Annals of Neurology最新文献

{"title":"Intravenous Thrombolysis Use before Inter-Facility Transfer for Thrombectomy: Association with Efficacy and Safety Outcomes.","authors":"Pierre Seners, Michael Mlynash, Adrien Ter Schiphorst, Anke Wouters, Nicole Yuen, Caroline Arquizan, Jeremy J Heit, Denis Sablot, Anne Wacongne, Thibault Lalu, Vincent Costalat, Gregory W Albers, Maarten G Lansberg","doi":"10.1002/ana.27303","DOIUrl":"https://doi.org/10.1002/ana.27303","url":null,"abstract":"<p><strong>Objective: </strong>Patients with acute ischemic stroke and large vessel occlusion (LVO) often require transfer from primary stroke centers (PSCs) to thrombectomy-capable centers. This study assessed the efficacy and safety of intravenous thrombolysis (IVT) initiated before inter-hospital transfer.</p><p><strong>Methods: </strong>Data from 2 prospective cohorts of patients with anterior circulation LVO transferred for thrombectomy from a PSC, regardless of whether thrombectomy was eventually attempted at the endovascular-capable center, were analyzed. Efficacy outcomes included good 3-month functional outcome (modified Rankin scale [mRS] = 0-2), excellent functional outcome (mRS = 0-1), and arterial recanalization during transfer. Safety outcomes included any intracerebral hemorrhage (ICH) and symptomatic ICH (sICH) at 24 hours. Propensity score with overlap weighting balanced the covariates between patients treated with IVT versus those without.</p><p><strong>Results: </strong>Of 521 patients, 260 (50%) received IVT before transfer. IVT was withheld mainly due to being outside the 4.5-hour window (58%) or anticoagulant use (21%). Median age was 72 years, 55% were men, and median baseline National Institutes of Health Stroke Scale (NIHSS) was 15. After propensity score with overlap weighting, patients receiving IVT more frequently had good functional outcome (odds ratio [OR] = 2.17, 95% confidence interval [CI] = 1.43-3.30, p < 0.01), excellent functional outcome (OR = 1.99, 95% CI = 1.21-3.25, p < 0.01), and inter-facility recanalization (OR = 5.64, 95% CI = 2.92-10.89, p < 0.01) compared with patients not treated with IVT. Any ICH (OR = 1.14, 95% CI = 0.76-1.70) and sICH (OR = 0.73, 95% CI = 0.36-1.51) rates were similar between groups.</p><p><strong>Interpretation: </strong>IVT before transfer was associated with improved recanalization and functional outcomes without increasing safety risks but is used in only 50% of patients. Expanding IVT criteria, including treatment beyond 4.5 hours and in anticoagulated patients, should be explored. ANN NEUROL 2025.</p>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144323950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric RNS Lead Migration: Wandering Eyes or Electrode?","authors":"Charuta Joshi MBBS, MSCS,&nbsp;Daniel Veltkamp MD,&nbsp;Cathleen Dodez BBA,&nbsp;Aaron E. L. Warren PhD,&nbsp;Deepa Sirsi MD,&nbsp;Afsaneh Talai MD,&nbsp;Rana Said MD,&nbsp;Angela Price MD","doi":"10.1002/ana.27273","DOIUrl":"10.1002/ana.27273","url":null,"abstract":"&lt;p&gt;Neuromodulation with responsive neurostimulation (RNS, NeuroPace, Mountain View, CA) is increasingly being used off-label in pediatric drug-resistant epilepsy (pDRE).&lt;/p&gt;&lt;p&gt;A 7-year-old boy, with RNS depth electrodes targeting bilateral thalamic centromedian nucleus (CM); developed paroxysmal bilateral esotropia (left &gt; right) 52 weeks after initial implantation. Esotropia worsened over 3 weeks and was discovered to be caused by a ventrally migrated left CM electrode.&lt;/p&gt;&lt;p&gt;Bilateral CM implantation of narrowly spaced (3.5 mm) 13.6 mm RNS electrodes was achieved using direct magnetic resonance imaging (MRI) visualization and Robotic Surgical Assistant (ROSA) guidance after extensive presurgical evaluation. The RNS battery was housed over the right parietal region, with the left CM electrode inserted via a 2.5 mm left frontal burr hole. A lead protector sheath covered the electrode and was secured with a “dogbone” titanium cranial plate provided by NeuroPace. A 50% seizure reduction was achieved after 6 months, and stepwise charge density increases were well tolerated without adverse effects. At 40 weeks, the mother reported increased seizures and at 50 weeks, “tilting head to one side” and drifting of the left eye; which seemed to be “floating around.” This was initially attributed to a refractive error. At 52 weeks, the family reported an episode of eyes “going in all directions” and occasional loss of vision. Urgent head computed tomography (CT) was initially reported as unchanged. The patient displayed left head tilt and intermittent right head turn. Neurologic examination, notable for intermittent esotropia (left &gt; right; see Fig 1A) with normal mental status, pupillary response, and full eye excursions directed localization hypothesis to the midbrain. CT images were re-examined with co-registration to preoperative MRI and ROSA coordinates, confirming an 8 mm ventral and medial migration of the left CM electrode into the midbrain (see Fig 1A).