JAMA neurology最新文献

{"title":"Risk Factors Associated With Late-Onset Epilepsy in Dementia and Mild Cognitive Impairment","authors":"Ifrah Zawar, Mark Quigg, Emily L. Johnson, Soutik Ghosal, Carol Manning, Jaideep Kapur","doi":"10.1001/jamaneurol.2025.0552","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0552","url":null,"abstract":"ImportanceThe risk of developing epilepsy substantially increases after the age of 60 years (late-onset epilepsy [LOE]), particularly in people with cognitive decline ([PWCD] ie, dementia and/or mild cognitive impairment). Epilepsy is associated with worse cognitive and mortality outcomes in PWCD. Identifying PWCD at risk for developing LOE can facilitate early screening and treatment of epilepsy.ObjectiveTo investigate factors associated with LOE in PWCD.Design, Setting, and ParticipantsThis longitudinal, multicenter study is based on participants from 39 US Alzheimer’s Disease Research Centers from September 2005 through December 2021. Of 44 713 participants, 25 119 PWCD were identified. Of these, 14 685 were included who did not have epilepsy at enrollment, had 2 or more visits, and were 60 years or older at the most recent follow-up.ExposureThe association between various factors and LOE development in PWCD was investigated.Main Outcomes and MeasuresThe primary outcome was LOE, defined as seizures starting at or after 60 years of age. Those who did not develop LOE but were 60 years or older at follow-up served as controls. A multivariable Cox regression analysis assessed the association between various factors and LOE. Independent variables included age, sex, and socioeconomic factors (education, race, ethnicity), cardiovascular risks (hypertension, diabetes, hyperlipidemia), cerebrovascular disease (stroke or history of transient ischemic attack [TIA]), other neurologic comorbidities (Parkinson disease [PD], traumatic brain injury), cognition (age at dementia onset, dementia severity, type of dementia [Alzheimer disease (AD) vs non–AD]), genetics (apolipoprotein E4 [<jats:italic>APOE4</jats:italic>] status), lifestyle (alcohol misuse, smoking), and depression.ResultsOf the 14 685 participants (7355 female [50%] and 7330 male [50%]; mean [SD] age, 73.8 [8.5] years) who met the inclusion criteria, 221 participants (1.5%) developed LOE during follow-up. After adjusting for demographics, cardiovascular risks, neurologic comorbidities, genetics, cognitive factors, and depression, the following were associated with a higher risk of developing LOE: <jats:italic>APOE4</jats:italic> allele (adjusted hazard ratio [aHR], 1.39; 95% CI, 1.04-1.86; <jats:italic>P</jats:italic> = .03), dementia onset before age 60 years (aHR, 2.46; 95% CI, 1.53-3.95; <jats:italic>P</jats:italic> < .001), worse cognition (aHR, 2.35; 95% CI, 1.97-2.79; <jats:italic>P</jats:italic> < .001), AD dementia subtype (aHR, 1.68; 95% CI, 1.13-2.49; <jats:italic>P</jats:italic> = .01), stroke/TIA (aHR, 2.03; 95% CI, 1.37-3.01; <jats:italic>P</jats:italic> < .001), and PD (aHR, 2.53; 95% CI, 1.08-5.95; <jats:italic>P</jats:italic> = .03). In sensitivity analysis, using an alternative LOE definition of epilepsy onset after age 65 years revealed the same factors associated with LOE.Conclusion and RelevanceThis study showed that the <jats:italic>APOE4</jat","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"17 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827729","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 Risk of Alzheimer Disease in APOE4 Homozygotes.","authors":"Eric M Reiman,Valentina Ghisays,Jessica B Langbaum","doi":"10.1001/jamaneurol.2025.0639","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0639","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"40 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831615","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":"Tongue Myokymia in IgLON5-IgG Autoimmunity","authors":"Shemonti Hasan, Divyanshu Dubey, Allen Aksamit","doi":"10.1001/jamaneurol.2025.0523","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0523","url":null,"abstract":"This case report discusses a man who tested positive for IgLON5-IgG antibody after intermittent episodes of paresthetic feeling involving the throat and jaw, associated with subtle dysarthria and dysphagia, and upper-extremity paresthesia with piloerection of the forearms.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"6 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827728","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":"Risk of Dementia in Individuals With Emergency Department Visits or Hospitalizations Due to Cannabis","authors":"Daniel T. Myran, Michael Pugliese, Lyndsay D. Harrison, Nathan M. Stall, Colleen Webber","doi":"10.1001/jamaneurol.2025.0530","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0530","url":null,"abstract":"ImportanceCannabis use is associated with short-term memory impairment and long-term changes in brain structure; however, little is known about whether disordered cannabis use is associated with an increased risk of a dementia diagnosis.ObjectiveTo investigate the association between emergency department visits or hospitalizations (acute care encounters) due to cannabis and future dementia diagnosis.Design, Setting, and ParticipantsPopulation-based, retrospective, matched cohort study using health administrative data from