Neurology最新文献

{"title":"Association of Cardiac Biomarkers With Structural Brain Changes and Cognitive Impairment: Results From the Hamburg City Health Study.","authors":"Märit Jensen, Eik Vettorazzi, Philipp Weber, Marvin Petersen, Maximilian Schell, Felix Leonard Nägele, Moritz Andreas Link, Eckhard Schlemm, David Leander Rimmele, Peter Moritz Becher, Bastian Cheng, Stefan Blankenberg, Paulus Kirchhof, Tanja Zeller, Raphael Twerenbold, Götz Thomalla","doi":"10.1212/WNL.0000000000213865","DOIUrl":"10.1212/WNL.0000000000213865","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cardiovascular disease is linked to an increased risk of dementia. The aim of this study was to evaluate whether blood-based cardiac biomarkers are associated with structural brain changes and cognitive impairment and to explore whether structural brain changes mediate alterations in cognitive function.</p><p><strong>Methods: </strong>We included participants from the population-based Hamburg City Health Study, recruiting citizens between 45 and 74 years of age. High-sensitivity cardiac troponin I (hs-cTnI), midregional pro-atrial natriuretic peptide, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations were measured. From brain MRI, we quantified markers of neurodegeneration (total brain volume, cortical thickness), markers of vascular brain damage (white matter hyperintensity volume, peak width of skeletonized mean diffusivity [PSMD]), and measures of structural brain network organization. Cognitive function was assessed using subtests of the CERAD-Plus battery. We applied multivariable-adjusted linear regression analyses and structural equation modeling to investigate the association of cardiac biomarkers with structural brain changes and cognitive function.</p><p><strong>Results: </strong>The analysis included 2,553 participants with a median age of 64 years, and 44% were women. Higher levels of natriuretic peptides were associated with imaging markers of neurodegeneration and vascular brain damage, for example, higher levels of NT-proBNP with lower cortical thickness (β = -0.081; 95% CI [-0.127 to -0.034]) and higher PSMD (β = 0.112; 95% CI [0.069-0.155]). Higher levels of hs-cTnI were associated with markers of vascular brain damage only, for example, with higher PSMD (β = 0.103; 95% CI [0.060-0.146]). All cardiac biomarkers studied were associated with alterations of structural brain connectivity reflecting changes in brain network organization toward less integration and more segregation. Elevated NT-proBNP was associated with lower scores in tests of verbal memory (β = -0.054; 95% CI [-0.100 to -0.008]) and verbal fluency (β = -0.054; 95% CI [-0.101 to -0.008]). In structural equation modeling, there was a significant effect of NT-proBNP on cognitive function mediated by structural brain changes.</p><p><strong>Discussion: </strong>Monitoring cardiac biomarkers, especially NT-proBNP, may provide a low-invasive and widely available method to assess cognitive risk and potentially guide early preventive interventions. Longitudinal studies are needed to establish causality and explore the observed associations over time.</p><p><strong>Clinical trial registration: </strong>ClinicalTrials.gov number, NCT03934957.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e213865"},"PeriodicalIF":7.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560635","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":"Reader Response: Teratogenesis, Perinatal, and Neurodevelopmental Outcomes After In Utero Exposure to Antiseizure Medication: Practice Guideline From the AAN, AES, and SMFM.","authors":"Marte-Helene Bjørk, Helga Zoega, Jakob Christensen","doi":"10.1212/WNL.0000000000210114","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210114","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e210114"},"PeriodicalIF":7.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608875","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: Teratogenesis, Perinatal, and Neurodevelopmental Outcomes After In Utero Exposure to Antiseizure Medication: Practice Guideline From the AAN, AES, and SMFM.","authors":"Aravind Ganesh, Steven L Galetta","doi":"10.1212/WNL.0000000000213924","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213924","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e213924"},"PeriodicalIF":7.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608874","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":"Should We Routinely Administer Intra-Arterial Thrombolysis After Endovascular Thrombectomy for Ischemic Stroke From Large Vessel Occlusion?","authors":"Timothy J England, Permesh Singh Dhillon","doi":"10.1212/WNL.0000000000213929","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213929","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e213929"},"PeriodicalIF":7.