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Patricio Reyes M.D., F.A.N.N.
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St. Joseph's Hospital and Medical Center
"2 NEW THERAPIES FOR ALZHEIMER'S"
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"2 NEW THERAPIES FOR ALZHEIMER'S"
Patricio Reyes M.D., F.A.N.N.
Director, Traumatic Brain Injury, Alzheimer's Disease & Cognitive Disorders Clinics; Phoenix, AZ; Chief Medical Officer, Retired NFL Players Association

St. Joseph's Hospital and Medical Center



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Patricio Reyes M.D.
Director, Traumatic Brain Injury, Alzheimer's Disease & Cognitive Disorders Clinics; Phoenix, AZ; Chief Medical Officer, Retired NFL Players Association

Barrow Neurological Institute

St. Joseph's Hospital and Medical Center
"PRESERVING BRAIN FUNCTIONS "
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BIOMEDICAL RESEARCH IN ALZHEIMER'S DISEASE
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Robert F. Spetzler M.D.
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Barrow Neurological Clinics
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Tuesday, September 30, 2008

 

NAMS: Estrogen Cream Eases Vaginitis with No Endometrial Safety Signals

ORLANDO, Sept. 27 -- Moderate to severe atrophic vaginitis can be eased for postmenopausal women by either of two low doses of estrogen cream, with no endometrial safety signals, investigators reported here.

Both low-dose regimens of the conjugated estrogen cream led to significant improvement in vaginal maturation index, vaginal pH, and most bothersome symptoms compared with placebo, Gloria Bachmann, M.D., of Robert Wood Johnson Medical School in New Brunswick, N.J., said at the North American Menopause Society meeting.

The improvement was statistically significant at 12 weeks and persisted during follow-up for a year.

In a subgroup of patients who had endometrial biopsies, no cases of endometrial hyperplasia or carcinoma occurred with either estrogen cream regimen.

"Low-dose [vaginal estrogen cream] represents an important therapy for treating atrophic vaginitis without endometrial safety concerns over a one-year study period," Dr. Bachmann and colleagues concluded.

As many as 40% of postmenopausal women are affected by atrophic vaginitis. Vaginal application of topical low-dose estrogens is thought to reduce systemic exposure to estrogen and limit its stimulatory effects on the endometrium, the investigators said.

Both daily and twice-weekly vaginal administration of low-dose vaginal estrogen cream have demonstrated efficacy for reducing symptoms of atrophic vaginitis. Dr. Bachmann reported findings from a randomized clinical trial comparing the two regimens.

Both active-therapy regimens led to significantly greater improvement in all outcome measures at 12 weeks compared with placebo.

A total of 155 patients treated with either regimen of vaginal estrogen cream had evaluable endometrial biopsies. In the patients assigned to daily therapy, six of 85 had evidence of proliferative endometrium. Among 72 assigned to twice-weekly treatment, six had proliferative endometrium.

In general, adverse events were similar in the active-treatment and placebo groups, Dr. Bachmann reported, and treatment-emergent adverse events were uncommon. Treatment-emergent vaginal bleeding occurred in no more than two patients in any randomized group during the double-blind and open-label phases of the study.

MedPage Today

CLICK HERE FOR FULL STORY & RELATED INFORMATION



Monday, September 22, 2008

 

Adherence to Mediterranean Diet Reduces Risk of Major Chronic Diseases

September 15, 2008 — Sticking with any diet is difficult, but the incentives of adhering to the traditional Mediterranean diet are particularly beneficial, a new meta-analysis has shown [1]. Strictly following the Mediterranean diet reduced the risk of dying from cancer and cardiovascular disease as well as the risk of developing Parkinson's and Alzheimer's disease, and investigators say that greater adherence can be a relatively simple tool to reduce the risk of premature death in the general population.

"The practical implication is that we are able to talk to our patients and show them that sticking to this diet, the specific characteristics of the diet, improves their overall health and quality of life," lead investigator Dr Francesco Sofi (University of Florence, Italy) told heartwire. "This is good information to give, especially if we're able to tell them something as simple as eating more fruits and vegetables."

