Revista de neurologia最新文献

{"title":"Trajectory-Based Modeling Improves Long-Term Outcome Prediction Beyond 90-Day Assessment in ICU-Treated Intracerebral Hemorrhage.","authors":"Qing Su, Xini Zhang, Baogui Wang, Liyun Zhu, Yufeng Li","doi":"10.31083/RN52441","DOIUrl":"10.31083/RN52441","url":null,"abstract":"<p><strong>Objective: </strong>To identify distinct long-term functional recovery trajectories among intensive care unit (ICU)-treated patients with spontaneous intracerebral hemorrhage (ICH) and to evaluate whether trajectory-based classification improves prediction of long-term quality of life (QoL) compared with conventional single time-point functional assessment.</p><p><strong>Methods: </strong>We conducted a prospective longitudinal cohort study of consecutive adult patients with spontaneous ICH admitted to a tertiary ICU between January 2024 and January 2025. Survivors to hospital discharge were followed for 12 months. Functional status was assessed using the modified Rankin Scale (mRS) at hospital discharge, 90 days, 6 months, and 12 months. Latent class mixed modeling (LCMM) was used to identify distinct recovery trajectories. Health-related QoL at 12 months was measured using the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) instrument. Multinomial logistic regression was performed to evaluate associations between early clinical characteristics and trajectory membership. Receiver operating characteristic curve analysis was conducted to compare the predictive performance of trajectory membership and 90-day mRS for 12-month QoL.</p><p><strong>Results: </strong>Among 196 patients (mean age 61.7 ± 12.4 years; 60.2% male), three distinct functional recovery trajectories were identified: good, moderate, and poor recovery. Twelve-month QoL demonstrated a graded decline across trajectory groups. Older age, lower admission Glasgow Coma Scale scores, and larger hematoma volume were independently associated with both moderate and poor recovery trajectories, while intraventricular hemorrhage, mechanical ventilation, and prolonged sedation (>48 hours) were specifically associated with the poor recovery trajectory. Trajectory-based classification demonstrated superior predictive performance for 12-month QoL compared with 90-day mRS (area under the curve [AUC], 0.81 vs 0.72; <i>p</i> = 0.003), with significant improvement in risk discrimination. Trajectory-based classification also improved risk reclassification (net reclassification improvement (NRI) = 0.27; integrated discrimination improvement (IDI) = 0.09).</p><p><strong>Conclusion: </strong>ICU-treated patients with intracerebral hemorrhage exhibit distinct long-term recovery trajectories that are strongly associated with quality of life. Importantly, trajectory-based classification provides incremental prognostic value beyond conventional single time-point functional assessment, supporting a shift toward dynamic outcome modeling for long-term prognostication in ICH.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 8","pages":"52441"},"PeriodicalIF":0.6,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[XVIII Post-ECTRIMS Meeting: Review of the New Developments Presented at the 2025 ECTRIMS Congress (Part II)].","authors":"Óscar Fernández, Xavier Montalban, Adrián Arés, Eduardo Agüera, Yolanda Aladro, Ana Alonso, Rafael Arroyo, Luis Brieva, Carmen Calles, Ana Belén Caminero, Tamara Castillo-Triviño, Lucienne Costa-Frossard, Sara Eichau, Lamberto Landete, Miguel Llaneza, Sara Llufriu, José E Meca-Lallana, Virginia Meca-Lallana, Enric Monreal, Ester Moral, Celia Oreja-Guevara, José María Prieto, Lucía Romero-Pinel, Àlex Rovira, Alfredo Rodríguez-Antigüedad","doi":"10.31083/RN55658","DOIUrl":"10.31083/RN55658","url":null,"abstract":"<p><p>The 18th edition of the post-European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) meeting was held on 17-18 October 2025 in Madrid, bringing together Spanish neurologists specialising in multiple sclerosis (MS), who presented the most relevant advances discussed at the ECTRIMS congress held a few days earlier in Barcelona. The aim of this edition was to present the latest developments in MS regarding the update of diagnostic criteria, advanced neuroimaging techniques, the role of Epstein-Barr virus, remyelination mechanisms and biomarkers. In the therapeutic field, emerging treatments were addressed, such as new monoclonal antibodies and chimeric antigen receptor T cells (CAR-T), the management of elderly patients and the risks associated with high-efficacy therapies. This article is the second of a two-part series (I and II). The article reviews recent data on disease progression and on the concept of progression independent of relapse activity (PIRA), including the definition, among those published, that leads to balanced incidence and persistence in PIRA rates. Certain neuropathological and imaging aspects are reviewed, and, with regard to serum biomarkers, it is emphasised that neurofilament light chain (NfL) is a marker of acute damage that is not specific to MS, and that the