INTRODUCTION:Cognitive trajectories may clarify how type 2 diabetes (T2D) and impaired fasting glucose (IFG) relate to dementia risk, but longitudinal associations remain unclear, particularly in the context of stroke. METHODS:Data from 5,631 dementia- and stroke-free older adults (mean age 75 years) from 7 international population-based cohorts were analyzed. Linear mixed-effects models estimated cognitive trajectories during stroke-free and post-stroke follow-up. Glucose status was defined by fasting glucose and prior T2D diagnosis. RESULTS:Over 6.6 years of follow-up (4.5% with incident stroke), T2D was associated with lower baseline cognitive performance compared with normal fasting glucose (-0.14 SD, 95% CI -0.21 to -0.07), but not with faster cognitive decline during stroke-free or post-stroke follow-up. IFG was not associated with lower cognitive performance or faster decline. DISCUSSION:In older adults, T2D was associated with persistently lower cognitive performance but not faster decline, suggesting adverse cognitive effects may be established before late life.

Individuals with chronic migraine (CM) experience substantial headache-related disability. Post hoc analyses from the PREVAIL trial assessed the long-term impact of eptinezumab preventive treatment for CM on patient-centered measures of headache frequency, headache pain severity, disability, and quality of life. In the 104-week, open-label PREVAIL trial, which evaluated long-term safety and patient-reported outcomes, participants received eptinezumab 300 mg intravenously every 12 weeks to week 84 for preventive treatment of CM. The Migraine Disability Assessment (MIDAS) scale was used to evaluate proportions of participants with sustained ≥ 50

Objective:Migraine attacks are frequently accompanied by patient-reported "subjective" cognitive symptoms, but objective findings have been inconsistent. We used high-frequency, smartphone-based cognitive testing to assess within-person changes in subjective and objective cognition across migraine phases using daily diaries. Methods:Adults with migraine were recruited through social media. Eligible participants met ICHD-3 migraine criteria and had 3 to 22 monthly headache days. For 30 days, they completed daily smartphone-based reports on headache features, cognitive symptoms, and three smartphone-based objective cognitive tasks. Objective tests included Symbol Search (processing speed/visual search), Color Dots (visual working memory/attention), and Grid Memory (visuospatial working memory). Primary analyses contrasted assessments on current headache days (ictal) versus days with no headache (nonictal). When possible, non-ictal days were subclassified using information from adjacent days as pre-ictal, post-ictal, and interictal days. Outcomes included subjective cognition, reaction time (mean across correctly scored trials), accuracy, and a speed-accuracy composite (Reaction Time/Accuracy). Mixed-effects models adjusted for age, sex, and practice effects. Results:The 139 eligible participants (84.9% female; mean age 38.2 years) contributed 3,014 person-days for ictal versus nonictal comparisons (2,097 nonictal; 917 ictal); for 1,828 person-days precise phase classification was possible. Subjective cognitive symptoms were worse on ictal days, with higher odds of more severe brain fog (OR=3.39, 95% CI 2.70-4.27) and task forgetting (OR=2.82, 95% CI 2.29-3.49). In adjusted models, reaction times were slower on ictal days for Symbol Search (reaction time ratio =1.043, 95% CI 1.028-1.059) and Color Dots (ratio=1.015, 95% CI 1.003-1.026) but not Grid Memory (reaction time ratio =1.006, 95% CI 0.985-1.028). Grid Memory accuracy was lower on ictal days (OR=0.867, 95% CI 0.823-0.914). In analyses based on phase, most nonictal phases showed faster reaction time and lower subjective symptom burden relative to ictal days, with limited differentiation among preictal, postictal, and interictal periods. Conclusions:In persons with migraine, daily smartphone assessments revealed subjective cognitive impairment on ictal vs nonictal days in brain fog and forgetfulness. Objective testing revealed slowing in processing speed and attention and modest differences in the accuracy of working-memory. High-frequency digital cognition appears feasible and may provide scalable functional endpoints for real-world monitoring and treatment evaluation.