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512243","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":"Intra-Arterial Thrombolysis Following Endovascular Recanalization for Large Vessel Occlusion Stroke: A Systematic Review and Meta-Analysis.","authors":"Xin Jiang, Zixu Zhao, Ying Zhang, Wei Luo, Keyang Zheng, Minghui Zhang, Enze Li, Hui Lang, Jian Wang, Can Zhou, Li He","doi":"10.1212/WNL.0000000000213842","DOIUrl":"10.1212/WNL.0000000000213842","url":null,"abstract":"<p><strong>Background and objectives: </strong>This systematic review and meta-analysis aims to evaluate the treatment effects of intra-arterial thrombolysis (IAT) after endovascular recanalization in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Endovascular recanalization is the standard treatment for large vessel occlusion (LVO) stroke. Despite successful reperfusion after thrombectomy, fewer than half of the patients regain functional independence at 90 days, highlighting the potential role of impaired microcirculation in poor neurologic outcomes. The efficacy and safety of intra-arterial thrombolysis (IAT) after endovascular recanalization remains controversial. This systematic review and meta-analysis aims to evaluate the treatment effects of IAT after endovascular recanalization in patients with acute ischemic stroke (AIS) due to LVO.</p><p><strong>Methods: </strong>We conducted a study-level systematic review and meta-analysis based on PubMed, Embase, CENTRAL, and ClinicalTrials.gov from database inception to February 8, 2025. Only randomized controlled trials (RCTs) reporting the efficacy and safety of IAT after endovascular recanalization in large vessel occlusion stroke were included. The risk of bias of the included studies was assessed using the Risk of Bias 2 tool. The pooled data were analyzed using a random-effects meta-analysis. Our primary outcome was the proportion of patients with modified Rankin Scale (mRS) scores 0-1 at 90 days. Other outcomes included the proportion of patients with mRS scores 0-2 at 90 days, all-cause mortality at 90 days, and symptomatic intracranial hemorrhage and any intracranial hemorrhage within 48 hours. The study protocol was registered on PROSPERO (CRD42025639519).</p><p><strong>Results: </strong>A total of 6 RCTs with 1,985 initially enrolled patients were included in the analysis. A higher proportion of mRS scores 0-1 at 90 days was observed in the IAT group (risk ratio [RR] 1.25, 95% CI 1.11-1.41). No significant differences were found in the proportion of mRS scores 0-2 at 90 days (RR 1.04, 95% CI 0.96-1.13) between the groups. Regarding safety outcomes, 90-day all-cause mortality (RR 1.00, 95% CI 0.83-1.21), symptomatic intracranial hemorrhage (RR 1.14, 95% CI 0.76-1.70), and any intracranial hemorrhage (RR 1.16, 95% CI 0.98-1.37) were similar in the IAT group and control group.</p><p><strong>Discussion: </strong>Among patients with AIS due to LVO, IAT after endovascular recanalization adds additional benefits to functional outcomes, with no increased risk of death or intracranial hemorrhage.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e213842"},"PeriodicalIF":7.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12239893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512242","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}

{"title":"Author Response: Teratogenesis, Perinatal, and Neurodevelopmental Outcomes After In Utero Exposure to Antiseizure Medication: Practice Guideline From the AAN, AES, and SMFM.","authors":"Mark Robert Keezer, Maryam Oskoui, Alison M Pack","doi":"10.1212/WNL.0000000000210186","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210186","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e210186"},"PeriodicalIF":7.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608873","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":"Dementia Risk Due to Traumatic Brain Injury in Subtypes of Dementia in the Welsh Population.","authors":"Emily Simmonds, Jun Han, George Kirov, David J Sharp, Thomas H Massey, Valentina Escott-Price","doi":"10.1212/WNL.0000000000213866","DOIUrl":"10.1212/WNL.0000000000213866","url":null,"abstract":"<p><strong>Background and objectives: </strong>Traumatic brain injury (TBI) can increase vulnerability to neurodegenerative disorders. The association between TBI and dementia has been previously reported, but studies have relied on self-reporting of TBI and often do not appropriately adjust for relevant risk factors or cover enough time to include both individuals at age of highest TBI risk and age of dementia onset. This study uses electronic health records, which include over 20 years of data and 1.7 million individuals with hospital or general practitioner diagnoses of dementia and TBI. Therefore, the aim of this study was to assess the association between TBI and dementia and between TBI and dementia subtypes (Alzheimer disease [AD], vascular dementia [VaD], and unspecified dementia).</p><p><strong>Methods: </strong>We performed a population-based study using Welsh (UK) electronic health records to estimate effect of TBI on the risk of dementia for individuals aged between 30 and 65 years in 1999 without a previous dementia diagnosis. The long-term risk of dementia after TBI was established using Cox proportional hazard models adjusting for sex, social deprivation, and other comorbidities. The effect of the time between TBI and dementia was investigated with time-stratified analyses. We assessed separately the risks of AD, VaD, and unspecified dementia related to TBI.