Safety and Efficacy of Nerinetide at Year 1 in Participants Enrolled in ESCAPE‐NEXT: A Multicenter, Double‐Blind, Randomized Controlled Trial

 Wil your competent? doctor and hospital be DOING ANYTHING WITH THIS?

Do you prefer your doctor, hospital and board of director's incompetence NOT KNOWING? OR NOT DOING? Your choice; let them be incompetent or demand action!

Safety and Efficacy of Nerinetide at Year 1 in Participants Enrolled in ESCAPE‐NEXT: A Multicenter, Double‐Blind, Randomized Controlled Trial

Corey Adams, PhD https://orcid.org/0009-0001-3645-3154, Kathy Heard, MSc https://orcid.org/0009-0002-4807-2217, 

Yatika Kohli, PhD, Shabnam Vatanpour, PhD https://orcid.org/0000-0002-2398-5039, 

Jorg Berrouschot, MD https://orcid.org/0000-0002-6297-3153, Brian Buck, MD https://orcid.org/0000-0002-7984-6062, 

Andrew Demchuk, MD https://orcid.org/0000-0002-4930-7789, … Show All … the ESCAPE‐NEXT Investigators

Author Info & Affiliations

Journal of the American Heart Association

New online

https://doi.org/10.1161/JAHA.125.044080

 

Abstract

Background

Nerinetide is a neuroprotective agent recently evaluated in the ESCAPE‐NEXT (Efficacy and Safety of Nerinetide in Participants With Acute Ischemic Stroke Undergoing Endovascular Thrombectomy Excluding Thrombolysis) trial (NCT04462536), which was terminated after failing to meet its Day 90 primary end point; however, by that time, Year 1 follow‐up outcomes were already available for 513 participants.

Methods

The primary end point at Year 1 was functional independence, defined as modified Rankin Scale score 0 to 2, analyzed by logistic regression adjusted for treatment and baseline covariates. In a post hoc analysis, the interaction between early (<3 hours) versus late (3–12 hours) enrollment window and treatment effect was also tested and the results reported separately by enrollment window.

Results

A total of 513 of 850 participants had documented Year 1 outcomes before study termination, of whom 442 reached their scheduled Year 1 visit. In the nerinetide group, 110 (48.0%) of 229 participants achieved functional independence at Year 1 compared with 102 (47.9%) of 213 in the placebo group (adjusted odds ratio [aOR], 1.12 [95% CI, 0.74–1.71]; P=0.593). There was treatment effect modification by enrollment window (early versus late; Pinteraction=0.044). Among early window participants (n=163), 51 (52.6%) in the nerinetide group and 30 (45.5%) in placebo achieved functional independence (aOR, 2.80 [95% CI, 1.18–6.66], P=0.019) at Year 1. Additionally, the nerinetide group exhibited improved survival (aOR, 2.61 [95% CI, 1.17–5.83], P=0.019). Conversely, no significant clinical benefit of nerinetide at Year 1 was observed among late window participants. Analyses on all 513 participants with documented Year 1 outcomes provided similar results.

Conclusions

Long‐term benefits of early administration of neuroprotection may emerge up to 1 year after stroke.

Alzheimer’s study finds link between breakfast staple and reduced risk of disease

 I may have to bump up my egg  consumption to go along with the coffee reduction of Alzheimers.

Alzheimer’s study finds link between breakfast staple and reduced risk of disease

(NEXSTAR) – A study from researchers at Loma Linda University in California suggests that eating eggs — fairly frequently — could be linked to lower risk of Alzheimer’s disease among older adults.

The findings, published in the Journal of Nutrition, indicated a 27 percent decreased risk of Alzheimer’s among study participants who ate at least five eggs per week, but even participants who ate fewer eggs were said to have a reduced risk, including those who only ate eggs between one and three times per month, according to the study.

“Overall, any egg intake was associated with a 17 percent to 27 percent reduced risk of Alzheimer’s disease relative to no intake,” reads a portion of the published results.

The findings were based on an analysis of a large nationwide study comprised of Seventh Day Adventists at Loma Linda University who enrolled in 2007. Only information from those over the age of 65 at enrollment was considered in the latest published study.  