BACKGROUND AND OBJECTIVES:Low life-course socioeconomic position (SEP) has been associated with worse cognitive function in older age. However, its association with brain structure remains unclear. We assessed whether SEP at 3 periods of the life-course and socioeconomic mobility are associated with later-life MRI-derived brain volumes. METHODS:We used longitudinal data from the Hispanic Community Health Study/Study of Latinos and its Investigations of Neurocognitive Aging-MRI ancillary study. We determined childhood SEP using participant self-reports of their parent's educational attainment (<high school vs ≥high school). We used indexes combining participant's education, employment, household income, and assets to determine adult SEP at visits 1 (2008-2011) and 2 (2014-2017). Using childhood and adult SEP at visit 1, we classified participants into 4 socioeconomic mobility categories (stable low or high SEP, upward or downward mobility). We also used the discrepancy between attained height and genetically predicted height (e.g., height residuals) as a biomarker of childhood environment. A higher residual would indicate a more favorable environment for growth and development. Using 3T MRI scans, we quantified (2018-2022) brain volumes (e.g., total brain volume, total gray matter volume [TGMV], total cortical gray volume, hippocampal volume, and white matter hyperintensity volume [WMHV]). We fitted linear marginal structural models accounting for the complex sampling design and covariates to quantify the association between life-course SEP and z-scored brain volumes. RESULTS:We included 2,400 adults aged 50-85 years. Higher childhood SEP (TGMV 0.13; 95% CI 0.02-0.24) and higher height residuals (TGMV 0.17; 95% CI 0.09-0.24) were associated with larger brain volumes. Similarly, higher adult SEP at visit 1 (TGMV 0.18; 95% CI 0.05-0.31) and visit 2 (TGMV 0.16; 95% CI 0.04-0.29), upward socioeconomic mobility, and stable high SEP were associated with larger brain volumes. Higher adult SEP at visit 2 (log-WMHV -0.16; 95% CI -0.29 to -0.02) and upward mobility were also associated with smaller log-WMHV. DISCUSSION:This study highlights the contribution of higher life-course SEP to greater brain health as indexed by larger brain volumes in later life. Our results suggest that the effect of early-life socioeconomic disadvantages persists beyond socioeconomic conditions in adulthood.

BACKGROUND AND OBJECTIVES:High adherence to the Mediterranean diet (MeDi) has been associated with slower age-dependent cognitive decline and better cardiovascular health (CVH). We examined the association between adherence to MeDi and white matter (WM) integrity in community-dwelling Hispanic or Latino adults. In secondary analysis, we assessed whether CVH and WM integrity were pathway variables between MeDi and global cognition (GC). METHODS:Data from Study of Latinos-Investigation of Neurocognitive Aging-MRI Ancillary Study were analyzed. Dietary intake was collected during the baseline visit (2008-2011) using 24-hour recalls, from which a MeDi score ([MeDiS], range 0-9) was derived. Brain MRI scans with diffusion tensor imaging were obtained between 2017 and 2022. WM integrity was assessed using total WM volume (tWM), WM hyperintensity (WMH) volume, fractional anisotropy (FA), and free water (FW). GC was ascertained between 2015 and 2018 using a composite score derived from 4 standardized cognitive tests. CVH was evaluated at baseline using the Life's Essential 7 score ([LE7], range 0-100), a modified version of the existing Life's Essential 8 score, in which diet was excluded to avoid collinearity with our exposure. We used linear regression models that controlled for age, sex, and socioeconomic factors to investigate the association of MeDiS with WM integrity. We performed mediation analysis to explore whether CVH and WM integrity were pathway variables between diet and GC. RESULTS:A total of 2,642 participants with a mean age of 64.3 years (95% CI 63.4-65.1, 44% male) were included. The average MeDiS was 5.0 (95% CI 4.9 to 5.1), and the LE7 score was 66.6 (95% CI 65.-67.6). Higher MeDiS was associated with lower WMH volume (β = -0.08, 95% CI -0.11 to -0.04), higher tWM volume (β = 0.05, 95% CI 0.005-0.09), lower FW (β = -0.04, 95% CI -0.08 to -0.002), and higher fractional anisotropy (FA) (β = 0.09, 95% CI 0.05-0.13). WMH, tWM, and FA mediated the association between MeDiS and GC. In addition, there was serial mediation from MeDiS on GC through LE7 score, WMH, tWM, and FA. DISCUSSION:Higher adherence to MeDi is linked to better WM structural integrity, which, together with CVH, mediates the association between MeDi and GC.

