Journal of Clinical Neurology最新文献

{"title":"Comparative Prognostic Performance of Hippocampal Volume and Plasma Biomarkers in Amyloid-Negative Subjective Cognitive Decline: A Four-Year Follow-up.","authors":"Bora Yoon, Hyuk-Je Lee, Yun Jeong Hong, Kee Hyung Park, SangYun Kim, Min Jeong Wang, Seong Hye Choi, Sungmin Kang, Jee Hyang Jeong, Dong Won Yang","doi":"10.3988/jcn.2025.0659","DOIUrl":"10.3988/jcn.2025.0659","url":null,"abstract":"<p><strong>Background and purpose: </strong>Subjective cognitive decline (SCD) may precede mild cognitive impairment (MCI) and dementia. However, the prognosis of patients with amyloid-negative (A-) SCD remains unclear. We investigated whether baseline plasma and imaging biomarkers predict four-year clinical progression in A-SCD.</p><p><strong>Methods: </strong>Sixty-five individuals with A-SCD were followed for four years. Baseline plasma biomarkers-phosphorylated tau 181 (pTau181), glial fibrillary acidic protein, neurofilament light chain (NfL), and pTau181/Aβ42 ratio-and MRI markers (hippocampal volume and white matter hyperintensity [WMH] grade) were assessed. Outcomes included MCI conversion and cognitive progression defined as ≥1-point (Prog-1) or ≥2-point (Prog-2) decline in Korean Mini-Mental State Examination. Predictive performance was evaluated using multivariable logistic regression and bootstrap-validated receiver operating characteristic analyses.</p><p><strong>Results: </strong>Fourteen participants (21.5%) converted to MCI, and 24 (36.9%) were classified as Prog-1. Plasma biomarkers did not show consistent predictive performance across predefined endpoints (all <i>p</i>>0.05), although NfL demonstrated modest discrimination for MCI conversion (area under the curve [AUC] 0.686, <i>p</i>=0.008). Hippocampal volume demonstrated significant discriminative performance for MCI conversion (AUC 0.765, <i>p</i>=0.016) and Prog-1 (AUC 0.933, <i>p</i><0.001). For Prog-2, hippocampal volume showed high discrimination (AUC 0.952, <i>p</i><0.001). WMH grade also demonstrated significant discrimination for MCI conversion (AUC 0.835, <i>p</i><0.001) and Prog-1 (AUC 0.857, <i>p</i><0.001). Bootstrap analyses (1,000 iterations) tended to show higher AUC estimates for imaging markers compared with plasma biomarkers.</p><p><strong>Conclusions: </strong>In this A-SCD cohort, hippocampal atrophy demonstrated more consistent prognostic performance than Alzheimer's disease-focused plasma biomarkers for predicting four-year conversion to MCI and cognitive decline, suggesting a potential role for MRI-based neurodegeneration markers in clinical risk stratification.</p>","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"560-572"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Positivity: Understanding and Interpreting MOG-IgG Testing in MOGAD.","authors":"Jieun Chung, Su-Hyun Kim, Fabienne Brilot, Ho Jin Kim","doi":"10.3988/jcn.2026.0472","DOIUrl":"10.3988/jcn.2026.0472","url":null,"abstract":"<p><p>The diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) relies heavily on detecting serum MOG-IgG by cell-based assay, but seropositivity alone does not establish the disease. In selected clinical cohorts, the positive predictive value of MOG-IgG ranges from approximately 50%-70% at low titers, depending on the assay and cohort, to near 100% at high titers, and inter-laboratory agreement is markedly lower in the low-positive samples than for clearly positive or negative samples. The difficulty in interpreting low-positive MOG-IgG results largely reflects the interplay of two elements: biological factors (including antigen-related background reactivity and potential cross-reactive immunoreactivity) and methodological variability between assays (including differences in antigen presentation, live versus fixed assay platforms, secondary antibody selection, fluorescence readout, sample timing, and locally validated cutoffs). This ambiguity is unlikely to be resolved by assay optimization alone. The 2023 International MOGAD Panel criteria address these issues by requiring stronger clinical and radiological support when the serological evidence is weaker. Accordingly, MOG-IgG should be interpreted as probabilistic evidence within the clinical and MRI context, rather than as a stand-alone diagnostic marker.