Previous studies have found similar links between egg consumption and Alzheimer’s risk. A 2024 study out of University of California San Diego had determined that egg consumption among middle-aged participants was associated with “better cognitive performance” in later life. And a 2025 study from researchers at Tufts in Massachusetts and the Rush Alzheimer’s Disease Center in Chicago found that participants who ate more than one egg per week could see as much as a 47 percent decline in Alzheimer’s risk.

In all of the studies, it was the nutritional components of the eggs, and especially choline, that was found to help preserve cognitive function. Other nutrients, such as lutein, tryptophan and an omega-3 fat known as docosahexaenoic acid, or DHA, were said to play a role.

“These nutrients may act synergistically to support cognitive resilience and mitigate neurodegenerative processes,” the researchers of the Loma Linda study wrote. “Notably, deficiencies in choline and DHA have been documented in the brains of individuals with Alzheimer’s disease.”

The study’s authors, however, acknowledged that “some” of the funding for the research was provided by the American Egg Board, though it had “no role” in the execution or publication of the study. They also acknowledged a few of the study’s limitations — including participants who may have underreported any cognitive symptoms, or those who may have changed their diet in later years — and said further research is needed.

“Further research is warranted to explore this relationship in more diverse populations, evaluate whether long-term egg consumption earlier in life influences later risk of Alzheimer’s disease, and to investigate the role of specific egg-derived nutrients in relation to that risk,” the study states.

Copyright 2026 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Blood metabolites reveal lifestyle links to brain health before dementia

Is your competent? doctor testing for these post stroke so those EXACT DEMENTIA PREVENTION PROTOCOLS CAN BE INITIATED? Sorry, nothing exists!

Your risk of dementia, has your doctor told you of this?  Your doctor is responsible for preventing this! Is s/he willing to prevent this?

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

 Blood metabolites reveal lifestyle links to brain health before dementia

A large analysis suggests that blood metabolites may capture how smoking, BMI, medication use, gut microbes, and other exposures intersect with cognition and brain structure years before dementia emerges.

In a recent study published in the journal Nature Aging, researchers investigated the relationships between blood metabolites, magnetic resonance imaging (MRI) measures, and general cognition in middle-aged adults without dementia.

Alterations in peripheral metabolism have been increasingly implicated in brain diseases, including Alzheimer’s disease (AD). Studies have linked blood metabolites, such as lipids, lipoproteins, and amino acids, to AD-related phenotypes. Functional and structural changes in the brain, as well as changes in neuropsychological markers, appear years before AD manifestation. Specifically, brain atrophy and white matter hyperintensities are neurodegenerative and vascular markers associated with AD.

Studying early metabolic changes related to these features may help identify metabolites critical to disease etiology. Besides genetics, the exposome (lifestyle factors, medication use, and other environmental exposures) and the gut microbiome can influence metabolite levels, and their management offers opportunities to stabilize metabolism and counter metabolic changes associated with disease.

The study and findings

In the present study, researchers evaluated the association of blood metabolites with general cognition and MRI markers in dementia-free middle-aged adults. First, plasma levels of 1,387 metabolites were measured in 1,082 participants of the Rotterdam study. Next, the team assessed the cross-sectional relationships of 991 frequent metabolites with general cognition and MRI markers in 1,068 participants after data preprocessing. This revealed significant associations between 14 metabolites and cognition.

Increased levels of uridine, 2-deoxyuridine, ergothioneine, and two uncharacterized metabolites, and reduced levels of seven sulfated xenobiotics and two uncharacterized metabolites were associated with improved cognition. After adjustment for education, 12 of these 14 associations remained significant; after further adjustment for smoking, diabetes, and hypertension, all 14 remained nominally associated, but no longer met FDR-adjusted significance.

Regarding MRI markers, S-adenosylhomocysteine was associated with white matter lesion (WML) volume, while 21 metabolites were associated with total brain volume. No individual metabolite was significantly associated with hippocampal volume after multiple-testing correction.

Higher levels of 6-bromotryptophan, glycerophosphorylcholine, argininate, X-11787, and three sphingomyelins were associated with increased brain volume. Meanwhile, lower levels of N-lactoyltyrosine, six metabolites related to caffeine degradation, and seven intercorrelated metabolites, including hydroxylated acylcarnitines and a hydroxylated dicarboxylic fatty acid, were associated with elevated brain volume. The team also conducted a replication analysis in an independent sample of 847 older adults from the Rotterdam study. In this cohort, nine of 14 metabolites were significantly associated with cognition.