challenge lies in establishing a value that differentiates it from other diseases. It is also discussed whether the low sensitivity of NfL for predicting progression lies in the z-score used in clinical practice, and the usefulness of glial fibrillary acidic protein (GFAP) in combination with NfL to refine the assessment of chronic progressive damage. The importance of age in MS is indisputable. The elderly patient with MS has a greater number of comorbidities and is more vulnerable to certain treatments. Menopause is a normal but expected physiological transition of female ageing that may trigger or aggravate certain health problems, and whose symptoms should not be confused with worsening of the disease. As for cognitive impairment in MS, the latest developments and expert opinions that could help improve its identification and monitoring are summarised. Much of this part II article focuses on summarising the key advances in emerging therapies and treatment prospects in related diseases, without overlooking the risks associated with very high-efficacy therapies and the possible risk-prevention strategies. Finally, as important findings that translate into clinical practice, the notable improvement in diagnosis with the new 2024 McDonald criteria stands out, despite the barriers to accessing paraclinical tests in certain populations. Overall, the data reviewed, together with those gathered in part I, reflect the research effort to advance the understanding of the disease from multiple complementary perspectives, which is transforming the care of patients with MS.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 8","pages":"55658"},"PeriodicalIF":0.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[XVIII Post-ECTRIMS Meeting: Review of the New Developments Presented at the 2025 ECTRIMS Congress (Part I)].","authors":"Óscar Fernández, Xavier Montalban, Adrián Arés, Eduardo Agüera, Yolanda Aladro, Ana Alonso, Rafael Arroyo, Luis Brieva, Carmen Calles, Ana Belén Caminero, Tamara Castillo-Triviño, Lucienne Costa-Frossard, Sara Eichau, Lamberto Landete, Miguel Llaneza, Sara Llufriu, José E Meca-Lallana, Virginia Meca-Lallana, Enric Monreal, Ester Moral, Celia Oreja-Guevara, José María Prieto, Lucía Romero-Pinel, Àlex Rovira, Alfredo Rodríguez-Antigüedad","doi":"10.31083/RN51701","DOIUrl":"10.31083/RN51701","url":null,"abstract":"<p><p>The 18th edition of the post-European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) meeting was held on 17-18 October 2025 in Madrid, bringing together Spanish neurologists specialising in multiple sclerosis (MS), who presented the most relevant advances discussed at the ECTRIMS congress held a few days earlier in Barcelona. The aim of the meeting was to summarise the latest developments in the pathogenesis, new diagnostic criteria and biomarkers of MS. This article is the first of a two-part series (I and II) that reviews recent data on cell trafficking into the central nervous system, highlighting the functional heterogeneity of the brain endothelium, the molecular mechanisms regulating leukocyte infiltration and the differential role of macrophages and resident microglia in tissue damage and chronic inflammation. The evidence supporting the role of Epstein-Barr virus as a necessary risk factor in MS is presented, together with the therapeutic and preventive implications from studies of antiviral therapies, cell-based therapies and vaccines. Regarding diagnosis, the new criteria for neuromyelitis optica spectrum disorders are addressed, with particular attention to the molecular heterogeneity of double-seronegative forms, as well as the update of the magnetic resonance imaging (MRI) guidelines following the 2024 revision of the McDonald criteria. Advances in the neuroimaging of chronic active inflammation, quantitative spinal cord imaging and the concept of spinal cord reserve are highlighted. The growing role of artificial intelligence applied to MRI for the early prediction of progression and treatment response is also reviewed. Finally, advances in remyelination mechanisms and in biomarkers are presented, underscoring the value of multimodal and longitudinal approaches for prognostic stratification and treatment monitoring. Overall, the data reviewed reflect a change into a more integrated and predictive understanding of MS, with direct implications for early diagnosis, treatment personalisation and the design of future clinical trials.