JAMA neurology最新文献

{"title":"Hearing Intervention for Older Adults With Mild Cognitive Impairment: The CHOICE Randomized Clinical Trial.","authors":"Ying Chen, Haibo Shi, Mingliang Xiang, Xia Li, Zhili Wang, Wen Lu, Yilin Shen, Yuan Fang, Jie Chen, Lei Guan, Feifan Zhao, Zaichao Wu, Rong Tian, Qiongfei Yu, Kun Han, Haibin Sheng, Shengqi Chen, Jiayu Sun, Guangyu Liu, Hao Wu","doi":"10.1001/jamaneurol.2026.3395","DOIUrl":"10.1001/jamaneurol.2026.3395","url":null,"abstract":"<p><strong>Importance: </strong>Hearing loss is a significant modifiable risk factor for cognitive decline, but the effectiveness of hearing intervention for cognition stabilization or improvement still remains controversial.</p><p><strong>Objective: </strong>To investigate whether hearing intervention could reduce dementia-level impairment incidence in older adults with coexisting hearing loss and mild cognitive impairment (MCI).</p><p><strong>Design, setting, and participants: </strong>This multicenter, parallel-group, open-label randomized clinical trial was conducted between September 2021 and February 2024, with the 24-month follow-up completed in February 2026. This study was conducted at 3 tertiary otology outpatient clinics and 3 CHOICE cohort community health stations in Shanghai, China. Of 21 908 adults aged 60 years or older assessed for eligibility, 703 participants with coexisting MCI (Clinical Dementia Rating [CDR] global score of 0.5) and moderate to severe hearing loss were enrolled and randomized. These data were analyzed from February 2026 to July 2026.</p><p><strong>Interventions: </strong>Participants were randomized 1:1 to receive either hearing aid intervention (n = 353) or hearing care education (n = 350).</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the conversion rate from MCI to dementia-level impairment over 24 months, defined as a CDR global score 1 or more. Key prespecified secondary outcomes comprised rate of cognitive improvement (CDR = 0) and CDR global and domain scores.</p><p><strong>Results: </strong>Among 703 randomized patients (mean [SD] age, 74.53 [7.16] years; range, 60-96 years; 250 female [35.56%] and 452 male [64.44%]), 610 (86.77%) completed the trial. No significant difference was observed in the primary outcome, in which the conversion rate from MCI to dementia-level impairment was 3.09% (95% CI, 1.62%-5.74%) in the intervention group vs 4.74% (95% CI, 2.60%-8.29%) in the control group (risk difference [RD], -2.07%; 95% CI, -4.74% to 0.61%; relative risk [RR], 0.59; 95% CI, 0.25-1.38; P = .23). Meanwhile, prespecified secondary analysis demonstrated that hearing intervention increased the rate of cognitive improvement (15.34%; 95% CI, 11.84%-19.62% vs 2.36%; 95% CI, 0.99%-5.22%; RD, 12.00%; 95% CI, 8.79%-15.21%; RR, 5.94; 95% CI, 2.46-14.37). No study-related adverse events were reported.</p><p><strong>Conclusions and relevance: </strong>In this study, among older adults with mild cognitive impairment and coexisting hearing loss, a hearing aid intervention did not significantly reduce the incidence of dementia-level impairment at 24 months.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry Identifier: ChiCTR2000036139.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":23.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074602","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":"Targeting Cancer Workup After a First Seizure.","authors":"Koichiro Yuji, Wakako Yuji","doi":"10.1001/jamaneurol.2026.3295","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.3295","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":23.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074559","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":"Targeting Cancer Workup After a First Seizure-Reply.","authors":"Andreas Lund Pedersen, Holly Elser, Henrik Toft Sørensen","doi":"10.1001/jamaneurol.2026.3298","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.3298","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":23.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074581","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":"Error in Abstract.","authors":"","doi":"10.1001/jamaneurol.2026.3672","DOIUrl":"10.1001/jamaneurol.2026.3672","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":23.6,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074398","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":"Portable Low-Field MRI of the Brain in Clinic and Community Settings.","authors":"Adam de Havenon, Ian Johnson, Hailey Brigger, Mirriam Mananah, Annabelle Shanks, Stephanie Maynez, Steven Schiff, Megan Johnson, Matt De Both, Calla Price, Yareli Barraza, Danielle Metz, Darian Chambers, Gordon Sze, Seyedmehdi Payabvash, Annabel Sorby-Adams, Matthew Rosen, Juan Eugenio Iglesias, Sean Deoni, Stephanie Debette, W Taylor Kimberly, Arman Fesharaki-Zadeh, Matt Huentelmen, Kevin N Sheth","doi":"10.1001/jamaneurol.2026.3217","DOIUrl":"10.1001/jamaneurol.2026.3217","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":23.