Journal of Neurology最新文献

{"title":"Letter to editors regarding \"Serological analysis of gluten‑related antibodies in idiopathic neuropathies and cerebellar ataxia\".","authors":"Iain D Croall, Nigel Hoggard, Richard A Grunewald, Marios Hadjivassiliou","doi":"10.1007/s00415-025-13376-7","DOIUrl":"https://doi.org/10.1007/s00415-025-13376-7","url":null,"abstract":"","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 10","pages":"647"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124824","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":"Kappa free light chain index as a diagnostic and prognostic biomarker in multiple sclerosis.","authors":"Luis Moreno-Navarro, Sergio Mora-Diaz, Lourdes Ruiz-Escribano-Menchen, Angel P Sempere","doi":"10.1007/s00415-025-13381-w","DOIUrl":"10.1007/s00415-025-13381-w","url":null,"abstract":"<p><strong>Background: </strong>The proposed 2024 McDonald criteria incorporate the kappa free light chain (KFLC) index as an additional biomarker in multiple sclerosis (MS) diagnosis. Emerging evidence suggests that a high KFLC index may relate to worse outcomes in people with MS (pwMS). This study had two main objectives: to evaluate the diagnostic performance of the KFLC index against the 2017 and proposed 2024 clinico-radiological McDonald criteria, and to explore its prognostic significance.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of adults with a first episode suggestive of MS (2019-2024). All underwent lumbar puncture with simultaneous determination of the KFLC index and oligoclonal bands (OCB).</p><p><strong>Results: </strong>Among 150 participants, OCB showed sensitivities of 85.9% (2017) and 86.6% (2024) with specificities of 79.7% and 81.9%. A KFLC index cut-off of 12.0 yielded sensitivities of 87.5% (2017) and 88.1% (2024) with specificities of 79.2% and 81.4%, comparable to OCB. In pwMS, KFLC index ≥ 100 was associated with younger age (OR 1.53, p = 0.048), women (OR 1.53, p = 0.037), relapses (OR 2.30, p = 0.029) and new infratentorial or spinal cord (SC) lesions (OR 6.90, p = 0.003). In multivariable analysis, KFLC index ≥ 100 remained associated with new infratentorial or SC lesions (aOR 8.07, p = 0.019).</p><p><strong>Conclusion: </strong>The KFLC index shows diagnostic utility comparable to OCB; however, it is an adjunctive biomarker that complements clinical and MRI findings and should not be used as a standalone diagnostic test. An elevated KFLC index was associated with short-term accrual of infratentorial or SC lesions; these exploratory findings require validation in larger, longer-term cohorts.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 10","pages":"646"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Widespread and progressive brain atrophy is a common feature in patients with mitochondrial disease.","authors":"Nora Mickelsson, Jussi Hirvonen, Mika H Martikainen","doi":"10.1007/s00415-025-13354-z","DOIUrl":"10.1007/s00415-025-13354-z","url":null,"abstract":"<p><strong>Background: </strong>Primary mitochondrial diseases comprise a group of inherited disorders that frequently affect the central nervous system. Previous studies have reported brain imaging findings commonly associated with mitochondrial disease. However, longitudinal data on volumetric brain abnormalities, their progression in time, and associations with clinical features of the disease remain limited.</p><p><strong>Methods: </strong>We conducted a retrospective observational study of 36 patients with genetically confirmed mitochondrial disease at Turku University Hospital (Turku, Finland). A total of 73 brain magnetic resonance scans (1-8 per patient) were analysed using the cNeuro® image quantification tool to assess lobar and regional cortical atrophy. Associations with clinical features, including stroke-like episodes (SLEs), sex, and genetic subtype, were investigated.</p><p><strong>Results: </strong>Cerebral atrophy was present in all patients and was most pronounced in the temporal and occipital lobes. Patients with a history of SLEs exhibited significantly greater atrophy in both temporal lobes and the right occipital and parietal lobes. Follow-up imaging (available for 15 patients) revealed progressive atrophy, particularly in the occipital lobes, in patients with SLEs. No significant differences in atrophy severity or progression were found between patients with the m.3243A > G variant and those with other genetic causes.</p><p><strong>Conclusions: </strong>Cerebral atrophy is a common and often progressive feature of mitochondrial disease, even in patients without clinical brain symptoms. Atrophy predominantly affects posterior brain regions, and its progression is particularly evident in patients with SLEs. These findings underline the neurodegenerative nature of mitochondrial disease and highlight the need to develop neuroprotective therapies.