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 8","pages":"51701"},"PeriodicalIF":0.6,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association and Risk-Stratification Value of the Positive Remodeling Index of Middle Cerebral Artery Atherosclerotic Plaques for Perforator-Territory Infarction Based on High-Resolution Magnetic Resonance Imaging.","authors":"Xiaojun Li, Yu Zhang, Huawu Zhang, Chunyang Hu, Xuebing Li","doi":"10.31083/RN53244","DOIUrl":"10.31083/RN53244","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Atherosclerosis of the middle cerebral artery (MCA) is a major contributor to ischemic stroke, and infarcts confined to the perforator territory can produce considerable neurological dysfunction even when the affected volume is comparatively small. As the severity of luminal narrowing measured by conventional methods does not, on its own, account for the variety of observed infarction patterns, additional contributions from plaque remodeling and plaque vulnerability are likely. High-resolution magnetic resonance imaging (HR-MRI) permits fine-grained characterization of intracranial plaques. The present work was undertaken to examine how the positive remodeling index (PRI) of MCA atherosclerotic plaques relates to perforator-territory infarction and to provide a preliminary appraisal of the value of PRI for stratifying the risk of this infarct subtype.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients admitted to our institution between January 2021 and December 2024 with acute ischemic stroke attributable to MCA atherosclerosis were reviewed retrospectively, yielding 283 cases. Each patient completed both conventional MRI and HR-MRI vessel wall imaging. Based on where the infarct was located, patients were separated into a perforator-territory infarction group (n = 127) and a non-perforator-territory infarction group (n = 156). The cross-sectional vessel area at the culprit lesion and at the reference segment were quantified from HR-MRI, from which the PRI was derived. Clinical and imaging variables showing an independent relationship with perforator-territory infarction were identified through univariate followed by multivariable logistic regression. The apparent discrimination of PRI was summarized using receiver operating characteristic (ROC) analysis, and the stability of the derived cutoff was examined by bootstrap resampling together with stratified 10-fold cross-validation. The added value of the PRI was judged using net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;PRI values were greater among patients with perforator-territory infarction than among those without. In the multivariable model, perforator-territory infarction was independently linked to the PRI (odds ratio [OR] = 8.67, 95% confidence interval [CI]: 3.42-21.98, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), diabetes mellitus (OR = 2.18, 95% CI: 1.21-3.92, &lt;i&gt;p&lt;/i&gt; = 0.009), homocysteine (OR = 1.03, 95% CI: 1.00-1.05, &lt;i&gt;p&lt;/i&gt; = 0.032), severe stenosis (OR = 2.45, 95% CI: 1.38-4.35, &lt;i&gt;p&lt;/i&gt; = 0.002), marked enhancement (OR = 2.32, 95% CI: 1.28-4.21, &lt;i&gt;p&lt;/i&gt; = 0.006), and intraplaque hemorrhage (OR = 1.95, 95% CI: 1.09-3.49, &lt;i&gt;p&lt;/i&gt; = 0.025). Used alone, the PRI achieved moderate discrimination, with an area under the curve (AUC) of 0.728 (95% CI: 0.670-0.786). After internal validation, the bootstrap-corrected AUC was 0.716 (95% CI: 0.654-0.775) and the stratified 10-fold cross","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 7","pages":"53244"},"PeriodicalIF":0.6,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Cases of Isolated Intracranial Aspergilloma Mimicking Convexity and Skull Base Meningioma: Diagnostic and Radiological Dilemmas.","authors":"Muhammad Nawaz Khan, Muhammad Junaid, Syed Shayan Shah, Syed Jawad Ahmad, Muhammad Sohaib Khan, Muhammad Affan Khan, Kaviya Selvapandian, Bipin Chaurasia","doi":"10.31083/RN52189","DOIUrl":"10.31083/RN52189","url":null,"abstract":"<p><strong>Background: </strong>Intracranial aspergilloma is a rare fungal infection of the central nervous system, predominantly affecting immunocompromised individuals. However, cases in immunocompetent hosts are increasingly reported, often mimicking meningiomas due to similar radiological features, leading to diagnostic delays and poor outcomes.</p><p><strong>Case presentation: </strong>We present two cases of isolated intracranial aspergilloma in immunocompetent patients. The first case involved a 55-year-old female with a right parietal scalp swelling mimicking a convexity meningioma, confirmed as aspergilloma on histopathology following surgical excision. The second case was a 63-year-old male with symptoms of raised intracranial pressure and a right planum sphenoidale lesion mimicking skull base meningioma, also diagnosed postoperatively as invasive aspergillosis. Both patients underwent surgical resection and voriconazole therapy, with favorable short-term outcomes. These cases highlight the diagnostic challenges posed by overlapping imaging characteristics of aspergilloma and meningioma.</p><p><strong>Conclusions: </strong>A high index of suspicion, even in immunocompetent patients, is essential for timely histopathological confirmation and antifungal treatment to mitigate morbidity and mortality. Adding aspergilloma to the differential diagnosis of meningioma-like lesions on radiology may improve outcomes.