Neurology最新文献

{"title":"Breaking Barriers to Stroke Trial Participation: A Tale of Two Zip Codes?","authors":"Clinton B Wright,Lawrence Scott Janis,Joseph P Broderick","doi":"10.1212/wnl.0000000000213928","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213928","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"12 1","pages":"e213928"},"PeriodicalIF":9.9,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144594375","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":"Acute Ischemic Stroke Risk After Cardiac Interventions: An Increasing Threat.","authors":"Katrina Hannah D Ignacio, Umberto Pensato","doi":"10.1212/WNL.0000000000213858","DOIUrl":"https://doi.org/10.1212/WNL.0000000000213858","url":null,"abstract":"","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213858"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266909","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":"A Decision-Analytic Model to Evaluate Cost-Effectiveness of Regional Implementation of a Mobile Stroke Unit.","authors":"Peter L van Hulst,Ruben M van de Wijdeven,Esmee Venema,Florentina M E Pinckaers,Myriam G M Hunink,Aad van der Lugt,Diederik W J Dippel,Hester F Lingsma,Daniel Bos,Bob Roozenbeek, ","doi":"10.1212/wnl.0000000000213834","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213834","url":null,"abstract":"BACKGROUND AND OBJECTIVESMobile stroke units (MSUs) have the potential to improve functional outcome of ischemic stroke patients, through shortening onset-to-treatment times. Previous cost-effectiveness studies have limited generalizability to nonmetropolitan settings and did not evaluate cost-effectiveness over a lifetime horizon. We aimed to develop a regionally adaptable decision-analytic model, to evaluate cost-effectiveness of MSU implementation and to identify the optimal dispatch scenario.METHODSWe developed a generalizable state-transition microsimulation model with modifiable region-specific parameters and dispatch characteristics to evaluate the lifetime cost-effectiveness from a health care perspective of 1-year MSU implementation. We used the southwest of the Netherlands (1,770,000 inhabitants, 1,592 km2, 7 primary stroke centers, 2 thrombectomy-capable stroke centers) as an example. Region-specific input parameters for the model, such as population density, age distribution, and driving times, were obtained at the level of postal codes. We developed a virtual cohort of suspected stroke patients based on age-dependent stroke risks and the number of inhabitants per postal code. We compared the combined dispatch of an MSU and emergency medical services (EMS) with dispatch of EMS alone for patients with onset-to-alarm time <6 hours, living within the catchment area of the MSU. In the base case analysis, the MSU could be dispatched to all postal codes in the study region between 7.00 am and 11.00 pm from a central dispatch site. We assessed the long-term cost-effectiveness through incremental net monetary benefits (iNMBs). Discount rates were 1.5% for effects and 4.0% for costs.RESULTSIn the base case scenario, the MSU was dispatched to 2,080 of 3,628 patients (57.3%) with a suspected stroke and onset-to-alarm time <6 hours, resulting in a lifetime gain of 399 (95% CI 384-414) additional quality-adjusted life years, €3.9 million (95% CI €3.5 million-€4.3 million) cost savings, and an iNMB of €23.9 million (95% CI €22.8 million-€24.9 million). A smaller catchment area for MSU dispatch was associated with increased cost-effectiveness.DISCUSSIONAdding an MSU to the dispatch strategy for suspected stroke patients is expected to be cost-effective in our region. Our model facilitates evaluation of the cost-effectiveness of MSU implementation in different regions, settings, and scenarios with varying characteristics.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"10 1","pages":"e213834"},"PeriodicalIF":9.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586570","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":"Screening and Care for Emotional and Cognitive Problems After Ischemic Stroke: Results of a Multicenter, Cluster-Randomized Controlled Trial.","authors":"Jos P L Slenders, Renske M Van Den Berg-Vos, Caroline M Van Heugten, Johanna Visser-Meily, Ruben P A van Eijk, Marthè A A Moonen, Sarah Godefrooij, Vincent I H Kwa","doi":"10.1212/WNL.0000000000213774","DOIUrl":"10.1212/WNL.0000000000213774","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objectives: &lt;/strong&gt;Evidence regarding effectiveness of screening for emotional and cognitive problems after stroke is lacking. The primary aim of this study was to test the hypothesis that an intervention focusing on screening and care for emotional and cognitive problems after stroke would improve societal participation at 1 year. Second, we tested the hypotheses