The meta-analysis, published online September 12, 2008 in BMJ, included primary-prevention studies that assessed how well individuals stuck to the traditional Mediterranean diet and whether this translated into health benefits. In each of the 12 trials included in the meta-analysis, which included more than 1.5 million patients followed from three to 18 years, a numerical score, known as the adherence score, was used to assess how closely individuals were following the diet. A score of zero indicated low adherence to the diet, while a score of 7 to 9 points indicated high adherence to the Mediterranean diet.

Individuals who stuck strictly to a Mediterranean diet—defined as a two-point increase in the adherence score—had significant improvements in their overall health, including a 9% reduction in all-cause mortality, a 9% reduction in mortality from cardiovascular disease, and 6% reduction in cancer mortality. Although only three trials examined the association between adhering to the diet and the risk of Parkinson's and Alzheimer's disease, there was a reduced risk of these diseases when individuals closely followed the Mediterranean diet.

"The results overall showed that increasing two points on the adherence score results in a significant protective effect in terms of chronic diseases," said Sofi. "The study supports the current guidelines and recommendations of all the current scientific organizations that encourage the Mediterranean diet. It does say more, however, in terms of adherence, meaning it is important to actually stick with the diet."

In terms of applying the findings to the real world, Sofi said creating an adherence score based on "a theoretically defined Mediterranean diet" could be used as preventive tool for reducing the risk of mortality and morbidity in the general population. However, he added, it is important to define the diet properly.

"The problem with the literature is that a lot of papers suggest eating in a Mediterranean way, but what is the Mediterranean way? That's the problem. If you ask two subjects, you're going to get two different answers. We need to attempt to develop the characteristics of the Mediterranean diet and create the adherence score based on that."

CLICK HERE FOR FULL STORY ON Medscape Today & RELATED INFO

 

Long-Term Osteoporosis Risk in Men Rises with Weight Loss

OSLO, Sept. 19 -- Thinner men in middle age, or those who lose substantial weight as they grow older, may have brittle bones in their 70s, researchers here said.

Some 15.1% of men who lost 10% or more of their body weight after their late 40s had osteoporosis when they reached 75, compared with 0.6% of those who had weight gains of at least 10%, reported Haakon E. Meyer, M.D., Ph.D., of the University of Oslo, and colleagues in the Aug. 15 issue of the American Journal of Epidemiology.

The researchers, who studied nearly 1,500 men over a 30-year period, found that combination of low initial weight and subsequent weight loss was an even stronger risk factor for osteoporosis.

"Low BMI in middle-age men was related to the risk of osteoporosis three decades later and ... this risk was modulated considerably by later weight change," Dr. Meyer and colleagues wrote. They said a clinical implication of their findings is that weight loss, while generally beneficial, is not risk-free. "When considering weight-loss interventions, the effect on osteoporosis and fracture should also be included and, if possible, counteracted," they suggested.

Slimness and short-term weight loss are already recognized as a risk factor for osteoporosis for men as well as women, the researchers said, but their effects had not previously been studied for such a long period.

The new findings emerged from studies of 1,476 Norwegian men in the cities of Oslo and Tromsø who underwent general health exams from 1972 to 1975 and again from 2000 to 2001. The follow-up screening also included bone mineral density testing of the hip.

They also estimated that men in the lowest quartile of BMI who lost at least 5% of body weight would be 2.79 times as likely to suffer a future hip fracture relative to those in the highest quartile and with stable weight.

"Weight change might act on the skeleton through changes in mechanical loading, changes in mechanical muscle stress, changes in hormone regulation of bone metabolism, and changes in intake of nutrients," the researchers wrote in addressing possible mechanisms.

Altered smoking habits or physical activity can affect weight as well as osteoporosis risk, they said.

CLICK HERE TO GO TO MEDPAGE TODAY FOR FULL STORY & RELATED INFO

Saturday, September 20, 2008

 

Adherence to Mediterranean Diet Reduces Risk of Major Chronic Diseases

September 15, 2008 — Sticking with any diet is difficult, but the incentives of adhering to the traditional Mediterranean diet are particularly beneficial, a new meta-analysis has shown [1]. Strictly following the Mediterranean diet reduced the risk of dying from cancer and cardiovascular disease as well as the risk of developing Parkinson's and Alzheimer's disease, and investigators say that greater adherence can be a relatively simple tool to reduce the risk of premature death in the general population.