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016656","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":"When to Use the HINTS Examination in Patients With Dizziness","authors":"Carl Sars, Daniel Lelli, Darren Tse, Peter Johns","doi":"10.1001/jamaneurol.2026.2942","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.2942","url":null,"abstract":"Importance The Head Impulse, Nystagmus, Test of Skew (HINTS) examination is a widely recognized bedside tool for distinguishing peripheral vestibular disorders from central causes, such as stroke, in patients presenting with acute vestibular syndrome. However, despite its introduction in 2009, confusion persists regarding its proper application. Misuse of the HINTS examination, particularly when applied to inappropriate patient populations, may lead to misdiagnosis, unnecessary imaging, or missed strokes. This review aims to clarify the appropriate use of the HINTS examination and to address misconceptions that contribute to diagnostic errors in emergency and clinical practice. Observations HINTS is most effective when performed for patients with continuous dizziness and spontaneous nystagmus at rest. However, various guidelines and educational resources have failed to clearly define these criteria, leading to widespread misapplication of the test. Common errors include using HINTS for patients without nystagmus, failing to screen for central features before performing the examination, and misinterpreting test components. Studies show that the HINTS examination, when applied correctly, has high sensitivity for detecting stroke, but its diagnostic accuracy declines significantly when used for inappropriate patients. Furthermore, recent guidelines, such as the third Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-3), may have introduced ambiguities that may contribute to ongoing confusion in clinical practice. Conclusions and Relevance To optimize the diagnostic utility of the HINTS examination and reduce stroke misdiagnosis, clinicians should first screen for central features before applying HINTS and ensure it is only performed for patients with nystagmus at rest. Future guidelines should provide clearer recommendations to prevent inappropriate HINTS use and thus avoid inaccurate results. Emphasizing the correct application of HINTS in the right patient population will enhance its reliability as a critical tool for emergency physicians in distinguishing central from peripheral causes of dizziness, ultimately improving patient outcomes and reducing unnecessary investigations.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"35 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009907","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":"Unprecedented In Vivo MRI Resolution of Basal Ganglia at 11.7 T.","authors":"Béchir Jarraya, Rüdiger Stirnberg, Nicolas Boulant","doi":"10.1001/jamaneurol.2026.3264","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.3264","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":23.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016724","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":"Error in Funding/Support.","authors":"","doi":"10.1001/jamaneurol.2026.3431","DOIUrl":"10.1001/jamaneurol.2026.3431","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":23.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016596","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":"A Harmonized Visual Reading Framework for Tau PET Staging in Alzheimer Disease.","authors":"Emma Ruppert, Marie R Vermeiren, Marina Scop Medeiros, Guilherme Povala, Carolina Soares, Andreia Rocha, Alvaro de Oliveira Franco, Matheus Scarpatto Rodrigues, Markley Oliveira, Rayan Mroué, Pamela C L Ferreira, Guilherme Bauer-Negrini, Firoza Z Lussier, Livia Amaral, Bruna Bellaver, Cécile Tissot, Joseph Masdeu, Dana L Tudorascu, Thomas Karikari, David N Soleimani-Meigooni, Juan Fortea, Val J Lowe, Hwamee Oh, Belen Pascual, Brian A Gordon, Pedro Rosa-Neto, Suzanne Baker, Rik Ossenkoppele, Elsmarieke van de Giessen, Tharick A Pascoal","doi":"10.1001/jamaneurol.2026.3253","DOIUrl":"10.1001/jamaneurol.2026.3253","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Tau positron emission tomography (PET) can detect and stage Alzheimer disease pathology; however, current binary regulatory-approved visual interpretation focuses on advanced disease, limiting early detection and patient stratification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To develop and validate a harmonized tau PET visual reading framework across radiotracers that stages tau burden into 5 classes: negative, low, moderate, high, and atypical.