Journal of the Neurological Sciences最新文献

{"title":"Functional cognitive disorder in Alzheimer's disease","authors":"Verónica Cabreira ,&nbsp;Martin Zeidler ,&nbsp;Laura McWhirter ,&nbsp;Suvankar Pal ,&nbsp;Jon Stone ,&nbsp;Alan Carson","doi":"10.1016/j.jns.2025.123618","DOIUrl":"10.1016/j.jns.2025.123618","url":null,"abstract":"<div><h3>Objectives</h3><div>To conduct a preliminary exploration of functional cognitive disorders (FCD) in the context of Alzheimer's disease (AD), and potential shared mechanisms.</div></div><div><h3>Methods</h3><div>Retrospective analysis of a convenience sample of FCD patients with an overlapping diagnosis of AD evaluated in two outpatient services in the United Kingdom, between 2010 and 2023. Demographics, latency until AD diagnosis, detailed description of FCD and AD, comorbidities, family history, imaging and fluid biomarkers, cognitive testing, symptom trajectory, and employment status were collected from hospital records. Possible clues for AD among FCD patients were explored by comparing FCD-AD cases against a sample of insidious onset FCD-only patients matched for age at symptom onset.</div></div><div><h3>Results</h3><div>Twelve FCD-AD cases were identified (eight female). All patients had FCD symptoms before or simultaneously with an AD diagnosis (median latency of 2.5 years). Low cognitive scores at baseline, sleep disturbance and/or mood and anxiety disorders were more common in the FCD-AD cases, in comparison with the FCD-only group. Informants' concern, executive, language and/or praxis difficulties, and an increase in repetitions may point to underlying AD. No cases appeared to be a misdiagnosis. Initial relative symptom stability or transient improvement, stressful life events around symptom onset and a family history of cognitive difficulties did not differentiate between FCD patients with or without AD.</div></div><div><h3>Discussion</h3><div>FCD may be a prodromal or presenting feature of AD. We discuss potential links between the two, and the clinical relevance of these findings for prognostication and management of FCD patients, including its implications for clinical trials.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123618"},"PeriodicalIF":3.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144654997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the nuances of Ocrevus therapy in MS: A scholarly perspective on virus antibody dynamics","authors":"Tao Li ,&nbsp;Chengqiang Jin ,&nbsp;Lixia Xu","doi":"10.1016/j.jns.2025.123621","DOIUrl":"10.1016/j.jns.2025.123621","url":null,"abstract":"","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123621"},"PeriodicalIF":3.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144656722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post TIA care in Ontario: A population-based cohort study on secondary prevention","authors":"Jamie L. Fleet ,&nbsp;Brooke Carter ,&nbsp;Moira K. Kapral ,&nbsp;Melody Lam ,&nbsp;Stephanie Frisbee ,&nbsp;Salimah Z. Shariff","doi":"10.1016/j.jns.2025.123603","DOIUrl":"10.1016/j.jns.2025.123603","url":null,"abstract":"<div><h3>Background</h3><div>Transient ischemic attacks (TIAs) often precede ischemic strokes. Little is known about adherence to secondary prevention guidelines among individuals post TIA.</div></div><div><h3>Methods</h3><div>We conducted a population-level, retrospective cohort study of individuals in Ontario, Canada, with a TIA between April 2010 to March 2019, that survived at least one year. We assessed low density lipoprotein (LDL) and glycated hemoglobin (HbA1C) testing, receipt of important secondary prevention medications for individuals aged 65 years and older, and receipt of influenza vaccines. Health care utilization was described in the 90 days following the TIA. We compared these rates to a cohort of individuals after first ischemic stroke.</div></div><div><h3>Results</h3><div>After exclusions, 36,487 individuals were included (mean age 68.6 years; 50.0 % female). LDL testing was performed in 66.3 % of individuals, and 58.4 % had an HbA1C test in the year following their TIA. Lipid lowering medications were prescribed to 75.2 %, while 82.7 % received an antihypertensive. Among individuals with diabetes, 68.6 % were prescribed an anti-hyperglycemic, and among those with atrial fibrillation, 81.1 % were prescribed an anticoagulant. Influenza vaccines were administered to 43.6 % of individuals. Within 90 days, 30.2 % visited an emergency department, and 94.2 % saw a primary care provider. Results were similar when individuals were followed for three years post TIA. Compared to ischemic stroke survivors, individuals post-TIA were less likely to have an HbA1C test (<em>p</em>-value &lt;0.001) or receive important secondary prevention medications, but were more likely to receive an influenza vaccine (p-value &lt;0.001).