Neurology最新文献

{"title":"Long-Term Risk of Dementia After TIA: A Population-Wide Matched Cohort Study.","authors":"Raed A Joundi, Jiming Fang, Peter C Austin, Eric E Smith, Amy Ying Xin Yu, Vladimir Hachinski, Luciano A Sposato, Aravind Ganesh, Mukul Sharma, Moira K Kapral","doi":"10.1212/WNL.0000000000218554","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218554","url":null,"abstract":"<p><strong>Background and objectives: </strong>Long-term risk of dementia after TIA remains poorly characterized, despite a known impact on cognition. We aimed to quantify the rate, relative risk, and time course of incident dementia after TIA compared with a matched reference population (controls) and individuals with stroke.</p><p><strong>Methods: </strong>We conducted a population-wide cohort study using linked administrative health data for the province of Ontario, Canada (2002-2022). Adults with a first TIA were identified from emergency department visits or hospital admissions and followed from 90 days after the index event. Individuals with prior dementia, prior stroke, early death, or long-term care admission were excluded. Patients with TIA were matched to population controls on age, sex, neighborhood-level deprivation, rurality, and vascular comorbidities. Patients with TIA were also matched to those with first stroke. Incident dementia was ascertained using a validated algorithm based on hospital diagnoses, physician claims, and dementia-specific medications. Cause-specific and subdistribution hazard models accounting for competing risk of death were used for 1-, 5-, and 10-year risk of dementia, with time-varying analyses.</p><p><strong>Results: </strong>Among 113,081 matched patients with TIA (mean age 70 years; 50% female), dementia was diagnosed in 19.3% over a mean follow-up of 7.11 years (SD 5.16). Dementia rates after TIA were consistently higher than in matched controls across all time horizons (overall rate 2.71 vs 2.03 per 100 person-years). The hazard ratio for dementia after TIA was highest within the first year (hazard ratio [HR] 1.75, 95% CI 1.66-1.85) and remained elevated over 20 years of follow-up (overall HR 1.34, 95% CI 1.31-1.36). Compared with stroke, the hazard of dementia was lower after TIA early on (1-year HR 0.67, 95% CI 0.64-0.70) but converged and became similar after 5 years of follow-up. Dementia incidence substantially exceeded stroke incidence, and adjustment for incident stroke minimally attenuated results.</p><p><strong>Discussion: </strong>TIA is associated with a large and sustained increase in dementia risk, approaching that observed after stroke over long-term follow-up. Dementia occurs far more frequently than incident stroke after TIA, highlighting cognitive decline as a major long-term complication and a target for prevention with new strategies that include and extend beyond stroke prevention.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 8","pages":"e218554"},"PeriodicalIF":8.9,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030985","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":"Editors' Note: The Muted Role of Vascular Risk Factors in Parkinson Disease and Associated Dementia","authors":"Aravind Ganesh,Steven L. Galetta","doi":"10.1212/wnl.0000000000218652","DOIUrl":"https://doi.org/10.1212/wnl.0000000000218652","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"5 1","pages":""},"PeriodicalIF":9.9,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149048979","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":"Clinical Factors Associated With Discordant Plasma P-Tau217 and Established Alzheimer Disease Biomarkers","authors":"Dror Shir,Alicia Algeciras-Schimnich,Yoav D. Piura,Joshua A. Bornhorst,Daniel J. Figdore,Anas Elgenidi,Christian Lachner,Neill R. Graff-Radford,Gregory S. Day","doi":"10.1212/wnl.0000000000218591","DOIUrl":"https://doi.org/10.1212/wnl.0000000000218591","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"13 1","pages":""},"PeriodicalIF":9.9,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089084","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":"Author Response: Efficacy and Safety of IV Thrombolysis for Acute Ischemic Stroke Patients With Moyamoya Disease.","authors":"Huanwen Chen, Marco Colasurdo, Mihir Khunte, Ajay Malhotra, Dheeraj Gandhi","doi":"10.1212/WNL.0000000000213576","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213576","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 