Objective To examine acute and preventive migraine prescription treatment needs among participants with active migraine and identify factors associated with needing treatment optimization.Background A high unmet treatment need exists for individuals with migraine.Methods ObserVational survey of the Epidemiology, tReatment and Care Of MigrainE (United States) is a prospective, multi-cohort, longitudinal, web-based survey in a demographically representative sample of US adults with active migraine in the preceding year. The current study is a pooled analysis of the baseline surveys of the 2018, 2019, and 2020 migraine cohorts. Criteria for determining need for migraine treatment initiation/modification were based on the American Headache Society 2021 consensus statement. For preventive treatment, need was defined based on the number of headache days per month and Migraine Disability Assessment Scale scores. For acute treatment, need was defined using the Migraine Treatment Optimization Questionnaire scores or based on the presence of two or more disability days per month. Participants were categorized into four groups based on their need for initiation/modification of acute or preventive treatment or both. The categories were "not a candidate (no need for treatment initiation/modification)," "acute need only," "preventive need only," or "preventive + acute needs." Interictal burden was measured using the Migraine Interictal Burden Scale-4.Results Among 59,001 participants with migraine, 77.1% of the total population were candidates for migraine prescription treatment initiation/modification. Among those, 39.4% had unmet acute needs only, 2.8% had unmet preventive needs only, and 34.9% met criteria for both. Up to one-quarter of participants in each group were taking preventive medication. Acute prescription medication use was reported by 55.7% of those with preventive + acute needs, 46.9% of those with acute needs only, 36.9% of those with preventive needs only, and 27.1% of those who were not candidates for treatment initiation/modification. The highest rate of acute medication overuse was seen in the preventive + acute needs group (37.0%). Over half of the participants in the preventive + acute (69.9%) and acute (58.7%) needs groups reported experiencing moderate-to-severe interictal burden on the Migraine Interictal Burden Scale-4. Migraine-related stigma was highest among those with acute + preventive treatment needs, with 46.4% experiencing stigma often or very often. Experiencing severe interictal burden was most associated with having acute treatment needs (odds ratio [OR], 2.66; 95% confidence interval [CI], 2.48-2.86), whereas overusing acute medication was most associated with having preventive treatment needs (OR, 10.04; 95% CI, 8.64-11.65) and preventive + acute treatment needs (OR, 10.19; 95% CI, 9.09-11.43).Conclusion Over 75% of participants with migraine in this population sample were candidates for initiation or modification of migraine prescription treatment. These findings highlight the opportunity for optimizing treatment and improving outcomes for patients with migraine.

Introduction RESOLUTION est un essai clinique de phase IV, randomisé, en double aveugle chez des patients souffrant de migraine chronique et de céphalées par abus médicamenteux selon la classification internationale ICHD-3. Objectifs Evaluer l’efficacité et la sécurité d’emploi d’éptinezumab 100mg vs placebo, en complément d’une intervention éducative sur la surconsommation des traitements de crise. Méthodes RESOLUTION porte sur une période de traitement de 12 semaines en double aveugle évaluant éptinezumab 100mg vs placebo. Le critère d’évaluation principal était la variation du nombre de Jours de Migraine par Mois (JMM) entre la baseline et la période semaines 1 à 4. D’autres évaluations comprenaient notamment un score de douleur, le nombre de traitements de crise consommé par mois, le score PGIC, et un score sur le symptôme le plus gênant. Résultats Sur 608 participants randomisés, 596 (98 %) ont terminé la période contrôlée par placebo. Le critère d’évaluation principal a été atteint, avec une diminution moyenne entre la baseline et la période semaines 1 à 4 de −6,9 JMM avec éptinezumab 100mg contre −3,7 avec le placebo (p<0,0001). Tous les autres critères d’évaluation secondaires sont également statistiquement significatifs. La proportion de patients ayant présenté des événements indésirables était similaire entre les deux groupes. Discussion N.A. Conclusion L’étude RESOLUTION a démontré l’efficacité d’éptinezumab 100mg chez des patients avec un double diagnostic de migraine chronique et de céphalées par abus médicamenteux et confirmé la tolérance précédemment observée.

