JAMA neurology最新文献

{"title":"Temporal Dynamics and Biological Variability of Alzheimer Biomarkers.","authors":"Jihwan Yun, Daeun Shin, Eun Hye Lee, Jun Pyo Kim, Hongki Ham, Yuna Gu, Min Young Chun, Sung Hoon Kang, Hee Jin Kim, Duk L Na, Chi-Hun Kim, Ko Woon Kim, Si Eun Kim, Yeshin Kim, Jaeho Kim, Na-Yeon Jung, Yeo Jin Kim, Soo Hyun Cho, Henrik Zetterberg, Kaj Blennow, Fernando Gonzalez-Ortiz, Nicholas J Ashton, Joseph Therriault, Nesrine Rahmouni, Pedro Rosa-Neto, Michael W Weiner, Sang Won Seo, Hyemin Jang","doi":"10.1001/jamaneurol.2024.5263","DOIUrl":"10.1001/jamaneurol.2024.5263","url":null,"abstract":"<p><strong>Importance: </strong>Understanding the characteristics of discordance between plasma biomarkers and positron emission tomography (PET) results in Alzheimer disease (AD) is crucial for accurate interpretation of the findings.</p><p><strong>Objective: </strong>To compare (1) medical comorbidities affecting plasma biomarker concentrations, (2) imaging and clinical features, and (3) cognitive changes between plasma biomarker and PET discordant and concordant cases.</p><p><strong>Design, setting, and participants: </strong>This multicenter cohort study, conducted between 2016 and 2023, included individuals with unimpaired cognition, mild cognitive impairment, or Alzheimer-type dementia, who had both amyloid β (Aβ) PET imaging and plasma biomarkers. A subset of participants also underwent tau PET imaging.</p><p><strong>Exposures: </strong>Participants were categorized into 4 groups based on their plasma and PET biomarker results: plasma-/PET-, plasma+/PET-, plasma-/PET+, and plasma+/PET+.</p><p><strong>Main outcomes and measures: </strong>Clinical characteristics were compared between the 4 groups, focusing on the discordant groups.</p><p><strong>Results: </strong>A total of 2611 participants (mean [SD] age was 71.2 [8.7] years; 1656 female [63.4%]), of whom 124 additionally underwent tau PET, were included. Among the plasma biomarkers, phosphorylated tau (p-tau) 217 exhibited the highest concordance rate with Aβ (2326 of 2571 [90.5%]) and tau (100 of 120 [83.3%]) PET. The p-tau217+/Aβ PET- group was older (mean [SD] age, 75.8 [7.2] years vs 70.0 [8.8] years; P < .001) with a higher prevalence of hypertension (56 of 152 [36.8%] vs 266 of 1073 [25.0%]), diabetes (40 of 152 [26.3%] vs 156 of 1059 [14.7%]), and chronic kidney disease (17 of 152 [11.2%] vs 21 of 1073 [2.0%]) compared with the p-tau217-/Aβ PET- group (P < .001 for all). Body mass index was higher in p-tau217-/Aβ PET+ than in p-tau217+/Aβ PET+ (mean [SD], 24.1 [2.8] vs 23.1 [3.1], respectively; P = .001; calculated as weight in kilograms divided by height in meters squared). The p-tau217+/Aβ PET- group had lower hippocampal volume (mean [SD], 2555.4 [576.9] vs 2979.1 [545.8]; P < .001) and worse clinical trajectory compared with p-tau217-/Aβ PET- (β = -0.53; P < .001). In contrast, tau PET discordant cases did not show significant differences in medical comorbidities or clinical outcomes compared with the p-tau217-/tau PET- group. Only the p-tau 217+/tau PET+ group demonstrated faster cognitive deterioration compared with the p-tau 217-/tau PET- group (β = -1.66; P < .001).</p><p><strong>Conclusions and relevance: </strong>Results of this cohort study suggest that the mechanisms underlying the discordance between plasma biomarkers and PET findings may be multifaceted, underscoring the need to consider the temporal dynamics and biological variability of plasma biomarkers.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11833660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440815","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":"Computer Vision in Clinical Neurology","authors":"Maximilian U. Friedrich, Samuel Relton, David Wong, Jane Alty","doi":"10.1001/jamaneurol.2024.5326","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.5326","url":null,"abstract":"ImportanceNeurological examinations traditionally rely on visual analysis of physical clinical signs, such as tremor, ataxia, or nystagmus. Contemporary score-based assessments aim to standardize and quantify these observations, but these tools suffer from clinimetric limitations and often fail to capture subtle yet important aspects of human movement. This poses a significant roadblock to more precise and personalized