Industry Focus eBook - Neurology/Neuroscience - 2nd edition eBook The latest Neuroscience Industry Focus eBook is now ready!Download the latest edition

A second replication analysis was conducted in the Alzheimer Gut Microbiome Project (AGMP) cohort of 512 participants; associations with three cognitive scores were investigated: the Uniform Data Set (UDS) Benson Figure Total Delayed score, the National Alzheimer’s Coordinating Center (NACC) Montreal Cognitive Assessment (MoCA) score, and the Craft Story Delayed Recall (CRAFTDRE) score. Seven metabolites were significantly associated with at least one cognitive score. Across the RSI-4 and AGMP replication analyses, all 14 cognition-associated metabolites were significant in at least one replication test.

The researchers also compared the metabolite signature of cognition with incident AD in the older RSI-4 cohort, finding strong concordance between metabolites linked to cognition and those linked to later AD diagnosis.

Sex-stratified analyses revealed suggestive evidence of interactions with sex for multiple metabolites associated with MRI markers and general cognition. In particular, reduced levels of five metabolites, including glycocholate and taurocholate, were significantly associated with improved cognition in females only. Conversely, higher N-acetyl-aspartyl-glutamate was associated with improved cognition in males only. However, these sex-stratified findings were exploratory and did not replicate in the older RSI-4 cohort.

Next, the team investigated how much variance of metabolites was explained by genetic, lifestyle, microbial, clinical, and medication features. Among cognition-related metabolites, lifestyle features explained a substantial part of the variance of nine metabolites. Likewise, clinical, medication, and lifestyle features were the major factors affecting the variance of metabolites associated with WML or total brain volume.

The researchers also assessed associations of cognition- and MRI marker-related metabolites with clinical features, lifestyle factors, gut microbiota, and medication use using regression analyses. This revealed a significant association of 13 (out of 14) cognition-related metabolites with distinct lifestyle factors. Specifically, smoking was associated with increased levels of sulfated metabolites and lower levels of 2′-deoxyuridine and uridine.

In addition, observationally increased ergothioneine levels, linked to improved cognition, were associated with lower body mass index (BMI), higher alcohol intake, and higher education. Meanwhile, lower ergothioneine levels were associated with antacid use. Among medications and clinical factors, antidiabetic medication and diabetes showed the most associations. BMI and alcohol intake showed the most associations with metabolites linked to MRI markers.

In particular, 20 metabolites linked to MRI markers were associated with alcohol intake or BMI. Among metabolites associated with MRI markers and cognition, 22 were significantly associated with specific gut microbiota. For instance, higher ergothioneine was associated with increased abundance of 12 microbial genera, including six genera that showed positive associations, such as Fusicatenibacter and Romboutsia. Mediation analyses revealed that ergothioneine mediated 31.5% of the negative association between antacid use and cognition in an exploratory cross-sectional mediation analysis. The authors cautioned that this does not establish causality and that confirmation is required in longitudinal and mechanistic studies before any clinical prescribing implications can be drawn.

Conclusions

Taken together, the findings suggest that lifestyle factors play a substantial role in shaping blood metabolites linked to cognition and MRI markers in middle-aged people without dementia. Smoking was identified as a crucial lifestyle factor associated with cognition-associated metabolites. Meanwhile, BMI, antidiabetic medication, diabetes, and alcohol intake were associated with metabolites linked to MRI markers. Overall, the results could inform future prevention and intervention efforts, but they do not prove that modifying any single factor will improve brain outcomes.

Want to read later? Download your PDF copy by clicking here.

Journal reference:

• Ahmad S, Wu T, Arnold M, et al. (2026). The blood metabolome of brain health in midlife and influences of genes, microbiome and exposome. Nature Aging. DOI: 10.1038/s43587-026-01149-4, https://www.nature.com/articles/s43587-026-01149-4

BCI Headset Detects Hidden Consciousness in Patients

 You better hope your hospital is competent enough to get this for detecting locked in patients. You would hate to get ignored.

BCI Headset Detects Hidden Consciousness in Patients

Summary: Patients surviving severe traumatic brain injuries often enter states designated as Prolonged Disorders of Consciousness (PDoC) or Locked-In Syndrome (LIS). For decades, standard bedside clinical diagnostic assessments have relied entirely on observable motor responses—such as tracking an object with the eyes, reflexive flinches, or simple physical command following.

