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Abstract Nicotinamide adenine dinucleotide (NAD) replenishment therapy using nicotinamide riboside (NR) shows promise for Parkinson’s disease (PD) and other neurodegenerative disorders. However, the optimal dose of NR remains unknown, and doses exceeding 2000 mg daily have not been tested in humans. To evaluate the safety of high-dose NR therapy, we conducted a single-center, randomized, placebo-controlled, double-blind, phase I trial on 20 individuals with PD, randomized 1:1 on NR 1500 mg twice daily (n = 10) or placebo (n = 10) for four weeks. The trial was conducted at the Department of Neurology, Haukeland University Hospital, Bergen, Norway. The primary outcome was safety, defined as the frequency of moderate and severe adverse events. Secondary outcomes were tolerability defined as frequency of mild adverse events, change in the whole blood and urine NAD metabolome, and change in the clinical severity of PD, measured by MDS-UPDRS. All 20 participants completed the trial. The trial met all prespecified outcomes. NR therapy was well tolerated with no moderate or severe adverse events, and no significant difference in mild adverse events. NR therapy was associated with clinical improvement of total MDS-UPDRS scores. However, this change was also associated with a shorter interval since the last levodopa dose. NR greatly augmented the blood NAD metabolome with up to 5-fold increase in blood NAD+ levels. While NR-recipients exhibited a slight initial rise in serum homocysteine levels, the integrity of the methyl donor pool remained intact. Our results support extending the dose range of NR in phase II clinical trials to 3000 mg per day, with appropriate safety monitoring. Clinicaltrials.gov identifier: NCT05344404.

Damage to the orbitofrontal cortex (OFC) often occurs following a traumatic brain injury (TBI) and can lead to complex behavioral changes, including difficulty with attention and concentration. We investigated the effects of musical training on patients with behavioral and cognitive deficits following a mild traumatic brain injury (mTBI) and found significant functional neuro-plastic changes in the OFC’s networks. The results from neuropsychological tests revealed an improved cognitive performance. Moreover, six out of seven participants in this group returned to work post intervention and reported improved well-being and social behavior. In this study, we explore the functional changes in OFC following music-supported intervention in reference to connecting networks that may be responsible for enhanced social interaction. Furthermore, we discuss the factor of dopamine release during playing as an element providing a possible impact on the results. The intervention consisted of playing piano, two sessions per week in 8 weeks, 30 min each time, with an instructor. Additional playing was required with a minimum of 15 min per day at home. Mean time playing piano in reference to participant’s report was 3 h per week during the intervention period. Three groups participated, one mTBI group (n = 7), two control groups consisting of healthy participants, one with music training (n = 11), and one baseline group without music training (n = 12). Participants in the clinical group had received standardized cognitive rehabilitation treatment during hospitalization without recovering from their impairments. The intervention took place 2 years post injury. All participants were assessed with neuropsychological tests and with both task and resting-state functional magnetic resonance imaging (fMRI) pre-post intervention. The results demonstrated a significant improvement of neuropsychological tests in the clinical group, consistent with fMRI results in which there were functional changes in the orbitofrontal networks (OFC). These changes were concordantly seen both in a simple task fMRI but also in resting-state fMRI, which was analyzed with dynamic causal modeling (DCM). We hypothesized that playing piano, as designed in the training protocol, may provide a positive increase in both well-being and social interaction. We suggest that the novelty of the intervention may have clinical relevance for patients with behavioral problems following a TBI.

Previous research has demonstrated that people with Parkinson's disease (PD) have difficulties with the perceptual discrimination of rhythms, relative to healthy controls. It is not however clear if this applies only to simpler rhythms (a so called "beat-based" deficit), or if it is a more generalized deficit that also applies to more complex rhythms. Further insight into how people with PD process and perceive rhythm can refine our understanding of the well known problems of temporal processing in the disease. In this study, we wanted to move beyond simple/complex-dichotomy in previous studies, and further investigate the effect of tempo on the perception of musical rhythms. To this end, we constructed ten musical rhythms with a varied degree of complexity across three different tempi. Nineteen people with PD and 19 healthy controls part-took in an internet based listening survey and rated 10 different musical rhythms for complexity and likeability. In what we believe is the first study to do so, we asked for the participants subjective ratings of individual rhythms and not their capacity to directly compare or discriminate between them. We found an overall between-group difference in complexity judgments that was modulated by tempo, but not level of complexity. People with PD rated all rhythms as more complex across tempi, with significant group differences in complexity ratings at 120 and 150bpm, but not at 90bpm. Our analysis found a uniform elevated baseline for complexity judgments in the PD-group, and a strong association between the two groups' rank-ordering the rhythms for complexity. This indicates a preserved ability to discriminate between relative levels of complexity. Finally, the two groups did not significantly differ in their subjective scoring of likeability, demonstrating a dissimilarity between judgment of complexity and judgment of likeability between the two groups. This indicates different cognitive operations for the two types of judgment, and we speculate that Parkinson's disease affects judgment of complexity but not judgment of likeability.

