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Rupture of an unruptured intracranial aneurysm (UIA) is the most common cause of subarachnoid haemorrhage (SAH), and at least one in 20–30 adults is estimated to carry an asymptomatic UIA. However, the likelihood and epidemiology of UIA rupture and the associated risk factors are poorly understood. In this Perspectives article, Korja and Kaprio discuss possible misconceptions in the epidemiology of UIAs and SAH, and suggest options to improve the quality of future research.
The risk factors for cardiovascular disease are largely the same as those that harm brain health, and—importantly—these shared risk factors are modifiable. This Perspectives article discusses how the conceptual shift from avoiding vascular risk factors to promoting brain health creates opportunities for reducing morbidity and mortality associated with poor brain health.
The term 'preclinical Alzheimer disease (AD) treatment' refers to interventions that are initiated in cognitively unimpaired at-risk individuals, and are intended to postpone, reduce the risk of, or prevent the clinical onset of AD. In this article, the authors review emerging strategies for the accelerated evaluation of preclinical AD treatments, and discuss the work that has set the stage for implementing these strategies. In particular, they highlight the role of the Collaboration for Alzheimer's Prevention (CAP)—an initiative that is designed to help stakeholders advance AD prevention research in a coordinated, transparent and effective way.
The use of infant formula as a substitute for or supplementation to breast milk has increased dramatically since the middle of the 20th century. Such formula is typically supplemented with high levels of iron, yet the long-term effects of high exposure to iron during infancy are poorly understood. In this Perspectives article, Hare et al. discuss evidence that iron overload in infancy increases the risk of neurodegenerative disorders, such as Parkinson disease, in old age. They also consider methods for accurate measurement of past iron exposure that could be used to further investigate the risks.
The symptoms and neuropathology of frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) can show a high degree of overlap, and few effective treatments exist for these conditions. In this Perspectives article, Ittner and colleagues describe recent failures in the translation of data from mouse models into clinical trials for patients with FTD and/or ALS. The authors summarize the strengths and weaknesses of several available mouse models, and make recommendations for improving future research practice.
The randomized controlled trial represents the gold standard in clinical trial design, but large phase III studies are difficult and expensive to conduct in neurological diseases. In this Perspectives article, Koch and colleagues argue that the futility trial, a phase II design first developed in the oncology field, should be used more widely by neurologists. The authors describe how futility trials could be employed in Parkinson disease, stroke, multiple sclerosis and other conditions.