However, if a neural injury completely disconnects the motor cortex from the musculature, a fully aware, conscious mind can remain entirely trapped inside an unresponsive body. Historical estimates suggest that up to 40% of patients categorized as minimally conscious are misdiagnosed as entirely unaware due to these physical evaluation boundaries.

To bridge this diagnostic gap, researchers developed a wearable Brain-Computer Interface (BCI) system that successfully detects patterns of intentional brain activity without requiring physical movement. The study introduces a structured, multi-session framework that provides real-time auditory neurofeedback to patients. By evaluating 42 participants across multiple clinical sites, the team discovered that repeated training sessions dramatically strengthen the clarity of covert cognitive signals, nearly doubling the clinical detection rate of minimally conscious states from 39% to 69% and opening an eventual path toward basic non-verbal communication.

Key Facts

• The BCI Paradigm Shift: While historical BCI trials evaluated patients in a single testing session, the University of Bath study introduces a longitudinal, multi-session training framework designed to help damaged brains actively learn to modulate their signals over time.
• Motor Imagery Detection: The wearable EEG headset records internal electrical rhythms, capturing distinct, intentional shifts in brain activity when an unresponsive patient simply imagines a motor action (e.g., lifting weights with the left hand or lifting both feet).
• Auditory Neurofeedback Loops: Patients receive immediate, real-time sound confirmations the moment the BCI algorithm captures an intentional motor imagery signature. This neurofeedback allows patients to systematically refine their internal mental strategies, making their brain waves sharper and more consistent across sequential sessions.
• Staged Cognitive Questioning: Approximately 90% of participants who demonstrated reliable brainwave modulation advanced to a staged questioning phase, where they were trained to utilize distinct motor imagery signals to answer basic binary “yes” or “no” exploratory prompts.
• Quantitative Diagnostic Gains: When combined with traditional behavior checklists, the multi-session BCI framework elevated the clinical detection rate of minimal consciousness from 39% to 69%, unmasking hidden awareness that traditional bedside exams missed entirely.
• Deployment Versatility: Bypassing dense, immobile laboratory machinery, this lightweight, portable BCI architecture is engineered to run seamlessly within active, real-world clinical environments, long-term care homes, or domestic residences.

Source: University of Bath

A new approach for identifying signs of hidden awareness in people who cannot speak or move after severe brain injury has been demonstrated by researchers at the University of Bath in the UK.

The system detects patterns of brain activity through a wearable headset using an advanced application of brain–computer interface (BCI) technology.

A multi-session BCI training framework with embedded auditory feedback can train brain-injured patients to enhance their motor imagery signatures, boosting the objective detection of covert consciousness to 69%. Credit: Neuroscience News

Across multiple experimental sessions, the researchers have uncovered signs of consciousness that were previously undetected in unresponsive patients.

This represents a potential advance in diagnostic methods and rehabilitation planning for patients. It also offers promising possibilities for future technologies that may help patients communicate without the use of voice or movement.

Published in the Nature journal Communications Medicine, the study was carried out in patients with prolonged disorders of consciousness (PDoC) and locked-in syndrome (LIS) – conditions in which awareness may be preserved but cannot be outwardly expressed.

By recording brainwaves in these patients, this BCI technology detects when a person imagines a hand or arm movement, even when no physical movement is possible. Detection accuracy can improve if neurofeedback is provided over multiple sessions.

Structured approach

The study introduced a structured multi-session approach to assessing awareness in patients, combining:

• Repeated training, where participants were taught to intentionally change their brain signals over time. Study participants were asked to imagine actions such as lifting a weight with their left hand or lifting both feet. This led to distinct patterns of brain activity that could be detected, even in the absence of any physical movement, and translated into meaningful signals.
• Real-time feedback, where participants received immediate sound-based feedback, confirming to them that the system had detected the correct pattern of imagined movement.This real-time feedback has the potential to help participants refine their mental strategies across sessions, with their brain responses becoming clearer and more consistent over time – in a manner similar to how an uninjured person learns a physical or cognitive skill. Importantly, the researchers found that repeated, structured evaluations across multiple sessions was found to improve the detection of awareness in, and engagement from, unresponsive patients.
• Staged questioning, where participants progressed to an exploratory yes–no question phase (for instance, they were asked to imagine one movement to indicate ‘yes’ and a different movement to indicate ‘no’).These questions were structured to explore different types of mental capacity and awareness.