8","pages":"e213576"},"PeriodicalIF":8.9,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081403","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":"Comparative Effectiveness of Treatments for Relapse Prevention in Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease.","authors":"Akash Virupakshaiah, Vinicius Andreoli Schoeps, Jonathan Race, Claudia Gambrah-Lyles, Gina Chang, Michael Waltz, Parinaz Nasr, Carson E Moseley, Scott S Zamvil, Alice Rutatangwa Edwards, Carla Francisco, T Charles Casper, John W Rose, Eoin P Flanagan, Moses Rodriguez, Jan-Mendelt Tillema, Tanuja Chitnis, Mark P Gorman, Leslie A Benson, Jennifer S Graves, Mary Rensel, Aaron W Abrams, Lauren B Krupp, Kimberly A O'Neill, Timothy E Lotze, Kristen S Fisher, Nikita Malani Shukla, Gregory S Aaen, Yolanda S Wheeler, Teri L Schreiner, Amy Tara Waldman, Janet Chong, Emmanuelle Waubant, Soe S Mar","doi":"10.1212/WNL.0000000000218508","DOIUrl":"10.1212/WNL.0000000000218508","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objectives: &lt;/strong&gt;The most effective treatment strategy to prevent relapses after a first myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) event remains unclear. Our objective was to evaluate the comparative effectiveness of maintenance therapies in preventing relapses in pediatric-onset MOGAD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed prospectively collected data from November 2011 to August 2023 across 13 US pediatric neuroimmunology centers. Eligible patients had demyelinating disease onset before age 18 years, confirmed MOG-IgG positivity through cell-based assay, and negative aquaporin-4 IgG. Maintenance therapies were defined as ≥90 consecutive days of treatment and included IV immunoglobulin (IVIG), anti-CD20 therapy, oral corticosteroids, and other immunosuppressants. Two complementary approaches were used: (1) a primary full-course analysis using time-varying Cox proportional hazards models, adjusted for a priori-selected confounders, accounting for treatment changes throughout the disease course, and (2) a secondary early-course analysis using 1:1 propensity score-matched Cox models for the first qualifying treatment initiated within 90 days of onset, applying an intention-to-treat framework to minimize immortal time bias.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 312 patients (58% female; mean age at onset 8.9 ± 4.2 years), 145 (46%) experienced at least 1 relapse during a median follow-up of 2.53 years (interquartile range 0.75-5.26). In the full-course analysis, IVIG was associated with a statistically significant 46% reduction in relapse risk (hazard ratio [HR] 0.54; 95% CI 0.31-0.93; &lt;i&gt;p&lt;/i&gt; = 0.028). Anti-CD20 therapy (HR 0.98; 95% CI 0.56-1.72), oral corticosteroids (HR 0.86; 95% CI 0.55-1.35), and other immunosuppressants showed no significant association with relapse risk. In the early-course propensity-matched analysis, directional trends favoring IVIG (n = 23 matched pairs; HR 0.29; 95% CI 0.07-1.14; &lt;i&gt;p&lt;/i&gt; = 0.076) and anti-CD20 therapy (n = 6 matched pairs; HR 0.34; 95% CI 0.03-3.82; &lt;i&gt;p&lt;/i&gt; = 0.38) were observed but did not reach statistical significance, likely due to limited sample sizes. Oral corticosteroids showed a nonsignificant trend toward increased relapse risk in early-course analysis (HR 2.18; 95% CI 0.79-6.31; &lt;i&gt;p&lt;/i&gt; = 0.13). Older age at disease onset independently increased relapse hazard (HR 1.67 per year; 95% CI 1.49-1.87; &lt;i&gt;p&lt;/i&gt; &lt; 0.001), and prior relapse count was a strong predictor of future relapse risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;In this large, prospective, multicenter pediatric MOGAD cohort, IVIG was the only treatment consistently associated with reduced relapse risk across both analytical approaches, supporting its potential role as first-line maintenance therapy. Anti-CD20 therapy showed directional trends warranting further investigation. Key limitations include potential residual confounding by indication and small sample sizes in","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 8","pages":"e218508"},"PeriodicalIF":8.9,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128173","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":"Neglect as an Ictal Phenomenon Confirmed by Functional Cortical Stimulation.","authors":"Stephan Hu, Huasheng Wang, Melanie Lucas, Kurt Qing, Doris Deng","doi":"10.1212/WNL.0000000000218581","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218581","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 