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 10","pages":"648"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroanatomical normative modelling in frontotemporal lobar degeneration: higher heterogeneity in the behavioural variant.","authors":"Srijan Konwar, Nikolett Hunyadvari, Annalena Venneri, James H Cole, Martina Bocchetta","doi":"10.1007/s00415-025-13378-5","DOIUrl":"10.1007/s00415-025-13378-5","url":null,"abstract":"<p><strong>Introduction: </strong>Frontotemporal lobar degeneration (FTLD) includes heterogenous diseases: behavioural variant frontotemporal dementia (bvFTD), primary progressive aphasias (PPA), progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). We applied neuroanatomical normative modelling to quantify individual atrophy patterns and heterogeneity within and between FTLD forms.</p><p><strong>Methods: </strong>We included 160 participants across FTLDNI and 4RTNI studies: controls (n = 15), bvFTD (n = 22), nfvPPA (n = 14), svPPA (n = 21), CBS (n = 43) and PSP (n = 45). Using cortical thickness and subcortical volumes from 3T MRIs, we applied normative modelling with a large healthy reference dataset (n = 58,836), further accounting for age, sex, and scanner. Outlier regions (z < - 1.96) were used to compute total outlier counts (tOC) and Hamming distances, capturing individual atrophy patterns and inter-subject dissimilarity.</p><p><strong>Results: </strong>bvFTD, svPPA, CBS and PSP showed significantly higher cortical tOC than controls, with all groups showing higher subcortical tOC than controls, especially svPPA and PSP. bvFTD, svPPA, CBS and PSP had significantly higher cortical Hamming distance scores than controls, with higher scores in bvFTD and svPPA than nfvPPA and PSP. svPPA and PSP had significantly higher subcortical scores than controls and CBS. Greater disease severity (measured using the Clinical Dementia Rating-CDR for PSP and CBS, and the CDR® plus NACC-FTLD global scores for FTD variants) was associated with increased tOC and dissimilarity, highlighting the link between clinical progression and neuroanatomical heterogeneity.</p><p><strong>Conclusions: </strong>The pronounced heterogeneity within and between FTLD subtypes (particularly in bvFTD) increases with disease progression and may reflect distinct underlying pathologies. This supports the development of subtype-specific biomarkers and emphasize the need for personalized diagnostic and therapeutic strategies.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 10","pages":"642"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Olfactory identification impairment in cerebral small-vessel disease indicates cognitive network disconnection and predicts accelerated cognitive decline.","authors":"Xiaoshu Fu, Bo Xie, Ludi Li, Yitong Hao, Simin Yang, Chunjie Guo, Yu Yang","doi":"10.1007/s00415-025-13375-8","DOIUrl":"10.1007/s00415-025-13375-8","url":null,"abstract":"<p><strong>Background: </strong>Olfactory identification impairment is a well-established early screening index for cognitive decline in neurodegenerative disorders. However, whether this simple sensory test can similarly detect or predict cognitive deficits in cerebral small vessel disease (CSVD)-a leading cause of vascular cognitive impairment-remains unclear.</p><p><strong>Methods: </strong>All participants-including 193 CSVD patients and 164 normal controls (NC)-completed the University of Pennsylvania Smell Identification Test (UPSIT) and a comprehensive neuropsychological battery. Multimodal MRI analyses were conducted to identify structural and functional abnormalities associated with UPSIT performance. A cognitive follow-up assessment was performed 24 months post-baseline, and the rate of cognitive decline was annualized.</p><p><strong>Results: </strong>Compared to NC, CSVD patients exhibited significantly lower UPSIT scores (p < 0.001). UPSIT performance correlated strongly with cognition. Local structural and functional abnormalities in primary and secondary olfactory cortices did not reliably predict UPSIT performance in CSVD patients. In contrast, dorsolateral prefrontal cortex functional connectivity strength was significantly associated with odor-identification performance. Mediation models further demonstrated that greater white matter lesion burden indirectly impaired olfactory identification via disrupted inter-network connectivity between the salience network (SN) and posterior default mode network (pDMN). CSVD patients with baseline UPSIT < 20 exhibited a steeper annual MMSE decline than those with UPSIT ≥ 20 (1.0 vs. 0.5 points per year; p < 0.001).</p><p><strong>Conclusion: </strong>Olfactory identification impairment in patients with CSVD reflects disruption of higher-order cognitive networks, and a baseline UPSIT score below 20 predicts accelerated cognitive decline.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 10","pages":"644"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognition, FDG metabolism, and amyloid accumulation in relation to intracranial arachnoid cysts.","authors":"Victoria Emilie Neesgaard, Johanne Asperud Thomsen, Jette Stokholm Pedersen, Steen Gregers Hasselbalch, Ian Law, Frantz Rom Poulsen, Tiit Illimar Mathiesen","doi":"10.1007/s00415-025-13299-3","DOIUrl":"10.1007/s00415-025-13299-3","url":null,"abstract":"<p><strong>Background: </strong>Though traditionally regarded as harmless, incidental findings, recent literature indicates neuropsychological symptoms associated with intracranial arachnoid cysts (AC). Pathogenesis is unknown, but compression of parenchyma and altered metabolism has been suggested. Patients suspected of dementia often undergo evaluation which can lead to identification of an AC. It is uncertain whether AC can be a primary or contributing cause to symptoms in these and AC have sometimes been raised as a differential diagnosis.