Study outcomes

The protocol was tested in 42 participants aged between 17 and 73 years, recruited across multiple NHS and Irish clinical sites. 

Key findings included:

• 31 of 42 participants (73.8%) showed reliable intentional modulation of brain activity – i.e. consistent patterns or rhythms in the signals – when asked to imagine specific movements. 
• Approximately 90% of those participants progressed to the phase of the study designed to elicit yes-no responses.
• Brain responses often became more consistent across sessions. 
• When used alongside standard behavioural tests, the multi session BCI approach improved detection of minimal conscious state from 39% to 69%, helping identify awareness that might otherwise go unnoticed. 

Why behavioural tests alone are not enough

Standard bedside assessments rely heavily on observable movement such as eye movements, reflexes and simple command following. However, when injuries are severe enough to prevent physical movement, these assessments can substantially underestimate awareness.

Previous research suggests that up to 40% of patients in a minimally conscious state may be misdiagnosed as ‘awake but unaware’ because signs of cognitive activity are missed. 

Brain-based assessments offer a means to detect purposeful responses even when a person cannot express themselves behaviourally. While earlier studies have demonstrated that a single assessment could reveal covert awareness, a single session represents only a minimal assessment window.

The researchers of the new study anticipated that such signals could be trained over time through repeated assessment where feedback was also provided, potentially leading to stronger evidence that consistently points to the presence of awareness and consciousness.

Lead author Dr Naomi du Bois, a researcher at the Institute for the Augmented Human (IAH) at the University of Bath, said: “This work shows how brain based response to structured questions could complement bedside assessment and help clinicians detect hidden awareness earlier.” 

Senior author Professor Damien CoyleInstitute for the Augmented Human director of the IAH and a researcher in the Department of Computer Science at Bath, said: “The novelty here is the move beyond single-session assessment. We’ve shown that a structured multi-session BCI framework, with training, feedback and staged questioning, can operate in real clinical environments or in the home or care home, and strengthen the reliability of detecting signs of awareness.

“This creates a pathway toward improved diagnosis and may ultimately support patients to interact and communicate basic responses in some cases.”

Key Questions Answered:

Q: Why do traditional bedside medical tests fail to detect awareness in nearly 40% of minimally conscious patients?

A: Traditional tests rely almost entirely on visible, physical proof—doctors look to see if a patient can squeeze a hand, blink on command, or follow a moving object with their eyes. However, severe brain trauma can fracture the structural pathways that connect a perfectly conscious, thinking mind to the body’s physical muscles. The patient might hear and understand the command perfectly, but they are physically “locked in” and incapable of generating a motor response. Because the baseline exam only measures the body’s physical execution rather than the brain’s internal intent, covert awareness goes completely unnoticed.

Q: How does this new BCI system help a completely paralyzed patient learn to generate clearer brain signals?

A: The secret lies in the system’s real-time auditory feedback loop. In older BCI experiments, a patient’s brain waves were recorded in a single session with zero interaction, which is incredibly difficult for a damaged brain. The University of Bath system turns the assessment into an active learning process. When a patient imagines a movement, like lifting their left hand, the headset listens for that specific neural rhythm. The absolute millisecond it detects the correct pattern, it plays a distinct sound. This immediate feedback lets the patient realize, “Yes, that mental strategy worked,” allowing them to practice and sharpen that thought pattern over multiple sessions just like someone learning a new physical skill.

Q: What is the long-term goal of this portable technology for families and long-term care facilities?

A: The ultimate milestone is to transition this technology out of elite research labs and deploy it directly into hospitals, care facilities, and private homes as a permanent communication tool. By moving from simple motor imagery to “staged questioning,” researchers have already shown that patients can learn to associate one imagined movement with “yes” and another with “no.” Professor Damien Coyle emphasizes that this creates a highly accessible pathway to give completely non-verbal, paralyzed individuals a reliable, non-invasive voice, allowing them to communicate basic needs, express comfort levels, and actively participate in their own long-term medical care.

