JAMA neurology最新文献

{"title":"Alzheimer Disease as a Clinical-Biological Construct-An International Working Group Recommendation.","authors":"Bruno Dubois, Nicolas Villain, Lon Schneider, Nick Fox, Noll Campbell, Douglas Galasko, Miia Kivipelto, Frank Jessen, Bernard Hanseeuw, Mercè Boada, Frederik Barkhof, Agneta Nordberg, Lutz Froelich, Gunhild Waldemar, Kristian Steen Frederiksen, Alessandro Padovani, Vincent Planche, Christopher Rowe, Alexandre Bejanin, Agustin Ibanez, Stefano Cappa, Paulo Caramelli, Ricardo Nitrini, Ricardo Allegri, Andrea Slachevsky, Leonardo Cruz de Souza, Andrea Bozoki, Eric Widera, Kaj Blennow, Craig Ritchie, Marc Agronin, Francisco Lopera, Lisa Delano-Wood, Stéphanie Bombois, Richard Levy, Madhav Thambisetty, Jean Georges, David T Jones, Helen Lavretsky, Jonathan Schott, Jennifer Gatchel, Sandra Swantek, Paul Newhouse, Howard H Feldman, Giovanni B Frisoni","doi":"10.1001/jamaneurol.2024.3770","DOIUrl":"10.1001/jamaneurol.2024.3770","url":null,"abstract":"<p><strong>Importance: </strong>Since 2018, a movement has emerged to define Alzheimer disease (AD) as a purely biological entity based on biomarker findings. The recent revision of the Alzheimer's Association (AA) criteria for AD furthers this direction. However, concerns about a purely biological definition of AD being applied clinically, the understanding of AD by society at large, and the translation of blood-based biomarkers into clinical practice prompt these International Working Group (IWG) updated recommendations.</p><p><strong>Objective: </strong>To consider the revised AA criteria and to offer an alternative definitional view of AD as a clinical-biological construct for clinical use. The recommendations of the 2021 IWG diagnostic criteria are updated for further elaborating at-risk and presymptomatic states.</p><p><strong>Evidence review: </strong>PubMed was searched for articles published between July 1, 2020, and March 1, 2024, using the terms \"biomarker\" OR \"amyloid\" OR \"tau\" OR \"neurodegeneration\" OR \"preclinical\" OR \"CSF\" OR \"PET\" OR \"plasma\" AND \"Alzheimer's disease.\" The references of relevant articles were also searched.</p><p><strong>Findings: </strong>In the new AA diagnostic criteria, AD can be defined clinically as encompassing cognitively normal people having a core 1 AD biomarker. However, recent literature shows that the majority of biomarker-positive cognitively normal individuals will not become symptomatic along a proximate timeline. In the clinical setting, disclosing a diagnosis of AD to cognitively normal people with only core 1 AD biomarkers represents the most problematic implication of a purely biological definition of the disease.</p><p><strong>Conclusions and relevance: </strong>The ultimate aim of the field was to foster effective AD treatments, including preventing symptoms and dementia. The approach of diagnosing AD without a clinical and biological construct would be unwarranted and potentially concerning without a clear knowledge of when or whether symptoms will ever develop. It is recommended that those who are amyloid-positive only and, more generally, most biomarker-positive cognitively normal individuals, should not be labeled as having AD. Rather, they should be considered as being at risk for AD. The expansion of presymptomatic AD is viewed as a better diagnostic construct for those with a specific pattern of biomarkers, indicating that they are proximate to the expression of symptoms in the near future.</p>","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"1304-1311"},"PeriodicalIF":20.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557844","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":"Peripheral-Type Facial Paralysis and Unilateral Hemisphere Hemorrhage.","authors":"Chunyong Chen, Jian Zhang, Jingjing Huang","doi":"10.1001/jamaneurol.2024.3270","DOIUrl":"10.1001/jamaneurol.2024.3270","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"1312-1313"},"PeriodicalIF":20.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346891","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":"Barriers to Tofersen Therapy for Variant SOD1-Mediated ALS.","authors":"Stanley H Appel, Jason R Thonhoff","doi":"10.1001/jamaneurol.2024.3331","DOIUrl":"10.1001/jamaneurol.2024.3331","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"1239-1240"},"PeriodicalIF":20.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380871","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":"Collaborative Dementia Care During the New Therapeutic Era.","authors":"Katherine L Possin, Jeffrey M Burns, Brent P Forester","doi":"10.1001/jamaneurol.2024.3379","DOIUrl":"10.1001/jamaneurol.2024.3379","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":"1241-1242"},"PeriodicalIF":20.