</div></div><div><h3>Conclusions</h3><div>Observance of secondary prevention guidelines following a TIA could be improved for several clinical recommendations, especially when compared to ischemic stroke survivors.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123603"},"PeriodicalIF":3.6,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delirium screening in the neurointensive care unit: Comparison of the confusion assessment method for the intensive care unit and intensive care delirium screening checklist","authors":"Hannah Breit ,&nbsp;Nicholas G. Panos ,&nbsp;Kristen Fisher ,&nbsp;Amy Blackwood ,&nbsp;Christine Yeager ,&nbsp;Mica Schachter ,&nbsp;George Michalopoulos ,&nbsp;Luke G. Petry ,&nbsp;Ivan Da Silva ,&nbsp;Sayona John","doi":"10.1016/j.jns.2025.123619","DOIUrl":"10.1016/j.jns.2025.123619","url":null,"abstract":"<div><h3>Background</h3><div>Delirium is a common and serious potential complication of an ICU stay, associated with risk of mortality and worse outcomes. Screening tools including ICDSC and CAM-ICU have been validated in critical care populations, however, few studies have examined their utility in neurocritically ill patients. Research on delirium is highly segregated with varying terminology used among specialties, making research efforts difficult.</div></div><div><h3>Objectives</h3><div>Evaluate which screening tool is more feasible in neurocritically ill patients.</div></div><div><h3>Methods</h3><div>Single-center, retrospective analysis of a prospective QI initiative in a neurosciences ICU at a tertiary medical center in Chicago, IL. Patients admitted January 2019–2020 were screened for delirium with ICDSC, CAM-ICU and “gold-standard” DSM-5 throughout ICU stay. 206 patients were included who underwent 1442 assessments. Agreement of detection tools assessed using Fleiss' kappa.</div></div><div><h3>Results</h3><div>Prevalence of delirium using DSM-5 criteria was 1.6 %. Of the 1442 assessments, 116 were CAM-ICU-positive (8 %) and 343 were ICDSC-positive (23.8 %). The three tools had a kappa-agreement of 0.249. Of the 23 patients with confirmed delirium per DSM-5, 10 (4.8 %) were also positive for ICDSC but negative for CAM-ICU. 7 patients with a positive DSM-5 diagnosis were negative for both the CAM-ICU and ICDSC. CAM-ICU: sensitivity 26 %, specificity 94.5 %. ICDSC: sensitivity 69.5 %, specificity 87.6 %.</div></div><div><h3>Conclusions</h3><div>Current methods for detection of delirium in the neurocritically ill are imperfect, and terminology bias exists in the literature, limiting data comparison. While limited, the ICDSC appears a more sensitive tool for detection of delirium in the neurocritically ill compared to CAM-ICU. Larger validation studies are warranted.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123619"},"PeriodicalIF":3.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter in reply","authors":"Nadia Zivlaei ,&nbsp;Daut Can Asani ,&nbsp;Nicole Hartwig Trier ,&nbsp;Danguolė Žiogienė ,&nbsp;Alma Gedvilaitė ,&nbsp;Rasa Petraitytė Burneikienė ,&nbsp;Evaldas Ciplys ,&nbsp;Rimantas Slibinskas ,&nbsp;Gunnar Houen ,&nbsp;Jette Lautrup Frederiksen","doi":"10.1016/j.jns.2025.123622","DOIUrl":"10.1016/j.jns.2025.123622","url":null,"abstract":"","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123622"},"PeriodicalIF":3.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of blood-based biomarkers in Parkinsonian disorders, Alzheimer's disease and frontotemporal dementia","authors":"Marta Campagnolo ,&nbsp;Eleonora Fiorenzato ,&nbsp;Giulia Musso ,&nbsp;Valentina Misenti ,&nbsp;Simone Cauzzo ,&nbsp;Annachiara Cagnin ,&nbsp;Roberta Biundo ,&nbsp;Cinzia Bussè ,&nbsp;Carmelo Alessandro Fogliano ,&nbsp;Stefano Mozzetta ,&nbsp;Alessandra Codemo ,&nbsp;Elisabetta Gasparoli ,&nbsp;Stefania Moz ,&nbsp;Marco Narici ,&nbsp;Paola Pizzo ,&nbsp;Maurizio Corbetta ,&nbsp;Martina Montagnana ,&nbsp;Angelo Antonini","doi":"10.1016/j.jns.2025.123617","DOIUrl":"10.1016/j.jns.2025.123617","url":null,"abstract":"<div><div>The complexity of neurodegenerative disorders necessitates an integrative approach that incorporates morphological, functional, and molecular biomarkers. The advent of highly sensitive single-molecule array (Simoa®) assays has significantly enhanced the accuracy of blood-based biomarker quantification, including glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and phosphorylated tau181 (p-tau181). This study evaluates the diagnostic utility of these biomarkers in neurodegenerative diseases.