Revue neurologique最新文献

{"title":"Evolution of epilepsy comorbidities in seizure free patients: Is no seizure a synonym of no epilepsy?","authors":"S. Lagarde ,&nbsp;F. Bartolomei","doi":"10.1016/j.neurol.2025.04.004","DOIUrl":"10.1016/j.neurol.2025.04.004","url":null,"abstract":"<div><div>Epilepsy is a prevalent neurological disorder, with most patients achieving seizure freedom through antiseizure medications (ASM). However, being seizure-free does not necessarily equate to being free from epilepsy-related comorbidities. This review explores the persistence of psychiatric, cognitive, and social challenges in seizure-free patients and their impact on quality of life (QoL). Seizure-free patients generally report a better QoL than those with active epilepsy, with scores approaching those of the general population. However, detailed analyses reveal impairments in specific subdomains, such as emotional well-being, energy levels, and employment concerns. The most significant determinants of QoL in seizure-free patients include ASM side effects, psychiatric symptoms, and social functioning. Notably, polytherapy is associated with a poorer QoL. After epilepsy surgery, improvements in QoL are well documented, especially in the first two years postoperatively. However, for some patients, achieving seizure freedom does not necessarily result in significant QoL improvements, often due to persistent psychiatric or cognitive impairments. Psychiatric comorbidities, particularly depression and anxiety, remain a significant determinant of QoL in seizure-free patients, sometimes exerting a greater influence than seizure control itself. Depression is significantly more prevalent in patients treated with ASMs, especially those on polytherapy. After surgery, 15–45% of patients achieve remission from psychiatric disorders, particularly those who become seizure-free. Cognitive deficits could persist in seizure-free patients, particularly in those on ASMs. Studies have reported impairments in verbal fluency, memory, and processing speed, especially in patients with magnetic resonance imaging lesions or early epilepsy onset. ASM withdrawal has been associated with improved verbal fluency, psychomotor speed, and attention in some patients, but not necessarily in overall QoL. After epilepsy surgery, cognitive outcomes vary, with verbal memory decline being the most concerning effect, particularly after left-sided resections. However, some patients experience cognitive improvements, particularly in executive functioning and IQ in children. Importantly, QoL improvements post-surgery are generally independent of cognitive changes, as long as seizure control is achieved. Seizure freedom positively impacts employment, with studies reporting that seizure-free patients are significantly more likely to obtain or retain full-time employment. However, barriers remain, including stigma and employer perceptions of epilepsy. Driving ability is crucial to patient independence, with up to 80% of seizure-free patients regaining their license. While most seizure-free patients achieve financial and residential independence, social adaptation can be challenging. Some patients and families struggle with the “burden of normality,” which describes difficulties adjusti","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 5","pages":"Pages 456-470"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seizure-related cardiovascular symptoms: Comorbidities or SUDEP risk factors?","authors":"R. Surges","doi":"10.1016/j.neurol.2025.04.002","DOIUrl":"10.1016/j.neurol.2025.04.002","url":null,"abstract":"<div><div>Sudden unexpected death in epilepsy (SUDEP) is one of the leading drivers of premature mortality in people with epilepsy (PWE), especially in those with difficult-to-treat epilepsy and frequent tonic-clonic seizures (TCS). Cardiovascular symptoms commonly occur in association with seizures, prompting the hypothesis that SUDEP is primarily linked to seizure-related cardiovascular dysfunction. This short narrative review summarizes the spectrum of cardiovascular alterations in the context of seizures and discusses putative links to SUDEP. Focal seizures go frequently along with increased heart rates (HR) that resolve shortly after seizure cessation. HR decrease and ictal asystole (IA) are rarely observed in focal unaware seizures in a small proportion of people with temporal lobe epilepsy. IA is reported to be a self-limiting benign condition without a link to SUDEP. Focal to bilateral or generalized TCS are typically accompanied by excessively released catecholamines, which underlie, in turn, various postictal symptoms. Prominent, sustained sinus tachycardia is a common and