</p><p><strong>Methods: </strong>In this cross-sectional study, patients with AC ≥ 2 cm in a group of 2292 patients referred as part of evaluation for dementia for positon emission tomography (PET) scans with [¹⁸F]Fluorodeoxyglucose (FDG) and/or Pittsburgh compound B (PiB) were investigated. FDG metabolism, amyloid accumulation, and neuropsychological symptoms were studied when data were available.</p><p><strong>Results: </strong>The prevalence of intracranial AC ≥ 2 cm was 21 (1%). For 16 (76%) patients, the lesion was supratentorial; for 8 (50%), it was in the left temporal fossa. Neuropsychological symptoms did not correlate with AC localization and did not improve post-surgically. Nineteen (90%) did not have FDG alteration associated with the AC; two (10%) had indication of crossed cerebellar diaschisis. Focal amyloid accumulation around the AC was not found.</p><p><strong>Conclusion: </strong>In an elderly population of 2292 individuals referred for PET scans under dementia evaluation, 21(1%) had an intracranial AC ≥ 2 cm. Amyloid accumulation and neuropsychological symptoms did not correlate well with cyst localization; a few cases had indication of crossed cerebellar diaschisis on FDG scans. AC are not usually explanatory of cognitive decline in a population investigated for dementia.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 10","pages":"643"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of cognitive rehabilitation and exercise on brain structure in progressive multiple sclerosis: results from the CogEx trial.","authors":"Francesco Romanò, Maria A Rocca, Elisabetta Pagani, Maria Pia Amato, Giampaolo Brichetto, Jeremy Chataway, Nancy D Chiaravalloti, Gary Cutter, Ulrik Dalgas, John DeLuca, Rachel Farrell, Peter Feys, Jennifer Freeman, Matilde Inglese, Emilio Cipriano, Cecilia Meza, Robert W Motl, Amber Salter, Brian M Sandroff, Anthony Feinstein, Massimo Filippi","doi":"10.1007/s00415-025-13382-9","DOIUrl":"10.1007/s00415-025-13382-9","url":null,"abstract":"<p><strong>Background: </strong>We previously showed increased cortical grey matter (GM) volume in CogEx trial participants who performed cognitive rehabilitation (CR). Here, we explore combined CR and aerobic exercise (EX) effects on regional changes in brain volumes and white matter (WM) integrity.</p><p><strong>Methods: </strong>Seventy-three patients were randomized into four groups receiving a combination of CR and EX or their sham versions: CR + EX, CR + EX-sham, EX + CR-sham, and CR-sham + EX-sham. A diagnosis of progressive multiple sclerosis (PMS) and impaired information processing speed were required for inclusion. Participants attended a 12-week intervention twice/week. Assessments were performed at baseline, week-12 (W12), and nine months post-baseline (M9). Structural MRI scans were acquired with a standardized protocol, and voxelwise variations of brain volumes and WM fractional anisotropy (FA) were analyzed.</p><p><strong>Results: </strong>Baseline regional brain volumes and WM FA were comparable between groups. Voxelwise analyses at W12 and M9 revealed generalized volume reductions in all groups. We found different patterns of volumetric changes in the left inferior temporal gyrus between CR + EX and CR-sham + EX-sham, and in the right cerebellum crus II between EX + CR-sham and CR + EX-sham. WM FA values remained stable throughout the trial and no longitudinal between-group differences were found.</p><p><strong>Conclusions: </strong>Our analysis showed a decrease in brain volumes and limited effects of the combined CR + EX intervention, indicating that the previously found cortical GM increase was not superimposable at voxel level. Methodological and sampling differences between the studies could explain these discrepancies. In few cognitively relevant areas, the combined CR interventions might have affected patterns of volume changes, while EX modified cerebellar motor regions.</p><p><strong>Clinical trial registration: </strong>The main trial was registered on ClinicalTrials.gov (NCT03679468; registration date: 20 Sep 2018).</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 10","pages":"645"},"PeriodicalIF":4.6,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12457549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency and characteristics of functional neurological disorder in the emergency department.","authors":"Kay Hellwig, Benedikt Frank, Rosa Michaelis, Christoph Kleinschnitz, Stoyan Popkirov","doi":"10.1007/s00415-025-13386-5","DOIUrl":"10.1007/s00415-025-13386-5","url":null,"abstract":"<p><strong>Background: </strong>Functional neurological disorders (FND) are common yet frequently under-recognized in emergency settings. Reliance on diagnostic coding alone (e.g. ICD-10 diagnoses F44 and F45) likely underestimates their true prevalence and healthcare impact. This study aimed to assess the frequency and characteristics of FND among adult neurological emergency department (ED) presentations using a hybrid case-finding strategy.