Background There is no consensus on the management of incidental meningiomas. The literature on long-term growth dynamics is sparse and the natural history of these tumors remains to be illuminated. Methods We prospectively assessed long-term tumor growth dynamics and survival rates during active monitoring of 62 patients (45 female, mean age 63.9 years) harboring 68 tumors. Clinical and radiological data were obtained every 6 months for 2 years, annually until 5 years, then every second year. Results The natural progression of incidental meningiomas during 12 years of monitoring was growth (P  < .001). However, mean growth decelerated at 1.5 years and became insignificant after 8 years. Self-limiting growth patterns were seen in 43 (63.2%) tumors, non-decelerating in 20 (29.4%) and 5 (7.4%) were inconclusive due to  ≤ 2 measurements. Decelerating growth persisted once established. Within 5 years, 38 (97.4%) of 39 interventions were initiated. None developed symptoms prior to intervention. Large tumors (P  < .001) involving venous sinuses (P  = .039) grew most aggressively. Since inclusion 19 (30.6%) patients have died of unrelated causes and 2 (3%) from grade 2 meningiomas. Conclusion Active monitoring seems a safe and appropriate first-line management of incidental meningiomas. Intervention was avoided in  > 40% with indolent tumors in this cohort. Treatment was not compromised by tumor growth. Clinical follow-up seems sufficient beyond 5 years if self-limiting growth is established. Steady or accelerating growth warrant monitoring until they reach a stable state or intervention is initiated. [ABSTRACT FROM AUTHOR]

Background: Common genetic variance in apolipoprotein E (APOE), β‐glucocerebrosidase (GBA), microtubule‐associated protein tau (MAPT), and α‐synuclein (SNCA) has been linked to cognitive decline in Parkinson's disease (PD), although studies have yielded mixed results. Objectives: To evaluate the effect of genetic variants in APOE, GBA, MAPT, and SNCA on cognitive decline and risk of dementia in a pooled analysis of six longitudinal, non‐selective, population‐based cohorts of newly diagnosed PD patients. Methods: 1002 PD patients, followed for up to 10 years (median 7.2 years), were genotyped for at least one of APOE‐ε4, GBA mutations, MAPT H1/H2, or SNCA rs356219. We evaluated the effect of genotype on the rate of cognitive decline (Mini‐Mental State Examanation, MMSE) using linear mixed models and the development of dementia (diagnosed using standardized criteria) using Cox regression; multiple comparisons were accounted for using Benjamini−Hochberg corrections. Results: Carriers of APOE‐ε4 (n = 281, 29.7%) and GBA mutations (n = 100, 10.3%) had faster cognitive decline and were at higher risk of progression to dementia (APOE‐ε4, HR 3.57, P < 0.001; GBA mutations, HR 1.76, P = 0.001) than non‐carriers. The risk of cognitive decline and dementia (HR 5.19, P < 0.001) was further increased in carriers of both risk genotypes (n = 23). No significant effects were observed for MAPT or SNCA rs356219. Conclusions: GBA and APOE genotyping could improve the prediction of cognitive decline in PD, which is important to inform the clinical trial selection and potentially to enable personalized treatment © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society [ABSTRACT FROM AUTHOR]