&lt;/p&gt;&lt;p&gt;Comparison to anatomic atlases using Lead-DBS software,&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; including previously published atlases of brainstem tractography&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; and histology&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; (see Fig 1B), revealed that the left CM tip had crossed the midline and was located within the medial longitudinal fasciculus (MLF), immediately adjacent to the oculomotor nucleus and approximately 3 mm anterior to the periaqueductal gray area.&lt;/p&gt;&lt;p&gt;Within a few minutes of disabling RNS stimulation, the eye movements normalized. During surgical admission for left CM electrode repositioning, the abnormal eye movements were reproduced (medial deviation L &gt; R, non-reproducible downward deviation without pupil changes) with stimulation of the 3 deepest left CM electrode contacts, but not with the remaining 4 right CM or the most superficial left CM contact. Intraoperative exposure revealed distal migration of the left CM electrode sheath protector from under the securing “dogbone","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":"98 2","pages":"354-356"},"PeriodicalIF":8.1,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ana.27273","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144323951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Annals of Neurology: Volume 98, Number 1, July 2025","authors":"","doi":"10.1002/ana.26985","DOIUrl":"https://doi.org/10.1002/ana.26985","url":null,"abstract":"","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":"98 1","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ana.26985","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144308753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebrospinal Fluid Metabolome in Central Nervous System Infections: A Study of Diagnostic Accuracy.","authors":"Steven L Staal, Sabine E Olie, Michel van Weeghel, Bauke V Schomakers, Frédéric M Vaz, Diederik van de Beek, Matthijs C Brouwer","doi":"10.1002/ana.27291","DOIUrl":"https://doi.org/10.1002/ana.27291","url":null,"abstract":"<p><strong>Objective: </strong>To assess the diagnostic accuracy of metabolites in cerebrospinal fluid (CSF) for central nervous system (CNS) infections.</p><p><strong>Methods: </strong>Patients were derived from three prospective cohort studies in the Netherlands. All studies included adults suspected of a CNS infection who underwent a diagnostic lumbar puncture. Metabolomics was performed on CSF using ultra-high-performance liquid chromatography with tandem mass spectrometry on a discovery and validation cohort. Metabolite quantification was the index test; a microbiologically confirmed diagnosis was the reference standard.</p><p><strong>Results: </strong>In total, 343 episodes were included, of whom 170 (50%) had a CNS infections and 173 (50%) episodes had other diagnoses. CNS infections included bacterial meningitis in 88 (26%), viral meningoencephalitis in 50 (15%), and other CNS infections in 32 (9%) episodes. Other diagnoses consisted of CNS autoimmune disorders in 21 (6%), other neurological diseases in 84 (24%), and systemic infections in 68 (20%) episodes. A distinct metabolomic profile was observed in CSF of CNS infections, particularly bacterial meningitis. Glucose, glycerate, 1.3-diphosphoglyceric acid, pyruvate, lactate, taurine, and alpha-ketoglutarate had the highest diagnostic accuracy (area under the curve 0.87 to 0.95). Combinations further improved diagnostic accuracy, resulting in models that outperformed both individual metabolites and CSF leukocytes. Episodes with CSF leukocytes between 5 and 1,000 cells per mm³ showed similar results.</p><p><strong>Interpretation: </strong>CSF metabolites demonstrate high diagnostic accuracy for CNS infections, particularly bacterial meningitis. Combinations further improve the diagnostic performance, exceeding that of CSF leukocytes alone. These findings highlight the potential of cerebrospinal fluid metabolites to improve diagnostic accuracy in clinical practice. ANN NEUROL 2025.