that this intervention would improve emotional and cognitive concerns, symptoms of anxiety, symptoms of depression, quality of life (QoL), self-efficacy, and disability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This multicenter, patient-masked, cluster-randomized controlled trial assigned clusters (1:1) to intervention or usual care. Clusters were Dutch nonuniversity hospitals with a stroke unit. Ischemic stroke patients aged 18 years and older discharged home without inpatient or outpatient rehabilitation were included. The intervention was a consultation conducted by a specialized stroke nurse at the outpatient neurology clinics at 6 weeks after stroke and included screening for emotional and cognitive problems, screening for participation restrictions, self-management support, and, if needed, referral to rehabilitation services. The primary outcome was societal participation (Restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation [USER-P-R]) 1 year after stroke. Secondary outcomes were cognitive and emotional concerns (Checklist for Cognitive and Emotional Consequences following Stroke), symptoms of anxiety (Hospital Anxiety and Depression Scale-Anxiety subscale [HADS-A]), symptoms of depression (HADS-Depression subscale), QoL (5-level version of the EuroQoL 5-dimensional questionnaire [EQ-5D-5L], EuroQoL Visual Analog Scale [EQ-VAS], and Patient-Reported Outcome Measurement Information System [PROMIS-10]), self-efficacy (General Self-Efficacy Scale), and disability (modified Rankin Scale) at 3 and 12 months. Continuous outcome data were analyzed using a mixed model for repeated measures, and ordinal data were analyzed with an ordinal mixed-effects model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Between August 14, 2019, and May 11, 2022, a total of 531 patients were included in 12 clusters. The mean age was 70.6 ± 9.7 years, 40.0% were female, and the median NIH Stroke Scale score was 2 (2). Two hundred sixty-four patients were included in 6 hospitals providing the intervention and 267 patients in 6 hospitals providing usual care. Primary analysis demonstrated no difference in USER-P-R score at 1 year after stroke (mean difference [MD] 0.77; 95% CI -2.46 to 4.06; &lt;i&gt;p&lt;/i&gt; = 0.652). Secondary outcome analyses at 3 months showed a MD between the intervention group and usual care group in HADS-A scores of -0.86 (95% CI -1.33 to -0.39), a MD in EQ-5D-5L index scores of 0.044 (95% CI 0.022-0.065), and a MD in EQ-VAS score of 2.90 (95% CI 0.69-5.10). Secondary outcome analyses at 1 year demonstrated a MD in EQ-5D-5L index scores of 0.043 (95% CI","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213774"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258564","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":"Remote Monitoring of Amyotrophic Lateral Sclerosis Using Digital Health Technologies: Shifting Toward Digitalized Care and Research?","authors":"Jordi W J van Unnik, Leslie Ing, Miguel Oliveira Santos, Christopher J McDermott, Mamede de Carvalho, Ruben P A van Eijk","doi":"10.1212/WNL.0000000000213738","DOIUrl":"10.1212/WNL.0000000000213738","url":null,"abstract":"<p><p>Current care and research pathways for amyotrophic lateral sclerosis (ALS) primarily rely on regularly scheduled visits to specialized centers. These visits provide intermittent clinical information to health care professionals and require patients to travel to the clinic. Digital health technologies enable continuous data collection directly from the patient's home, bringing new opportunities for personalized, timely care and a refined assessment of disease severity in clinical trials. In this review, we summarize the state of the art in digital health technologies for remote monitoring of patients with ALS, ranging from televisits through videoconferencing to sensor-based wearable devices. We explore how these technologies can benefit clinical care and advance treatment development. Despite significant progress, real-world adoption of these technologies remains limited. An overview is provided of the key barriers hindering their widespread implementation and the opportunities to advance the field. Significantly, there is an urgent need for harmonization across stakeholders through consensus guidelines and consortia. These efforts are essential to accelerate progress and harness the full potential of digital health technologies to better meet the needs of patients.