Journal of Neurology, Neurosurgery, and Psychiatry最新文献

{"title":"Left atrial appendage occlusion in patients with atrial fibrillation and intracerebral haemorrhage associated with cerebral amyloid angiopathy: a multicentre observational study and pooled analysis of published studies.","authors":"Kitti Thiankhaw, Jonathan Best, Sonal Srivastava, Ishika Prachee, Smriti Agarwal, Serena Tan, Patrick A Calvert, Asim Chughtai, Richard Ang, Oliver R Segal, David J Werring","doi":"10.1136/jnnp-2024-334718","DOIUrl":"10.1136/jnnp-2024-334718","url":null,"abstract":"<p><strong>Background: </strong>Cerebral amyloid angiopathy (CAA) is a common cause of intracerebral haemorrhage (ICH) with a high recurrence risk. Left atrial appendage occlusion (LAAO) is a method for ischaemic stroke prevention in patients with atrial fibrillation (AF), potentially reducing the risk of intracranial bleeding in CAA-associated ICH. We aimed to determine the outcomes of patients with AF with CAA-associated ICH undergoing LAAO.</p><p><strong>Methods: </strong>We conducted a multicentre study of patients with CAA-associated ICH who underwent LAAO for stroke prevention. We pooled our findings with data from a systematic review of relevant published studies of LAAO for AF in ICH survivors reporting CAA diagnosis.</p><p><strong>Results: </strong>We included data from two published studies (n=65) with CAA-specific data and our cohort study (n=37), providing a total of 102 participants (mean age 76.2±8.0 years, 74.6% male) with CAA-related symptomatic ICH and AF treated with LAAO. The median follow-up period was 9.4 months (IQR 4.2-20.6). Postprocedural antithrombotic regimens varied between single (73.0%) or dual antiplatelet therapy (16.2%), or direct oral anticoagulant (DOAC) (10.8%), with a median duration of 42 days (IQR 35-74). Postprocedural complications were uncommon, but included transient arrhythmias (2.1%) and non-life-threatening tamponade (2.1%). Pooled incidence rates of ischaemic stroke and ICH during follow-up were 5.16 (95% CI 1.36 to 17.48) and 2.73 (95% CI 0.41 to 13.94) per 100 patient years, respectively.</p><p><strong>Conclusions: </strong>LAAO followed by short-term antithrombotic therapy might be a safe and effective ischaemic stroke preventive strategy in people with CAA-associated ICH and AF. However, randomised controlled trials are needed to determine how LAAO compares with long-term DOAC in this population.</p><p><strong>Prospero registration number: </strong>CRD42023415354.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"528-536"},"PeriodicalIF":8.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854476","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":"Multiple sclerosis reactivations after fingolimod discontinuation for pregnancy planning.","authors":"Lina Jeantin, Caroline Bensa-Koscher, Romain Deschamps, Olivier Gout, Elisabeth Maillart, Caroline Papeix, Marine Boudot de la Motte","doi":"10.1136/jnnp-2024-334629","DOIUrl":"10.1136/jnnp-2024-334629","url":null,"abstract":"","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"617-618"},"PeriodicalIF":8.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780400","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":"Depression and dementia: interrogating the causality of the relationship.","authors":"Alvar Paris, Guru Amirthalingam, Tasvee Karania, Isabelle F Foote, Ruth Dobson, Alastair J Noyce, Charles R Marshall, Sheena Waters","doi":"10.1136/jnnp-2024-334675","DOIUrl":"10.1136/jnnp-2024-334675","url":null,"abstract":"<p><strong>Background: </strong>Depression is often cited as a major modifiable risk factor for dementia, though the relative contributions of a true causal relationship, reverse causality and confounding factors remain unclear. This study applied a subset of the Bradford Hill criteria for causation to depression and dementia including strength of effect, specificity, temporality, biological gradient and coherence.