Ontario, Canada, between 2008 and 2021 (with follow-up until 2022) including all individuals aged 45 to 105 years living in Ontario who were eligible and did not have a diagnosis of dementia at cohort entry (2 620 083 individuals excluded).ExposureIndividuals with incident acute care due to cannabis use, defined using <jats:italic>International Classification of Diseases and Related Health Problems, Tenth Revision</jats:italic> coding.Main Outcomes and MeasuresWe used cause-specific adjusted hazard models to compare new diagnoses of dementia (from a validated algorithm) between individuals with acute care due to cannabis use with (1) individuals with all-cause acute care (excluding cannabis), (2) the general population, and (3) individuals with acute care due to alcohol use.ResultsThe study included 6 086 794 individuals, of whom 16 275 (0.3%) had incident acute care due to cannabis use (mean age, 55.2 [SD, 8.3] years; 60.3% male). Annual rates of incident acute care due to cannabis use increased 5.0-fold in individuals aged 45 to 64 years (from 10.16 to 50.65 per 100 000) and 26.7-fold in individuals aged 65 years or older (from 0.65 to 16.99 per 100 000) between 2008 and 2021. Individuals with incident acute care due to cannabis use were at a 1.5-fold and 3.9-fold increased risk of dementia diagnosis within 5 years relative to individuals with all-cause acute care and the general population of the same age and sex, respectively (absolute rates of dementia diagnosis: 5.0% for cannabis-related acute care, 3.6% for all-cause acute care, and 1.3% in the general population). After adjustment for sociodemographics and chronic health conditions, individuals with acute care due to cannabis use remained at elevated risk relative to those with all-cause acute care (adjusted hazard ratio [aHR], 1.23; 95% CI, 1.09-1.39) and the general population (aHR, 1.72; 95% CI, 1.38-2.15). Individuals with acute care due to cannabis use were at lower risk than those with acute care due to alcohol use (aHR, 0.69; 95% CI, 0.62-0.76).Conclusions and RelevanceIndividuals with cannabis use severe enough to require hospital-based care were at increased risk of a new dementia diagnosis compared with those with all-cause hospital-based care or the general population. These findings have important implications considering increasing cannabis use among older adults.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"60 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827726","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":"Mind the Itch","authors":"David Matuskey","doi":"10.1001/jamaneurol.2025.0479","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0479","url":null,"abstract":"This essay details the author’s personal experience with poison ivy itch and the synchronicity of a similar realization for a patient at his former facility.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"37 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790165","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":"Apraxia of Eyelid Opening in Myasthenia Gravis","authors":"Ryan Naum, Jonathan Morena","doi":"10.1001/jamaneurol.2025.0704","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0704","url":null,"abstract":"This case report describes a 61-year-old man with myasthenia gravis initially diagnosed with blepharospasm who was later found to have the nonparalytic disorder apraxia of eyelid opening.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"10 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790152","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":"Cardioprotective Glucose-Lowering Agents and Dementia Risk","authors":"Allie Seminer, Alfredi Mulihano, Clare O’Brien, Finn Krewer, Maria Costello, Conor Judge, Martin O’Donnell, Catriona Reddin","doi":"10.1001/jamaneurol.2025.0360","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0360","url":null,"abstract":"ImportanceAlthough diabetes is a risk factor for dementia, the effect of glucose-lowering therapy for prevention of incident dementia is uncertain.ObjectiveTo determine whether cardioprotective glucose-lowering therapy (sodium-glucose cotransporter-2 inhibitors [SGLT2is], glucagon-like peptide-1 receptor agonists [GLP-1RAs], metformin, and pioglitazone), compared with controls, was associated with a reduction in risk of dementia or cognitive impairment, and among primary dementia subtypes.Data SourcesThe PubMed and Embase databases were searched for studies published from inception of the database to July 11, 2024.Study SelectionRandomized clinical trials comparing cardioprotective glucose-lowering therapy with controls that reported dementia or change in cognitive scores. Cardioprotective glucose-lowering therapies were defined as drug classes recommended by guidelines for reduction of cardiovascular events, based on evidence from phase III randomized clinical trials. Inclusion criteria were assessed independently and inconsistencies were resolved by consensus.Data Extraction and SynthesisData were screened and extracted independently by 2 authors adhering to the PRISMA guidelines in August 2024. Random-effects meta-analysis models were used to estimate a pooled treatment effect.Main Outcomes and MeasuresThe primary outcome measure was dementia or cognitive impairment. The secondary outcomes were primary dementia subtypes, including