Journal of Neurology最新文献

{"title":"Antiplatelet therapy is not associated with increased risk of complications after lumbar puncture.","authors":"Laura Stichaller, Nik Krajnc, Fritz Leutmezer, Elisabeth Stögmann, Friedrich Zimprich, Tobias Zrzavy, Thomas Berger, Gabriel Bsteh","doi":"10.1007/s00415-024-12864-6","DOIUrl":"https://doi.org/10.1007/s00415-024-12864-6","url":null,"abstract":"<p><strong>Background: </strong>Lumbar puncture (LP) is a critical diagnostic procedure in the evaluation of neurological diseases. Although considered safe, complications such as post-dural puncture headache (PDPH), back pain, subdural hematoma or venous sinus thrombosis may still occur. Whether the use of antiplatelet therapy (APT) increases the risk of complications after LP, remains unclear.</p><p><strong>Methods: </strong>This retrospective observational study included 783 patients who underwent diagnostic LP. We employed multivariate logistic regression models with complications as the dependent variable, and APT as the independent variable, adjusting for potential confounders.</p><p><strong>Results: </strong>Among 783 patients included (54.0% female, median age 48 years [IQR 33-64], median BMI 24.7 kg/m² [IQR 21.8-28.3], 111 [14.2%] receiving APT), complications were observed in 182 (23.2%) patients. The most common complications were PDPH and back pain in 152 (19.4%) and 42 (5.4%) patients, respectively. Venous sinus thrombosis occurred in one (0.1%) patient. In the multivariate logistic regression model, younger age (OR 1.49 per 10 years, 95% CI 1.32-1.69, p < 0.001) and female sex (OR 1.74, 95% CI 1.19-2.54, p = 0.005) were associated with higher likelihood of complications, whereas APT (OR 0.63, 95% CI 0.30-1.36, p = 0.241) and the final diagnosis were not.</p><p><strong>Conclusion: </strong>Complications following LP occur in approximately one fourth of patients, with younger age and female sex being significant risk factors. As APT is not associated with increased risk of complications, withholding LP in patients on APT may not be necessary.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 1","pages":"88"},"PeriodicalIF":4.8,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CSF synaptic biomarkers and cognitive impairment in multiple sclerosis.","authors":"Lorenzo Barba, Lorenzo Gaetani, Silvia Sperandei, Elena Di Sabatino, Samir Abu-Rumeileh, Steffen Halbgebauer, Patrick Oeckl, Petra Steinacker, Lucilla Parnetti, Massimiliano Di FIlippo, Markus Otto","doi":"10.1007/s00415-024-12851-x","DOIUrl":"https://doi.org/10.1007/s00415-024-12851-x","url":null,"abstract":"<p><strong>Background: </strong>People with multiple sclerosis (PwMS) experience various degrees of cognitive impairment (CI). Synaptic dysfunction may contribute to CI in PwMS but cerebrospinal fluid (CSF) synaptic biomarkers are unexplored in MS.</p><p><strong>Objective: </strong>To assess the role of CSF synaptosomal-associated protein 25 (SNAP-25), β-synuclein, neurogranin and neurofilament light chain protein (NfL) in patients with early relapsing MS with and without CI.</p><p><strong>Methods: </strong>We measured CSF SNAP-25, β-synuclein, and neurogranin in 48 untreated PwMS and 50 controls with other neurological diseases (ONDs) and tested their associations with neuropsychological and MRI data.</p><p><strong>Results: </strong>CSF synaptic protein levels did not discriminate between MS subjects and patients with ONDs, with only SNAP-25 values being slightly increased in MS (p = 0.009). CSF synaptic markers were positively correlated with each other and with CSF NfL. Moreover, lower biomarker levels were found to be correlated with longer disease duration and lower brain volumes (especially of the thalamus). Moreover, we found significantly lower CSF SNAP-25 (p = 0.025), β-synuclein (p = 0.044), and neurogranin (p = 0.007) levels in PwMS with vs. without domain-specific cognitive impairment.</p><p><strong>Conclusion: </strong>Lower CSF synaptic biomarker levels were found in PwMS with longer disease duration and lower brain volumes and may identify PwMS at risk of CI.