Real-world data on the effectiveness of rimegepant for the acute treatment of migraine is limited, particularly regarding consistency of response over multiple attacks. CONFIDENCE was a prospective observational survey study with screening and baseline questionnaires; a 28-day observational period where participants completed daily assessments on migraine occurrence, treatment, and outcomes; and an end of study questionnaire. Adults in the United States with 3–14 headache days in the last 30 days, a rimegepant prescription for the acute treatment of migraine, and plans to use rimegepant in the next 30 days were recruited in phases via the Migraine Buddy® app; firstly, those with/without preventive therapies, and then, those taking specific preventive therapies. A primary outcome of CONFIDENCE was consistency of rimegepant response across multiple attacks at the population and participant levels regardless of preventive migraine therapy. Positive treatment outcomes were defined as (1) meaningful pain relief (MPR) within 2 hours, (2) meaningful improvement in function (MIF) within 2 hours, and (3) attacks where participants reported being ‘satisfied’ or ‘extremely satisfied’ with rimegepant (treatment satisfaction). 416 participants recorded data for 2169 rimegepant-treated migraine attacks (median: 7/participant). Participants’ mean age was 40 years, 91

BACKGROUND:In the DELIVER trial, eptinezumab administration was associated with sustained reductions in headache frequency and migraine-related impact in participants for whom previous preventive treatments have failed. This post hoc analysis evaluated long-term maintenance of initial ≥ 50% and ≥ 75% migraine response. METHODS:DELIVER was a 24-week, randomized, double-blind, placebo-controlled trial with a 48-week dose-blinded extension. For participants with initial ≥ 50% or ≥ 75% reduction in monthly migraine days-defined as response following their first dose (Weeks 1-12) or first and second dose (Weeks 1-24)-maintenance of ≥ 50% or ≥ 75% migraine response was assessed for each subsequent 12-week dosing interval. Proportions of severe migraine attacks, 6-Item Headache Impact Test (HIT-6) total score, migraine-specific Work Productivity and Activity Impairment (WPAI:M) presenteeism subscore, and Patient Global Impression of Change (PGIC) categories were also evaluated in Weeks 1-12 responders. RESULTS:Of participants with ≥ 50% migraine response over Weeks 1-12, 61.0% (69/113, 100 mg) and 73.8% (93/126, 300 mg) maintained response over the entire 72-week treatment period; ≥ 50% responders (Weeks 1-24) and ≥ 75% responders (Weeks 1-12 and 1-24) showed similar trends. Weeks 1-12 responders (≥ 50% and ≥ 75%) experienced sustained reductions in migraine severity, HIT-6 total score, and presenteeism subscore, with most reporting improvements per the PGIC. CONCLUSIONS:For both eptinezumab doses, ≥ 50% or ≥ 75% migraine response over Weeks 1-12 or 1-24 was maintained for the entire 72-week treatment period for many participants. An initial response within the first two doses of eptinezumab can indicate long-term improvements. TRIAL REGISTRATION:ClinicalTrials.gov (Identifier: NCT04418765; URL: https://clinicaltrials.gov/study/NCT04418765); EudraCT (Identifier: 2019-004497-25; URL: https://www.clinicaltrialsregister.eu/ctr-search/search?query=2019-004497-25).

BackgroundPeople with migraine report reduced health-related quality of life during ictal and interictal phases. However, most patient-reported outcome measures (PROMs) focus on impact during migraine episodes (ictal) or globally (both ictal and interictal), potentially neglecting interictal burden. This exploratory analysis evaluated correlations between the 4-item Migraine Interictal Burden Scale (MIBS-4) total score and other PROMs in people with migraine.MethodsA post hoc analysis was conducted using participant data from a galcanezumab phase 3, placebo-controlled, 3-month study, followed by a 3-month open-label extension in participants with prior treatment failures. Correlations were assessed between baseline MIBS-4 and disease characteristics, baseline MIBS-4 and demographics, and MIBS-4 and other PROMs/monthly migraine headache days at baseline and at Month (M) 6, using Spearman’s rank correlation coefficient (rs).ResultsA total of 462 participants were included (mean age: 45.8 years); 85.9% were female, 58.2% had episodic migraine and 41.8% had chronic migraine. At baseline, highest correlations with MIBS-4 were observed for Migraine Specific Quality of Life Questionnaire (MSQ)-total score, MSQ-Emotional Function (MSQ-EF), and the Patient Health Questionnaire (PHQ-9) score, which measures depressive symptoms (all p < 0.001). Correlation analysis between MIBS-4 and MSQ-total score revealed moderate correlation at baseline (rs:–0.53) that transitioned to moderate-high at M6 (rs:–0.70). MIBS-4 was moderately correlated with PHQ-9 score at baseline (rs:0.55) and M6 (rs:0.55). The Migraine Disability Assessment score transitioned from moderate-low correlation at baseline (rs:0.41) to moderate at M6 (rs: 0.53) and Generalized Anxiety Disorder score had moderate-low correlation at both time points (rs:0.42–0.47). MIBS-4 had moderate-negligible correlation with monthly migraine headache days at baseline (rs:0.21) and low correlation at Month 6 (rs:0.32).ConclusionInterictal burden, as assessed by MIBS-4, was moderately correlated with PROMs like MSQ, PHQ-9, and MIDAS, but moderate-negligible to low correlation was observed with monthly migraine headache days. These results indicate that interictal burden is a unique construct that is correlated with, but not fully captured by, other measures and should be considered when managing people with migraine.Clinical trial registrationClinicalTrials.gov identifier NCT03559257.