</p><p><strong>Results: </strong>Our study investigated 42,974 individuals with dementia (mean diagnosis age of 70 [SD = 10.5]), 10,164 individuals with a history of TBI, and 1,737,480 controls (mean age of 62 [SD = 11.9]). 49% of all individuals were female. TBI was associated with increased risk of dementia (hazard ratio [HR] = 2.32, 95% CI [1.88-2.85], <i>p</i> = 3.8 × 10^-15), with the risk increasing for multiple TBIs (HR = 1.22, 95% CI [1.08-1.38], <i>p</i> = 1.8 × 10^-03). The effect size of association between TBI and dementia was higher in people diagnosed with VaD (HR = 1.71, 95% CI [1.06-2.75], <i>p</i> = 0.027) and unspecified dementia (HR = 1.90, 95% CI [1.29-2.80], <i>p</i> = 0.0011) compared with the AD group (HR = 1.44, 95% CI [0.84-2.48], <i>p</i> = 0.189).</p><p><strong>Discussion: </strong>Our study confirms that TBI increases dementia risk. We have shown a higher risk of VaD and unspecified dementia in those with a TBI, compared with AD. This study will direct future research into which biological mechanisms drive the association between TBI and dementia.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e213866"},"PeriodicalIF":7.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560636","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}

{"title":"Outcome Prediction After Thrombectomy: Better Late Than Never.","authors":"James Ernest Siegler, Seemant Chaturvedi","doi":"10.1212/WNL.0000000000213860","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213860","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e213860"},"PeriodicalIF":7.7,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560637","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":"Reader Response: Incidence and Prevalence of Early-Onset Dementia in Finland.","authors":"Steven R Brenner","doi":"10.1212/WNL.0000000000210284","DOIUrl":"https://doi.org/10.1212/WNL.0000000000210284","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 3","pages":"e210284"},"PeriodicalIF":7.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584403","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":"Focal Hypoperfusion on Baseline Perfusion-Weighted MRI and the Risk of Subsequent Cerebrovascular Events in Patients With TIA.","authors":"Sofiya Shamailova,Luiz Dalla Vecchia,Elias Auer,Pasquale Castigliego,Victor Ziegler,Marc Fluri,Anna Boronylo,Moritz C Kielkopf,Arsany Hakim,Adnan Mujanovic,Johannes Kaesmacher,Ava Leigh Liberman,Barbara Birner,Thomas R Meinel,Mirjam Rachel Heldner,David Julian Seiffge,Thomas Horvath,Marcel Arnold,Urs Fischer,Simon Jung,Morin Beyeler,Philipp Bücke","doi":"10.1212/wnl.0000000000213930","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213930","url":null,"abstract":"BACKGROUND AND OBJECTIVESWhile MRI is known to be crucial for TIA workup, the benefit of perfusion-weighted imaging (PWI) is underexplored. We aimed to assess the association between focal hypoperfusion on baseline PWI MRI and the long-term incidence of subsequent acute ischemic stroke (AIS) after TIA.METHODSConsecutive patients with TIA who underwent baseline PWI MRI as part of their emergency consultation between January 2015 and December 2019 were retrospectively identified. For study inclusion, both a time-based (symptom duration <24 hours) and an imaging-based (no signs of ischemia on diffusion-weighted imaging) TIA definition were applied. Long-term incidences of AIS after TIA were identified based on follow-up reports. Associations between focal hypoperfusion and subsequent AIS were assessed using Cox regression models adjusted for predefined predictors of stroke occurrence including symptomatic extracranial or intracranial stenosis. In subgroup analyses, we aimed to determine effects of focal hypoperfusion within vs outside the expected TIA territory, defined as a brain region potentially correlating with TIA symptoms.RESULTSOf 1,359 eligible patients with TIA, 1,075 with PWI MRI (79%) were included (median age 70 years, 46% female). Focal hypoperfusion was identified in 211 patients (20%); in 116 of 211 (55%), hypoperfusion occurred within the expected TIA territory. The median time from symptom onset to imaging was 233 minutes (interquartile range [IQR] 131-632) for patients with focal hypoperfusion vs 229 minutes [IQR 140-441] for patients without (p = 0.42). Focal hypoperfusion was associated with a higher incidence of AIS (adjusted hazard ratio [aHR] 2.13; 95% CI 1.19-3.80). While this was observed for focal hypoperfusion within the expected TIA territory (aHR 3.95; 95% CI 2.05-7.60), there was no such association in case of focal hypoperfusion outside the expected TIA territory (aHR 0.72; 95% CI 0.25-2.03).DISCUSSIONFocal hypoperfusion on acute PWI MRI was found in 1 in 5 patients with TIA. It was associated with a higher incidence of AIS during long-term follow-up, especially when within the expected TIA territory. Further research is needed to clarify the predictive value of focal hypoperfusion in relation to the incidence of AIS after TIA and to explore potential therapeutic implications.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"115 1","pages":"e213930"},"PeriodicalIF":9.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701090","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}