neurological care, which increasingly focuses on early stages of disease. Computer vision, a branch of artificial intelligence, has the potential to address these challenges by providing objective measures of neurological signs based solely on video footage.ObservationsRecent studies highlight the potential of computer vision to measure disease severity, discover novel biomarkers, and characterize therapeutic outcomes in neurology with high accuracy and granularity. Computer vision may enable sensitive detection of subtle movement patterns that escape the human eye, aligning with an emerging research focus on early disease stages. However, challenges in accessibility, ethics, and validation need to be addressed for widespread adoption. In particular, improvements in clinical usability and algorithmic robustness are key priorities for future developments.Conclusions and RelevanceComputer vision technologies have the potential to revolutionize neurological practice by providing objective, quantitative measures of neurological signs. These tools could enhance diagnostic accuracy, improve treatment monitoring, and democratize specialized neurological care. Clinicians should be aware of these emerging technologies and their potential to complement traditional assessment methods. However, further research focusing on clinical validation, ethical considerations, and practical implementation is necessary to fully realize the potential of computer vision in clinical neurology.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"24 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143427372","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":"Detection of Alzheimer Neuropathology in Alzheimer and Non-Alzheimer Clinical Syndromes With Blood-Based Biomarkers","authors":"Lawren VandeVrede, Hanna Cho, Mark Sanderson-Cimino, Fattin Wekselman, Yann Cobigo, Maria Luisa Gorno-Tempini, Hilary W. Heuer, Joel H. Kramer, Argentina Lario Lago, Dana Leichter, Peter Ljubenkov, Bruce L. Miller, David C. Perry, Gil D. Rabinovici, Julio C. Rojas, Howard J. Rosen, Rowan Saloner, Adam Staffaroni, Gallen Triana-Baltzer, Salvatore Spina, William W. Seeley, Lea T. Grinberg, Hartmuth C. Kolb, Renaud La Joie, Adam L. Boxer","doi":"10.1001/jamaneurol.2024.5017","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.5017","url":null,"abstract":"ImportanceBlood-based biomarkers for Alzheimer disease (AD) are clinically available, but their value is not well understood in syndromes typically associated with frontotemporal lobar degeneration syndromes (FTLD).ObjectiveTo investigate the clinical importance and detectability of AD in FTLD-related neurodegenerative syndromes using 3 plasma biomarkers, phosphorylated tau 217 (p-tau217), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP).Design, Setting, and ParticipantsThis clinicopathological study took place at the University of California San Francisco Alzheimer Disease Research Center from August 2008 to July 2022. Autopsied individuals with clinical evaluation and neuropathological examination, diagnosed with clinical syndromes related to AD (n = 125), frontotemporal lobar degeneration (FTLD; n = 198), or cognitively unimpaired (CU) at the time of evaluation (n = 16) were included.ExposuresAD-related or FTLD-related clinical syndromes or CU.Main Outcomes and MeasuresP-tau217, NfL, and GFAP were measured with single-molecule array (SIMOA). AD was defined as intermediate or high AD neuropathological change (ADNC) at autopsy. Clinical biomarker associations were evaluated using linear regressions. Imaging analyses used bayesian linear mixed-effects modeling.ResultsA total of 349 individuals (191 [55%] male; mean [SD] age at death, 72 [11] years) were included. AD was common in both AD-related syndromes (110/125 [88%]) and FTLD-related syndromes (45/198 [23%]). Neuropathological stage at autopsy was higher in AD-related syndromes (high ADNC: 82/88 [93%] AD vs 13/23 [56%] FTLD), and AD was frequently considered a copathology in FTLD-related syndromes (30/198 [15%]). Plasma p-tau217 concentrations were higher in AD-related syndromes (mean [SD], 0.28 [0.16] pg/mL) than FTLD-related syndromes (mean [SD], 0.10 [0.09] pg/mL) (&lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .05). Plasma p-tau217 concentrations were highest in