JAMA neurology最新文献

{"title":"Mechanical Thrombectomy and Final Infarct Volume in Medium or Distal Vessel Occlusion Stroke: A Post Hoc Analysis of a Randomized Clinical Trial.","authors":"Aikaterini Anastasiou,Hélène Corbaz,Evangelia Christodoulou,Gregory W Albers,Jeremy J Heit,Georgios Tsivgoulis,Lioba Müller,Adriaan van Es,Nyika D Kruyt,Julie Staals,Wim van Zwam,Sterre Dassen,Tomas Dobrocky,Steven D Hajdu,Frans van den Bergh,Nikki Rommers,Vera Aebischer,Alex Brehm,Urs Fischer,Marios Psychogios, ","doi":"10.1001/jamaneurol.2026.0805","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.0805","url":null,"abstract":"ImportanceImaging-based end points may enhance the understanding of endovascular treatment (EVT) outcomes in patients with medium- or distal-vessel occlusion stroke.ObjectiveTo investigate the outcomes of endovascular treatment (EVT) in addition to best medical treatment (BMT) compared with BMT alone on the volume of brain tissue initially at risk preserved in patients with a medium or distal vessel occlusion stroke.Design, Setting, and ParticipantsPost hoc imaging analysis of the Endovascular Treatment for Stroke Due to Occlusion of Medium or Distal Vessels (DISTAL) trial, a multicenter randomized clinical trial with blinded end point assessment conducted at 55 hospitals in 11 countries from December 2021 through July 2024, with clinical follow-up at 90 days. Patients with baseline perfusion imaging and follow-up imaging at 24 hours were included.InterventionsEVT plus BMT compared with BMT alone.Main Outcomes and MeasuresPrimary outcome was calculated as the difference in volume of tissue at risk and the final infarct volume divided by the tissue at risk (change in Vrel). We defined a Vrel of 0.8 or greater as a good imaging outcome, meaning that at least 80% of the brain tissue initially at risk was not infarcted at 24 hours. Additionally, the association between brain tissue preserved and clinical outcome at 90 days was investigated.ResultsFrom the 447 patients (252 [56.4%] male; median [IQR] age, 77.0 [68.0-84.0] years) included in this secondary analysis, 226 received EVT plus BMT and 221 received BMT alone. Median (IQR) time of the follow-up imaging was 22.9 (19.2-25.5) hours. Median (IQR) Time to maximum less than 6 seconds (Tmax6) volume was 34.0 (20.0-50.0) mL. Median follow-up infarct volume was 7.0 (1.0-22.9) mL. The median (IQR) change in absolute volume in the EVT plus BMT group was 23.6 (5.7-38.9) mL and 14.8 (0-30.3) mL in the BMT group. Median (IQR) change in Vrel was 0.8 (0.2-1.0) in the EVT plus BMT group and 0.6 (0-0.9) in the BMT group. Odds for reaching a change in Vrel of 0.8 or greater were higher in the EVT plus BMT group compared with BMT (adjusted odds ratio [aOR], 1.6; 95% CI, 1.1-2.3) and with successful reperfusion compared with no successful reperfusion (aOR, 2.5; 95% CI, 1.3-4.8). Patients with a change in Vrel of 0.8 or greater had a better clinical outcome at 90 days.Conclusions and RelevanceIn this post hoc analysis of the DISTAL trial data, EVT plus BMT was associated with a higher likelihood of achieving a good imaging outcome compared with BMT alone. A good imaging outcome was associated with a better clinical outcome in both treatment groups.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"136 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147726028","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":"Reimagining Care Delivery for Alzheimer Disease","authors":"Jeffrey M. Burns, Jennifer L. Woodward, Jill K. Morris, Ryan A. Townley","doi":"10.1001/jamaneurol.2026.0801","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.0801","url":null,"abstract":"This Viewpoint describes a system-level redesign of Alzheimer disease diagnosis and treatment where memory clinic services are differentiated by purpose to match patient needs and complexity with appropriate oversight.