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 7","pages":"52189"},"PeriodicalIF":0.6,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-Enabled Modeling for Alzheimer's Disease Risk Prediction and Validation.","authors":"Pingping Li, Yida Wang","doi":"10.31083/RN49220","DOIUrl":"10.31083/RN49220","url":null,"abstract":"<p><strong>Background: </strong>To investigate the multimodal clinical influencing factors of Alzheimer's disease (AD) onset, and to establish and test a risk prediction tool derived from these determinants and additional clinical measures, thus facilitating early intervention and risk classification in individuals at high risk for AD.</p><p><strong>Methods: </strong>A retrospective cohort of 502 high-risk individuals for AD (exhibiting cognitive decline or family history) who visited our hospital was included. A total of 502 participants were randomly split into a training cohort (n = 350) and a validation cohort (n = 152) in a 7:3 proportion. Demographic characteristics, clinical indicators, biomarkers, and genetic markers were collected. In the training set, univariate analysis and least absolute shrinkage and selection operator (LASSO) regression were first applied for variable screening, followed by multivariate logistic regression to pinpoint independent influencing factors. Random forest (RF), XGBoost, and deep learning models were constructed using Python, with performance evaluated using area under the curve (AUC). The optimal model was selected, and feature importance was analyzed.</p><p><strong>Results: </strong>Between the training and validation sets, no statistically significant baseline characteristic differences were found (<i>p</i> > 0.05). Multivariate logistic regression identified the apolipoprotein E epsilon 4 allele (<i>APOE</i> ε4) genotype, cerebrospinal fluid (CSF) p-tau181/amyloid-beta 42 (Aβ42) ratio, and diabetes as independent risk factors for AD (<i>p</i> < 0.05), while serum folate levels, Mini-Mental State Examination (MMSE) scores, and Montreal Cognitive Assessment (MoCA) scores served as independent protective factors (<i>p</i> < 0.05). In the validation set, the RF model achieved the highest AUC (0.879), followed by XGBoost (0.869) and deep learning (0.844), with the CSF p-tau181/Aβ42 ratio identified as the most predictive feature.</p><p><strong>Conclusion: </strong>The RF model, based on integrated multimodal clinical influencing factors and clinical indicators, demonstrates potential for AD risk stratification in high-risk populations when evaluated on a validation cohort.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 7","pages":"49220"},"PeriodicalIF":0.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Value of Tissue-Based Assays in the Diagnosis of AE.","authors":"Yaxiu Fang, Yan Tan, Guanghui Liu, Dong Zheng, Yuefeng Zhang, Xiaoming Zhou, Huarong Zhou, Pengbo Gao, Hui Zhang, Lin Chen, Yafang Hu, Yuping Ning","doi":"10.31083/RN48873","DOIUrl":"10.31083/RN48873","url":null,"abstract":"<p><strong>Background: </strong>Tissue-based assay (TBA) results can reveal the existence of antibodies other than known antibodies. Clinically, some patients with negative cell-based assay (CBA) but positive TBA have similar symptoms to autoimmune encephalitis (AE), indicating that positive TBA results still provide a certain reference for clinicians to make decisions. Through a retrospective study, the diagnostic rate of AE in our center and the auxiliary diagnostic value of TBA for AE were analyzed. The sensitivity and specificity of cerebrospinal fluid TBA in the diagnosis of AE were also evaluated.</p><p><strong>Methods: </strong>Patients who met the diagnostic criteria for confirmed and possible AE in our center were retrospectively selected. The positive and negative rates of TBA in patients diagnosed with AE were analyzed, as were the positive rate and subcellular localization of TBA in possible AE patients with a negative CBA.</p><p><strong>Results: </strong>Among the 61 cases of confirmed AE, 48 cases had positive TBA, resulting in a detection rate of 79%. There were 13 cases (21%) with false negatives. Among the 115 possible AE patients with negative autoantibodies, 97 cases (45.8%) had positive TBA. Based on the cellular morphology revealed by staining, these cases were categorized into neuronal cell staining (48 cases, including 8 cases with membrane staining, 19 cases with nuclear staining, and 21 cases with cytoplasmic antibody), glial cell staining (15 cases), and simultaneous staining of neuronal and glial cells (4 cases); The area under the curve of AE confirmed by TBA positivity diagnosis was 0.672, 95% CI 0.594-0.749, <i>p</i> < 0.001, with sensitivity, specificity, and Youden's index of 78.7%, 55.6%, and 0.343, respectively. In the logistic regression model for positive TBA and elevated cerebrospinal fluid leukocyte counts, the area under the curve (AUC) was 0.728, 95% CI 0.654-0.803, <i>p</i> < 0.001, with sensitivity and specificity, and Youden's index of 57.4%, 79.5%, and 0.368, respectively.</p><p><strong>Conclusions: </strong>TBA serves as an effective complementary tool to CBA for AE diagnosis, with a sensitivity of 78.7% and specificity of 55.6%. Combining a positive TBA with an elevated cerebrospinal fluid (CSF) leukocyte count improved diagnostic specificity to 79.5%, suggesting that comprehensive evaluation integrating both assays can reduce missed diagnoses and optimize clinical management.