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11815596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465716","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":"Psychiatric Comorbidities in Persons With Epilepsy Compared With Persons Without Epilepsy","authors":"Churl-Su Kwon, Ali Rafati, Ruth Ottman, Jakob Christensen, Andres M. Kanner, Nathalie Jetté, Charles R. Newton","doi":"10.1001/jamaneurol.2024.3976","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.3976","url":null,"abstract":"ImportanceSeveral psychiatric disorders have been found to occur more frequently in persons with epilepsy (PWE) than in persons without epilepsy.ObjectiveTo summarize the prevalence of 20 psychiatric disorders in PWE compared with persons without epilepsy.Data SourcesThe search included records from inception to February 2024 in Ovid, MEDLINE, Embase, and PsycINFO.Study SelectionPublished epidemiological studies examining the prevalence of psychiatric disorders among PWE compared with persons without epilepsy were systematically reviewed. There were no restrictions on language or publication date.Data Extraction and SynthesisAbstracts were reviewed in duplicate, and data were extracted using a standardized electronic form. Descriptive statistics and meta-analyses are presented.Main Outcomes and MeasuresData were recorded on the prevalence of 20 psychiatric disorders among PWE compared with persons without epilepsy. Meta-analyses were performed along with descriptive analyses.ResultsThe systematic search identified 10 392 studies, 27 of which met eligibility criteria. The meta-analyses included 565 443 PWE and 13 434 208 persons without epilepsy. The odds of most psychiatric disorders studied were significantly increased in PWE compared with those without epilepsy, including anxiety (odds ratio [OR], 2.11; 95% CI, 1.73-2.58); depression (OR, 2.45; 95% CI, 1.94-3.09); bipolar disorder (OR, 3.12; 95% CI, 2.23-4.36); suicidal ideation (OR, 2.25; 95% CI, 1.75-2.88) but not suicide attempt (OR, 3.17; 95% CI, 0.49-20.46); psychotic disorder (OR, 3.98; 95% CI, 2.57-6.15); schizophrenia (OR, 3.72; 95% CI, 2.44-5.67); obsessive-compulsive disorder (OR, 2.71; 95% CI, 1.76-4.15); posttraumatic stress disorder (OR, 1.76; 95% CI, 1.14-2.73); eating disorders (OR, 1.87; 95% CI, 1.73-2.01); alcohol misuse (OR, 3.64; 95% CI, 2.27-5.83) and alcohol dependence (OR, 4.94; 95% CI, 3.50-6.96) but not alcohol abuse (OR, 2.10; 95% CI, 0.60-7.37); substance use disorder (OR, 2.75; 95% CI, 1.61-4.72); autism spectrum disorder (OR, 10.67; 95% CI, 6.35-17.91); and attention-deficit/hyperactivity disorder (OR, 3.93; 95% CI, 3.80-4.08).Conclusions and RelevanceIn this comprehensive study, most psychiatric comorbidities examined were significantly more prevalent in PWE than in those without epilepsy. These findings show the high burden of psychiatric comorbidities in PWE. This, in turn, underscores the need for appropriately identifying and treating psychiatric comorbidity in epilepsy to manage patients effectively and improve quality of life.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"19 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697065","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":"Wildfire Smoke Exposure and Incident Dementia","authors":"Holly Elser, Timothy B. Frankland, Chen Chen, Sara Y. Tartof, Elizabeth Rose Mayeda, Gina S. Lee, Alexander J. Northrop, Jacqueline M. Torres, Tarik Benmarhnia, Joan A. Casey","doi":"10.1001/jamaneurol.2024.4058","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4058","url":null,"abstract":"ImportanceLong-term exposure to total fine particulate matter (PM&lt;jats:sub&gt;2.5&lt;/jats:sub&gt;) is a recognized dementia risk factor, but less is known about wildfire-generated PM&lt;jats:sub&gt;2.5&lt;/jats:sub&gt;, an increasingly common PM&lt;jats:sub&gt;2.5&lt;/jats:sub&gt; source.ObjectiveTo assess the association between long-term wildfire and nonwildfire PM&lt;jats:sub&gt;2.5&lt;/jats:sub&gt; exposure and risk of incident dementia.Design, Setting, and ParticipantsThis open cohort study was conducted using January 2008 to December 2019 electronic health record (EHR) data among members of Kaiser Permanente Southern California (KPSC), which serves 4.7 million people across 10 California counties. KPSC members aged 60 years or older were eligible for inclusion. Members were excluded if they did not meet eligibility criteria, if they had a dementia diagnosis before cohort entry, or if EHR data lacked address information. Data analysis was conducted from May 2023 to May 2024.ExposuresThree-year rolling mean wildfire and nonwildfire PM&lt;jats:sub&gt;2.5&lt;/jats:sub&gt; in member census tracts from January 2006 to December 2019, updated quarterly and estimated via monitoring and remote-sensing data and statistical techniques.Main Outcome and MeasuresThe primary outcome was incident dementia, identified using diagnostic codes in the EHR. Odds of dementia diagnoses associated with 3-year mean wildfire and nonwildfire PM&lt;jats:sub&gt;2.5&lt;/jats:sub&gt; exposure were estimated using a discrete-time approach with pooled logistic regression. Models adjusted for age, sex, race and ethnicity (considered as a social construct rather than as a biological determinant), marital status, smoking status, calendar year, and census tract–level poverty and population density. Stratified models assessed effect measure modification by age, sex, race and ethnicity, and census tract–level poverty.ResultsAmong 1.64 million KPSC members aged 60 years or older during the study period, 1 223 107 members were eligible for inclusion in this study. The study population consisted of 644 766 female members (53.0%). In total, 319 521 members identified as Hispanic (26.0%), 601 334 members identified as non-Hispanic