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"49 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719982","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":"Brain Imaging Biomarkers and Cognitive Outcomes in a Multidomain Lifestyle Intervention","authors":"Theresa M. Harrison, Danielle J. Harvey, Trevor Chadwick, Yishu Chao, Jacinda Taggett, Pauline Maillard, Laura Lovato, Sarah Tomaszewski Farias, Kathryn V. Papp, Samuel N. Lockhart, Arthur W. Toga, Robert A. Koeppe, Youngkyoo Jung, William J. Jagust, Rachel A. Whitmer, Heather M. Snyder, Maria C. Carrillo, Laura D. Baker, Mark A. Espeland, Prashanthi Vemuri, Charles DeCarli, Susan M. Landau","doi":"10.1001/jamaneurol.2026.0832","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.0832","url":null,"abstract":"Importance Brain imaging biomarkers may (1) identify underlying mechanisms of intervention effects and (2) define brain characteristics of those most likely to benefit cognitively from the intervention. Objective To test whether (1) a lifestyle intervention is related to brain changes, (2) brain changes are correlated with intervention-specific cognition changes, and (3) brain imaging biomarkers provide information about who is likely to benefit from a lifestyle intervention. Design, Setting, and Participants In this randomized clinical trial, the POINTER Imaging study was an ancillary study of the 2-year, single-blind multicenter US POINTER clinical trial in which neuroimaging data were collected on eligible enrolled participants. The study was conducted from May 2019 to March 2023 (final follow-up, May 14, 2025). Participants were enrolled into the POINTER Imaging study following a standard procedure at 5 clinical sites in the US. Participant eligibility criteria included an age of 60 to 79 years, sedentary lifestyle, and suboptimal diet, plus at least 2 additional risk criteria for cognitive decline and no contraindications for neuroimaging. Interventions Participants were randomly assigned to receive the structured or self-guided intervention. Both interventions emphasized increased physical and cognitive activity, healthy nutrition, social engagement, and cardiovascular health monitoring, but they differed in intensity and accountability. Main Outcomes and Measures There were 4 primary imaging outcomes: global β-amyloid (Aβ) burden, tau burden in the entorhinal cortex (ERC), hippocampal (HC) volume, and white matter hyperintensity volume. The primary cognitive measure was a global cognitive composite. Results Among 1943 parent trial participants who were assessed for eligibility, 983 underwent at least 1 magnetic resonance imaging or positron emission tomography scanning session. The mean (SD) age was 68.4 (5.2) years; 605 participants (61.5%) were female and 378 male (38.5%). Five hundred sixteen participants received the structured intervention and 467 the self-guided intervention. There were no intervention group differences in longitudinal cognitive or imaging outcomes. Intervention group differences were not associated with or moderated by Aβ status or accumulation. There was a negative association between change in ERC tau and change in global cognition in the self-guided group that was attenuated in the structured group (difference in association: 0.289; 95% CI, 0.029 to 0.550; interaction <jats:italic>P</jats:italic> = .03). Lower baseline HC volume was associated with greater cognitive benefit for participants in the structured group vs the self-guided group (lower HC: 0.077 SD; 95% CI, 0.022 to 0.132; higher HC: 0.002 SD; 95% CI, −0.037 to 0.041; interaction <jats:italic>P</jats:italic> = .03). Conclusion and Relevance This study found that a high-intensity multidomain lifestyle intervention did not affect brain biomarker trajector","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"22 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719977","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":"Beyond Recurrence-Late Effects of Chronic Subdural Hematoma.","authors":"David J Robinson,Jared Knopman","doi":"10.1001/jamaneurol.2026.0655","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.0655","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"9 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663822","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":"Long-Term Mortality, Cognition, and Quality of Life After Chronic Subdural Hematoma Surgery.","authors":"Thomas Petutschnigg,Samuel Aschwanden,Claire Descombes,Danial Nasiri,David Bervini,Michael Murek,Levin Häni,C Marvin Jesse,Ralph T Schär,Irena Zubak,Werner J Z'Graggen,Andreas Raabe,Philippe Schucht,Johannes