vascular and Alzheimer dementia, and change in cognitive scores.ResultsTwenty-six randomized clinical trials were eligible for inclusion (N = 164 531 participants), of which 23 trials (n = 160 191 participants) reported the incidence of dementia or cognitive impairment, including 12 trials evaluating SGLT2is, 10 trials evaluating GLP-1RAs, and 1 trial evaluating pioglitazone (no trials of metformin were identified). The mean (SD) age of trial participants was 64.4 (3.5) years and 57 470 (34.9%) were women. Overall, cardioprotective glucose-lowering therapy was not significantly associated with a reduction in cognitive impairment or dementia (odds ratio [OR], 0.83 [95% CI, 0.60-1.14]). Among drug classes, GLP-1RAs were associated with a statistically significant reduction in dementia (OR, 0.55 [95% CI, 0.35-0.86]), but not SGLT2is (OR, 1.20 [95% CI, 0.67-2.17]; <jats:italic>P</jats:italic> value for heterogeneity = .04).Conclusions and RelevanceWhile cardioprotective glucose-lowering therapies were not associated with an overall reduction in all-cause dementia, this meta-analysis of randomized clinical trials found that glucose lowering with GLP-1RAs was associated with a statistically significant reduction in all-cause dementia.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"25 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790169","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":"GLP-1RA and SGLT2i Medications for Type 2 Diabetes and Alzheimer Disease and Related Dementias","authors":"Huilin Tang, William T. Donahoo, Steven T. DeKosky, Yao An Lee, Pareeta Kotecha, Mikael Svensson, Jiang Bian, Jingchuan Guo","doi":"10.1001/jamaneurol.2025.0353","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0353","url":null,"abstract":"ImportanceThe association between glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) and risk of Alzheimer disease and related dementias (ADRD) remains to be confirmed.ObjectiveTo assess the risk of ADRD associated with GLP-1RAs and SGLT2is in people with type 2 diabetes (T2D).Design, Setting, and ParticipantsThis target trial emulation study used electronic health record data from OneFlorida+ Clinical Research Consortium from January 2014 to June 2023. Patients were 50 years or older with T2D and no prior diagnosis of ADRD or antidementia treatment. Among the 396 963 eligible patients with T2D, 33 858 were included in the GLP-1RA vs other glucose-lowering drug (GLD) cohort, 34 185 in the SGLT2i vs other GLD cohort, and 24 117 in the GLP-1RA vs SGLT2i cohort.ExposuresInitiation of treatment with a GLP-1RA, SGLT2i, or other second-line GLD.Main Outcomes and MeasuresADRD was identified using clinical diagnosis codes. Hazard ratios (HRs) with 95% CIs were estimated using Cox proportional hazard regression models with inverse probability of treatment weighting (IPTW) to adjust for potential confounders.ResultsThis study included 33 858 patients in the GLP-1RA vs other GLD cohort (mean age, 65 years; 53.1% female), 34 185 patients in the SGLT2i vs other GLD cohort (mean age, 65.8 years; 49.3% female), and 24 117 patients in the GLP-1RA vs SGLT2i cohort (mean age, 63.8 years; 51.7% female). In IPTW-weighted cohorts, the incidence rate of ADRD was lower in GLP-1RA initiators compared with other GLD initiators (rate difference [RD], −2.26 per 1000 person-years [95% CI, −2.88 to −1.64]), yielding an HR of 0.67 (95% CI, 0.47-0.96). SGLT2i initiators had a lower incidence than other GLD initiators (RD, −3.05 per 1000 person-years [95% CI, −3.68 to −2.42]), yielding an HR of 0.57 (95% CI, 0.43-0.75). There was no difference between GLP-1RAs and SGLT2is, with an RD of −0.09 per 1000 person-years (95% CI, −0.80 to 0.63) and an HR of 0.97 (95% CI, 0.72-1.32).Conclusion and RelevanceIn people with T2D, both GLP-1RAs and SGLT2is were statistically significantly associated with decreased risk of ADRD compared with other GLDs, and no difference was observed between both drugs.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"64 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790172","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 Regulatory Landscape for Clinical Metagenomic Testing","authors":"Charles Y. Chiu, F. Xavier López-Labrador, Michael R. Wilson, Jutte J. C. de Vries","doi":"10.1001/jamaneurol.2025.0461","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0461","url":null,"abstract":"This Viewpoint discusses regulatory shifts and their effects on access to innovative diagnostic tests and provides ways to address regulatory barriers for clinical metagenomic testing.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"16 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790153","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":"Use of a Robot-Assisted Thrombectomy System in Acute Ischemic Stroke","authors":"Ming Yang, Haoquan Sun, Lei Li, Qi Wu, Xingkai Yang, Shen Qu, Feng Gao","doi":"10.1001/jamaneurol.2025.0418","DOIUrl":"https://doi.org/10.1001/jamaneurol.2025.0418","url":null,"abstract":"This observational study examines the feasibility and safety of a new preloaded robot-assisted thrombectomy system specifically designed for mechanical thrombectomy.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"108 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790154","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}