White (49.0%), and 80 993 members received a dementia diagnosis during follow-up (6.6%). In adjusted models, a 1-μg/m&lt;jats:sup&gt;3&lt;/jats:sup&gt; increase in the 3-year mean of wildfire PM&lt;jats:sub&gt;2.5&lt;/jats:sub&gt; exposure was associated with an 18% increase in the odds of dementia diagnosis (odds ratio [OR], 1.18; 95% CI, 1.03-1.34). In comparison, a 1-μg/m&lt;jats:sup&gt;3&lt;/jats:sup&gt; increase in nonwildfire PM&lt;jats:sub&gt;2.5&lt;/jats:sub&gt; exposure was associated with a 1% increase (OR, 1.01; 95% CI, 1.01-1.02). For wildfire PM&lt;jats:sub&gt;2.5&lt;/jats:sub&gt; exposure, associations were stronger among members less than 75 years old upon cohort entry, members from racially minoritized subgroups, and those living in high-poverty vs low-poverty census tracts.Conclusions and RelevanceIn this cohort study, after adjusting for measured confounders, long-te","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"1 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697128","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":"Equipping AI for Unbiased and Inclusive Neurology.","authors":"Nina F Schor","doi":"10.1001/jamaneurol.2024.3954","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.3954","url":null,"abstract":"","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":" ","pages":""},"PeriodicalIF":20.4,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709546","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":"Current and Future Roles of Chimeric Antigen Receptor T-Cell Therapy in Neurology","authors":"Fatme Seval Ismail, Marco Gallus, Sven G. Meuth, Hideho Okada, Hans-Peter Hartung, Nico Melzer","doi":"10.1001/jamaneurol.2024.3818","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.3818","url":null,"abstract":"ImportanceAdvancements in molecular engineering have facilitated the creation of engineered T cells that express synthetic receptors, termed <jats:italic>chimeric antigen receptors</jats:italic> (CARs). This is promising not only in cancer treatment but also in addressing a spectrum of other conditions. This review provides a comprehensive overview of the current approaches and future potential of CAR T-cell therapy in the field of neurology, particularly for primary brain tumors and autoimmune neurological disorders.ObservationsCAR T-cell therapy for glioblastoma is promising; however, first-in-human trials did not yield significant success or showed only limited success in a subset of patients. To date, the efficacy of CAR T-cell therapies has been demonstrated in animal models of multiple sclerosis, but larger human studies to corroborate the efficacy remain pending. CAR T cells showed efficacy in treatment of patients with relapsed or refractory aquaporin 4–immunoglobulin G–seropositive neuromyelitis optica spectrum disorders. Further studies with larger patient populations are needed to confirm these results. Success was reported also for treatment of cases with generalized myasthenia gravis using CAR T cells. Chimeric autoantibody receptor T cells, representing a modified form of CAR T cells directed against autoreactive B cells secreting autoantibodies, were used to selectively target autoreactive anti–<jats:italic>N</jats:italic>-methyl-<jats:sc>d</jats:sc>-aspartate B cells under in vitro and in vivo conditions, providing the basis for human studies and application to other types of autoimmune encephalitis associated with neuronal or glial antibodies.Conclusions and RelevanceCAR T cells herald a new era in the therapeutic landscape of neurological disorders. While their application in solid tumors, such as glioblastoma, has not universally yielded robust success, emerging innovative strategies show promise, and there is optimism for their effectiveness in certain autoimmune neurological disorders.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"19 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697122","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":"Vertebral Web and Embolic Stroke","authors":"Kiran Waqar, Praveen Kesav, Seby John","doi":"10.1001/jamaneurol.2024.4025","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.4025","url":null,"abstract":"This case report describes a female individual in her 30s with headache and vertigo; examination revealed acute embolic infarcts and a lesion on the vertebral artery.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"256 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142697104","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":"Epileptiform Electrographic Patterns After Cardiac Arrest","authors":"Andrea O. Rossetti, Sarah Benghanem","doi":"10.1001/jamaneurol.2024.3831","DOIUrl":"https://doi.org/10.1001/jamaneurol.2024.3831","url":null,"abstract":"This Viewpoint challenges conventional clinical practice that eschews pharmacological intervention for comatose patients with epileptiform abnormalities after cardiac arrest using evidence from the Treatment of Electroencephalographic Status Epilepticus after Cardiopulmonary Resuscitation (TELSTAR) trial.","PeriodicalId":14677,"journal":{"name":"JAMA neurology","volume":"95 1","pages":""},"PeriodicalIF":29.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142598511","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}