</p><p><strong>Methods: </strong>A total of 491 557 participants in UK Biobank aged between 40 and 69 at enrolment and followed up for a mean duration of 12.4 years were studied. Diagnoses of depression and dementia were ascertained from linked health records, self-reports and death certificate registration. Depressive symptoms were measured at enrolment using a combination of questions based on the Patient Health Questionnaire-9 depression screening questionnaire. Regional grey matter volumes were measured using T1-weighted MRI in 41 929 participants.</p><p><strong>Results: </strong>Depression was a strong risk factor for incident dementia with an OR of 1.76 (95% CI 1.63 to 1.90), a relationship which was found to be specific to depression rather than commonly proposed confounders. Depressive symptoms increased rapidly in the 10 years prior to dementia diagnosis. The severity of depressive symptoms showed a dose-response relationship with dementia risk. Depression at older ages correlated with reduced grey matter volume in an Alzheimer's pattern whereas younger onset depression was associated with reduced grey matter volume in the frontal lobes and cerebellum.</p><p><strong>Conclusions: </strong>This study provides evidence that the link between depression and dementia is due to reverse causation with a smaller component of causation with clear evidence of both mechanisms driving the association.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"573-581"},"PeriodicalIF":8.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971280","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":"Preventing one disease is not enough for brain health.","authors":"Giancarlo Logroscino","doi":"10.1136/jnnp-2025-335858","DOIUrl":"10.1136/jnnp-2025-335858","url":null,"abstract":"","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"513"},"PeriodicalIF":8.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780254","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":"How well do plasma Alzheimer's disease biomarkers reflect the CSF amyloid status?","authors":"Jemma Hazan, Emily Abel, Miguel Rosa Grilo, Deborah Alawode, Ines Laranjinha, Amanda J Heslegrave, Kathy Y Liu, Jonathan M Schott, Robert Howard, Henrik Zetterberg, Nick C Fox","doi":"10.1136/jnnp-2024-334122","DOIUrl":"10.1136/jnnp-2024-334122","url":null,"abstract":"<p><strong>Background: </strong>Can plasma biomarkers as well as cerebrospinal fluid (CSF) perform in the separation of amyloid-beta-positive (Aβ+) vs amyloid-beta-negative (Aβ-) groups across an age range seen in an NHS cognitive disorder clinic?</p><p><strong>Methods: </strong>As part of the routine diagnostic investigation of 111 clinic patients who had contemporaneous blood and CSF samples taken, patients were categorised into Aβ+ and Aβ- groups based on their CSF in an Aβ42/40 ratio. We then evaluated four single molecule array (Simoa) Quanterix assays, quantifying single plasma analytes and ratios (p-tau217, p-tau217/Aβ42 ratio, p-tau181, p-tau181/Aβ42 ratio and Aβ42/40 ratio) in their ability to distinguish between these groups and the effect of age.</p><p><strong>Results: </strong>The median (range) age of participants was 66 (55-79) years with 48 females (43.2%). The areas under the curve (AUC), not accounting for age, for the ability to discriminate Aβ+ from Aβ- groups were plasma p-tau217 AUC=0.94, Aβ42/40 AUC=0.78 and p-tau181 AUC=0.77. Combining p-tau217/Aβ42 increased the AUC to 0.97. The difference between the groups was influenced by age with less separation in older individuals: a significant negative interaction term between age and group for plasma p-tau217 concentrations (-0.037, p=0.013) and p-tau217/Aβ42 ratio (-0.007, p=0.008).</p><p><strong>Conclusions: </strong>There was variable performance of plasma biomarkers to recapitulate the CSF assay. Both p-tau217 and p-tau217/Aβ42 showed excellent promise as surrogates of CSF amyloid status, although with slightly reduced performance in older individuals. There was poorer discriminatory ability for p-tau181 and Aβ42/40. Further research is needed to address potential age-related confounds.