"The practical implication is that we are able to talk to our patients and show them that sticking to this diet, the specific characteristics of the diet, improves their overall health and quality of life," lead investigator Dr Francesco Sofi (University of Florence, Italy) told heartwire. "This is good information to give, especially if we're able to tell them something as simple as eating more fruits and vegetables."

The meta-analysis, published online September 12, 2008 in BMJ, included primary-prevention studies that assessed how well individuals stuck to the traditional Mediterranean diet and whether this translated into health benefits. In each of the 12 trials included in the meta-analysis, which included more than 1.5 million patients followed from three to 18 years, a numerical score, known as the adherence score, was used to assess how closely individuals were following the diet. A score of zero indicated low adherence to the diet, while a score of 7 to 9 points indicated high adherence to the Mediterranean diet.

Individuals who stuck strictly to a Mediterranean diet—defined as a two-point increase in the adherence score—had significant improvements in their overall health, including a 9% reduction in all-cause mortality, a 9% reduction in mortality from cardiovascular disease, and 6% reduction in cancer mortality. Although only three trials examined the association between adhering to the diet and the risk of Parkinson's and Alzheimer's disease, there was a reduced risk of these diseases when individuals closely followed the Mediterranean diet.

"The results overall showed that increasing two points on the adherence score results in a significant protective effect in terms of chronic diseases," said Sofi. "The study supports the current guidelines and recommendations of all the current scientific organizations that encourage the Mediterranean diet. It does say more, however, in terms of adherence, meaning it is important to actually stick with the diet."

In terms of applying the findings to the real world, Sofi said creating an adherence score based on "a theoretically defined Mediterranean diet" could be used as preventive tool for reducing the risk of mortality and morbidity in the general population. However, he added, it is important to define the diet properly.

"The problem with the literature is that a lot of papers suggest eating in a Mediterranean way, but what is the Mediterranean way? That's the problem. If you ask two subjects, you're going to get two different answers. We need to attempt to develop the characteristics of the Mediterranean diet and create the adherence score based on that."

Medscape Today Medical News
CLICK HERE FOR FULL ARTICLE & RELATED NEWS

Tuesday, September 16, 2008

 

Aging: Study Links Falls to Lack of Sleep

Women over 70 who get five hours of sleep a night or less may be more likely to fall than those who sleep seven to eight hours, according to a new study.

After controlling for age, body mass, alcohol use, sleep medications and many other variables, they found that women who slept less than five hours a night were about 47 percent more likely to have fallen twice or more in the course of the study.

Analysis showed that while a variety of factors associated with poor sleep might increase the risk of falls — depression, balance or gait problems — these things explained some, but not all, of the relationship. The association with shorter nighttime sleep remained an independent risk factor.

“People think getting less sleep is just a normal aspect of aging,” said Katie L. Stone, the lead author and a scientist at the California Pacific Medical Center Research Institute. “But you should bring it to the attention of your physician. There are options available for treatment.”

The New York Times

CLICK HERE TO READ THE FULL ARTICLE & LINKS TO RELATED TOPICS


Tuesday, September 9, 2008

 

Vitamin B12 status and rate of brain volume loss in community-dwelling elderly

Objectives: To investigate the relationship between markers of vitamin B12 status and brain volume loss per year over a 5-year period in an elderly population.

Conclusion:
Low vitamin B12 status should be further investigated as a modifiable cause of brain atrophy and of likely subsequent cognitive impairment in the elderly.

NEUROLOGY 2008;71:826-832

CLICK HERE TO READ FULL ABSTRACT

Saturday, September 6, 2008

 

Decline in Mental Skills Begins Years Before Death

August 29, 2008 — As people grow older, they experience a substantial acceleration in cognitive decline — even if they don't have dementia, a new study suggests.

"Based on previous studies, we expected to see an acceleration in the decline in cognitive abilities before death," lead author Valgeir Thorvaldsson, from the department of psychology at Göteborg University, in Sweden, told Medscape Neurology & Neurosurgery. "However, the onset of this acceleration was much earlier than we expected."