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of all neurological ED presentations (n = 5504) to a tertiary university hospital in 2023. A full-text keyword search of 184,279 ED documentation entries was followed by manual review to check the FND-related keywords' relevance to acute ED presentations. Additional cases were identified from neurological inpatient discharge records. Clinical and demographic variables, presenting symptoms, diagnostic classification, and management pathways were analyzed.</p><p><strong>Results: </strong>We identified 199 cases of functional symptoms as chief presenting complaints, representing 3.6% of all neurological ED presentations. The patients' median age was 33 years, and 71% were female. Functional seizures were the most common presentation (54%), followed by motor or sensory deficits (21%). Most patients (75%) were discharged directly from the ED, while 19% were admitted. Discharge against medical advice occurred in 4.5% of FND cases, compared to 1.5% overall. Only 39% of ED-discharged FND cases received F44 or F45 diagnostic codes.</p><p><strong>Conclusions: </strong>FND is a common cause of neurological emergency presentations. Epidemiological analyses that rely on diagnostic codes risk substantially underestimating its true prevalence. Our findings underscore the need for improved recognition, diagnostic clarity, and structured care pathways for FND in emergency settings.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 9","pages":"640"},"PeriodicalIF":4.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ringrose Atkins (1851-1898).","authors":"Andrew J Larner, Rónán O'Caoimh","doi":"10.1007/s00415-025-13394-5","DOIUrl":"https://doi.org/10.1007/s00415-025-13394-5","url":null,"abstract":"","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 9","pages":"641"},"PeriodicalIF":4.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124848","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":"Nonmotor fluctuations in Parkinson's disease: impact on caregiving and quality of life.","authors":"Claudia Ledda, Gabriele Imbalzano, Elena Scaglia, Carlo Alberto Artusi, Alessandra Nicoletti, Roberto Erro, Domiziana Rinaldi, Silvia Gallo, Elisa Montanaro, Maurizio Zibetti, Mario Giorgio Rizzone, Roberta Balestrino, Federica Agosta, Silvia Galli, Cristiano Sorrentino, Donato Indaco, Giulia Donzuso, Claudio Terravecchia, Massimo Filippi, Leonardo Lopiano, Alberto Romagnolo","doi":"10.1007/s00415-025-13390-9","DOIUrl":"10.1007/s00415-025-13390-9","url":null,"abstract":"<p><strong>Background: </strong>Parkinson's disease (PD) is characterized by a combination of motor and non-motor symptoms, which can fluctuate over time. Recognition of nonmotor fluctuations (NMF) as a distinct and relevant feature of PD is recent, and their impact on patients' health-related quality of life (HRQoL) and on caregivers' burden remains underexplored. This study aimed to evaluate the effect of NMF on patients' HRQoL and caregiver burden, and to compare it with the impact of motor complications (MC).</p><p><strong>Methods: </strong>Patients and caregivers were consecutively recruited from five Italian Movement Disorder centers. Assessments included the Non-Motor Fluctuation Assessment, the MDS-sponsored Unified PD Rating Scale, the Mini-Mental State Examination, the 39-item Parkinson's Disease Questionnaire (PDQ-39), and the Zarit Burden Interview (ZBI). Linear regression analyses examined associations between total NMF and MC scores with PDQ-39 and ZBI. Logistic regression estimated the odds of moderate-severe caregiver burden based on NMF.</p><p><strong>Results: </strong>149 patients and 135 caregivers were included. Higher NMF scores were associated with worse HRQoL (PDQ-39: Beta = 0.318; p < 0.001), and correlated with most PDQ-39 domains, excluding stigma. MC also correlated with PDQ-39-(Beta = 0.338; p < 0.001), particularly in domains such as mobility, ADLs, communication, and bodily discomfort. Both NMF and MC scores were associated with caregiver burden (ZBI: Beta = 0.374 and 0.437, respectively; p < 0.001). Each additional NMF point increased the odds of caregiver burden by 11.6% (OR = 1.116, 95% CI:1.043-1.194, p < 0.001).</p><p><strong>Conclusions: </strong>NMF significantly affect both patient HRQoL and caregiver burden, with an impact comparable to that of MC. Systematic assessment and targeted interventions for NMF should be integrated into routine PD care.</p>","PeriodicalId":16558,"journal":{"name":"Journal of Neurology","volume":"272 9","pages":"639"},"PeriodicalIF":4.6,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113304","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}