Barrow Neurological Institute

MONDAY, Feb. 2, 2026 -- White matter hyperintensity (WMH) burden predicts functional decline in real-world driving among older adults, according to a study scheduled to be presented at the annual American Stroke Association International Stroke Conference, held from Feb. 4 to 6 in New Orleans. Chia-Ling Phuah, M.D., from the Barrow Neurological Institute in Phoenix, and colleagues examined the relationship between WMH burden (quantified using deep learning-based magnetic resonance imaging segmentation) and longitudinal real-world driving behavior. Analysis included 220 community-dwelling adults ≥65 years without dementia at baseline. The researchers found that greater WMH burden was associated with reduced driving frequency, trip diversity, and adaptability at baseline and with faster decline in these outcomes over time. Over a mean follow-up of 5.6 years, 17 percent of participants with greater WMH burden developed cognitive impairment. WMH burden predicted more crashes and hard braking, with posterior WMH growth conferring the highest crash risk (β = 0.59). The association between WMH and risky driving was attenuated by antihypertensive use (β = −0.18), especially angiotensin-converting enzyme (ACE) inhibitors. These findings persisted independent of Alzheimer disease (AD) biomarkers, suggesting an additive role of cerebral small vessel disease independent of AD pathology. "One especially promising finding was that people taking blood pressure medications, particularly ACE inhibitors, tended to maintain safer driving habits even when their brain scans revealed more damage," Phuah said in a statement. "This effect was observed regardless of whether their blood pressure levels were at target levels. This suggests that these medications may help support brain health as we age." One author disclosed ties to the pharmaceutical industry. Press Release More Information

THURSDAY, Jan. 29, 2026 — Larry Duncan valued driving as part of his independence. But Duncan — a retired business owner from Pinehurst, North Carolina — started to become more nervous behind the wheel prior to his diagnosis with Alzheimer’s disease in 2023. “Larry was fine driving in familiar areas, but in new places where he had to make quick decisions, he became anxious,” his wife and caregiver, Pam Duncan, said in a news release. Such subtle changes in seniors’ driving habits can provide insight into their brain health, a new study says. Seniors who start driving less or are unwilling to change their usual routes are more likely to have greater brain damage linked to dementia , researchers are scheduled to report next week at the American Stroke Association’s annual meeting in New Orleans. They are also more likely to engage in unsafe driving practices and wind up in more car crashes, researchers said. “How often people drive, where they go, and how much they vary their routes may signal underlying damage to the brain’s white matter, which is linked to cognitive decline and dementia,” lead researcher Dr. Chia-Ling Phuah , co-director of the Neuro Analytics Center at Barrow Neurological Institute in Phoenix, said in a news release. “These findings suggest that even small shifts in daily driving patterns can offer important clues about brain changes — sometimes before traditional memory and thinking symptoms are noticeable,” Phuah said. For the new study, researchers studied the brain health and driving habits of 220 seniors 65 and older living independently in St. Louis, Missouri. All were without dementia at the beginning of the study. Each participant underwent an MRI brain scan when they entered the study, and about half had a second MRI at least 12 months later. Car sensors were used to track their driving behavior for more than five years, tallying up examples of speeding, collisions, hard braking or hard cornering. The sensors also tracked how often seniors drove and the routes they took. Researchers compared their driving behavior to changes in the white matter of the brain, looking specifically at changes indicative of brain damage called white matter hyperintensities. During follow-up, 17% of the participants developed cognitive impairment, and most were later diagnosed with Alzheimer’s disease , researchers said. Greater white matter damage in the brain was tied to decreased driving, fewer trips, repetitive routes and more driving errors, especially among people who later developed dementia. White matter damage in the back part of the brain – which helps people process visual information and coordinate movement – was most strongly tied to unsafe driving and crashes, researchers said. “Participants with white matter hyperintensities located in the back of the brain — a region responsible for processing what people see and how they move — were at even higher risk of crashes than those with changes in other brain areas, making them more likely to experience unsafe driving episodes and car accidents over time," Phuah explained. However, seniors who were taking blood pressure medicines – especially ACE inhibitors – were less likely to show risky driving behaviors, even when brain damage was present, the study found. “This effect was observed regardless of whether their blood pressure levels were at target levels,” Phuah said. “This suggests that these medications may help support brain health as we age.” American Stroke Association spokesperson Dr. Nada El Husseini called the results related to blood pressure medicine “surprising.” “The impact of ACE inhibitors on cognitive function and driving safety in people with white matter disease requires further investigation. Also, these results suggest cognitive screening and brain imaging might be considered for people with driving difficulties,” El Husseini said in a news release. She’s a professor of neurology at Duke University Medical Center in Durham, North Carolina, and was not involved in the study. Pam Duncan, who now volunteers for the ASA, said her husband’s case demonstrates that such changes in driving habits shouldn’t be waved off as meaningless. “In early-stage cognitive impairment, symptoms can be subtle, and driving is one of them,” she said. “Don’t ignore these changes,” Duncan continued. “As caregivers, our role is to support independence while having the courage to make tough decisions. You can live well with dementia, but it starts with awareness and action.” The findings are scheduled to be presented Thursday. Findings presented at medical meetings should be considered preliminary until published in a peer-reviewed journal. Sources American Stroke Association, news release, Jan. 29, 2026