Goldberg","doi":"10.1001/jamaneurol.2026.0656","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.0656","url":null,"abstract":"ImportanceChronic subdural hematoma (cSDH) is among the most common neurosurgical disorders in older adults. Although short-term outcomes after surgery are favorable, long-term survival and health-related quality of life (HRQoL) remain poorly characterized.ObjectiveTo evaluate long-term survival, excess mortality, and HRQoL 10 years after surgical treatment of cSDH.Design, Setting, and ParticipantsThis population-matched cohort study was conducted at a single tertiary referral center in Switzerland, with mortality follow-up through December 31, 2023 (mean [SD] follow-up, 9.55 [1.24] years), and cross-sectional HRQoL assessment through December 31, 2024 (mean [SD] follow-up, 10.05 [1.16] years). Analyses were conducted from October to December 2025. Adults surgically treated for cSDH between June 2012 and August 2016 were included, matched with the Swiss general population by age, sex, and birth month for mortality analysis. Among survivors, those completing HRQoL assessment were compared with age- and sex-weighted European reference values.ExposureSurgically treated cSDH.Main Outcomes and MeasuresThe primary outcome was all-cause mortality, estimated using Kaplan-Meier analysis, with excess mortality expressed as absolute survival differences and standardized mortality ratios (SMRs). Secondary outcomes were the following HRQoL domains: cognitive functioning (CF), physical functioning (PF), role functioning (RF), emotional functioning (EF), social functioning (SF), and global QoL, compared using 2-sided z tests.ResultsA total of 359 adults surgically treated for cSDH were included; among survivors, 147 completed HRQoL assessment and were compared with age- and sex-weighted European reference values. Among 359 patients (mean [SD] age, 73.4 [11.0] years; 117 female patients [32.6%]), overall survival was significantly lower than matched controls (hazard ratio [cohort vs control], 2.02; 95% CI, 1.73-2.37; log-rank P < .001). One-year survival in the cSDH cohort was 92.8% (95% CI, 90.1%-95.5%) vs 98.8% (95% CI, 98.7%-98.8%) in controls, representing an excess mortality of 6.0 percentage points (SMR, 3.22; 95% CI, 2.10-4.72); 5-year survival was 76.6% (95% CI, 72.3%-81.1%) vs 88.2% (95% CI, 88.2%-88.3%), representing an excess of 11.6 percentage points (SMR, 1.19; 95% CI, 0.95-1.47); and 10-year survival was 55.5% (95% CI, 50.3%-61.3%) vs 73.5% (95% CI, 73.4%-73.6%), representing an excess of 18.0 percentage points (SMR, 1.12; 95% CI, 0.94-1.31). Men reported significantly lower mean (SD) PF scores (75.9 [26.8] vs control mean score, 83.22; P < .001), RF scores (74.9 [32.0] vs 84.87; P < .001), CF scores (77.6 [22.6] vs 87.38; P < .001), and SF scores (84.3 [24.0] vs 90.00; P = .02) than controls, and women reported lower mean (SD) RF (69.0 [30.9] vs 80.91; P = .02) and CF scores (70.2 [24.8] vs 86.50; P < .001). EF and global QoL did not differ significantly from European reference values.Conclusions and RelevanceIn this population-matched cohort stud","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"67 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663825","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":"Cavernous Sinus Dural Arteriovenous Fistula With Ocular Congestion and Proptosis.","authors":"Liming Chen,Lei Pei","doi":"10.1001/jamaneurol.2026.0742","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.0742","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"12 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663824","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":"Interstitial Lung Disease as a Late Occurrence in Ocrelizumab-Treated Patients With Multiple Sclerosis.","authors":"Anna E Zurawska,Anne H Cross,Katarzyna Rzeszutek,Agnieszka Rogozinska-Zawislak,Krzysztof W Selmaj","doi":"10.1001/jamaneurol.2026.0548","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.0548","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"24 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147619426","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":"Advancing Precision Dementia Care With Genetic-Exposome Risk Assessment.","authors":"Shea J Andrews,Kristine