Editorial Notes:

• This article was edited by a Neuroscience News editor.
• Journal paper reviewed in full.
• Additional context added by our staff.

About this neurotech research news

Author: Vittoria D’Alessio
Source: University of Bath
Contact: Vittoria D’Alessio – University of Bath
Image: The image is credited to Neuroscience News

Original Research: Open access.
“Advancing EEG-based assessment of consciousness and cognition in prolonged disorders of consciousness” by Naomi du Bois, Attila Korik, Stephanie Hodge, Leah Hudson, Ainjila S. Elahi, Alain Bigirimana, Natalie Dayan, Jose M. Sanchez-Bornot, Alison McCann, Kudret Yelden, Lloyd Bradley, Krishnan P. S. Nair, Simon Judge, Damon Hoad, Emma Vines, Venu Harilal, Sheryl Parke, Paul Johnson, Jacqueline Pogue, Emma Dodds, Abayomi Salawu, Raymond Carson, Karl McCreadie, Jacqueline Stow, Jacinta McElligott, Aine Carroll & Damien Coyle. Communications Medicine
DOI:10.1186/s43856-026-01574-x

This Heart Disease Risk Factor Doesn't Show Up On A Blood Test - air pollution - by mindbodygreen

FYI

This Heart Disease Risk Factor Doesn't Show Up On A Blood Test

Down to the Core of the Paradox: Thrombectomy in Large Stroke and Favorable Outcome — Do Time and Mismatch Matter?

 I hope this doesn't mean you're giving up! Stroke survivors have no choice but to soldier thru regardless of the incompetence of the stroke medical world in not solving stroke to 100% recovery!

Down to the Core of the Paradox: Thrombectomy in Large Stroke and Favorable Outcome — Do Time and Mismatch Matter?

Chen J, Nie X, Wang M, Zhang D, Sun D, Pan Y, Huo X, Li Z, Miao Z, for the ANGEL-ASPECT Study Group. Time-Dependent Impact of Mismatch Profiles on Outcomes Following Endovascular Thrombectomy for Large Ischemic Stroke. Stroke. 2026;57:641–649.

Patients with large-core infarctions have long been considered poor candidates for reperfusion therapy.(Why?) Although six recent randomized controlled trials evaluating endovascular therapy (EVT) versus medical management have since largely challenged this view, only 20 to 30% of these patients achieve functional independence at 90 days. In small-core infarctions, perfusion mismatch between the irreversibly damaged tissue of the core and the salvageable penumbra has become the cornerstone of EVT decision-making, particularly in the late time window. However, whether the same principle applies to large-core infarctions is uncertain. Notably, previous subgroup analyses yielded conflicting results, and it remains unknown whether perfusion mismatch can reliably inform EVT decisions in large-core infarctions across different time windows.

The authors performed a secondary, post hoc analysis of the ANGEL-ASPECT trial, a multicenter randomized controlled trial comparing EVT with medical management in adults aged 18-80 years with acute ischemic stroke and large-core infarction of the anterior circulation defined as: ASPECTS 3-5 within 24 hours, or core volume 70-100mL and either ASPECTS 0-2 within 24 hours or ASPECTS > 5 at 6-24 hours. Perfusion mismatch was defined using two criteria: (1) mismatch ratio ≥ 1.8 and mismatch volume ≥ 15mL, or (2) mismatch radio ≥ 1.2 and mismatch volume ≥ 10mL. Unadjusted logistic regression assessed the association between treatment and 90-day functional independence (mRS 0–3), including treatment-by-mismatch interaction within each time stratum (≤6 versus >6 hours) and treatment-by-time interaction in the overall cohort. Secondary outcomes included recanalization, 90-day mRS distribution, mortality, and intracranial hemorrhage.

Using the most stringent definition, 346 of the 426 participants (81%) displayed a perfusion mismatch. In the early time window (≤ 6 hours), EVT was associated with higher odds of functional independence at 90 days among patients with a perfusion mismatch compared with medical management alone (49 vs 28%; OR 2.41 [95% CI 1.28–4.55]), whereas no benefit was observed in those without a mismatch. In the late window, EVT conferred no significant advantage, aside from a non-significant trend toward benefit in the no-mismatch group. Treatment-by-mismatch and treatment-by-time interaction tests were not statistically significant for primary and secondary outcomes. Sensitivity analyses excluding wake-up stroke yielded consisted results. Any ICH occurred more frequently in the EVT group, while rates of symptomatic ICH were comparable across treatment arms.