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"566-572"},"PeriodicalIF":8.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854456","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":"Is this a Gordian knot? Disentangling the relationship between depression and dementia.","authors":"Lindsey I Sinclair","doi":"10.1136/jnnp-2025-336445","DOIUrl":"10.1136/jnnp-2025-336445","url":null,"abstract":"","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"514"},"PeriodicalIF":8.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970565","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":"Modifiable risk factors for stroke, dementia and late-life depression: a systematic review and DALY-weighted risk factors for a composite outcome.","authors":"Jasper Senff, Reinier Willem Pieter Tack, Akashleena Mallick, Leidys Gutierrez-Martinez, Jonathan Duskin, Tamara N Kimball, Benjamin Y Q Tan, Zeina N Chemali, Amy Newhouse, Christina Kourkoulis, Cyprien Rivier, Guido J Falcone, Kevin N Sheth, Ronald M Lazar, Sarah Ibrahim, Aleksandra Pikula, Rudolph E Tanzi, Gregory L Fricchione, Hens Bart Brouwers, Gabriel J E Rinkel, Nirupama Yechoor, Jonathan Rosand, Christopher D Anderson, Sanjula D Singh","doi":"10.1136/jnnp-2024-334925","DOIUrl":"10.1136/jnnp-2024-334925","url":null,"abstract":"<p><strong>Background: </strong>At least 60% of stroke, 40% of dementia and 35% of late-life depression (LLD) are attributable to modifiable risk factors, with great overlap due to shared pathophysiology. This study aims to systematically identify overlapping risk factors for these diseases and calculate their relative impact on a composite outcome.</p><p><strong>Methods: </strong>A systematic literature review was performed in PubMed, Embase and PsycInfo, between January 2000 and September 2023. We included meta-analyses reporting effect sizes of modifiable risk factors on the incidence of stroke, dementia and/or LLD. The most relevant meta-analyses were selected, and disability-adjusted life year (DALY) weighted beta (<i>β</i>)-coefficients were calculated for a composite outcome. The <i>β</i>-coefficients were normalised to assess relative impact.</p><p><strong>Results: </strong>Our search yielded 182 meta-analyses meeting the inclusion criteria, of which 59 were selected to calculate DALY-weighted risk factors for a composite outcome. Identified risk factors included alcohol (normalised <i>β</i>-coefficient highest category: -34), blood pressure (130), body mass index (70), fasting plasma glucose (94), total cholesterol (22), leisure time cognitive activity (-91), depressive symptoms (57), diet (51), hearing loss (60), kidney function (101), pain (42), physical activity (-56), purpose in life (-50), sleep (76), smoking (91), social engagement (53) and stress (55).</p><p><strong>Conclusions: </strong>This study identified overlapping modifiable risk factors and calculated the relative impact of these factors on the risk of a composite outcome of stroke, dementia and LLD. These findings could guide preventative strategies and serve as an empirical foundation for future development of tools that can empower people to reduce their risk of these diseases.</p><p><strong>Prospero registration number: </strong>CRD42023476939.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":"515-527"},"PeriodicalIF":8.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143780253","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":"Neurofilament light chain improves clinical prognostic models for Guillain-Barré syndrome.","authors":"Robin C M Thomma, Linda W G Luijten, Sander J van Tilburg, Eveline J A Wiegers, Charlotte E Teunissen, Lisa Vermunt, Pieter A van Doorn, Ruth Huizinga, Bart C Jacobs","doi":"10.1136/jnnp-2025-336046","DOIUrl":"https://doi.org/10.1136/jnnp-2025-336046","url":null,"abstract":"<p><strong>Background: </strong>Several prognostic models predict clinical outcomes in Guillain-Barré syndrome (GBS). Recently, neurofilament light chain (NfL) has emerged as a prognostic biomarker. We investigated the added prognostic value of NfL in serum (sNfL) and cerebrospinal fluid (cNfL) to models based on clinical factors predicting respiratory failure and inability to walk in GBS.