atypical AD-related syndromes (mean [SD], 0.33 [0.02] pg/mL), followed by typical late-onset amnestic syndromes (mean [SD], 0.27 [0.03] pg/mL). FTLD-related syndromes with AD (mean [SD], 0.19 [0.02] pg/mL) were higher compared to without (mean [SD], 0.07 [0.00] pg/mL). Plasma p-tau217 detected AD neuropathology across syndromes (area under the receiver operating characteristic curve [AUC], 0.95; 95% CI, 0.93-0.97), with slightly better performance in AD-related syndromes (AUC, 0.98; 95% CI, 0.95-1.00) compared to FTLD-related syndromes (AUC, 0.89; 95% CI, 0.83-0.94). NfL and GFAP had lower performance for detecting AD (AUC, 0.73; 95% CI, 0.68-0.78 and AUC, 0.75; 95% CI, 0.67-0.80, respectively) and added little to no diagnostic value either alone or in combinations with p-tau217. The presence of AD in FTLD-related syndromes was associated with lower Mini-Mental State Examination score (mean [SD], −2.90 [1.09]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .05), worse performance on memory (mean [SD] &lt;jats:italic&gt;","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"12 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375363","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":"Aligning Alzheimer Disease Biology With Care.","authors":"Fred B Ketchum, Nathaniel A Chin, Joshua D Grill","doi":"10.1001/jamaneurol.2024.5154","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.5154","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382439","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":"Cognitive Decline After First-Time Transient Ischemic Attack","authors":"Victor A. Del Bene, George Howard, Toby I. Gropen, Michael J. Lyerly, Virginia J. Howard, Russell P. Sawyer, Ronald M. Lazar","doi":"10.1001/jamaneurol.2024.5082","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.5082","url":null,"abstract":"ImportancePrior research suggests reduced cognitive function after transient ischemic attack (TIA). Whether this is directly related to the TIA, a function of preexisting risk factors, or prior cognitive decline remains unclear.ObjectiveTo study if a single, diffusion-weighted image–negative, adjudicated TIA is associated with longitudinal declines in cognition, independent of preexisting risk factors.Design, Setting, and ParticipantsThis was a secondary data analysis from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a population-based cohort following up 30 239 Black and White participants for incident cerebrovascular events. The setting consisted of telephone cognitive assessments. Participants were individuals with first-time TIA, first-time stroke, and asymptomatic community control groups with neuroimaging used for adjudication.ExposuresFirst-time TIA and stroke.Main Outcomes and MeasuresVerbal fluency and memory measures administered biannually. Primary outcome was a composite standardized <jats:italic>z</jats:italic> score, with secondary outcomes individual test performances. Adjusted segmented regression models characterized pre-event and postevent cognition and annual cognitive change.ResultsIncluded in the study were 356 individuals with first-time TIA (mean [SD] age, 66.6 [8.7]; 188 female [53%]) and 965 individuals with first-time stroke (mean [SD] age, 66.8 [8.2]; 494 male [51%]). A total of 14 882 individuals (mean [SD] age, 63.2 [8.6] years; 8439 female [57%]) were included in the asymptomatic control group. Overall cognitive composite before index event was lower in the stroke (−0.25; 95% CI, −0.32 to −0.17) than TIA (−0.05; 95% CI: −0.17 to 0.07; <jats:italic>P</jats:italic> = .005) and asymptomatic (0; 95% CI, −0.03 to 0.03; <jats:italic>P</jats:italic> &amp;amp;lt; .001) groups. After the index event, the cognitive composite of the group with stroke significantly declined (−0.14; 95% CI, −0.21 to −0.07) compared with that of the group with TIA (0.01; 95% CI, −0.10 to 0.12; <jats:italic>P</jats:italic> = .02) and controls (−0.03; 95% CI, −0.05 to −0.01; <jats:italic>P</jats:italic> = .003). The annual decline after the index event was faster (<jats:italic>P</jats:italic> = .001) in the group with TIA (−0.05; 95% CI, −0.06 to −0.03) than that for asymptomatic controls (−0.02; 95% CI, −0.02 to −0.02) but not different from the group with stroke (−0.04; 95% CI, −0.05 to −0.03; <jats:italic>P</jats:italic> = .43).Conclusions and RelevanceResults of this cohort study suggest that despite the quick resolution of stroke symptoms in TIA, there was apparently sufficient impact to be associated with long-term cognitive decline. Whether the underlying mechanisms are by direct or secondary injury and/or interaction with concomitant neurodegenerative factors remains to be elucidated.