</p>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood α-Synuclein Separates Parkinson's Disease from Dementia with Lewy Bodies.","authors":"George T Kannarkat, Rebecca Zack, R Tyler Skrinak, James F Morley, Roseanne Davila-Rivera, Sanaz Arezoumandan, Katherine Dorfman, Kelvin Luk, David A Wolk, Daniel Weintraub, Thomas F Tropea, Edward B Lee, Sharon X Xie, Ganesh Chandrasekaran, Virginia M-Y Lee, David Irwin, Rizwan S Akhtar, Alice S Chen-Plotkin","doi":"10.1002/ana.27288","DOIUrl":"10.1002/ana.27288","url":null,"abstract":"<p><strong>Objective: </strong>Aggregation of misfolded α-synuclein (aSyn) within the brain is the pathologic hallmark of Lewy body diseases (LBDs), including Parkinson's disease (PD), and dementia with Lewy bodies (DLB) disease. Although evidence exists for aSyn \"strains,\" conformations with distinct biological properties, biomarkers for PD versus DLB are lacking. Here, we used monoclonal antibodies selective for two different in vitro aSyn species - termed strain A and B - to evaluate human brain tissue, cerebrospinal fluid (CSF), and plasma.</p><p><strong>Methods: </strong>Using these antibodies, we characterized specific aSyn species in human specimens from neurologically normal individuals and individuals with LBD using enzyme-linked immunosorbent assay (ELISA), Western blot, and immunohistochemistry. We also characterized aSyn species immunoprecipitated from brain lysate or plasma with these antibodies using seed amplification assays (SAAs) and a cellular model.</p><p><strong>Results: </strong>Surprisingly, levels of strain A and B aSyn species were higher in plasma from individuals with PD compared to DLB in 2 independent cohorts. Lower levels of plasma aSyn strain A species predicted a faster rate of cognitive decline in individuals with PD. Furthermore, strain A and strain B aSyn species were undetectable in CSF, and their levels in brain versus plasma did not correlate. Moreover, plasma aSyn species isolated by aSyn strain antibodies could template aSyn fibrillization, and they could seed formation of aSyn inclusions in cells.</p><p><strong>Interpretation: </strong>Our findings suggest that circulating plasma aSyn strains may impact LBD clinical presentation, particularly cognition. The enrichment of these aSyn species in plasma but not CSF also suggests a potential source outside the brain. ANN NEUROL 2025.</p>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":" ","pages":""},"PeriodicalIF":7.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12262490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Scale of Neurodegeneration in Moderate-to-Severe Traumatic Brain Injury: A Systematic Review of Longitudinal Studies.","authors":"Bhanu Sharma, Leanne Monteiro, Alana Changoor, Brenda Colella, Robin Green","doi":"10.1002/ana.27279","DOIUrl":"https://doi.org/10.1002/ana.27279","url":null,"abstract":"<p><strong>Objective: </strong>Although moderate-to-severe traumatic brain injury (msTBI) was once considered a static neural event following resolution of acute injuries, numerous studies now demonstrate progressive losses to volume and white matter integrity in the months and years postinjury, leading to a paradigm shift in our understanding. These findings have yet to be synthesized. Therefore, our objective was to assimilate longitudinal studies of chronic msTBI to better elucidate the scale and timelines of neurodegeneration, regions of vulnerability, and ongoing gaps in the literature.</p><p><strong>Methods: </strong>As per our published systematic review protocol (see PROSPERO CRD42019117548), 6 electronic databases were searched from inception to June 2024. Included studies examined adults (> 17) with msTBI, were longitudinal with first acquisition at least 2 months postinjury, and reported whole brain and/or regional volumetrics or fractional anisotropy (FA).</p><p><strong>Results: </strong>We identified 21 studies, with and without controls, and computed annualized percent change for the limited studies with overlapping regions and timelines with sufficient data. Overall, widespread progressive volumetric and FA losses were observed, with no evidence of accelerated progression across time. No volumetric but some FA increases (predominantly nonsignificant) were observed. Annualized percent changes in ascending order were: total grey matter volume (-0.28%), total white matter volume (-0.65%), hippocampal volume (-1.98%, bilaterally), and corpus callosum FA (-3.15%).