</p><p><strong>Methods: </strong>We included patients from a randomised placebo-controlled trial (second intravenous immunoglobulin dose in GBS). Serum was acquired at entry and week 1, 2, 4 and 12 and cerebrospinal fluid at entry. NfL levels were determined on a single molecule array. The additional prognostic value of NfL to the (modified) Erasmus GBS Outcome Score ((m)EGOS) and (modified) Erasmus GBS Respiratory Insufficiency Score was evaluated using logistic regression analyses.</p><p><strong>Results: </strong>In total, 293 patients were included (74 (25%) mechanically ventilated, 38/275 (13%) unable to walk at 26 weeks). Higher sNfL at entry, week 1 and week 2 and cNfL at entry were associated with inability to walk at 4 and 26 weeks. Neither sNfL nor cNfL levels at entry were associated with respiratory failure. The EGOS and mEGOS improved after adding NfL (∆C-statistic range: 0.01-0.11), especially the models predicting outcome at 26 weeks. A new model predicting inability to walk at 26 weeks consisting of sNfL at entry, GBS disability score at entry and Medical Research Council sum score at week 2 performed best (C-statistic: 0.88 (95% CI 0.83 to 0.94)).</p><p><strong>Conclusions: </strong>Addition of NfL may improve clinical prognostic models for the prediction of inability to walk, but not of respiratory failure.</p><p><strong>Trial registration number: </strong>NTR2224/NL2107.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996816","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":"Increased risk of recurrent stroke in patients with impaired kidney function: results of a pooled analysis of individual patient data from the MICON international collaboration.","authors":"Jeremy Molad, Kaori Miwa, Philip S Nash, Gareth Ambler, Jonathan Best, Duncan Wilson, Hen Hallevi, Simon Fandler-Höfler, Sebastian Eppinger, Houwei Du, Rustam Al-Shahi Salman, Hans R Jäger, Gregory Y H Lip, Martina B Goeldlin, Morin Beyeler, Philipp Bücke, Marwan El-Koussy, Heinrich Paul Mattle, Leonidas D Panos, Dianne H K van Dam-Nolen, Florian Dubost, Jeroen Hendrikse, M Eline Kooi, Werner Mess, Paul J Nederkoorn, Masayuki Shiozawa, Nicolas Christ, Maximilian Bellut, Sarah Gunkel, Christopher Karayiannis, John Van Ly, Shaloo Singhal, Lee-Anne Slater, Young Dae Kim, Tae-Jin Song, Keon-Joo Lee, Jae-Sung Lim, Hideo Hara, Masashi Nishihara, Jun Tanaka, Masaaki Yoshikawa, Derya Selcuk Demirelli, Zeynep Tanriverdi, Ender Uysal, Shelagh B Coutts, Francesca M Chappell, Stephen Makin, Henry Ka-Fung Mak, Kay Cheong Teo, Debbie Y K Wong, Lisa Hert, Marta Kubacka, Philippe Lyrer, Alexandros A Polymeris, Benjamin Wagner, Annaelle Zietz, Jill M Abrigo, Cyrus Cheng, Winnie C W Chu, Thomas W H Leung, Suk Fung Tsang, Brian Yiu, David J Seiffge, Urs Fischer, Simon Jung, Christian Enzinger, Thomas Gattringer, Daniel Bos, Kazunori Toyoda, Felix Fluri, Thanh G Phan, Velandai Srikanth, Ji Hoe Heo, Hee-Joon Bae, Yusuke Yakushiji, Dilek Necioglu Orken, Eric E Smith, Joanna M Wardlaw, Kui Kai Lau, Stefan T Engelter, Nils Peters, Yannie Soo, David C Wheeler, Robert J Simister, Natan M Bornstein, David J Werring, Einor Ben Assayag, Masatoshi Koga","doi":"10.1136/jnnp-2024-335110","DOIUrl":"https://doi.org/10.1136/jnnp-2024-335110","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease are at increased risk of stroke and frequently have cerebral microbleeds. Whether such patients also encounter an increased risk of recurrent stroke has not been firmly established. We aimed to determine whether impaired kidney function is associated with the risk of recurrent stroke, and microbleed presence, distribution and severity.