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 1","pages":"85"},"PeriodicalIF":4.8,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain MRI volumetry and atrophy rating scales as predictors of amyloid status and eligibility for anti-amyloid treatment in a real-world memory clinic setting.","authors":"A Zilioli, A Rosenberg, R Mohanty, A Matton, T Granberg, G Hagman, J Lötjönen, M Kivipelto, E Westman","doi":"10.1007/s00415-024-12853-9","DOIUrl":"https://doi.org/10.1007/s00415-024-12853-9","url":null,"abstract":"<p><p>Predicting amyloid status is crucial in light of upcoming disease-modifying therapies and the need to identify treatment-eligible patients with Alzheimer's disease. In our study, we aimed to predict CSF-amyloid status and eligibility for anti-amyloid treatment in a memory clinic by (I) comparing the performance of visual/automated rating scales and MRI volumetric analysis and (II) combining MRI volumetric data with neuropsychological tests and APOE4 status. Two hundred ninety patients underwent a comprehensive assessment. The cNeuro cMRI software (Combinostics Oy) provided automated computed rating scales and volumetric analysis. Amyloid status was determined using data-driven CSF biomarker cutoffs (Aβ42/Aβ40 ratio), and eligibility for anti-Aβ treatment was assessed according to recent recommendations published after the FDA approval of the anti-Aβ drug aducanumab. The automated rating scales and volumetric analysis demonstrated higher performance compared to visual assessment in predicting Aβ status, especially for parietal-GCA (AUC = 0.70), MTA (AUC = 0.66) scores, hippocampal (AUC = 0.68), and angular gyrus (AUC = 0.69) volumes, despite low global accuracy. When we combined hippocampal and angular gyrus volumes with RAVLT immediate recall and APOE4 status, we achieved the highest accuracy (AUC = 0.82), which remained high even in predicting anti-Aβ treatment eligibility (AUC = 0.81). Our study suggests that automated analysis of atrophy rating scales and brain volumetry outperforms operator-dependent visual rating scales. When combined with neuropsychological and genetic information, this computerized approach may play a crucial role not only in a research context but also in a real-world memory clinic. This integration results in a high level of accuracy for predicting amyloid-CSF status and anti-Aβ treatment eligibility.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 1","pages":"84"},"PeriodicalIF":4.8,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous thrombolysis and mechanical thrombectomy in acute stroke patients on direct oral anticoagulants.","authors":"Espen Saxhaug Kristoffersen, David Julian Seiffge, Thomas Raphael Meinel","doi":"10.1007/s00415-024-12832-0","DOIUrl":"https://doi.org/10.1007/s00415-024-12832-0","url":null,"abstract":"<p><p>Intravenous thrombolysis and mechanical thrombectomy reduce morbidity and improve functional outcome in ischemic stroke. However, acute recanalization therapies may increase the risk of symptomatic intracranial hemorrhage due to its effects on the brain tissue. An increasing proportion of patients with ischemic stroke are using direct oral anticoagulants (DOACs). While current international guidelines recommend against intravenous thrombolysis in patients with intake of DOACs within the last 48 h, they also highlight lack of evidence in the area. Based on these guidelines, a significant proportion of patients are consequently disqualified from intravenous thrombolysis. Measuring anticoagulant activity before intravenous thrombolysis has been suggested as a way to select patients with low risk of symptomatic intracranial hemorrhage, but uncertainty exists about feasibility, validity, availability and costs. Reversal agents have demonstrated potential in facilitating safer intravenous thrombolysis administration, though their efficacy is not established in randomized controlled trials, and logistical and