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 7","pages":"48873"},"PeriodicalIF":0.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of Plasma p-tau217 as a Biomarker of Prodromal Alzheimer's Disease.","authors":"Victoria Monge-García, Sofía Lorenzo-García, María-Carmen Bernal-Soriano, Patricia Torrella-Esteban, Sonia Monge-García, José Sánchez-Payá, José-Antonio Monge-Argilés","doi":"10.31083/RN50619","DOIUrl":"10.31083/RN50619","url":null,"abstract":"<p><strong>Background: </strong>Plasma phosphorylated tau 217 protein (p-tau217p) has recently been proposed as a useful biomarker for the early diagnosis of Alzheimer's disease (AD). However, local validation is recommended because of the potential influence of clinical, analytical, and preanalytical factors on assay performance.</p><p><strong>Methods: </strong>Between 2021 and 2024, we evaluated patients with amnestic mild cognitive impairment (aMCI) through clinical history, neurological and neuropsychological examination, blood sampling for biobanking, brain imaging, and lumbar puncture, among other diagnostic tests. In September 2025, p-tau217p levels were measured simultaneously using the LUMIPULSE immunoassay (Fujirebio). The diagnostic validity, reproducibility, receiver operating characteristic (ROC) curve performance, correlation with cerebrospinal fluid (CSF) biomarkers, and influence of clinical and analytical variables were evaluated in this study.</p><p><strong>Results: </strong>Among the 108 aMCI patients included, 66 met the criteria for clinic-biological AD, while the remainder had alternative clinical diagnoses. Using a two-threshold approach, p-tau217p levels ≥0.19 yielded a sensitivity of 88% and a positive predictive value of 83% for identifying AD. Levels ≥0.39 showed a specificity of 91% and a positive predictive value of 90% for the same purpose. Intermediate values (0.20-0.38) achieved a specificity of 83%. The intraclass correlation coefficient for the assay reproducibility was 0.97. The ROC curve for p-tau217p demonstrated an area under the curve of 0.86 for diagnosing AD. P-tau217p correlated more strongly with CSF p-tau181 (ρ = 0.63; <i>p</i> < 0.01) than with CSF Aβ1-42 (ρ = -0.40; <i>p</i> < 0.01). Finally, a reduced glomerular filtration rate was associated with a significant increase in p-tau217p levels (<i>p</i> < 0.006).</p><p><strong>Conclusions: </strong>In our setting, p-tau217p measurement showed a high validity for the diagnosis of prodromal AD, which is consistent with the recent neurological literature. The assay showed high reproducibility, although results may be influenced by renal function. P-tau217p correlated more strongly with CSF p-tau181 than with CSF Aβ1-42.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 7","pages":"50619"},"PeriodicalIF":0.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Memorias del XXXIV Congreso Anual de la Sociedad Mexicana de Neurología Pediátrica A.C.","authors":"","doi":"10.31083/RN49601","DOIUrl":"10.31083/RN49601","url":null,"abstract":"","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 7","pages":"49601"},"PeriodicalIF":0.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13421098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Statistical Inference in Database Exploitation: Sample Size and Confounding Factors.","authors":"Carmen Carazo-Díaz, Luis Prieto-Valiente","doi":"10.31083/RN52643","DOIUrl":"10.31083/RN52643","url":null,"abstract":"<p><p>Database (DB) exploitation is an essential tool in medical and epidemiological research, enabling the extraction of hidden insights from large volumes of information through statistical analysis. This work provides a methodological reflection on two critical aspects of such studies, namely sample size and confounder detection via multivariate analysis. When working with databases, researchers must perform statistical inference based exclusively on the available data and therefore often ask whether the fixed sample size is sufficient to detect relationships of interest. In most cases, no threshold value separates valid sizes from invalid ones, as statistical power increases gradually and depends on multiple parameters, with no fixed cutoff points. Even when the results are inconclusive (high <i>p</i>-values), possibly because of limited sample size, their publication is essential to feed future meta-analyses that may provide more solid conclusions. DB analysis requires discriminating between general and circumstantial associations. Although the relationships revealed by univariate analysis maintain their descriptive value, the accuracy of their interpretation can be increased by identifying possible confounding factors.</p>","PeriodicalId":21281,"journal":{"name":"Revista de neurologia","volume":"81 6","pages":"52643"},"PeriodicalIF":0.6,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13339777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}