Introduction:Zavegepant is a small-molecule calcitonin gene-related peptide receptor blocker (gepant). Gepants may be particularly useful in people who are triptan insufficient responders (TIR) and/or have contraindications for use of triptans. Methods:Post hoc analyses of efficacy and safety from the development program for zavegepant 10 mg nasal spray for the treatment of acute migraine in adults by baseline triptan experience. Pooled efficacy data from two double-blind, single-dose, randomized, placebo-controlled trials (NCT03872453, NCT04571060) were used to assess efficacy; co-primary efficacy endpoints were pain freedom (2 h PF) and most bothersome symptom (2 h MBS) freedom at 2 hours post-dose. Safety assessments included adverse events (AEs) from the 1-year, multiple-dose, open-label study (NCT04408794). Participants were grouped based on triptan use into a triptan naïve group (never used a triptan), TIR (used ≥1 triptans but not currently on a triptan), and current triptan users. Results:Overall, 2061 (pooled efficacy analysis set) and 603 (long-term safety analysis set) participants were included. In pooled analyses, 2 h PF rates for zavegepant versus placebo were 21.0% versus 11.9% (p=0.0254) for current triptan users, 24.8% versus 17.4% (p=0.0029) for triptan-naïve, and 21.8% versus 12.6% (p=0.0024) for TIR. For 2 h MBS freedom, corresponding rates were 40.0% versus 29.5% (p=0.0440), 40.4% versus 34.0% (p=0.0303), and 41.0% versus 29.9% (p=0.0035). In long-term safety analyses, incidences of AEs, serious AEs, and AEs leading to discontinuation were generally consistent across subgroups, regardless of triptan experience. Conclusion:In these post hoc analyses, response rates favored zavegepant versus placebo for the acute treatment of migraine, regardless of triptan experience. Zavegepant was well tolerated.

BACKGROUND:Triptans have long served as the primary acute migraine treatment, whereas gepants represent a newer, non-vasoconstrictive alternative. Although clinical trials have explored efficacy within each class, head-to-head studies are lacking, and real-world data on optimal treatment response and patient-level predictors of outcomes remain limited. We leverage cross-sectional data from the Headache Assessment via Digital Platform in United States study to conduct real-world comparisons of triptans and gepants for 2-h pain freedom (2hPF) and 24-h pain relief (24hPR), and to identify demographic, clinical, and treatment-related predictors of these outcomes. METHODS:Head-US is a survey conducted between September and December of 2023 among users of the Migraine Buddy application (Aptar, Crystal Lake, IL). Eligible participants completed the survey, met ICHD-3 criteria for migraine, and reported using acute monotherapy with gepants or a triptan. Primary outcomes, 2hPF and 24hPR posttreatment, were assessed using the Migraine Treatment Optimization Questionnaire-6 item. Potential predictors included demographic factors, clinical measures, and treatment-related factors. RESULTS:Among 1570 eligible respondents, 567 used gepants and 1003 used a triptan. Mean age was 43.35 years (standard deviation = 13.04), and 91.2% were female. Gepant users demonstrated 36% higher odds of achieving 24hPR compared to triptan users (adjusted odds ratio = 1.36, 95% confidence interval: 1.09-1.71), although there were no significant differences the 2hPF outcome. Reduced odds of adequate 2hPF were associated with higher migraine symptom severity, high-frequency episodic migraine, chronic migraine, severe pain intensity, and severe migraine disability. Odds of achieving 24hPR were reduced in those with higher attack frequency, severe migraine disability, and preventive medication use. Predictors of treatment response were similar in the pooled sample and in those using gepants and in those using triptans. CONCLUSION:In this large, real-world cohort, triptans and gepants did not significantly differ for 2hPF, but gepants demonstrated a significant advantage for 24hPR. Clinical features such as symptom severity, headache frequency, disability, and comorbid treatment burden were important predictors of treatment response. These findings support the need for larger, head-to-head clinical trials definitively comparing these medication classes for migraine management and may inform personalized selection of acute migraine therapies in clinical practice.