cost-related barriers limit their widespread use. During the last couple of years several large cohort studies reported no significant increase in symptomatic intracranial hemorrhage among selected patients on DOACs receiving intravenous thrombolysis compared to those not on anticoagulants, even without the use of DOAC plasma levels or reversal agents. Mechanical thrombectomy appears to be generally safe in patients with recent DOAC intake. The aim of this review is to discuss the uncertainty around the safety and efficacy of intravenous thrombolysis and thrombectomy in patients with a recent intake of DOAC, summarize existing knowledge, and outline potential approaches.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 1","pages":"82"},"PeriodicalIF":4.8,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using clinical data to reclassify ESUS patients to large artery atherosclerotic or cardioembolic stroke mechanisms.","authors":"Lauren Klein-Murrey, David L Tirschwell, Daniel S Hippe, Mona Kharaji, Cristina Sanchez-Vizcaino, Brooke Haines, Niranjan Balu, Thomas S Hatsukami, Chun Yuan, Nazem W Akoum, Eardi Lila, Mahmud Mossa-Basha","doi":"10.1007/s00415-024-12848-6","DOIUrl":"https://doi.org/10.1007/s00415-024-12848-6","url":null,"abstract":"<p><strong>Purpose: </strong>Embolic stroke of unidentified source (ESUS) represents 10-25% of all ischemic strokes. Our goal was to determine whether ESUS could be reclassified to cardioembolic (CE) or large-artery atherosclerosis (LAA) with machine learning (ML) using conventional clinical data.</p><p><strong>Methods: </strong>We retrospectively collected conventional clinical features, including patient, imaging (MRI, CT/CTA), cardiac, and serum data from established cases of CE and LAA stroke, and factors with p < 0.2 in univariable analysis were used for creating a ML predictive tool. We then applied this tool to ESUS cases, with ≥ 75% likelihood serving as the threshold for reclassification to CE or LAA. In patients with longitudinal data, we evaluated future cardiovascular events.</p><p><strong>Results: </strong>191 ischemic stroke patients (80 CE, 61 LAA, 50 ESUS) were included. Seven and 6 predictors positively associated with CE and LAA etiology, respectively. The c-statistic for discrimination between CE and LAA was 0.88. The strongest predictors for CE were left atrial volume index (OR = 2.17 per 1 SD increase) and BNP (OR = 1.83 per 1 SD increase), while the number of non-calcified stenoses ≥ 30% upstream (OR = 0.34 per 1 SD increase) and not upstream (OR = 0.74 per 1 SD increase) from the infarct were for LAA. When applied to ESUS cases, the model reclassified 40% (20/50), with 11/50 reclassified to CE and 9/50 reclassified to LAA. In 21/50 ESUS with 30-day cardiac monitoring, 1/4 in CE and 3/16 equivocal reclassifications registered cardiac events, while 0/1 LAA reclassifications showed events.</p><p><strong>Conclusion: </strong>ML tools built using standard ischemic stroke workup clinical biomarkers can potentially reclassify ESUS stroke patients into cardioembolic or atherosclerotic etiology categories.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 1","pages":"87"},"PeriodicalIF":4.8,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual quality of life in NMOSD and MOGAD: profiles, dynamics and associations with ageing and vision.","authors":"Mihaela Nicolescu, Vivien Häußler, Friedemann Paul, Frederike Cosima Oertel, Patrick Schindler, Judith Bellmann Strobl, Markus Krumbholz, Martin W Hümmert, Franziska Bütow, Daria Tkachenko, Corinna Trebst, Charlotte Schubert, Ilya Ayzenberg, Carolin Schwake, Thivya Pakeerathan, Katinka Fischer, Orhan Aktas, Marius Ringelstein, Markus Kraemer, Clemens Warnke, Matthias Grothe, Matthias Kaste, Klemens Angstwurm, Peter Kern, Ingo Kleiter, Paulus Rommer, Alexander Winkelmann, Annette Walter, Martin S Weber, Jonathan Wickel, Katrin Giglhuber, Florian Then Bergh, Makbule Senel, Hayrettin Tumani, Ioannis Vardakas, Eva Dawin, Lisa Revie, Luisa Klotz, Mirjam Korporal-Kuhnke, Sven Jarius, Brigitte Wildemann, Jonathan A Gernert, Tania Kümpfel, Daniel Engels, Joachim Havla, Natacha Stolowy, Jan-Patrick Stellmann","doi":"10.1007/s00415-024-12803-5","DOIUrl":"https://doi.org/10.1007/s00415-024-12803-5","url":null,"abstract":"<p><strong>Objective: </strong>In this multicentric study, we were interested in the vision-related quality of life and its association with visual impairment in neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in comparison to multiple sclerosis (MS) and healthy controls.