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213738"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216415","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":"Treatment Patterns and Disease Burden of Juvenile Myasthenia Gravis in the United States: A Cohort Study Using Health Care Claims Databases.","authors":"Jiachen Zhou, Sigrid Nilius, Olga Pilipczuk, Anna Scowcroft, Thaïs Tarancón, Frank Tennigkeit, Piotr Zaremba, Nishtha Chandra, Nancy Kuntz, Jonathan Strober, John Brandsema","doi":"10.1212/WNL.0000000000213736","DOIUrl":"10.1212/WNL.0000000000213736","url":null,"abstract":"<p><strong>Background and objectives: </strong>Juvenile myasthenia gravis (JMG) is a rare disorder defined as MG in patients younger than 18 years. Generalized JMG is more common in postpubertal than prepubertal patients. There are no formal international JMG treatment guidelines, and knowledge on treatment patterns and disease burden is limited. The aim of this study was to describe treatment patterns and health care resource utilization (HCRU) for patients with JMG and explore differences in disease presentation between prepubertal-onset (younger than 12 years) and postpubertal-onset (12-17 years) patients.</p><p><strong>Methods: </strong>Patients with JMG, newly diagnosed from 2008 to 2021, were identified from the US Merative MarketScan® Research Databases. Patients were followed from the first JMG claim (diagnosis/treatment with acetylcholinesterase inhibitors, immunoglobulin [Ig], or plasma exchange [PLEX]). The primary outcome was JMG-related treatment changes during follow-up, assessed descriptively. Rates of MG exacerbation, thymectomy, and acute intravenous immunoglobulin/PLEX treatment were assessed. HCRU was evaluated.</p><p><strong>Results: </strong>A total of 630 patients (64.1% female; mean [SD] age 9.07 [5.73] years; 57.6% prepubertal onset) were followed for a median (range) of 2.4 (0-13) years. Corticosteroids were started at a median (range) of 1.28 (0-37.02) and 3.19 (0-87.68) months from diagnosis for postpubertal-onset and prepubertal-onset patients, respectively. The rate of thymectomy was highest during treatment with maintenance Ig/PLEX (incidence rate [IR]; [95% CI] per 100 patient-years: 34.62 [14.41-83.17] for postpubertal-onset and 24.24 [9.10-64.60] for prepubertal-onset patients). MG exacerbations were most frequent during the first year of follow-up in both subgroups (34.1% and 30.3%). In postpubertal-onset patients, exacerbation was highest during treatment with maintenance Ig/PLEX and nonsteroid immunosuppressant therapy ([NSIST], mostly polytherapy) (IR [95% CI] 105.81 [68.99-162.29] and 91.22 [65.80-126.47]). For prepubertal-onset patients, exacerbation was most frequent during NSIST (polytherapy) and biologic treatment (IR [95% CI] 140.44 [115.45-170.85] and 142.95 [46.10-443.23]). JMG-related hospitalizations occurred in 36.0% and 30.0% of postpubertal-onset and prepubertal-onset patients, in the first year of follow-up.</p><p><strong>Discussion: </strong>Patients with JMG escalated rapidly through the treatment hierarchy. Postpubertal-onset patients escalated more quickly to later-line treatments than prepubertal-onset patients. However, some patients continued to experience high HCRU, highlighting the need for new JMG treatments to provide rapid disease control. A limitation is that treatment escalation reasons were not evaluated.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213736"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258565","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":"Incidence and Determinants of Nonfocal Transient Neurologic Attacks: The Rotterdam Study.","authors":"Bernhard Pieter Berghout,Daniel Bos,Maryam Kavousi,Mohammad Arfan Ikram,Mohammad Kamran Ikram","doi":"10.1212/wnl.0000000000213854","DOIUrl":"https://doi.org/10.1212/wnl.0000000000213854","url":null,"abstract":"BACKGROUND AND OBJECTIVESRecent literature suggests no elevated risk of cardiovascular disease in patients having nonfocal transient neurologic attacks (TNAs), yet the origin of these attacks remains unclear. Therefore, we investigated their incidence and potential risk factors in a prospective cohort study, hypothesizing associations with cardiovascular risk factors.METHODSWithin the Dutch population-based Rotterdam Study, community-living individuals aged 45 years or older underwent assessment for demographic and cardiovascular risk factors in study cohorts initiated in 1990, 2000, and 2006. Participants were subsequently followed until January 1, 2021, for disease incidence through automated linkage of the study database with medical records from participants' general practitioners. For this study, participants free from TNA at baseline were selected and followed up for the outcome of a nonfocal TNA. The risk of nonfocal TNA was determined through age-specific incidence rates (IRs). Potential risk factors of nonfocal TNA were identified using cause-specific, multivariable, Cox proportional hazard modeling accounting for age, sex, education (university or higher vocational vs lower education level), cardiovascular risk factors, ultrasound markers of carotid