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"120 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375361","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":"Central Retinal Artery Occlusion With Cilioretinal Artery Sparing After Semaglutide Injection","authors":"Julie M. Shabto, Jin Kyun Oh, Tarun Sharma","doi":"10.1001/jamaneurol.2024.5149","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.5149","url":null,"abstract":"This case report highlights a temporal relationship between the use of a glucagon-like peptide-1 receptor (GLP-1) agonist and the occurrence of central retinal artery occlusion.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"85 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375362","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":"Transient Ischemic Attack-Not So Transient After All!","authors":"Eric E Smith, Babak B Navi","doi":"10.1001/jamaneurol.2024.5090","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.5090","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382441","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":"Research Priorities in Neuropalliative Care","authors":"Winnie K. Lau, Corey R. Fehnel, Zachary A. Macchi, Ambereen K. Mehta, Manon Auffret, Jori F. Bogetz, Jori E. Fleisher, Jerome J. Graber, Heather E. Leeper, Heena R. Manglani-Terranova, Susanne Muehlschlegel, Emily L. Mroz, Elizabeth J. Pedowitz, Usha Ramanathan, Max Sarmet, Nathan A. Shlobin, Leonard Sokol, Susan Allyson Weeks, Jiayun Xu, Helen Bundy Medsger, Claire J. Creutzfeldt, Ana-Maria Vranceanu, Darin B. Zahuranec, David Y. Hwang","doi":"10.1001/jamaneurol.2024.4932","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4932","url":null,"abstract":"ImportanceThe integration of palliative care in neurology, or neuropalliative care, is an emerging area of practice focused on holistically improving quality of life and reducing the burden of suffering for people living with serious neurologic disease and their care partners. Major neurology and palliative care societies have recognized the need to advance primary and specialty palliative care services for people with neurologic disease. However, research to support this work is in its early stages.ObservationsThe International Neuropalliative Care Society Research Committee convened an interdisciplinary panel of experts, including clinicians, scientists, people with neurologic disease, and care partners, to identify priority research areas for the advancement of neuropalliative care as a field. Three priority areas highlighted in this review include (1) patient- and care partner–centered symptoms and outcomes specific to neurologic illness and tools for their assessment, (2) development of effective neuropalliative care interventions and delivery models, and (3) methods to support the ability to foster, deliver, and measure goal-concordant care over time.Conclusions and RelevanceThis Special Communication outlines some of the most pressing neuropalliative care research needs, the advancement of which will best serve patients of all ages living with serious neurologic diseases and their care partners. Research funding mechanisms are needed to support and sustain impactful work in this field.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"10 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143077158","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":"Is It Really Itching?","authors":"William G Ondo","doi":"10.1001/jamaneurol.2024.4830","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4830","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079961","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":"Is It Really Itching?-Reply.","authors":"Rafi Hadad","doi":"10.1001/jamaneurol.2024.4833","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4833","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080024","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}