</p><p><strong>Methods: </strong>We analysed extracted data from the German NEMOS registry including National Eye Institute Visual Function Questionnaire (NEI-VFQ) scores, high and low contrast visual acuity (HCVA, LCVA), visually evoked potentials (VEP) and the scores for the expanded disability status scale (EDSS) and other neurological tests which assessed their disease-related impairment. The mean follow-up time of our patients was 1.2 years. We used adjusted linear mixed effect models to analyse NEI-VFQ differences and interactions with visual acuity among NMOSD, MOGAD, a matched MS cohort and healthy controls.</p><p><strong>Results: </strong>Despite a younger age in the MOGAD cohort (39 y.o.), vision and socioemotional-related quality of life reduction was similar over all patient subgroups in comparison to healthy controls. The most impacted life quality dimension was general health, followed by general vision, driving and role difficulties. Decline in some of the NEI-VFQ subscales scores is mostly predicted by age. The HCVA was the best predictor for most of the subscales of the NEI-VFQ.</p><p><strong>Discussion: </strong>Despite important age differences, NMOSD, MOGAD and MS seem to share a rather similar perception on their vision and quality of life impairment, which is overall poorer than that of healthy controls.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 1","pages":"86"},"PeriodicalIF":4.8,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subtypes of cognitive impairment in cerebellar disease identified by cross-diagnostic cluster-analysis: results from a German multicenter study.","authors":"Qi Liu, Kerstin Rubarth, Jennifer Faber, Patricia Sulzer, Imis Dogan, Miriam Barkhoff, Martina Minnerop, Adam M Berlijn, Saskia Elben, Heike Jacobi, Julia-Elisabeth Aktories, Dana M Huvermann, Friedrich Erdlenbruch, Raquel Van der Veen, Johanna Müller, Enzo Nio, Benedikt Frank, Martin Köhrmann, Elke Wondzinski, Mario Siebler, Kathrin Reetz, Jürgen Konczak, Frank Konietschke, Thomas Klockgether, Matthis Synofzik, Sandra Röske, Dagmar Timmann, Andreas Thieme","doi":"10.1007/s00415-024-12831-1","DOIUrl":"https://doi.org/10.1007/s00415-024-12831-1","url":null,"abstract":"<p><strong>Background: </strong>Cognitive and neuropsychiatric impairment, known as cerebellar cognitive affective syndrome (CCAS), may be present in cerebellar disorders. This study identified distinct CCAS subtypes in cerebellar patients using cluster analysis.</p><p><strong>Methods: </strong>The German CCAS-Scale (G-CCAS-S), a brief screening test for CCAS, was assessed in 205 cerebellar patients and 200 healthy controls. K-means cluster analysis was applied to G-CCAS-S data to identify cognitive clusters in patients. Demographic and clinical variables were used to characterize the clusters. Multiple linear regression quantified their relative contribution to cognitive performance. The ability of the G-CCAS-S to correctly distinguish between patients and controls was compared across the clusters.</p><p><strong>Results: </strong>Two clusters explained the variance of cognitive performance in patients' best. Cluster 1 (30%) exhibited severe impairment. Cluster 2 (70%) displayed milder dysfunction and overlapped substantially with that of healthy controls. Cluster 1 patients were on average older, less educated, showed more severe ataxia and more extracerebellar involvement than cluster 2 patients. The cluster assignment predicted cognitive performance even after adjusting for all other covariates. The G-CCAS-S demonstrated good discriminative ability for cluster 1, but not for cluster 2.