8","pages":"e218581"},"PeriodicalIF":8.9,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039978","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":"Tremory.","authors":"Emily J Beckmann","doi":"10.1212/WNL.0000000000218563","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218563","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 8","pages":"e218563"},"PeriodicalIF":8.9,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149031094","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":"Relapse Prevention in Pediatric MOGAD: Prospective Registry Data Strengthen the Case for IV Immunoglobulin.","authors":"Silvia Bartolomeo, Romain Marignier, Yael Hacohen","doi":"10.1212/WNL.0000000000218656","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218656","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 8","pages":"e218656"},"PeriodicalIF":8.9,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128232","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":"Brain and Brainstem Silence, But Body Moves: Complex Motor Movements After Brain Death.","authors":"Juliette Conte, Sarah Myers, Ali Abu-Alya, Raymundo Maldonado, Taylor Teske, Sarah Wahlster, Abhijit Vijay Lele","doi":"10.1212/WNL.0000000000218362","DOIUrl":"https://doi.org/10.1212/WNL.0000000000218362","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 8","pages":"e218362"},"PeriodicalIF":8.9,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149017364","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":"Stroke in the Young: Incidence, 30-Day Case Fatality Rates, and Risk Factors Over Time in a Population-Based Study.","authors":"Emily R Fisher, Lili Ding, Robert J Stanton, Yasmin Ninette Aziz, Stacie Demel, Simona Ferioli, Matthew L Flaherty, Joseph LaPorta, Lauren E Menzies, Eva A Mistry, Paul Wechsler, Kyle B Walsh, Opeolu Adeoye, Elisheva R Coleman, Felipe De Los Rios La Rosa, Adam S Jasne, Pooja Khatri, Jason Mackey, Sharyl R Martini, Lisa Nobel, Sabreena Slavin, Brian Stamm, Michael Star, Daniel Woo, Shea Wright, Joseph P Broderick, Brett Kissela, Dawn Kleindorfer, David Robinson","doi":"10.1212/WNL.0000000000218622","DOIUrl":"10.1212/WNL.0000000000218622","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite an overall decline in incidence rate, the burden of stroke may be rising in young adults. We aimed to characterize the incidence rates, 30-day case fatality rates (CFRs), and the burden of stroke risk factors over time in young adults in a representative population-based study of stroke.</p><p><strong>Methods: </strong>Using validated methods, hospitalized stroke cases in a 5-county region were ascertained and adjudicated by stroke-trained physicians in 6 study periods: July 1993-June 1994 and calendar years 1999, 2005, 2010, 2015, and 2020. Stroke in the young was defined as those occurring among individuals who were aged 20-54 years. Incidence rates were generated using US Census data standardized to the 2010 population, and trends were tested with linear regression. Temporal trends in 30-day CFR were evaluated with logistic regression after adjusting for age, race, and sex.</p><p><strong>Results: </strong>Across all study periods, there were 2,076 first-ever strokes in young adults. Hypertension, diabetes, atrial fibrillation, and substance use were more common over time (<i>p</i> < 0.001). The stroke incidence rate increased in young adults over time (33.90 cases/100,000 person-years in 1993/4 to 62.18 cases/100,000 person-years in 2020, trend <i>p</i> = 0.04), while declining in older adults (618.78 cases/100,000 person-years in 1993/4 to 453.04 cases/100,000 person-years in 2020, trend <i>p</i> = 0.02). The rise in stroke incidence appeared driven by ischemic stroke, with an almost doubled incidence rate of 23.8 cases/100,000 person-years in 1993/4 to 47.3 cases/100,000 person-years in 2020 (trend <i>p</i> = 0.02). There was a modest decline in the 30-day CFR in young adults (11.7% in 1993/4 to 9.4% in 2020, trend <i>p</i> = 0.002), driven by intracerebral hemorrhage (27.5% in 1993/4 to 21.2% in 2020, trend <i>p</i> = 0.03) and subarachnoid hemorrhage (27.9% in 1993/4 to 18.6% in 2020, trend <i>p</i> = 0.09).</p><p><strong>Discussion: </strong>The incidence of stroke in young adults is rising over time, while the CFR simultaneously declines. This coincides with a rise in both traditional vascular risk factors and substance use.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"107 8","pages":"e218622"},"PeriodicalIF":8.9,"publicationDate":"2026-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}