Soccer is played by over 265 million people worldwide, with repetitive head impacts from ball heading being common practice. However, the long-term neurological effects of such impacts on amateur players remain poorly understood. This two-year longitudinal cohort study examined whether cumulative soccer ball heading affects white matter microstructure and cognitive performance in adult amateur players from the New York City metropolitan area. The study followed 159 amateur soccer players (24.3

Abstract Background The phase 4 RESOLUTION trial showed that the first 12 weeks of treatment with eptinezumab, an anti-calcitonin gene-related peptide monoclonal antibody, reduced migraine frequency, severity, and disease burden, and improved quality of life (QOL) versus placebo in participants with chronic migraine (CM) and medication-overuse headache (MOH) who also received patient education. Here, we present 24-week eptinezumab efficacy and safety in the RESOLUTION trial. Methods RESOLUTION was a randomized, parallel-group, multinational clinical trial that included a 12-week double-blind, placebo-controlled period and a 12-week open-label extension period (OLE). Adults (18–75 years) with CM and MOH (excluding opioid-overuse headache) received a brief educational intervention about MOH at baseline and were randomized (1:1) to IV eptinezumab 100 mg or placebo. At Week 12, all participants received eptinezumab 100 mg. Measures used for primary and key secondary efficacy endpoints were also captured during the OLE: mean changes from baseline in monthly migraine days (primary endpoint: Weeks 1–4), monthly headache days, monthly days with acute medication use, average daily pain, and participants no longer meeting threshold criteria for CM nor MOH. Secondary endpoints (including patient-reported-outcomes [PROs] assessing disease-related burden and health-related QOL) and treatment-emergent adverse events (TEAEs) were also captured during the OLE. Results Of 608 participants randomized, 593 (97.5%) were treated with eptinezumab in the OLE, and 584/608 (96.1%) completed the trial. Reductions in migraine frequency and active CM/MOH diagnosis, and improvements across multiple PROs observed in post hoc analyses during the placebo-controlled period were sustained during the OLE for participants initially treated with eptinezumab, with similar levels of improvement gained for those initially receiving placebo. The proportion of participants with TEAEs in the OLE was similar between eptinezumab–eptinezumab and placebo–eptinezumab treatment sequence groups (30% vs 34%); no new safety signals were identified. Conclusions In participants with CM and MOH who received patient education, reductions in disease burden and improvements in QOL during the first 12 weeks with eptinezumab treatment were sustained for up to 24 weeks following a second eptinezumab infusion, with similar improvements observed in participants switched from placebo to eptinezumab. Eptinezumab was generally well tolerated, with no new safety signals. Trial registration ClinicalTrials.gov Identifier: NCT05452239 (https://clinicaltrials.gov/study/NCT05452239); EudraCT Number: 2021-003049-40 (https://www.clinicaltrialsregister.eu/ctr-search/search?query=2021-003049-40)

Objective We aimed to study the experience of using continuous glucose monitoring (CGM) among older Chinese Americans with cognitive impairment (CI) and their care partners. We also explored physicians’ perspectives on using CGM in older adults with cognitive decline. Background CI can heighten the challenges of managing type 2 diabetes (T2D), particularly among older Chinese Americans due to the interplays of cultural, financial, and health-related burdens and older adults with cognitive decline that add additional challenges of diabetes management. The application of CGM in such populations remains understudied. Method Older Chinese American adults with CI and T2D and their care partners were recruited from the New York City (NYC) community. Clinicians who had clinical experience of the application of CGM in individuals with diabetes and cognitive decline were recruited nationally. After brief education, patients used CGM for 10 days and shared the data with their care partners. In-depth interviews were conducted among older Chinese Americans with both T2D and CI (n=11), care partners (n=11), and clinicians (n=8), transcribed, and then thematically analyzed using ATLAS.ti software. Results Older Chinese Americans with both T2D and CI had a mean age of 74.5 ± 5.2 years, and 63.6% were women. They reported CGM helped them assess the influence of various foods on glucose levels in order to choose appropriate foods (n=10) and portion sizes (n=5), gain insight on the role and impact of exercise (n=5), enhance care partner involvement (n=5) and communication (n=4), and promote a positive mindset by improving management confidence or disease understanding (n=9) in diabetes self-management. Care partners echoed similar sentiments but added that the device enhanced diabetes management as it was more persuasive in motivating behavioral changes (n=5), and increased care partner involvement by allowing them to check in more often (n=6) and review data with the patient at anytime and anywhere (n=4). Clinicians emphasized that CGM provided real-time, shareable continuous data, in contrast with occasional A1C results (n=5), improving safety, supporting individualized treatment decisions (n=5), highlighting the importance of strong care partner support systems (n=8), and noting that newer models with automatic data transmission (Dexcom G6/G7) are especially valuable (n=5). Conclusion Our findings indicate that CGM was feasible in easing management burden for older Chinese Americans with CI and T2D, while also enhancing care partner involvement and supporting clinicians in individualized treatment decisions. Application Potential applications of this research include the adaptation of the CGM in older Chinese Americans with CI and T2D to better accommodate their cultural needs in diabetes management.