</p><p><strong>Conclusions: </strong>The variance of cognitive impairment in cerebellar disorders is best explained by one severely affected and one mildly affected cluster. Cognitive performance is not only predicted by demographic/clinical characteristics, but also by cluster assignment itself. This indicates that factors that have not been captured in this study likely have effects on cognitive cerebellar functions. Moreover, the CCAS-S appears to have a relative weakness in identifying patients with only mild cognitive deficits.</p><p><strong>Study registration: </strong>The study has prospectively been registered at the German Clinical Study Register ( https://www.drks.de ; DRKS-ID: DRKS00016854).</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 1","pages":"83"},"PeriodicalIF":4.8,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of white matter hyperintensities on short-term outcomes of reperfusion therapy in patients with acute ischemic stroke.","authors":"Junying Li, Dan Yang, Rui Song, Jian Wang, Lanying He","doi":"10.1007/s00415-024-12755-w","DOIUrl":"https://doi.org/10.1007/s00415-024-12755-w","url":null,"abstract":"<p><strong>Background and purpose: </strong>This study aimed to explore the impact of white matter hyperintensities (WMH) on the short-term outcomes of reperfusion therapy in acute ischemic stroke (AIS) patients.</p><p><strong>Methods: </strong>We prospectively collected data on AIS patients undergoing reperfusion therapies at Chengdu Second People's Hospital from January 2020 and January 2024. WMH severity was graded as 0-3 (none to moderate) or 4-6 (severe) by the Fazekas scale. We analyzed National Institutes of Health Stroke Scale (NIHSS) scores, good functional outcomes (modified Rankin Scale, mRS 0-2) at 7 days and discharge, and safety outcomes like in-hospital mortality and intracranial hemorrhage.</p><p><strong>Results: </strong>During the study period, 669 patients were included, with 345 having none to moderate WMH and 324 with severe WMH. Patients with severe WMH exhibited significantly higher NIHSS and mRS at 7 days and discharge, with a decrease in good outcomes (mRS 0-2: 40.43% vs. 75.65%), and an increase in intracranial hemorrhage (16.4% vs. 5.8%) and in-hospital mortality (11.7% vs. 2.0%) compared with none to moderate WMH patients. After matching the baseline data, none to moderate WMH was associated with higher likelihood of good outcomes at discharge [adjusted odds ratio (aOR), 2.142; 95% confidence interval (CI), 1.380-3.304; P < 0.001] and a lower rate of any intracranial hemorrhage (aOR, 0.348; 95% CI 0.180-0.673; P < 0.001), with no significant difference in in-hospital mortality between the groups.</p><p><strong>Conclusion: </strong>Severe WMH could reduce the benefits of reperfusion therapy in AIS, with increased risk of hemorrhagic complications, warranting further research into treatment strategies for these patients.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 1","pages":"81"},"PeriodicalIF":4.8,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors of long-term brain health outcomes after hospitalization for critical illness.","authors":"C Peinkhofer, C S Grønkjær, L E Bang, L Fonsmark, J-U Stæhr Jensen, T L Katzenstein, J Kjaergaard, A Lebech, C Merie, V Nersesjan, P Sivapalan, P Zarifkar, Michael E Benros, Daniel Kondziella","doi":"10.1007/s00415-024-12786-3","DOIUrl":"10.1007/s00415-024-12786-3","url":null,"abstract":"<p><strong>Background: </strong>Brain health may be impaired years after hospitalization for critical illness, and similar impairments occur after hospitalization for COVID-19. However, it remains unclear which patients are most likely to experience long-term brain health consequences and whether these adverse events differ between non-COVID critical illness and COVID-19.