Background The number of incidental meningiomas has increased because of the increased availability of neuroimaging. Lack of prospective data on the natural history makes the optimal management unclear. We conducted a 5-year prospective study of incidental meningiomas to identify risk factors for tumor growth. Methods Sixty-four of 70 consecutive patients with incidental meningioma were included. Clinical and radiological status was obtained at 0, 0.5, 1, 1.5, 2, 3, 4, and 5 years. GammaPlan and mixed linear regression modeling were utilized for volumetric analysis with primary endpoint tumor growth. Results None of the patients developed tumor-related symptoms during the study period, although 48 (75%) tumors increased (>15%), 13 (20.3%) remained unchanged, and 3 (4.7%) decreased (>15%) in volume. Mean time to growth was 2.2 years (range, 0.5-5.0 years). The growth pattern was quasi-exponential in 26%, linear in 17%, sigmoidal in 35%, parabolic in 17%, and continuous reduction in 5%. There was significant correlation among growth rate, larger baseline tumor volume (P <.001), and age in years (<55 y: 0.10 cm3/y, 55-75 y: 0.24 cm3/y, and >75 y: 0.85 cm3/y). Conclusion The majority of meningiomas will eventually grow. However, more than 60% display a self-limiting growth pattern. Our study provides level-2 evidence that asymptomatic tumors can be safely managed utilizing serial imaging until persistent radiological and/or symptomatic growth. [ABSTRACT FROM AUTHOR]

The Joint Editors-in-Chief have retracted this article [1] at the request of the University of Bergen and the Norwegian Board of Health Supervision. [ABSTRACT FROM AUTHOR]

Previous research has demonstrated that people with Parkinson’s disease (PD) have difficulties with the perceptual discrimination of rhythms, relative to healthy controls. It is not however clear if this applies only to simpler rhythms (a so called “beat-based” deficit), or if it is a more generalized deficit that also applies to more complex rhythms. Further insight into how people with PD process and perceive rhythm can refine our understanding of the well known problems of temporal processing in the disease. In this study, we wanted to move beyond simple/complex-dichotomy in previous studies, and further investigate the effect of tempo on the perception of musical rhythms. To this end, we constructed ten musical rhythms with a varied degree of complexity across three different tempi. Nineteen people with PD and 19 healthy controls part-took in an internet based listening survey and rated 10 different musical rhythms for complexity and likeability. In what we believe is the first study to do so, we asked for the participants subjective ratings of individual rhythms and not their capacity to directly compare or discriminate between them. We found an overall between-group difference in complexity judgments that was modulated by tempo, but not level of complexity. People with PD rated all rhythms as more complex across tempi, with significant group differences in complexity ratings at 120 and 150bpm, but not at 90bpm. Our analysis found a uniform elevated baseline for complexity judgments in the PD-group, and a strong association between the two groups’ rank-ordering the rhythms for complexity. This indicates a preserved ability to discriminate between relative levels of complexity. Finally, the two groups did not significantly differ in their subjective scoring of likeability, demonstrating a dissimilarity between judgment of complexity and judgment of likeability between the two groups. This indicates different cognitive operations for the two types of judgment, and we speculate that Parkinson’s disease affects judgment of complexity but not judgment of likeability. [ABSTRACT FROM AUTHOR]

Damage to the orbitofrontal cortex (OFC) often occurs following a traumatic brain injury (TBI) and can lead to complex behavioral changes, including difficulty with attention and concentration. We investigated the effects of musical training on patients with behavioral and cognitive deficits following a mild traumatic brain injury (mTBI) and found significant functional neuro-plastic changes in the OFC's networks. The results from neuropsychological tests revealed an improved cognitive performance. Moreover, six out of seven participants in this group returned to work post intervention and reported improved well-being and social behavior. In this study, we explore the functional changes in OFC following music-supported intervention in reference to connecting networks that may be responsible for enhanced social interaction. Furthermore, we discuss the factor of dopamine release during playing as an element providing a possible impact on the results. The intervention consisted of playing piano, two sessions per week in 8 weeks, 30 min each time, with an instructor. Additional playing was required with a minimum of 15 min per day at home. Mean time playing piano in reference to participant's report was 3 h per week during the intervention period. Three groups participated, one mTBI group (n = 7), two control groups consisting of healthy participants, one with music training (n = 11), and one baseline group without music training (n = 12). Participants in the clinical group had received standardized cognitive rehabilitation treatment during hospitalization without recovering from their impairments. The intervention took place 2 years post injury. All participants were assessed with neuropsychological tests and with both task and resting-state functional magnetic resonance imaging (fMRI) pre-post intervention. The results demonstrated a significant improvement of neuropsychological tests in the clinical group, consistent with fMRI results in which there were functional changes in the orbitofrontal networks (OFC). These changes were concordantly seen both in a simple task fMRI but also in resting-state fMRI, which was analyzed with dynamic causal modeling (DCM). We hypothesized that playing piano, as designed in the training protocol, may provide a positive increase in both well-being and social interaction. We suggest that the novelty of the intervention may have clinical relevance for patients with behavioral problems following a TBI. [ABSTRACT FROM AUTHOR]