</p><p><strong>Interpretation: </strong>Gaps in our understanding include mechanisms of degeneration, whether progressive losses remain constant or attenuate with time, and how patterns vary by region. Longitudinal research with 3 timepoints, standardized reporting, and additional outcome modalities (eg, functional magnetic resonance imaging [fMRI], and blood biomarkers) would refine our understanding and inform treatment research. ANN NEUROL 2025.</p>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of Neuropsychiatric Conditions in United States Resettled Refugees at a Single Academic Center","authors":"Noor F. Shaik MD, PhD,&nbsp;Uttara Gadde MD,&nbsp;Aba Y. Barden-Maja MD","doi":"10.1002/ana.27296","DOIUrl":"10.1002/ana.27296","url":null,"abstract":"<p>Neuropsychiatric diseases are common among forcibly displaced persons, and a better understanding is needed to improve screening and treatment efforts. We performed a retrospective cross-sectional study at a single academic center looking at neuropsychiatric diagnoses of United States resettled refugees presenting for their domestic medical examination. Over one-third (33%) of our study population had at least one neuropsychiatric diagnosis. Although globally and in the United States, leading causes of neurological disease are stroke, dementia, and migraines, in our clinic the predominant etiologies were headache disorders, peripheral nerve disorders, and traumatic brain injury, highlighting a need for broadening screening at this initial visit. ANN NEUROL 2025;98:231–235</p>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":"98 2","pages":"231-235"},"PeriodicalIF":8.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ana.27296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual Features in Stereo-Electroencephalography to Predict Surgical Outcome: A Multicenter Study.","authors":"Chifaou Abdallah, John Thomas, Olivier Aron, Tamir Avigdor, Kassem Jaber, Irena Doležalová, Daniel Mansilla, Päivi Nevalainen, Prachi Parikh, Jaysingh Singh, Sandor Beniczky, Philippe Kahane, Lorella Minotti, Stephan Chabardes, Sophie Colnat-Coulbois, Louis Maillard, Jeff Hall, Francois Dubeau, Jean Gotman, Christophe Grova, Birgit Frauscher","doi":"10.1002/ana.27278","DOIUrl":"https://doi.org/10.1002/ana.27278","url":null,"abstract":"<p><strong>Objective: </strong>Epilepsy surgery needs predictive features that are easily implemented in clinical practice. Previous studies are limited by small sample sizes, lack of external validation, and complex computational approaches. We aimed to identify and validate visually stereo-electroencephalography (SEEG) features with the highest predictive value for surgical outcome, and assess the reliability of their visual extraction.</p><p><strong>Methods: </strong>We included 177 patients with drug-resistant epilepsy who underwent SEEG-guided surgery at 4 epilepsy centers. We assessed the predictive performance of 10 SEEG features from various SEEG periods for surgical outcome, using the area under the receiver operating characteristic curve, and considering resected channels and surgical outcome as the gold standard. Findings were validated externally using balanced accuracy. Six experts, blinded to outcome, evaluated the visual reliability of the optimal feature using interrater reliability, percentage agreement (standard deviation ± SD) and Gwet's kappa (κ ± SD).</p><p><strong>Results: </strong>The derivation cohort comprised 100 consecutive patients, each with at least 1-year of postoperative follow up (40% temporal lobe epilepsy; 42% Engel Ia). Spatial co-occurrence of gamma spikes and preictal spikes emerged as the optimal predictive feature of surgical outcome (area under the receiver operating characteristic curve 0.82). Applying the optimized threshold from the derivation cohort, external validation in 2 datasets showed similar performances (balanced accuracy 69.2% and 73.2%). Expert interrater reliability for gamma spikes (percentage agreement, 96% ± 2%; κ, 0.63 ± 0.16) and preictal spikes (percentage agreement, 92% ± 2%; κ, 0.65 ± 0.18) were substantial.</p><p><strong>Interpretation: </strong>Spatial co-occurrence of gamma spikes and preictal spikes predicts surgical outcome. These visually identifiable features may reduce the burden of SEEG analysis by reducing analysis time, and improve outcome by guiding surgical resection margins. ANN NEUROL 2025.