</p><p><strong>Methods: </strong>In a prospective observational study, we enrolled patients hospitalized for (1) non-COVID critical illness (pneumonia, myocardial infarction, or ICU-requiring conditions) or for (2) COVID-19, from March 2020 to June 2021. Brain health was assessed at 18-month follow-up with cognitive, psychiatric, and neurological tests. We used both logistic regression and prediction models to test for associations between different variables and brain health.</p><p><strong>Results: </strong>We included 245 patients: 125 hospitalized for non-COVID critical illness and 120 for COVID-19 [mean age 61.2 (± 13.6) years, 42% women]. Brain health was impaired in 76% of patients (72% critical illness, 81% COVID-19; p = 0.14) at 18-month follow-up. The strongest predictive factors associated with impaired brain health were education < 13 years, age ≥ 70 years, and neuroticism traits in the best performing model (AUC = 0.63). When analyzing non-COVID critical illness and COVID-19 patients separately, low education was one of the few factors associated with impaired brain health in both groups (AUCs for best models: 0.66 and 0.69).</p><p><strong>Conclusion: </strong>Brain health is comparably impaired after hospitalization for critical illness and COVID-19. Factors like higher age, lower education and neuroticism may help identifying vulnerable individuals, who could benefit from close monitoring to improve brain health after critical illness, regardless of the underlying disease etiology.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 1","pages":"71"},"PeriodicalIF":4.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cuneus atrophy and Parkinsonian phenoconversion in cognitively unimpaired patients with isolated REM sleep behavior disorder.","authors":"Andreas Myhre Baun, Alex Iranzo, Miriam Højholt Terkelsen, Morten Gersel Stokholm, Kristian Stær, Mónica Serradell, Marit Otto, Kristina Bacher Svendsen, Alicia Garrido, Dolores Vilas, Joan Santamaria, Arne Møller, Carles Gaig, David J Brooks, Per Borghammer, Eduardo Tolosa, Simon Fristed Eskildsen, Nicola Pavese","doi":"10.1007/s00415-024-12762-x","DOIUrl":"10.1007/s00415-024-12762-x","url":null,"abstract":"<p><p>Isolated rapid-eye-movement sleep behavior disorder (iRBD) is a strong predictor of Parkinson's disease and Dementia with Lewy bodies. Previous studies indicate that cortical atrophy in iRBD patients may be linked to cognitive impairment, but the pattern of atrophy is inconsistently reported. This study aimed to elucidate cortical atrophy patterns in a cognitively unimpaired iRBD cohort, focusing on regions associated with cognitive functions, particularly the cuneus/precuneus, and evaluated the predictive value for future phenoconversion. We conducted voxel-based morphometry and region of interest (ROI) analysis of structural MRI scans of 36 healthy controls and 19 iRBD patients, nine of whom also received a 3-year follow-up MRI scan. The iRBD patients were followed clinically for 8 years, and time-to-event analyses, using Cox regression, were performed based on baseline ROI volumes. The iRBD patients had lower gray-matter volume in the cuneus/precuneus region as well as in subcortical structures (caudate nuclei and putamen) compared to controls. Eight iRBD patients developed either Parkinson's disease (N = 4) or Dementia with Lewy bodies (N = 4) during the follow-up period. Time-to-event analyses showed that lower right cuneus volume was associated with a higher risk of phenoconversion to alpha-synuclein-linked Parkinsonism in the iRBD patients (Hazard ratio = 13.0, CI: 1.53-110), and correlated with shorter time to conversion. In addition, lower volumes of the bilateral precuneus trended to indicate a higher risk of phenoconversion. These findings suggest a potential predictive value of cuneus and precuneus volumes in identifying iRBD patients at risk of disease progression, even before the onset of cognitive impairment.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 1","pages":"59"},"PeriodicalIF":4.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}