Yaffe","doi":"10.1001/jamaneurol.2026.0573","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.0573","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"34 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147619428","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":"Teleneurology vs On-Site Neurology Consultation for Postadmission Hospital Care of Stroke.","authors":"Janina R Behrens,Maximilian Kaffes,Annette Aigner,Juliane Herm,Hebun Erdur,Timo Siepmann,Jessica Barlinn,Gordian Hubert,Hanni Wiestler,Christoph Gumbinger,Anna Ranta,Paul von Weitzel-Mudersbach,Andrea Rocco,Christina Hofmann-Shen,Florian Muhn,Thomas Liman,Michal Rozanski,Simon Litmeier,Christoph Riegler,Simon Hellwig,Rohat Geran,Leif Koschützke,Hannah Ditsche,Malgorzata Kotlarz-Böttcher,Stephan Kinze,Heinrich Audebert","doi":"10.1001/jamaneurol.2026.0615","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.0615","url":null,"abstract":"ImportanceTelestroke networks provide coverage of neurological expertise in rural areas. While most teleneurological consultations focus on acute stroke care in emergency departments, neurological expertise remains crucial in the subacute phase. However, teleneurological ward rounds have not yet been systematically investigated for feasibility and quality.ObjectiveTo assess noninferiority of teleneurological ward rounds compared with conventional on-site ward rounds during subacute inpatient stroke care, focusing on adherence to guideline-based quality indicators.Design, Setting, and ParticipantsThis prospective, multicenter, nonrandomized, noninferiority study was conducted at 15 primary care hospitals within 4 German telestroke networks from October 2022 to December 2024. Adults (18 years or older) hospitalized with suspected acute ischemic or hemorrhagic stroke or transient ischemic attack were eligible. A total of 1908 patients were screened. These data were analyzed from January 2025 to May 2025.ExposuresPatients received both a teleneurological and an on-site neurological ward round. Teleneurological ward rounds were performed by network neurologists via video consultation; on-site consultations were performed by local neurologists. Documentation from both consultations was evaluated by blinded external neurovascular experts.Main Outcomes and MeasuresThe primary outcome was complete fulfillment of 6 predefined, guideline-based quality domains: etiological classification, neurological examination, risk assessment, diagnostic recommendations, secondary prevention, and recommended aftercare. Noninferiority was defined as a maximum difference in proportions of correct assessments of 5 percentage points. Secondary outcomes included correctness of individual domains and expert quality ratings on a visual analoge scale.ResultsA total of 518 patients were enrolled (median age, 71 years; 222 female [44%] and 296 male [56%]) and 501 were included in the final analysis. Complete adherence to all quality criteria was achieved in 92% (95% CI, 90%-94%) of teleneurological ward rounds compared with 54% (95% CI, 49%-58%) of on-site ward rounds (absolute difference, 38 percentage points; 90% CI, 34-42). Superiority of teleneurological ward rounds was consistent across all quality domains with the most pronounced differences observed for secondary prevention (absolute difference, 21% percentage points; 90% CI, 17-24).Conclusions and relevanceTeleneurological ward rounds in subacute stroke care were noninferior and even superior when compared with on-site consultations, with respect to guideline adherence across all quality domains. These findings support the integration of telemedicine into routine inpatient stroke care, particularly in regions with limited access to neurological expertise.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"64 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147619427","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":"Association Between GLP-1 RAs and Idiopathic Intracranial Hypertension-Reply.","authors":"Georgios S Sioutas, John Reavey-Cantwell, Dennis J Rivet","doi":"10.1001/jamaneurol.2026.0004","DOIUrl":"10.1001/jamaneurol.2026.0004","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"406-407"},"PeriodicalIF":21.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146201660","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}