atherosclerosis, antithrombotic medication use, and a history of vascular diseases. Sensitivity analyses consisted of conducting this regression among participants without any history of vascular disease at study entrance.RESULTSAfter 204,474 person-years of follow-up in 14,096 participants (mean [SD] age 65.5 [10.3] years, 59.0% female), 518 index nonfocal TNAs (3.7%) occurred. The incidence of nonfocal TNA increased with age, with an IR in those aged between 55 and 59 years of 65.5 (95% CI 33.6-116.2) per 100,000 person-years of follow-up to 424.0 (95% CI 348.0-512.0) in those aged 85 years or older. Older age (hazard ratio [HR] 1.08, 95% CI 1.07-1.09), a lower education level (HR 1.62, 95% CI 1.15-2.29), plaque presence on carotid ultrasound (HR 0.80, 95% CI 0.65-1.00), and the use of antithrombotics (HR 0.59, 95% CI 0.39-0.90) were all independently associated with the risk of nonfocal TNA. After restricting analyses to the 12,499 individuals without history of vascular disease, only the associations of age and a higher maximum attained education level with the risk of nonfocal TNA remained statistically significant.DISCUSSIONNonfocal TNAs predominantly affect older adults and those with lower educational attainment, suggesting that these attacks originate from socioeconomic determinants rather than from established cardiovascular risk factors.","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"21 1","pages":"e213854"},"PeriodicalIF":9.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586667","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":"Advance Care Planning and Decision Regret Among Stroke Surrogate Decision Makers: A Longitudinal Cohort Study.","authors":"Darin B Zahuranec, Christopher J Becker, Lourdes Carhuapoma, Carmen Ortiz, Rebecca J Lank, Guanghao Zhang, Kevin He, Erin Case, Lewis B Morgenstern","doi":"10.1212/WNL.0000000000213787","DOIUrl":"10.1212/WNL.0000000000213787","url":null,"abstract":"<p><strong>Objectives: </strong>Investigate the association between advance care planning and decision regret among stroke surrogate decision makers.</p><p><strong>Methods: </strong>People hospitalized with ischemic or hemorrhagic stroke and their surrogate decision makers were enrolled. Surrogates completed the validated decision regret scale (range 0-100, higher worse, analyzed as \"any\" vs \"none\") in the year after stroke (postdischarge, 3, 6, and 12 months). The association of advance care planning and regret was assessed with multilevel mixed effects logistic regression models, adjusted for prespecified covariates.</p><p><strong>Results: </strong>Participants were 317 surrogates for 255 patients with stroke (enrolled April 2016 to October 2020). Patients had a mean age of 74.6 years and mean NIH Stroke Scale of 14.7, with 53% deceased at 3 months. Surrogate characteristics were mean age: 55.8 years, child of patient: 62%, and decision considered (do-not-resuscitate 36%, comfort care 16%, feeding tube 14%, mechanical ventilation 14%, brain surgery 10%, and other 10%). Overall, 132/317 (42%) surrogates reported formal advance care plans. Decision regret scores overall were low (postdischarge mean: 11.2). Formal written advance care plans were associated with lower odds of any decision regret (odds ratio 0.46, 95% CI 0.24-0.89, <i>p</i> = 0.02) after full adjustment.</p><p><strong>Discussion: </strong>Formal written advance care plans were associated with lower odds of any decision regret among surrogate decision makers in the year after stroke.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213787"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258559","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":"Association of Leucocyte Telomere Length With Stroke, Dementia, and Late-Life Depression: The Role of Modifiable Risk Factors.","authors":"Tamara N Kimball, Savvina Prapiadou, Reinier W P Tack, Benjamin Yong-Qiang Tan, Jasper R Senff, Christina Kourkoulis, Sanjula Singh, Jonathan Rosand, Christopher D Anderson","doi":"10.1212/WNL.0000000000213794","DOIUrl":"10.1212/WNL.0000000000213794","url":null,"abstract":"<p><strong>Background and objectives: </strong>Stroke, dementia, and late-life depression (LLD) are age-related brain diseases that pose significant public health challenges and costs. Leucocyte telomere length (LTL) is a biological aging marker influenced by both genetic and lifestyle factors. The aim of our study was to determine the association between LTL and these diseases. We further investigated whether modifying risk factors of age-related brain disease, as measured using the Brain Care Score (BCS), mitigates LTL associations.