Behavioral studies indicate that persons with Parkinson's disease have complexity dependent problems with the discrimination of auditory rhythms. Furthermore, neuroimaging studies show that rhythm processing activates many brain areas that overlap with areas affected by Parkinson's disease (PD). This study sought to investigate the neural correlates of rhythm processing in PD and healthy controls, with a particular focus on rhythmic complexity. We further aimed to investigate differences in brain activation during initial phases of rhythm processing. Functional magnetic resonance imaging was used to scan 15 persons with Parkinson's disease and 15 healthy controls while they listened to musical rhythms with two different levels of complexity. Rhythmic complexity had no significant effect on brain activations, but patients and controls showed differences in areas related to temporal auditory processing, notably bilateral planum temporale and inferior parietal lobule. We found indications of a particular sequential or phasic activation pattern of brain activity, where activity in caudate nucleus in the basal ganglia was time‐displaced by activation in the saliency network—comprised of anterior cingulate cortex and bilateral anterior insula—and cortical and subcortical motor areas, during the initial phases of listening to rhythms. We relate our findings to core PD pathology, and discuss the overall, rhythm processing related hyperactivity in PD as a possible dysfunction in specific basal ganglia mechanisms, and the phasic activation pattern in PD as a reflection of a lack of preparatory activation of task‐relevant brain networks for rhythm processing in PD. [ABSTRACT FROM AUTHOR]

Objectives: Olfactory dysfunction has been related to cognitive deficits in Parkinson's disease (PD), but evidence is conflicting and little is known about the relationship between these symptoms in early PD. Our objective was to study the association between smell deficits measured with a simple odor identification test at diagnosis of PD and the subsequent risk of cognitive decline. Materials & methods: One hundred and ninety two PD patients from a population‐based study were examined at time of diagnosis, before initiation of dopaminergic treatment, with follow‐up of 177 patients after 3 years, 162 patients after 5 years and 146 patients after 7 years. Cognitive function was assessed repeatedly with tests of global cognition, verbal memory, visuospatial abilities, processing speed, and executive function. Olfactory function was tested with a simple odor identification test at baseline. Associations between outcome measures and hyposmia were assessed by linear mixed effects models. Results: After 7 years, there were significant differences in global cognition (B: 1.96 (95% CI: 0.68, 3.24), P = 0.0031), verbal memory including immediate recall (B: 5.36 (95% CI: 2.04, 8.67), P = 0.0018) and delayed recall (B: 1.55 (95% CI: 0.51, 2.59), P = 0.0041) and word reading speed (B: 6.90 (95% CI: 2.17, 11.63), P = 0.0048) between hyposmic and normosmic PD patients. Conclusions: The decline of cognitive function in early PD is more rapid in patients with hyposmia at diagnosis, compared to normosmic ones. A simple smell test may contribute to identify patients at risk of accelerated decline in global cognition, verbal memory, and processing speed within the first 7 years from diagnosis. [ABSTRACT FROM AUTHOR]

Background and purpose: Myasthenia gravis (MG) is an autoimmune disease with muscular weakness as the only symptom, and often with immunosuppressive treatment. All these aspects could have relevance for the risk of infections as well as their prophylactic and curative treatment.Methods: This is a review article, where Web of Science has been searched for relevant key words and key word combinations. Full papers were selected first by title and then by abstract.Results and conclusions: MG can be triggered and worsened by infections. No virus or other pathogen has been proven to have a specific link to MG. Treatment with immunosuppressive drugs and thymectomy implies a slightly increased risk for infections. Infections should be actively treated, but a few antibiotics are avoided due to potential interference with neuromuscular transmission. Hospitalization and intensive care may be necessary during infections because of MG deterioration and risk of insufficient respiration. Vaccinations are generally recommended in MG, but live microorganisms should be avoided if possible in immunosuppressed patients. [ABSTRACT FROM AUTHOR]