</p>","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"501-513"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pseudoephedrine for Central Sympathetic Insufficiency.","authors":"Jessica Wcislo, Andrew Posen, Jared Davis","doi":"10.3988/jcn.2026.0096","DOIUrl":"10.3988/jcn.2026.0096","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"628-630"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent Large-Vessel Occlusion Associated With Flow Disturbance in a Carotid Web.","authors":"Jae Ho Jeon, Won Jin Lee, Sung-Il Sohn, Jaeseob Yun","doi":"10.3988/jcn.2026.0101","DOIUrl":"10.3988/jcn.2026.0101","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"613-615"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Amyloid: Hippocampal Atrophy as a Prognostic Marker in Amyloid-Negative Subjective Cognitive Decline.","authors":"Hyuk Sung Kwon, Seong-Ho Koh","doi":"10.3988/jcn.2026.0375","DOIUrl":"10.3988/jcn.2026.0375","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"498-500"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Spinal Reflex Movements Mimicking Decerebrate Posturing Triggered by Sternal Stimulation During Brain-Death Evaluations.","authors":"Pritam Panigrahi, Karan Singla, Ankita Goyal, Kajal Jain","doi":"10.3988/jcn.2026.0149","DOIUrl":"10.3988/jcn.2026.0149","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"625-627"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Education Moderates the Biomarker-Cortical-Thickness Relationship in Females With Cognitive Decline: A Descriptive Study With Sex Comparisons.","authors":"Yeonsil Moon, Hong Jun Jeon, Hee-Jin Kim, Min-Young Noh, Seung Hyun Kim, Seol-Hui Han, Hosung Kim, Won-Jin Moon","doi":"10.3988/jcn.2025.0686","DOIUrl":"10.3988/jcn.2025.0686","url":null,"abstract":"<p><strong>Background and purpose: </strong>Education is a well-established proxy for cognitive reserve and hence may influence the relationship between Alzheimer's disease pathology and brain structure. This is particularly relevant in South Korea, where historical sex disparities in educational level among current elderly populations create unique cohort characteristics. This study examined how educational level moderates the biomarker-cortical-thickness relationship in females with cognitive decline, with descriptive sex comparisons used to contextualize these findings within a cohort reflecting disparities in the history of educational opportunities in South Korea.</p><p><strong>Methods: </strong>In 80 patients (58 females, 22 males) with cognitive decline, we assessed plasma amyloid-β 42 (Aβ42), phosphorylated tau 181 (p-tau), and total tau levels, p-tau/Aβ42 ratio, regional cortical thickness, and scores on the Mini-Mental State Examination. Given the substantial confounding between sex and educational level in this cohort, moderated mediation analyses examining the biomarker-cortical-thickness-cognition pathway were restricted to females (<i>n</i>=53 with complete data).</p><p><strong>Results: </strong>Females had a higher p-tau/Aβ42 ratio (<i>p</i>=0.026) and thicker frontal cortex (<i>p</i>=0.049) despite the absence of a significant difference in age-adjusted cognition. No significant sex× educational level interaction was observed for the biomarkers or cognition. In females, educational level moderated the relationship between the p-tau/Aβ42 ratio and cortical thickness (<i>p</i><0.05 in all five brain regions), with high-educational level females showing the expected cortical thinning with pathology, while low-educational level females exhibited preserved thickness, which did not mediate the cognitive performance.</p><p><strong>Conclusions: </strong>Descriptive sex comparisons revealed a higher biomarker burden yet greater cortical thickness in females. Importantly, educational level significantly moderated the biomarker-cortical thickness relationship specifically in females, with lower-educated individuals showing structural preservation despite the presence of pathology. These findings suggest that measurements of the cortical thickness can underestimate the disease burden in lower-educated females, which highlights the need for educational level-stratified interpretations of structural biomarkers.</p>","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"552-559"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Comments on \"Association of Sleep Hygiene Practice With Disturbed Sleep in Early-Stage Parkinson's Disease\".","authors":"Chan Young Lee, Dongyeop Kim, Jee Hyun Kim, Ji Young Yun","doi":"10.3988/jcn.2026.0368","DOIUrl":"10.3988/jcn.2026.0368","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"633-634"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postmortem Demonstration of Tau Pathology in a Korean Patient With <i>WDR45</i>-Related β-Propeller Protein-Associated Neurodegeneration.","authors":"Jae Eun Sohn, Kyoungyul Lee, YeShin Kim, Seung-Hwan Lee","doi":"10.3988/jcn.2026.0094","DOIUrl":"10.3988/jcn.2026.0094","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"616-618"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rescue Tirofiban for Early Neurological Deterioration After Tenecteplase in Capsular Warning Syndrome.","authors":"Claudia Cuccurullo, Antonio De Mase, Paolo Candelaresi, Vincenzo Andreone","doi":"10.3988/jcn.2026.0124","DOIUrl":"10.3988/jcn.2026.0124","url":null,"abstract":"","PeriodicalId":15432,"journal":{"name":"Journal of Clinical Neurology","volume":"22 5","pages":"607-609"},"PeriodicalIF":3.6,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}