benign finding, whereas ventricular fibrillation/tachycardia were only anecdotally reported in a few near-SUDEP or SUDEP patients. Cases of transient, non-fatal atrial fibrillation were also scarcely described in the aftermaths of TCS. Takotsubo cardiomyopathy was rarely reported following TCS, usually with a favorable outcome. In most recorded SUDEP cases, however, a rather stereotypical fatal cascade was consistently documented, characterized by primary central apnea that occurs in the early postictal phase after a TCS, secondarily followed by bradyarrhythmia and terminal asystole. Blood pressure commonly increases in association with focal seizures and TCS, but the pattern may be complex with transient decreases or no significant change during or after seizures. Apart from the immediate effects on cardiovascular function, increasing evidence suggests that recurrent seizures also have a remote impact on cardiac properties, coined by the term `epileptic heart syndrome'. In conclusion, cardiovascular symptoms related to focal seizures are typically transitory and benign. In contrast, TCS can rarely cause postical onset of ventricular tachycardia and acute cardiomyopathy, potentially leading to sudden cardiac death. SUDEP, in turn, was consistently reported to occur in the aftermaths of TCS primarily due to central apnea. To prevent potentially serious cardiovascular complications, full control of TCS whether by antiseizure medication, neuromodulatory devices or epilepsy surgery should be aimed at.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 5","pages":"Pages 397-402"},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemic stroke care for patients affiliated to the French agricultural health insurance scheme: A national study","authors":"O. Grimaud ,&nbsp;S. Kerbrat ,&nbsp;L. Menant ,&nbsp;S. Timsit ,&nbsp;J.-M. André ,&nbsp;E. Nowak ,&nbsp;V. Olié ,&nbsp;C. Padilla ,&nbsp;N. Le Meur","doi":"10.1016/j.neurol.2025.01.410","DOIUrl":"10.1016/j.neurol.2025.01.410","url":null,"abstract":"<div><h3>Background</h3><div>Health disparities along the rural-urban spectrum are a growing concern. The objective of this study was to determine whether in France, clinical profile, care and outcome after ischemic stroke differed between patients affiliated to the statutory health insurance system dedicated to the agricultural economic sector (i.e., <em>Mutualité Sociale Agricole</em> [MSA]) and all other patients.</div></div><div><h3>Methods</h3><div>Data on all patients aged<!--> <!-->≥<!--> <!-->20 years hospitalized for ischemic stroke in mainland France in 2018 were extracted from the French National Health Insurance Data System. Age-standardized percentages were used to compare the care accessed by MSA versus other stroke patients. Associations between health insurance scheme and case fatality were assessed using Poisson regression.</div></div><div><h3>Results</h3><div>Of 87,864 stroke cases 7928 (9%) were MSA patients. MSA patients were more often rural dwellers (75.4 versus 32%) and older (median age: 84 versus 76 years). In the 12 months prior to the stroke, access to general practitioner (GP) was similar, but MSA patients were less likely to have an appointment with a cardiologist. Pre-stroke drug prescriptions suggested a better cardiovascular profile in male MSA patients (e.g., antidiabetics: 18.1 versus 21.5%). A part from a lower access to stroke unit (e.g., women: 55.3 versus 59%) other acute care indicators, including reperfusion therapy, were comparable. The crude 7-day case fatality was higher for MSA patients (Relative Risk [RR]: 1.44, 95% CI [1.32–1.57]), but this disadvantage reduced to non-significant level after adjustment for age, comorbidities and stroke management (adjusted RR: 1.07 95% CI [0.98–1.18])</div></div><div><h3>Conclusions</h3><div>For the mostly farming, rural, MSA population, pre-stroke, acute and post-stroke care did not differ markedly from that provided to other patients. The lower density of GP in rural areas and the remoteness from specialized center did not result in less access to preventive and acute stroke care for MSA patients in 2018.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 4","pages":"Pages 298-304"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TOUlouse TAhiTI Stroke Study (TOUTATIS): A comparative analysis of young pacific islanders with ischemic stroke","authors":"R. Buon ,&nbsp;C. Tessier ,&nbsp;L. Watrin ,&nbsp;G. Gueyraud ,&nbsp;V. Larrue ,&nbsp;C. Gollion","doi":"10.1016/j.neurol.2025.01.413","DOIUrl":"10.1016/j.neurol.2025.01.413","url":null,"abstract":"<div><h3>Background and purpose</h3><div>Incidence of stroke among young adults is on the rise worldwide. Inequities remain among minorities and little is known about stroke characteristics among young Pacific patients. French Polynesia (FP), located in the middle of the South Pacific Ocean, could provide insight into this problem.