Mr. Thorvaldsson said this was especially the case for perceptual speed, where the average onset of terminal decline was almost 15 years before death.

"The findings imply that the brain changes that influence cognitive abilities in old age occur over a relatively long period of time," he noted.

Their findings were published online August 27 in Neurology.

Medscape Today

CLICK HERE TO READ FULL ARTICLE

 

Omega-3 Fatty Acids, but Not Statin Therapy, Cuts Mortality and Hospitalizations in Heart Failure

September 3, 2008 — Omega-3 fatty-acid supplementation improves morbidity and mortality in symptomatic heart-failure patients, while statins failed to have any beneficial effect in the same group of patients, two new studies have shown [1,2]. The long-term administration of omega-3 fatty acids reduced all-cause mortality and admission to the hospital for cardiovascular (CV) reasons, while there was no effect on these end points with 10-mg rosuvastatin (Crestor, AstraZeneca)....

Medscape Today

CLICK HERE TO READ FULL ARTICLE

 

No Neuroprotective Effect of Dipyridamole, Aspirin, or Telmisartan in Recurrent Stroke

September 3, 2008 — Results of a randomized trial show no evidence that extended-release dipyridamole (Aggrenox, Boehringer Ingelheim), aspirin, or telmisartan (Micardis, Boehringer Ingelheim) have neuroprotective effects on either disability due to a recurrent stroke or cognitive decline over time.

The results of this third factorial analysis of the Prevention Regimen for Effectively Avoiding Second Strokes (PROFESS) trial are published online August 29 in Lancet Neurology. Results of the other 2 main analyses, 1 comparing aspirin plus extended-release dipyridamole with clopidogrel for the prevention of recurrent stroke and another comparing telmisartan vs placebo in these same patients, were published online August 27 in the New England Journal of Medicine.

"PROFESS is the largest trial so far to investigate in a prespecified manner whether treatment with antiplatelet drugs or angiotensin II receptor agonists (such as telmisartan) are neuroprotective in patients who have had a recurrent stroke," the researchers, with first author Hans-Christoph Diener, MD, from the University of Duisberg/Essen, in Essen, Germany, conclude. "The degree of functional impairment at 3 months poststroke was similar across treatment arms."

The findings from all 3 analyses were previously presented at the 17th European Stroke Conference in Nice and reported by Medscape Neurology & Neurosurgery at that time.

Medscape Today

CLICK HERE TO READ FULL STORY

 

High-Risk Patients With Atrial Fibrillation Not Anticoagulated Before Stroke

September 4, 2008 — Results of a new study show that among high-risk patients with atrial fibrillation admitted to the hospital for a stroke, the vast majority were either not taking warfarin or were in subtherapeutic ranges at the onset of the stroke. In fact, only 10% of patients admitted with a first ischemic stroke were found to be receiving warfarin and were in a therapeutic range at the time of their stroke.

"These findings should encourage greater efforts to prescribe and monitor appropriate antithrombotic therapy to prevent stroke in individuals with atrial fibrillation," the researchers, with first author David J. Gladstone MD, PhD, from Sunnybrook Health Sciences Center and the Institute for Clinical Evaluative Sciences in Toronto, Ontario, Canada, conclude.

Their results were released in the August 28 Online First issue and will appear in the January 2009 issue of Stroke.

Medscape Today

CLICK HERE TO READ FULL ARTICLE

 

Atorvastatin Beneficial for Elderly Patients with Recent Stroke or TIA

September 5, 2008 — Post hoc analysis of data from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial shows no significant difference in the reduction of nonfatal or fatal stroke with atorvastatin (Lipitor, Pfizer) treatment vs placebo after a first stroke or transient ischemic attack (TIA) between older and younger patients in that trial, although the benefit trended to be higher for the younger age group.

"We found that there was no statistical difference in the results for prevention of stroke or some of the other outcomes" on the basis of age, lead author Seemant Chaturvedi, MD, from Wayne State University, in Detroit, Michigan, told Medscape Neurology & Neurosurgery. In addition, older patients receiving atorvastatin had significantly fewer cardiac events, including major coronary events and revascularization, compared with placebo, he added.