THURSDAY, Dec. 11, 2025 — People hospitalized for a debilitating migraine should receive targeted nerve blocks rather than IV opioids to quell their pain, according to a major update of treatment guidelines. Doctors should use a nerve block injection to stop pain signals from thrumming through the occipital nerves located near the top of the spine, a report published in Headache: The Journal of Head and Face Pain , said. “The occipital nerves at the base of the skull bring in pain signals to the same area of the brain where pain signals from all over the head are coming in,” senior researcher Dr. Serena Orr , an associate professor of neurology at the University of Calgary, said in a news release. Anesthetizing these nerves provides relief in two ways. “First, the back of the head goes numb for several hours," Orr said. "Second, we see that pain signals more broadly from all over the head can be dampened down in the brain, given this shared area where pain signals come in for both occipital nerves and other nerves’ branches from the head.” The guidelines recommend that this occipital nerve block be combined with IV prochlorperazine , a drug that treats nausea and vomiting. On the other hand, the new guidelines say IV opioids and IV acetaminophen are not recommended pain relievers for treatment of migraines in the ER. This is the first major update to American Headache Society guidelines for ER migraine treatment since 2016. “This update marks a major change in emergency department migraine care, with stronger evidence supporting effective non-opioid treatments,” lead researcher Dr. Jennifer Robblee , a headache specialist at Barrow Neurological Institute in Phoenix, said in a news release. “Implementing these approaches can improve patient outcomes and reduce reliance on opioids.” Migraine accounts for about a quarter of the 3.5 million headache-related cases that U.S. emergency rooms see each year, researchers said in background notes. Unfortunately, ER doctors still struggle to quell migraine pain, with only 37% of patients leaving the hospital with no headache pain following treatment, researchers said. Opioids have not been recommended for years but continue to be used in treating migraine cases in the ER, researchers noted. However, their use decreased from 54% of cases in 2007-2010 to 28% in 2015-2018. To develop the new guidelines, researchers evaluated data from 26 new clinical trials evaluating 20 injectable treatments for migraine. The trials all occurred after a 2016 guideline update. Researchers found that the combination of an occipital nerve block and IV prochlorperazine had the strongest evidence of effectiveness. “For the first time, these guidelines formally recommend nerve blocks as an evidence-based treatment for acute migraine attacks in the emergency department. Integrating this option into practice can offer patients faster pain relief and expand the tools available to emergency clinicians,” Robblee said. However, Orr noted that it make take time for this approach to reach all emergency rooms. “Because nerve block use requires trained personnel and supplies, dissemination of procedural training and support for implementation will be essential,” she said. Sources University of Calgary, news release, Dec. 5, 2025 Barrow Neurological Institute, news release, Dec. 5, 2025 Headache: The Journal of Head and Face Pain, December 2025