</div><div>We analyzed data from 279 individuals from the PADUA-CESNE cohort: 120 with Parkinson's disease (PD), 88 with Alzheimer's disease (AD), 16 with frontotemporal dementia (FTD), 11 with multiple system atrophy (MSA), 14 with progressive supranuclear palsy (PSP), and 30 cognitively unimpaired controls.</div><div>NfL levels were significantly lower in PD and AD compared to atypical parkinsonisms and FTD, effectively distinguishing MSA and PSP from controls. NfL also negatively correlated with Montreal Cognitive Assessment (MoCA) scores in AD and PD, indicating its association with cognitive decline.</div><div>Elevated GFAP levels were observed in both PD and AD and inversely correlated with global cognition. Combining GFAP and p-tau181 improved AD differentiation from PD and other parkinsonian disorders, while the integration of all three biomarkers facilitated the distinction between AD and FTD. Notably, lower NfL levels (&lt;20 ng/L) in conjunction with elevated p-tau181 were indicative of AD, whereas NfL levels below 40 ng/L were suggestive of PD.</div><div>In conclusion, NfL serves as a sensitive indicator of neurodegeneration, albeit with limited specificity. However, by establishing biomarker concentration thresholds and integrating complementary biomarkers, blood-based assays may enhance the differential diagnosis of neurodegenerative diseases, providing valuable clinical insights.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123617"},"PeriodicalIF":3.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of prestroke frailty and disability for outcome prediction in older stroke patients","authors":"Paola Forti ,&nbsp;Marianna Ciani ,&nbsp;Fabiola Maioli","doi":"10.1016/j.jns.2025.123606","DOIUrl":"10.1016/j.jns.2025.123606","url":null,"abstract":"<div><h3>Background</h3><div>Prestroke disability, measured by the modified Rankin Scale (mRS), is routinely used in older (≥65 years) patients to predict stroke outcomes. Frailty, a common geriatric syndrome, is also associated with poor health outcomes but is rarely assessed in older stroke patients. The Clinical Frailty Scale (CFS) is a simple frailty assessment tool; however, its prognostic value in stroke clinical practice remains uncertain. This study compares the predictive value of prestroke mRS and CFS for stroke outcomes in older patients.</div></div><div><h3>Methods</h3><div>We included 4086 older patients with acute stroke (82.6 % ischemic), consecutively admitted to an Italian hospital. The median age was 81 years (25th–75th percentile: 75–87 years). Prestroke mRS was assessed at admission, while prestroke CFS was retrospectively evaluated from medical records. Multivariable-adjusted models tested the association of each scale with prolonged admission, unfavorable discharge setting, and mortality at 30 days and 1 year. For each outcome, the predictive value of the mRS and CFS scales was compared using the difference in Akaike's Information Criterion (AIC) between the respective models (AIC_mRS-CFS).</div></div><div><h3>Results</h3><div>Both mRS and CFS were positively associated with unfavorable discharge and mortality and inversely associated with prolonged admission. However, based on AIC_mRS-CFS, CFS was a stronger outcome predictor than mRS. In ischemic stroke patients receiving reperfusion therapies, CFS was also superior to mRS in predicting neurological improvement following treatment and the likelihood of discharge to long-term care.</div></div><div><h3>Conclusions</h3><div>Compared to prestroke mRS, prestroke CFS may offer additional prognostic information in older stroke patients.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123606"},"PeriodicalIF":3.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflections on the cognitive training of immersive virtual reality in executive function and prospective memory for PD-MCI patients and healthy older adults","authors":"Shan Liu,&nbsp;Zhipeng Huang,&nbsp;Shuangyang Li,&nbsp;Xue Bai","doi":"10.1016/j.jns.2025.123607","DOIUrl":"10.1016/j.jns.2025.123607","url":null,"abstract":"","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123607"},"PeriodicalIF":3.