</p>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Relationship between Rest Tremor and Underlying Lewy Pathology in Essential Tremor: A Clinical-Pathological Study of 201 Cases.","authors":"Elan D Louis, Nora C Hernandez, Tomer Guy, Phyllis L Faust","doi":"10.1002/ana.27302","DOIUrl":"https://doi.org/10.1002/ana.27302","url":null,"abstract":"<p><strong>Objectives: </strong>Prospective studies demonstrated that essential tremor is a risk factor for Parkinson's disease. Identifying clinical markers for conversion from essential tremor to essential tremor-Parkinson's disease would be of considerable value. Rest tremor can be present in advanced essential tremor and may be a harbinger of conversion. We examined (1) the brain distribution and severity of Lewy pathology and (2) whether patients met pathologically based criteria for Lewy body disease in relation to (1) the presence and severity of isolated rest tremor and (2) the diagnosis of essential tremor-Parkinson's disease during life.</p><p><strong>Methods: </strong>Two hundred one essential tremor brains in the Essential Tremor Centralized Brain Repository underwent deep clinical phenotyping and complete neuropathological assessment, including assessment of Lewy pathology with α-synuclein immunostaining.</p><p><strong>Results: </strong>Clinical diagnoses were essential tremor (93.5%), essential tremor with possible Parkinson's disease (3.5%), and essential tremor-Parkinson's disease (3.0%). Among 188 with essential tremor, 90 (47.9%) had rest tremor; 75.6% with rest tremor did not have Lewy pathology and 80% were not assigned pathological diagnoses of Lewy body disease. Rest tremor increased the odds of a pathological diagnosis of Lewy body disease (odds ratios = 1.98-2.73), but its positive predictive value was only 20.0 to 25.6%.</p><p><strong>Interpretation: </strong>In clinical practice, isolated rest tremor should be viewed as a finding that is associated with increased odds of Parkinson's disease but not, in the large majority of cases, indicative of underlying Lewy body disease. Our quantitative data can be conveyed to patients to provide prognostic information in discussions of risk stratification. ANN NEUROL 2025.</p>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Cognitive Profiles of Individuals with Alzheimer's Disease and Comorbid Seizures.","authors":"Anny Reyes, Ifrah Zawar, Vineet Punia, Rani A Sarkis, Jaideep Kapur, Robyn M Busch, Mark W Bondi, David P Salmon, Bruce P Hermann, Carrie R McDonald","doi":"10.1002/ana.27284","DOIUrl":"10.1002/ana.27284","url":null,"abstract":"<p><strong>Objective: </strong>Seizures are a highly prevalent comorbidity in Alzheimer's disease (AD), with a 2- to 6-fold increased risk, and are associated with accelerated cognitive decline. Despite growing research on seizure detection and treatment in AD, the cognitive profiles of individuals with both AD and seizures remain poorly characterized using comprehensive neuropsychological methods.</p><p><strong>Methods: </strong>Clinical and cognitive data from individuals age 65+ with AD were analyzed from the National Alzheimer's Coordinating Center (NACC) dataset. Cognitive domains assessed included memory, language, attention, processing speed, and executive function. Raw scores were converted into z-scores using a control sample (n = 14,665). Group comparisons were conducted using independent t tests, χ² tests, and Kruskal-Wallis tests, and logistic regression was used to examine factors associated with seizures.</p><p><strong>Results: </strong>Among 9,662 individuals with AD, 1.2% (n = 117) had active seizures (AD-S). The AD-S group was younger, had higher stroke and transient ischemic attack rates, earlier cognitive decline, longer symptom duration, cognitive fluctuations, abrupt cognitive changes, and worse cognitive and functional outcomes. Cognitive deficits in AD-S, particularly in executive function and processing speed, persisted after adjusting for dementia severity. Compared to vascular dementia, AD-S individuals exhibited greater impairments in fluency, naming, and processing speed.</p><p><strong>Interpretation: </strong>Comorbid AD and seizures are associated with distinct cognitive and clinical profiles, greater vascular disease burden, and more severe dementia. Findings emphasize the need for early seizure detection, comprehensive cognitive evaluations, and research on cerebrovascular contributions to inform targeted interventions. ANN NEUROL 2025.</p>","PeriodicalId":127,"journal":{"name":"Annals of Neurology","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}