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This prospective multicenter cross-sectional study among a cohort with head-to-head tau PET acquisitions was conducted from March 2022 to August 2025 and data analyzed from February to June 2026, with blinded visual reads performed by clinicians. The study was conducted at 9 sites across North America and Europe. Of those individuals enrolled in the HEAD (Head-to-Head Harmonization of Tau Tracers in Alzheimer's Disease) study, a proportion of participants aged 50 to 90 years who completed multitracer tau PET (2-4 scans) and cognitive assessments were included, spanning cognitively unimpaired to dementia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposures: &lt;/strong&gt;Tau PET with 18F-MK-6240 (TAUKLARIFY, n = 681), 18F-flortaucipir (Tauvid, n = 644), 18F-RO948 (n = 150), and 18F-PI-2620 (n = 149); all participants underwent amyloid-β (Aβ) PET and magnetic resonance imaging.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcomes were interrater and intertracer agreement for 5-class tau classification; prevalence ratio (PR) vs the regulatory-approved 18F-flortaucipir framework; and associations with cognition, Aβ burden, and plasma phosphorylated tau 217 (p-tau217).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 822 individuals enrolled in the HEAD study, 681 participants spanning cognitively unimpaired to dementia were included. Mean (SD) age was 69.3 (8.4) years, and 367 participants (53.9%) were female. The harmonized 5-class framework achieved excellent interrater agreement (κ = 0.77-0.85) and good to excellent intertracer agreement, highest between 18F-MK-6240 and 18F-flortaucipir (κ = 0.88). Compared with the regulatory-approved framework, the harmonized classification identified more tau-positive cognitively unimpaired participants (regulatory-approved binary: 26 of 364 participants; harmonized 18F-flortaucipir: 49 of 364 [PR = 1.89; 95% CI, 1.31-2.70; P = .001]; harmonized 18F-MK-6240: 71 of 364 [PR = 2.73; 95% CI, 1.95-3.83; P &lt; .001]) and those with mild cognitive impairment (regulatory-approved binary: 100 of 223; harmonized 18F-flortaucipir: 123 of 223 [PR = 1.23; 95% CI, 1.12-1.35; P &lt; .001]; harmonized 18F-MK-6240: 142 of 223 [PR = 1.42; 95% CI, 1.27-1.59; P &lt; .001]), with convergence in dementia. Tau burden classes showed stepwise worsening of cognition, Aβ PET burden, and plasma p-tau217, with 1.4-fold, 3.2-fold, and 2.5-fold differences between the low and high tau classes, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/st","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":23.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016567","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":"Clinical Characteristics, Neuroimaging Findings, and Mortality in Korsakoff Syndrome","authors":"Imelda Coffi, Emmanuel Lecœur, Kevin Zarca, Lidia Kardas-Sloma, Isabelle Durand-Zaleski, Jean-Marc Treluyer, Luc Mouthon, Benjamin Chaigne","doi":"10.1001/jamaneurol.2026.3114","DOIUrl":"https://doi.org/10.1001/jamaneurol.2026.3114","url":null,"abstract":"Importance Korsakoff syndrome is a severe neurocognitive disorder resulting from thiamine deficiency, most often associated with alcohol use disorder. Contemporary data describing its clinical presentation, neuroimaging findings, and long-term outcomes remain limited. Objective To characterize the clinical features and outcomes of patients diagnosed with Korsakoff syndrome in routine clinical practice and to identify factors associated with mortality. Design, Setting, and Participants This cohort study included electronic health records of adults with a diagnosis of Korsakoff syndrome between August 1, 2017, and December 31, 2022, from the Clinical Data Warehouse of the Greater Paris University Hospitals (AP-HP), which includes 39 hospitals. Data were analyzed March 2023. Exposure Korsakoff syndrome diagnosis. Main Outcomes and Measures The primary outcome was all-cause mortality. Secondary outcomes included clinical manifestations, comorbidities, and neuroimaging findings in patients diagnosed with Korsakoff syndrome. Results Among 1320 patients with Korsakoff syndrome (mean [SD] age, 62.9 [11.1] years; 962 men [72.9%]), a well-documented subgroup of 114 patients most frequently presented with anterograde amnesia (61.4%). Among this subgroup, 22 patients (19%) had a reported history of Wernicke encephalopathy. Among patients who underwent brain magnetic resonance imaging, abnormalities involving the Papez circuit and vascular leukoencephalopathy were each observed in 40 patients (44.4%) each. During a median (IQR) follow-up of 3.1 (1.2-5.0) years, 398 patients (30.2%) died. In multivariable analyses, malnutrition (hazard ratio [HR], 1.54; 95% CI, 1.15-2.05), alcoholic liver disease (HR, 1.45; 95% CI, 1.10-1.91), male sex (HR, 1.45; 95% CI, 1.13-1.86), and age 80 to 89 years (HR, 1.89; 95% CI, 1.27-2.81) were associated with mortality. Conclusions and Relevance In this large clinical cohort, patients diagnosed with Korsakoff syndrome had a high burden of vascular comorbidities, frequent under-recognition of Wernicke encephalopathy, and substantial mortality. These findings highlight the need for earlier recognition and more standardized diagnostic evaluation of Korsakoff syndrome.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"19 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148964253","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}