"Our conclusion is that clinicians should more strongly consider using statins after a TIA or stroke even in an elderly population," Dr. Chaturvedi said.

The analysis, using data from the SPARCL trial, is published online September 3 in Neurology.

Medscape Today

CLICK HERE TO READ FULL ARTICLE

 

Treadmill Exercise Activates Subcortical Neural Networks After Stroke

August 29, 2008 — Survivors of stroke with long-term mobility impairment may benefit from a treadmill exercise rehabilitation plan, a new study shows. Reporting in the August 28 Online First issue of the journal Stroke, researchers describe evidence of neuroplastic mechanisms that may improve functional outcomes.

Medscape Today

CLICK HERE TO VIEW FULL STORY

 

Exercise May Improve Cognition in Adults With Memory Impairment

September 4, 2008 — Results of a randomized trial in older adults with subjective memory impairment but without dementia show a "modest" but lasting improvement in cognitive function after a 6-month program of physical activity.

"To our knowledge, this trial is the first to demonstrate that exercise improves cognitive function in older adults with subjective and objective mild cognitive impairment," the researchers, led by Nicola T. Lautenschlager, MD, from the University of Melbourne and St. Vincent's Hospital, in Australia, conclude. "The benefits of physical activity were apparent after 6 months and persisted for at least another 12 months after the intervention had been discontinued."

Their results are interesting given the relatively modest increase in physical activity, amounting to about 142 extra minutes per week, or 20 minutes per day, they note.

The study is published in the September 3 issue of the Journal of the American Medical Association.

Medscape Today
CLICK HERE TO VIEW STORY AND RELATED INFO

Wednesday, September 3, 2008

 

Exercise May Improve Memory in Adults with Alzheimer's Risk

The study was conducted from 2004 to 2007 in metropolitan Perth, Australia. MELBOURNE,

Australia, Sept. 2 -- A six-month program of physical activity provided modest improvement in cognition over 18 months for older individuals with subjective memory impairment, a study found.

As the world population ages, the number of older adults living with Alzheimer's disease is estimated to increase from the current 26.6 million to 106.2 million by 2050, Nicola T. Lautenschlager, M.D., of the University of Melbourne, and colleagues, wrote in the Sept. 3 issue of the Journal of the American Medical Association.

If illness onset could be delayed by 12 months, they said, 9.2 million fewer cases of Alzheimer's would occur worldwide, they said.

To test whether a physical-activity intervention might delay progression of prodromal symptoms to full-blown dementia, the researchers conducted a randomized controlled trial of 138 patients who did not meet criteria for dementia but who reported memory problems and had lower scores on the cognitive section of an Alzheimer's disease scale.

Patients (about 40% women, mean age about 68) were randomly assigned to a 24-week, home-based exercise program or to an education and usual-care group.

At 18-month follow-up, the exercisers showed a statistically significant though modest difference of 0.69 points on cognitive tests compared with the usual-care control group.

Participants in the exercise group were asked to perform at least 150 minutes of moderate-intensity physical activity per week in three 50-minute sessions each week.

The most frequently recommended and used activity was walking. However, participants could choose light strength training or other aerobic exercise.

Participants also received regular mailed newsletters to reinforce the key messages of the program. The intervention did not include home-based equipment.

Individuals in the usual care group received educational material about memory loss, stress management, healthful diet, alcohol consumption, and smoking, but not about physical activity. Participants in the physical activity group were offered the same educational materials.

Those in the exercise group achieved 142 minutes more physical activity a week or 20 minutes a day more than those in the usual care group.

Cognitive function over 18 months was assessed with the Alzheimer Disease Assessment Scale -- Cognitive Substance Subscale (ADAS-COG), a measure that included 11 brief cognitive tests (possible range, 0 to 70).

In an intent-to-treat analysis, participants in the intervention group improved 0.26 points (95% confidence interval −0.89 to 0.54), whereas those in the usual-care group deteriorated 1.04 points (95% CI 0.32 to 1.82) on the ADAS-Cog measure.

At 18 months, participants in the intervention group improved 0.73 points (95% CI −1.27 to 0.03) on the ADAS-Cog, while those in the usual-care group improved only 0.04 points (95% CI −0.46 to 0.88) for a 0.69 difference.