Objective: We explored the effects of playing the piano on patients with cognitive impairment after mild traumatic brain injury (mTBI) and, addressed the question if this approach would stimulate neural networks in re-routing neural connections and link up cortical circuits that had been functional inhibited due to disruption of brain tissue. Functional neuroimaging scans (fMRI) and neuropsychological tests were performed pre-post intervention. Method: Three groups participated, one mTBI group (n = 7), two groups of healthy participants, one with music training (n = 11), one baseline group without music (n = 12). The music groups participated in 8 weeks music-supported intervention. Results: The patient group revealed training-related neuroplasticity in the orbitofrontal cortex. fMRI results fit well with outcome from neuropsychological tests with significant enhancement of cognitive performance in the music groups. Ninety per cent of mTBI group returned to work post intervention. Conclusion: Here, for the first time, we demonstrated behavioural improvements and functional brain changes after 8 weeks of playing piano on patients with mTBI having attention, memory and social interaction problems. We present evidence for a causal relationship between musical training and reorganisation of neural networks promoting enhanced cognitive performance. These results add a novel music-supported intervention within rehabilitation of patients with cognitive deficits following mTBI. [ABSTRACT FROM AUTHOR]

Myasthenia gravis (MG) is an autoimmune disorder mediated by antibodies against proteins at the neuromuscular junction. Juvenile-onset MG (JMG) has been reported to have special characteristics. It is still unclear whether there are any pathogenic and genetic differences between juvenile and adult MG. In this study, we evaluated the clinical characteristics, autoantibody status (antibodies against AChR, MuSK, LRP4, titin and RyR) and genetic susceptibility (CHRNA1, CTLA4 and AIRE) in 114 Chinese JMG patients, and compared with 207 young adult MG patients (onset age 18-40 years). JMG patients were classified into two subgroups: the very early onset group (<8 years) and puberty onset group (8-18 years). The very early onset MG patients had a higher proportion of ocular MG and thymus hyperplasia, compared with puberty onset MG and young adult MG ( P < 0.05). AChR antibodies were found in majority of JMG patients and were associated with more severe disease ( P < 0.05), while other antibodies were rare in JMG. Moreover, the very early onset MG had a more prominent genetic predisposition than puberty and adult MG, affecting the susceptible genes CHRNA1 and CTLA4. JMG has the same pathogenic background as adult MG, but has typical clinical features and a prominent genetic predisposition in very early onset patients (<8 years). Specific therapeutic considerations are needed. [ABSTRACT FROM AUTHOR]

Background: Familial aggregation has been described in PD of both early and late onset, but has not been studied in a true population-based sample. Moreover, little is known about its association with disease progression and endophenotypes.Objectives: The objectives of this work were to determine familial aggregation of idiopathic PD in a population-based cohort and study the association with clinical endophenotypes and disease progression.Methods: We examined family history data from the Norwegian ParkWest study, a well-characterized, population-based cohort of incident PD patients and age-matched healthy controls. Family data were collected at baseline with a simplified questionnaire (192 cases and 193 controls) and after 3 years of longitudinal follow-up using an extended questionnaire (172 cases and 171 controls).Results: Compared to the controls, the PD patients had an increased relative risk of having a first-degree relative with PD when using the extended questionnaire (relative risk = 1.988; P = 0.036), but not when using the simplified questionnaire (relative risk = 1.453; P = 0.224). There was no significant difference in age of onset or motor subtype (P = 0.801). However, cases with a family history of PD had reduced progression over 7 years as measured by UPDRS II (P = 0.008) and smaller rate of decrease of MMSE (P = 0.046).Conclusions: Our findings confirm familial aggregation in a population-based cohort of idiopathic PD. Moreover, we show that positive family history of PD in patients is associated with a slower progression of PD symptoms and cognitive decline. © 2016 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Defining both a threshold of progression and the optimal endpoint for clinical trials on radiation therapy for benign meningiomas is difficult. In fact, the growth rates of meningiomas are variable, overall survival (OS) is often very long, and progression-free survival (PFS) requires long-term follow-up. To assess radiation response various strategies have been evaluated. Although most of the published studies describe the criteria for control assessment, there is no uniform definition. Volumetric analysis of magnetic resonance imaging (MRI) imaging has been proposed as the most appropriate method for detecting change in slowly evolving brain tumors. In this scenario, we analyzed this method in post-radiosurgical intracranial meningiomas as part of a prospective clinical trial. The primary aim of the present study was to validate a volumetric assessment method after fractionated radiosurgery or fractionated stereotactic radiotherapy (fSRS) for benign intracranial meningiomas. Secondary aims were evaluation of a cut-off to define progression, stable or partial response and volumetric response after fSRS treatment. To validate the volumetric assessment, we appraised delta values (ΔV) of volume variations. To evaluate tumor response, a volumetric analysis has been performed by means of co-registration of each follow-up MRI on baseline MRI and contouring of the lesion on each post-treatment exam. Overall, 150 patients were considered eligible for the purpose of the volumetric analysis. After a mean followup of 60.5 months (SD 17.45, median 59, range 14–101 months) the median reduction in tumor volume was -21.26%, (range -82.26% to 91.36%) to reach a median final tumor of 8.65 cm3 (range 0.38 - 56.28 cm3) that differed significantly from baseline (p < 0.001). Among 150 irradiated meningiomas, 75 (50%) ultimately regressed, 67 (45%) remained stable, and 8 (5%) progressed. Baseline volumes were similar in each group (p = 0.092), and final volumes were significantly larger in tumors that progressed (p < 0.001) supporting the use of a ΔV of 20% as a cutoff for progression. The mean %ΔV became significantly different by 10 months, with continued diversion up to 36 months. Our results suggest quantitative volumetric assessment of tumor response to fSRS may help clinicians to better understand early response profiles and provide a valuable tool for patient management following fSRS for meningiomas. [ABSTRACT FROM AUTHOR]