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal evolution of diffusion metrices within the Cerebello-Thalamo-cortical tract after MRgFUS thalamotomy for essential tremor","authors":"Neeraj Upadhyay ,&nbsp;Marcel Daamen ,&nbsp;Veronika Purrer ,&nbsp;Valeri Borger ,&nbsp;Carsten Schmeel ,&nbsp;Jonas Krauss ,&nbsp;Angelika Maurer ,&nbsp;Alexander Radbruch ,&nbsp;Ullrich Wüllner ,&nbsp;Henning Boecker","doi":"10.1016/j.jns.2025.123604","DOIUrl":"10.1016/j.jns.2025.123604","url":null,"abstract":"<div><div>Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy in essential tremor (ET) targets ventral intermediate nucleus hub region within cerebello-thalamo-cortical tract (CTCT). Understanding the microstructural changes in CTCT over time and their link to tremor improvement is crucial from a tremor-network perspective. We retrospectively analyzed tremor scores, lesion characteristics, and diffusion MRI-derived CTCT microstructural measures in 27 ET patient's pre-treatment (T0), at 1 month (T2), and 6 months (T3) post-MRgFUS. Using probabilistic tractography, we created an average CTCT mask at T0 for assessing fractional anisotropy (FA), axial (AD), mean (MD), and radial diffusivity (RD) measures across time points. Significant tremor reduction was observed at T2 and T3. The Linear mixed effect analyses showed significant time effects for FA, MD, and AD. Relative to baseline, post-hoc comparisons showed a significant decrease of FA and AD at lesion site only for T2. Instead, there was a significant increase in AD and MD at T3 compared to T2 at lesion site, and remotely near the motor cortex. Lesion size and FA changes in the CTCT at T2 showed only trend-level correlations with tremor outcome. Stronger associations were observed for the thalamic lesion-tract overlap at T2, which were even more robust at T3. Dynamic microstructural changes suggest early axonal disruption at the lesion site and subsequent reorganization, with remote CTCT changes potentially indicating chronic degeneration. Meanwhile, microstructural measures show limited predictive value for tremor outcome at 6 months compared with macroanatomical lesion-CTCT overlap. Yet, advanced diffusion imaging protocol could increase the sensitivity to predict MRgFUS clinical outcome.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123604"},"PeriodicalIF":3.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuroimaging patterns in patients with mitochondrial leukoencephalopathies","authors":"Sonal Sharma ,&nbsp;James Peterson ,&nbsp;Cesar Augusto Alves ,&nbsp;Rui Xiao ,&nbsp;Amy Goldstein","doi":"10.1016/j.jns.2025.123605","DOIUrl":"10.1016/j.jns.2025.123605","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Leukoencephalopathies are characterized by white matter (WM) abnormalities and include various primary mitochondrial diseases (MD) that impact mitochondrial function across all neuroglial cells. Understanding these associations is vital for effective clinical management.</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of patients with genetically confirmed MD who exhibited white matter abnormalities at a pediatric academic medical center. Data were obtained through medical record reviews, collecting information on demographics, genetic etiology, features of WM involvement, and other areas such as the basal ganglia, cortex, cerebellum, and spine on MRI. Biomarkers like CSF protein and plasma lactate levels were also recorded. Statistical analysis was conducted using R version 4.4.1 to assess significance of specific MRI features in relation to nuclear vs. mitochondrial DNA.</div></div><div><h3>Results</h3><div>Among 192 MD patients, 142 had available neuroimaging. Of these, 43 (30 %) patients with a median age of 15.5 months exhibited WM involvement, with 53.4 % being female. The most common findings were periventricular (32 %), diffuse (42 %), and multifocal (17 %) WM lesions, with corpus callosum involvement in 51 % of cases. Distinct patterns observed included cystic changes (19 %), diffusion restriction (42 %), and white matter volume loss (40 %). Genetic analysis revealed a diverse range of mutations affecting mtDNA (30 %) and nDNA (70 %) genes.</div></div><div><h3>Discussion</h3><div>Our study highlights specific neuroimaging patterns associated with leukoencephalopathies in MD. For example, periventricular involvement in <em>MTRFR</em> mutations and diffuse abnormalities in <em>FBXL4</em> mutations reflect the variability of WM manifestations. These findings can help clinicians identify the genetic etiology in this patient cohort.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"476 ","pages":"Article 123605"},"PeriodicalIF":3.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144605807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}