</p><p><strong>Methods: </strong>We used pooled data from the Microbleeds International Collaborate Network to investigate associations of impaired kidney function, defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m². Our primary outcome was a composite of recurrent ischaemic stroke (IS) and intracranial haemorrhage (ICrH). Secondary outcomes included: (1) individual components of the primary outcome; (2) modification of the primary outcome by microbleed presence or anticoagulant use and (3) microbleed presence, distribution and severity.</p><p><strong>Results: </strong>11 175 patients (mean age 70.7±12.6, 42% female) were included, of which 2815 (25.2%) had impaired kidney function. Compared with eGFR ≥60, eGFR <60 was associated with a higher risk of the primary outcome (adjusted HR, aHR 1.33 (95% CI 1.14 to 1.56), p<0.001) and higher rates of the recurrent IS (aHR 1.33 (95% CI 1.12 to 1.58)). Reduced eGFR was not associated with ICrH risk (aHR 1.07 (95% CI 0.70 to 1.60)). eGFR was also associated with microbleed presence (adjusted OR, aOR 1.14 (95% CI 1.03 to 1.26)) and severity (aOR 1.17 (95% CI 1.06 to 1.29)). Compared with having no microbleeds, eGFR was lower in those with strictly lobar microbleeds (adjusted mean difference (aMD) -2.10 mL/min/1.73 cm² (95% CI -3.39 to -0.81)) and mixed microbleeds (aMD -2.42 (95% CI -3.70 to -1.15)), but not strictly deep microbleeds (aMD -0.67 (95% CI -1.85 to 0.51)).</p><p><strong>Conclusions: </strong>In patients with IS or transient ischaemic attack, impaired kidney function was associated with a higher risk of recurrent stroke and higher microbleeds burden, compared with those with normal kidney function. Further research is needed to investigate potential additional measures for secondary prevention in this high-risk group.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006978","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":"Evolution of autonomic nervous system abnormalities in multiple sclerosis: a 6-year follow-up.","authors":"Berislav Ruška, Ivan Adamec, Luka Crnosija, Tereza Gabelić, Barbara Barun, Anamari Junakovic, Magdalena Krbot Skoric, Mario Habek","doi":"10.1136/jnnp-2024-335376","DOIUrl":"https://doi.org/10.1136/jnnp-2024-335376","url":null,"abstract":"<p><strong>Background: </strong>Due to the lack of long-term studies, this research aimed to explore the changes and predictors of autonomic dysfunction (AD) in people with multiple sclerosis (pwMS) over a 6-year period from disease onset.</p><p><strong>Methods: </strong>Among the 121 pwMS cohort, 75 underwent autonomic function tests at baseline and year 6. Autonomic symptoms were assessed using the Composite Autonomic System Score-31 (COMPASS-31), while the results of autonomic tests were recorded using the Composite Autonomic Scoring Scale (CASS) at baseline and biennially over 6 years. Symptomatic dysautonomia was identified by a COMPASS-31 score greater than 7.913 and a CASS score greater than 0.</p><p><strong>Results: </strong>No significant changes were noted in the COMPASS-31 and CASS scores from baseline to year 6. However, there was a significant decline in the cardiovagal index (p=0.001) and the sudomotor index (p=0.036 and p=0.001, respectively) at years 4 and 6, compared with baseline. The number of participants with symptomatic dysautonomia increased significantly from year 0 to 6 (14 (20.9%) vs 29 (39.2%), respectively; p=0.049). Multivariable logistic regression analysis revealed that experiencing a relapse during the 6 years increased the likelihood of symptomatic dysautonomia (Exp(B) 3.886, 95% CI 1.019 to 14.825, p=0.047). Conversely, transitioning to high-efficacy disease-modifying therapy (HET) reduced the probability of having a CASS score greater than 0 at year 6 (Exp(B) 0.221, 95% CI 0.067 to 0.734, p=0.014).</p><p><strong>Conclusions: </strong>Dysfunction of the cardiovagal and sudomotor systems progresses alongside disease duration in pwMS. The early initiation of HET may help mitigate the risk of developing AD.</p>","PeriodicalId":16418,"journal":{"name":"Journal of Neurology, Neurosurgery, and Psychiatry","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986489","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}