Background: Patients with meningiomas are typically treated with maximal safe surgical resection. After subtotal resection or at the time of tumor recurrence, stereotactic radiosurgery (SRS) is often used as the treatment of choice. While contrast-enhanced magnetic resonance imaging (MRI) is typically used for SRS target delineation, differentiating tumor growth from postoperative change can be challenging. 68Ga-DOTATATE, a positron emission tomography (PET) radiotracer targeting the somatostatin receptor type 2 (SSTR2), has been shown to be a reliable biomarker of meningiomas. Objective: The aim of this study was to evaluate the impact of 68Ga-DOTATATE on treatment planning in patients who had previously undergone meningioma resection. Methods: We present a consecutive case series of 13 patients with histologically-proven meningioma who received a 68Ga-DOTATATE PET between April 2019 and April 2021. Treatment planning was done at first using MRI only. The DOTATATE-PET images were then used to assess the accurate identification of tumor. Results: Ten of the patients had WHO grade 2 meningioma and three patients had grade 1 tumor. Nine patients had recurrent meningiomas and four patients had newly diagnosed disease. Overall, the 68Ga-DOTATATE PET scan led to a change in the previously formulated treatment plans in 6 of 13 patients. Additionally, 8 of the 13 patients had foci of disease not appreciated on post-contrast MRI. Conclusion: In this series, incorporation of 68GaDOTATATE PET imaging had clinical utility for most patients in whom it was used. It proved particularly useful in demonstrating intraosseous meningiomas, differentiating between recurrence and post-operative changes, and identifying sub-centimeter foci of disease. We recommend incorporating this imaging method as part of postoperative SRS for patients with meningiomas. [ABSTRACT FROM AUTHOR]

Background: There is no consensus for the management of incidental meningiomas. The literature on long-term growth dynamics is sparse and the natural history of these tumors remains to be illuminated. Methods: We prospectively assessed long-term tumor growth dynamics and survival rates during active monitoring of 62 patients (45 female, mean age 63.9) harbouring 68 tumors. Clinical and radiological data was obtained every 6 months for two years, then annually. Results: The natural history of incidental meningiomas during 12 years of monitoring was growth (p < 0.001). However, mean growth decelerated and became insignificant at 1.5 years. Self-limiting growth patterns were seen in 43 (63.2 %) tumors, non-self-limiting in 20 (29.4%) and 5 (7.4 %) were indecisive due to ≤ 2 measurements. Decelerating growth persisted once established. During follow-up, 38 (97.4 %) of 39 tumor treatments were initiated within 5 years. None developed symptoms prior to intervention. Tumor volume (p < 0.001) and relation to venous sinuses (p = 0.039) correlated with more aggressive growth. Since inclusion 16 (25 %) patients died of unrelated causes and 2 (3 %) from atypical tumors. Conclusion: Active monitoring seems an optimal first line management for incidental meningiomas. Intervention was avoided in > 40 % with indolent tumors. Nearly all treatments were initiated within five years and were not compromised by tumor growth. Clinical follow-up seems sufficient beyond five years if self-limiting growth is established. Tumors with steady or accelerating growth warrant monitoring until they reach a stable state or treatment is mandatory. [ABSTRACT FROM AUTHOR]