Overall, this post hoc analysis suggests that among patients with large-core infarctions, those imaged within the early time window and exhibiting a perfusion mismatch may, as predicted by the core/penumbra model, derive the greatest benefit from EVT, whereas benefit in the late-time window appeared less dependent on mismatch status. These results contrast with subgroup analyses from SELECT-2,1 which reported EVT benefit irrespective of mismatch status, but partially align with those of TESLA,2 which did not meet its primary endpoint yet, somewhat unexpectedly, suggested a trend toward EVT benefit primarily in patients without a mismatch. Notably, some patients with no apparent mismatch still experienced favorable outcomes with EVT in extended time windows, further challenging the large-core paradox. Such findings may reflect favorable baseline characteristics; however, alternative explanations, including imaging limitations, overestimation of the core, residual tissue viability (so-called heterogeneity within the core), and reduction of vasogenic edema, cannot be excluded.3

Considering the limited subgroup sizes, potential selection bias with high prevalence of perfusion mismatch, and the unadjusted nature of the statistical analyses, these findings should be interpreted with caution. Current guidelines do not support selecting or excluding patients from EVT solely based on perfusion imaging,4 and further studies are needed to clarify how perfusion mismatch profiles and imaging timing should inform EVT decisions in large stroke.

We asked 4 dietitians the one supplement they actually take—they all said the same thing - magnesium

 

Do you really think your competent? doctor will instruct the dietician to get this correctly in your diet protocol? Sorry, you DON'T HAVE A DIET PROTOCOL, DO YOU?

We asked 4 dietitians the one supplement they actually take—they all said the same thing

Dietitians agree on this go-to supplement for better rest, recovery and daily nutrient support when diet alone falls short

Reviewed by Dietitian Katey Davidson, M.Sc.FN, RD, CPT

Key Points

• Dietitians recommend magnesium supplements when food alone doesn’t meet daily needs.
• Magnesium supports sleep, muscle and nerve function, making it important to prioritize.
• Individual needs vary, so work with a healthcare provider for personalized advice.

Getting your nutrition from food first is an important goal, but even nutrition experts can have occasional nutrient gaps. Registered dietitians spend their careers helping others eat well, so it may be surprising that many turn to supplements to fill in where food falls short.

Although individual needs vary, some supplements are more widely beneficial than others, since certain nutrients can be difficult to get through diet alone. We asked four dietitians which supplement they take every day, and they all gave the same answer: magnesium. Keep reading to learn why magnesium is often recommended as a go-to supplement and what you should know before considering it yourself.

Why Dietitians Take Magnesium

Magnesium is an essential mineral that plays a role in hundreds of processes throughout the body—from supporting muscle function and nerve signaling to helping regulate blood sugar levels. It’s naturally found in foods like nuts, seeds, leafy greens, legumes and whole grains. However, many people don’t consume enough of these foods on a regular basis.

Related video: Doctors urge caution over rising magnesium supplement trend (Welltica+)

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Doctors urge caution over rising magnesium supplement trend

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As a result, nearly half of Americans fall short of the recommended daily intake, which is 400–420 milligrams (mg) per day for men and 310–320 mg for women, says Elizabeth Ward, M.S., RDN.

For Ward, this gap was the reason she began supplementing. "I started taking [magnesium] because I realized I wasn't getting enough magnesium every day from food."

Beyond filling nutrient gaps, dietitians shared several other reasons they take magnesium daily. One of the most common? Better sleep. Magnesium helps regulate gamma-aminobutyric acid (GABA), a brain chemical that calms the central nervous system. This can make it easier to unwind at the end of the day and improve overall sleep quality. As dietitian Lisa Moskovitz, RD, CDN explains, "When I do take it at night I will feel more rested and I have better quality sleep."

Magnesium’s benefits extend beyond sleep. It also supports muscle and nerve function. Megan Huff, RDN, says it has made a noticeable difference: "I started taking magnesium glycinate for restless legs and leg cramps, and since taking it, I haven't experienced either for two years!"

For Ashley Kitchens, M.P.H., RD, the draw was athletic recovery. "As a CrossFit athlete, I train hard five days a week. Because magnesium plays a key role in muscle function, I added it in to supplement my workouts and recovery."