OBJECTIVES/BACKGROUND:This study was undertaken to evaluate patient reasons for nonadoption of migraine-preventive medications. Despite clear recommendations and eligibility criteria for migraine-preventive treatment by the American Headache Society and the availability of these treatments, many people with migraine are not taking appropriate preventive medications. Many are not seeking medical care in the first place, but even among those who are seeking medical care and have a diagnosis of migraine, the uptake of preventive medications remains low. METHODS:The OVERCOME (Observational Survey of the Epidemiology, Treatment, and Care of Migraine) study is an observational, longitudinal web-based survey conducted in more than 60,000 adults with migraine in the United States (US). The current analysis, a secondary post hoc analysis of the 2018-2020 baseline cross-sectional surveys, evaluated medication use in participants. In particular, the analysis investigates why some participants have never taken prescription medication for migraine prevention and examines how this group differs from those who are taking preventive medication, specifically in terms of disease severity and other patient-reported outcomes. RESULTS:Our findings revealed that among OVERCOME (US) participants who met criteria for migraine (n = 59,001), only approximately half (51.3%) had sought medical care for migraine in the previous 12 months, approximately one third (36.3%) had sought care and received a migraine diagnosis, and only 10% of participants had sought care, received a diagnosis of migraine, and were currently taking prescription medications for migraine prevention. Furthermore, among those who were eligible for migraine-preventive medication based on their headache frequency and associated disability (n = 22,249), 65.3% indicated they had never taken a preventive medication for migraine. The reasons for this were mostly medication-related (25.5% stated they were concerned about side effects, 23.3% said they did not like taking prescription medication, and 20.8% stated that their other medications worked well enough); however, there were also other reasons related to stigma, access, and communication with the health care provider that were noted by participants. CONCLUSION:This study highlights an important need for patient education, especially as many of these individuals who had never taken medications to prevent migraine reported experiencing ≥15 monthly headache days (25.3%), severe interictal burden (43.3%), and severe migraine-related disability (53.1%). We believe that these results may be of interest to health care providers who see people with migraine and help them better understand and anticipate their patients' educational needs regarding migraine prevention.

Background and ObjectivesHigh adherence to the Mediterranean diet (MeDi) has been associated with slower age-dependent cognitive decline and better cardiovascular health (CVH). We examined the association between adherence to MeDi and white matter (WM) integrity in community-dwelling Hispanic or Latino adults. In secondary analysis, we assessed whether CVH and WM integrity were pathway variables between MeDi and global cognition (GC).MethodsData from Study of Latinos-Investigation of Neurocognitive Aging-MRI Ancillary Study were analyzed. Dietary intake was collected during the baseline visit (2008-2011) using 24-hour recalls, from which a MeDi score ([MeDiS], range 0-9) was derived. Brain MRI scans with diffusion tensor imaging were obtained between 2017 and 2022. WM integrity was assessed using total WM volume (tWM), WM hyperintensity (WMH) volume, fractional anisotropy (FA), and free water (FW). GC was ascertained between 2015 and 2018 using a composite score derived from 4 standardized cognitive tests. CVH was evaluated at baseline using the Life's Essential 7 score ([LE7], range 0-100), a modified version of the existing Life's Essential 8 score, in which diet was excluded to avoid collinearity with our exposure. We used linear regression models that controlled for age, sex, and socioeconomic factors to investigate the association of MeDiS with WM integrity. We performed mediation analysis to explore whether CVH and WM integrity were pathway variables between diet and GC.ResultsA total of 2,642 participants with a mean age of 64.3 years (95% CI 63.4-65.1, 44% male) were included. The average MeDiS was 5.0 (95% CI 4.9 to 5.1), and the LE7 score was 66.6 (95% CI 65.-67.6). Higher MeDiS was associated with lower WMH volume (beta = -0.08, 95% CI -0.11 to -0.04), higher tWM volume (beta = 0.05, 95% CI 0.005-0.09), lower FW (beta = -0.04, 95% CI -0.08 to -0.002), and higher fractional anisotropy (FA) (beta = 0.09, 95% CI 0.05-0.13). WMH, tWM, and FA mediated the association between MeDiS and GC. In addition, there was serial mediation from MeDiS on GC through LE7 score, WMH, tWM, and FA.DiscussionHigher adherence to MeDi is linked to better WM structural integrity, which, together with CVH, mediates the association between MeDi and GC.