</div></div><div><h3>Methods</h3><div>Patients aged 18–54<!--> <!-->years consecutively treated for first-ever acute ischemic stroke in Tahiti, FP, from January 2022 to December 2023 were compared to a reference cohort enrolled from January 2017 to July 2021 in Toulouse, France. Patients’ characteristics were recorded and cause of stroke was classified using the ASCOD (A: atherosclerosis; S: small vessel disease; C: cardiac pathology; O: other causes; D: dissection) classification system.</div></div><div><h3>Results</h3><div>In total, 187 patients were included in Tahiti (Polynesians) and compared to 743 patients in Toulouse (mainland French [MF]). Median age was 47<!--> <!-->years old in both groups. Hypertension, diabetes, hyperlipidemia, obesity, atrial fibrillation and mechanical valve were significantly higher in Polynesian patients, whereas MF patients were more likely to be men, tobacco users, and to have a stroke related to a foramen oval with atrial septal aneurysm (all <em>P</em> <!-->&lt;<!--> <!-->0.05). Multivariate analysis revealed higher prevalence of grade 1 (potentially causal) atherothrombotic (adjusted OR [aOR]: 1.775; 95% CI: 1.117–2.820; <em>P</em> <!-->=<!--> <!-->0.015) and cardio-embolic stroke in Tahiti (aOR: 2.966; 95% CI: 1.956–4.496; <em>P</em> <!-->&lt;<!--> <!-->0.001), and higher rate of dissections in Toulouse (aOR: 4.545; 95% CI: 1.616–12.821; <em>P</em> <!-->=<!--> <!-->0.004). Cervical atherosclerosis was significantly associated with MF patients (aOR: 5.587; 95% CI: 2.326–13.514; <em>P</em> <!-->&lt;<!--> <!-->0.001), and intracranial atherosclerosis with Polynesian patients (aOR: 3.257; 95% CI: 1.364–7.778; <em>P</em> <!-->=<!--> <!-->0.008).</div></div><div><h3>Conclusion</h3><div>Polynesian and MF young adults with stroke appeared to have widely different characteristics and cause of stroke. These disparities underscore the necessity for tailored prevention programs and therapeutic approaches that address the unique risk profile and etiological patterns observed in Pacific Islanders.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 4","pages":"Pages 342-348"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The COVID-19 pandemic reduced delays in the care pathway for patients with glioma at a French institute","authors":"M. Brison ,&nbsp;W. Bouleftour ,&nbsp;J.-B. Pelletier ,&nbsp;F. Vassal ,&nbsp;F. Barral-Clavel ,&nbsp;E. Jadaud ,&nbsp;C. Boutet ,&nbsp;J.-P. Camdessanche ,&nbsp;F. Forest ,&nbsp;C. Ramirez","doi":"10.1016/j.neurol.2025.01.412","DOIUrl":"10.1016/j.neurol.2025.01.412","url":null,"abstract":"<div><h3>Context</h3><div>Delays in cancer management have been reported during the COVID-19 pandemic. Neuro-oncology patients represent a real challenge as their disease can progress rapidly without appropriate care. However, data available for these patients over this period is scarce.</div></div><div><h3>Objective</h3><div>Therefore, the aim of this study was to examine the impact of the COVID-19 pandemic on therapeutic care within a specific population at a French institute. A retrospective descriptive study was conducted using electronic medical records. All patients who underwent surgery for glioma in a neurosurgery unit between January 1st, 2019 and December 31st, 2020 were included.</div></div><div><h3>Results</h3><div>A total of 114 patients were operated for a glioma; 70 patients in 2019 (before the pandemic) and 44 in 2020 (during the pandemic). Among these patients, 89% were diagnosed with a high-grade glioma, including 81% with glioblastoma. The mean time between first symptoms and imaging process increased from 35<!--> <!-->days in 2019 to 40<!--> <!-->days in 2020. However, in the subsequent steps of the care pathway, timelines improved at each stage with a reduction up to four days. The time reduction was statistically significant for two specific stages of care: (i) the interval between the surgery and the histomolecular diagnosis, with a reduction of two days, and (ii) the period between the histomoleculardiagnosis and the consultation for results announcement, with a reduction of three days. In summary, on average, the first treatment was initiated 49 days post-surgery in 2019 and 36<!--> <!-->days post-surgery in 2020.</div></div><div><h3>Conclusion</h3><div>This study showed that the COVID-19 outbreak positively impacted the therapeutic care pathway of patients with glioma at a French institute. Although the improvement can be measured in days, this acceleration of care was nonetheless crucial for the population studied.