Who Is Most Likely to Benefit

While magnesium can be helpful for many people, dietitians say certain groups may be more likely to benefit from supplementation:

• Athletes and Very Active Individuals. People who exercise frequently or sweat heavily may have increased magnesium needs. "You lose magnesium through sweat, plus it's critical for muscle contraction and recovery," says Kitchens.
• Older Adults. As we age, the body becomes less efficient at absorbing magnesium from food, making supplementation potentially beneficial for this group, explains Kitchens.
• People with Sleep Difficulties. “People who wake up in the middle of the night, don't wake up feeling well-rested are most likely to benefit from magnesium,” says Huff. However, it’s important to consider that underlying health issues may also be contributing and should be discussed with a healthcare provider.
• People with Low Magnesium Intake. Individuals who don’t regularly consume magnesium-rich foods due to dietary limitations or picky eating patterns may also fall short. Working with a registered dietitian can help improve food choices and determine whether supplementation is needed.

Who Should Use Caution

Although magnesium supplements are generally safe for most people, certain groups should speak with their healthcare provider before starting one.

People with chronic kidney disease, in particular, need to be cautious. Healthy kidneys help remove excess magnesium from the body, but when kidney function is impaired, magnesium can build up to unsafe levels, warn Kitchens and Huff.

Huff also notes that individuals with myasthenia gravis—an autoimmune condition that causes muscle weakness—should consult a healthcare professional before supplementing. Since magnesium has a muscle-relaxing effect, it may worsen symptoms in some cases.

Potential Side Effects

Magnesium supplements are generally well tolerated, but the most common side effects are digestive. "High doses of magnesium from supplements or medications such as laxatives and antacids that contain magnesium can result in diarrhea, nausea and cramping," says Ward. She adds that magnesium oxide, in particular, is more likely to cause stomach upset.

To minimize these effects, Kitchens recommends starting with a lower dose and increasing gradually. She learned this firsthand after taking too high of a dose before bed and experiencing noticeable digestive discomfort the next morning.

At very high doses, more serious effects—such as low blood pressure or an irregular heartbeat—can occur, Kitchens notes.

Ward also cautions that magnesium supplements can interact with certain medications, including antibiotics and osteoporosis treatments, potentially reducing their effectiveness. For this reason, always let your healthcare provider and pharmacist know about any supplements you're taking.

What to Look for When Buying Magnesium

Not all magnesium supplements are created equal. Dietitians recommend keeping a few key factors in mind when choosing one:

• Choose a Well-Absorbed Form. Forms like magnesium glycinate (or bisglycinate) and magnesium malate are typically well absorbed and gentle on the stomach. In contrast, magnesium oxide tends to be less bioavailable and more likely to cause digestive discomfort.
• Match the Form to Your Goal. "Know what your goal and objective is with taking magnesium so you can find the best form for your goals and needs," says Moskovitz. For example, magnesium citrate is often used for its mild laxative effect, while magnesium glycinate is commonly chosen for sleep and muscle support.
• Follow Dosing Instructions. The recommended upper limit for supplemental magnesium is 350 mg per day for adults. Exceeding this amount isn’t necessary unless advised by a healthcare provider, says Ward.
• Look for Independent Testing. To ensure quality and accuracy, Huff suggests choosing supplements verified by an independent organization such as NSF International, USP or Informed Choice.
• Watch for Misleading Claims. "Common red flags when it comes to searching for a magnesium supplement is vague labeling and companies that make wild health claims without any evidence to back them up," says Kitchens.
• Be Cautious with Added Ingredients. Huff advises against products that contain proprietary herbal blends or extra nutrients that may interact with medications or lead to excessive intake when combined with other supplements. In many cases, taking just a magnesium supplement on its own is the simplest and safest choice.

Our Expert Take

Dietitians generally recommend a food-first approach to nutrition, but in some cases, supplements can help fill nutritional gaps. With nearly half of adults falling short of the daily recommendations for magnesium from food alone, it’s easy to see why dietitians choose to supplement and often recommend magnesium.

That said, not everyone needs a magnesium supplement, and more isn’t always better. Individual needs can vary based on diet, health status and lifestyle. For that reason, it’s important to work with a healthcare provider to determine what’s right for you.

Read the original article on EatingWell