Migraine is a common neurological disorder that can severely diminish quality of life. Quantifying migraine-related changes in a real-world population over time can increase understanding of the natural history of migraine and improve clinical care of individuals with migraine. The Observational survey of the Epidemiology, treatment, and Care Of MigrainE (OVERCOME) is a web-based study that longitudinally assessed migraine-related outcomes in a demographically representative adult population with migraine in the United States. Migraine disease status was classified as “overall improved,” “overall worsened,” or “no net change” based on changes in monthly headache days (MHDs), the Migraine Disability Assessment Scale (MIDAS) score, and the Migraine-Specific Quality-of-Life Questionnaire–Role Function-Restrictive (MSQ-RFR) domain score over 1 year. Migraine-related characteristics and patient-reported outcomes were evaluated for each group. Among 11,634 individuals with migraine who completed the baseline and 1-year follow-up surveys, 40.4

OBJECTIVE:This longitudinal observational study investigated the role of prodromal symptoms in predicting headache onset, using electronic headache diaries to assess symptom occurrence and predictive utility in individuals with migraine. BACKGROUND:Prodromal symptoms are early indicators of migraine that occur 2-48 h before the headache phase. Whereas commonly reported symptoms include fatigue, stiff neck, and sensitivity to light and sound, few studies have assessed their predictive abilities for headache onset. Understanding the relationship and reliability of these symptoms is important for early migraine intervention strategies. METHODS:This is a secondary analysis of a longitudinal observational headache diary study. Participants with episodic migraine (N = 43) were recruited from Einstein College of Medicine between 2017 and 2021 and completed a mobile headache diary three times daily over 3 months. They reported the presence of 11 prodromal symptoms and headache anticipation during headache-free intervals. Associations between prodromal symptoms, anticipation, and subsequent headache onset were examined across multiple time lags. Headache anticipation was evaluated as a moderator of these relationships. RESULTS:Across 7061 headache-free observations, prodromal symptoms were reported in 52.7% of cases (n = 3721). Phonophobia doubled the odds of head pain onset 6 h before head pain. Nausea, photophobia, and difficulty thinking/concentrating were associated with higher odds of head pain within 24 h of symptom reporting. Blurred vision was associated with higher odds of future head pain at all time points evaluated. Thirst and dizziness were associated with higher odds of head pain 18-36 h before head pain onset. All prodromal symptoms were associated with increased odds of headache anticipation. Headache anticipation itself was associated with higher odds of headache onset within the ~6, 12, and 36 h prior to headache onset (~6 h odds ratio [OR] = 3.35, 95% confidence interval [CI] [2.57, 4.36]). Anticipation weakened the predictive value of several symptoms on headache occurrence, including feeling tired/weary (OR = 0.50, 95% CI [0.37, 0.68]); difficulty thinking/concentrating (0.37, 95% CI [0.24, 0.58]); thirst (OR = 0.42, 95% CI [0.31, 0.58]); blurred vision (OR = 0.63, 95% CI [0.42, 0.93]); photophobia (OR = 0.15, 95% CI [0.07, 0.33]); phonophobia (OR = 0.19, 95% CI [0.12, 0.28]); nausea (OR = 0.33, 95% CI [0.17, 0.65]); and dizziness (OR = 0.17, 95% CI [0.08, 0.35]). CONCLUSION:Cardinal (phonophobia, photophobia, and nausea) symptoms of migraine were all associated with higher odds of future head pain 24 h before head pain onset. Other neurologic and homeostatic symptoms also emerged as predictors for head pain. However, predictive performance was modest; therefore, these symptoms should not be considered stand-alone migraine predictors. Headache prediction was weaker when individuals anticipated a headache, suggesting that anticipation may influence symptom interpretation.