Delayed word recall and Clinical Dementia Rating improved modestly as well, whereas total immediate word recall, digit symbol coding, verbal fluency, Beck depression score, and the Medical Outcomes summary did not change significantly.

Although the average improvement was small, it is potentially important given the relatively modest amounts of physical exercise undertaken by study participants, the investigators said.

The mechanisms by which physical activity improves cognition in these patients are not clear, the researchers said, but possible explanations include alteration in cerebral vascular function and brain perfusion or environmental enrichment associated with greater activity.

It is also possible that the benefits in this trial were attenuated by preexisting or ongoing deleterious effects of APOE ε 4, the researchers said.

Limitations of the study included the fact that the sample was relatively small and may not have represented the population at high risk for cognitive decline.

In addition, it was a single-site study, and the investigators had no access to brain imaging or biochemistry, making it impossible to study potential physiological mechanisms.

Finally, the researchers said, the study cannot be used to infer that physical activity reduces the risk of dementia among older adults, because it was not powered to investigate development of dementia.

But, the researchers said, physical activity has health benefits that are not confined to cognitive function alone as suggested by other findings for depression, quality of life, falls, cardiovascular function, and disability, the investigators said.

In an accompanying editorial, Eric B. Larson, M.D., of the Group Heath Center for Health Studies in Seattle, wrote that despite the statistically significant mean "improvement" in the exercise group of 0.74 versus 0.04 for the controls, neither patients, family members, nor clinicians could easily detect that level of difference.

On the other hand, Dr. Larson said, although it is easier to take a pill, patients and their families are likely to be gratified by the benefits of habitual exercise and often may be disappointed with the effects of cholinesterase inhibitors.

Neither exercise nor drugs are very potent and no evidence to date shows that either method can prevent conversion to Alzheimer disease, Dr. Larson said.

For an illness that starts so late in life, prevention means delaying onset, he said. If exercise is protective in delaying loss of cognition and if its effects can be sustained, presumably with minimum cost and adverse effects, then it is an attractive strategy in an increasingly aging society.

Future larger multi-site trials including persons older than 70 could test the effect of habitual exercise on cognitive decline and conversion to dementias. These studies could also evaluate which methods are most worthwhile in promoting behavior change, Dr. Larson concluded.

MedPage Today
CLICK HERE TO VIEW ARTICLE AND RELATED NEWS


Monday, September 1, 2008

 

Antipsychotics Confirmed to Increase Stroke Risk in Elderly


LONDON, Aug. 29 -- Elderly patients taking antipsychotic drugs are at an increased risk for ischemic stroke, and the greatest danger faces those with dementia, researchers here said.


Compared with patients not on antipsychotics, those taking the drugs had a 73% higher rate of stroke (95% CI 60% to 87%), reported Ian J. Douglas, Ph.D., and Liam Smeeth, M.B.Ch.B., Ph.D., of the London School of Hygiene and Tropical Medicine, online in BMJ.


The findings confirmed and extended previous studies derived from more limited data, the researchers said.


"Use of antipsychotic drugs in [demented] patients should be avoided whenever possible," the researchers wrote.

As a result, the researchers said that in patients needing antipsychotic treatment who may be at risk for stroke, first-generation agents are preferable.

First-generation agents were far more commonly prescribed than atypicals, with 6,334 patients receiving a phenothiazine, butyrophenone, thioxanthine, or sulpride, versus 905 who received an atypical agent.

Of the atypicals, risperidone (Risperdal) was used in 81% and olanzapine (Zyprexa) in 18%.
The study design did not allow Drs. Douglas and Smeeth to determine much about possible mechanisms by which antipsychotic drugs may contribute to strokes.

He said concerns about increased stroke rates in connection with antipsychotic drugs first arose in the wake of a 2002 clinical study, prompting official warnings about the risk.

In 2004, British health authorities recommended that antipsychotics be avoided in patients with dementia, on the basis of very little clinical evidence, prompting substantial criticism, Drs. Douglas and Smeeth said.

The researchers determined that the risk applied only to non-hemorrhagic stroke, as there was no increased rate of cerebral hemorrhagic events linked to antipsychotic agents.


MedPage Today