State Examination (MMSE) and the Bristol Activities of Daily Living scale. About 62% of the 200 mg/d minocycline–treated group compared with 64% of the placebo-treated group completed 2 years of treatment; only 29% of the group receiving 400 mg/d of minocycline completed the trial. There was no evidence for efficacy of minocycline at either dose. Planned subset and sensitivity analyses to assess predictors of outcomes and potential sources of bias (eg, dropout bias) did not suggest that outcomes could have been different.

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