</p><p><strong>Methods: </strong>We analyzed participants from the UK Biobank with available LTL and risk factor information. We examined LTL's associations with stroke, dementia, and LLD, individually and as a composite outcome, using continuous measures and tertile stratification. Disease risks were evaluated through cumulative incidence curves, incidence rates per 1,000 person-years, and adjusted Cox models. Risk comparisons across LTL tertiles were stratified by risk factor profiles, with high BCS (≥15) indicating healthier lifestyle choices and low BCS (≤10) reflecting less optimal lifestyle choices. Mendelian randomization (MR) was used to test causal associations.</p><p><strong>Results: </strong>The study included 356,173 participants (median age 56 years; 53.69% female). Shorter LTL was consistently associated with higher incidence rates across all outcomes. Participants in the shortest LTL tertile had elevated risks of the composite outcome (hazard ratio [HR] 1.11; 95% CI 1.08-1.15), stroke (HR 1.08; 95% CI 1.02-1.15), dementia (HR 1.19; 95% CI 1.12-1.26), and LLD (HR 1.14; 95% CI 1.09-1.18). Individuals with both shorter LTL and lower BCS faced significantly increased risks of age-related brain diseases (HR 1.11; 95% CI 1.07-1.16) and individually for stroke (HR 1.10; 95% CI 1.02-1.19), dementia (HR 1.17; 95% CI 1.08-1.28), and LLD (HR 1.13; 95% CI 1.07-1.19). Conversely, individuals with higher BCS within the shortest LTL group did not show a significant increase in risk of any age-related brain diseases. MR analyses did not identify causal relationships between LTL and these outcomes.</p><p><strong>Discussion: </strong>Individuals with shorter LTL are at increased risk of stroke, dementia, and LLD. Improved modifiable risk factor profiles seem to mitigate the impact of LTL on these diseases. Future research should explore the effectiveness of lifestyle interventions in mitigating adverse biological aging effects on brain health.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213794"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275466","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":"Estimated Theoretical Benefit of Aggressive LDL Lowering in Patients With Symptomatic Intracranial Atherosclerosis.","authors":"James Ernest Siegler, Elena Badillo Goicoechea, Shadi Yaghi, Rami Z Morsi, Andrea Arevalo, Matthew M Smith, Sachin Kothari, Harsh Desai, Neha Sehgal, Rohini Rana, Caroline Alice Kellogg, Aditya Jhaveri, Adam de Havenon, Therese Dunne, Kamil Cameron, Seemant Chaturvedi, Malik Ghannam, Shyam Prabhakaran, Elisheva Coleman, James R Brorson, Rachel Mehendale, Tareq Kass-Hout","doi":"10.1212/WNL.0000000000213768","DOIUrl":"10.1212/WNL.0000000000213768","url":null,"abstract":"<p><strong>Objectives: </strong>Given the high risk of recurrent atherosclerotic vascular events in patients with stroke due to intracranial atherosclerotic disease (ICAD), we estimated the potential benefit of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in this population.</p><p><strong>Methods: </strong>In this secondary analysis of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial, we estimated the association between 30-day low-density lipoprotein (LDL) reduction and recurrent stroke or myocardial infarction (MI) beyond 30 days (primary outcome). Estimates were assessed using adjusted Cox proportional hazards regression. We applied relative LDL reduction estimates from PCSK9i trials to project adjusted incidence rate differences of the primary outcome with an equivalent LDL reduction.</p><p><strong>Results: </strong>Of the 451 patients from SAMMPRIS, 378 met inclusion criteria. In adjusted Cox regression, every 10 mg/dL LDL improvement was associated with a 9% lower rate of the primary outcome (adjusted hazard ratio 0.91, 95% CI 0.83-0.997). Assuming an average projected effect of PCSK9i, estimating if half of SAMMPRIS patients were treated, PCSK9i use could reduce the annualized risk of the primary outcome by 33.2% in this trial population.</p><p><strong>Discussion: </strong>Every 10 mg/dL reduction in LDL for patients with stroke due to ICAD is associated with lower rates of recurrent stroke or MI, and this theoretical framework suggests that PCSK9i can help achieve this goal.</p><p><strong>Trial registration information: </strong>Secondary analysis of NCT00576693 prospectively registered interventional clinical trial. First registered December 7, 2007. Actual study start date: October 2008. https://clinicaltrials.gov/show/NCT00576693.</p><p><strong>Classification of evidence: </strong>This study provides Class IV evidence that a higher absolute reduction in LDL was associated with a lower risk of recurrent cerebral infarction or MI in patients with recent stroke due to intracranial stenosis.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"105 1","pages":"e213768"},"PeriodicalIF":7.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187450","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}