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 4","pages":"Pages 314-319"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of the experience of patients living with multiple sclerosis in terms of care pathway quality: An original French study","authors":"D. Veillard ,&nbsp;K. Baumstarck ,&nbsp;A. Ousmen ,&nbsp;S. Hamonic ,&nbsp;G. Edan ,&nbsp;P. Auquier","doi":"10.1016/j.neurol.2025.01.375","DOIUrl":"10.1016/j.neurol.2025.01.375","url":null,"abstract":"<div><h3>Purpose</h3><div>Taking into account the experience of patients living with chronic diseases, like multiple sclerosis (MS), in the assessment of the quality of their care pathway contributes significantly to improve these quality and their own state of health. This challenge requires better identification of the determinants of this experience. The study aimed to explore the determinants of the experience of MS patients in France concerning their care pathway quality.</div></div><div><h3>Patient and methods</h3><div>This study was based on a dedicated cross-sectional national survey that took place in 2021. Teams from regional MS networks and MS unit at the hospital, as well as patients’ associations, invited patients to participate throughout France. Patients’ experience was assessed using the Musicare questionnaire. The determinants explored concerned their sociodemographic characteristics, quality of life and disease characteristics. To explore association between MusiCare questionnaire dimension scores and these determinants, bivariate and multivariate analysis were performed.</div></div><div><h3>Results</h3><div>Data were exploitable for 1971 patients living throughout France. Multivariate analysis identified significant relationships between all but one of the Musicare dimensions and several of the determinants considered in this study. The presence of a supportive caregiver, better quality of life scores, receiving specialized follow-up for MS, being a male patient and long-term illness significantly improves patient experience on one or more dimensions of the Musicare questionnaire.</div></div><div><h3>Conclusion</h3><div>Some of these results are consistent with those of previous studies on other chronic diseases. They require confirmation, but they pave the way for targeted interventions for these patients in France.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 4","pages":"Pages 289-297"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racemose neurocysticercosis with meningitis and infectious vasculitis: A case report","authors":"B. Leger ,&nbsp;E. Chaugne ,&nbsp;M. Boudot de la Motte ,&nbsp;M. Boucenna ,&nbsp;C. Papeix","doi":"10.1016/j.neurol.2025.02.003","DOIUrl":"10.1016/j.neurol.2025.02.003","url":null,"abstract":"","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 4","pages":"Pages 364-366"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"French validation of the Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ-23) with determination of cutoff scores: A valuable tool in clinical practice","authors":"H. Joly ,&nbsp;H. Brissart ,&nbsp;R. Fabre ,&nbsp;S. Cambiaggio ,&nbsp;M. Zerlini ,&nbsp;C. Honan ,&nbsp;C. Lebrun-Frenay","doi":"10.1016/j.neurol.2025.02.005","DOIUrl":"10.1016/j.neurol.2025.02.005","url":null,"abstract":"<div><div>Work difficulties are a primary issue of multiple sclerosis (MS). This is because disease onset usually occurs during a time when establishing a career and employment is of paramount importance. The MSWDQ-23 (Multiple Sclerosis Work Difficulties Questionnaire) was developed to assess work difficulties in MS. The WORKSEP project aimed to adapt and validate the French MSWDQ-23 and develop cutoff scores through a multicentric study in 14 centers across France. Two hundred and six persons with MS were recruited: 149 with relapsing-remitting MS and 57 with progressive forms of MS. They completed the MSWDQ-23 in French, the DEX to assess the subjective cognitive executive complaint, and the SF-36 evaluating mental (MC) and physical (PC) health-related quality of life. The results indicated that the French version of MSWDQ-23 has high internal consistency (Cronbach's α: 0.93) and test-retest reliability (ICC<!--> <!-->=<!--> <!-->0.83). A confirmatory factor analysis demonstrated a scale structure identical to the original English version comprising physical barriers (PB), psychological and cognitive barriers (PCB), and external barriers (EB). The construct and convergent validity were strong. A higher level of work difficulties at PB score was related to a higher level of disability at the EDSS and lower PC quality of life, and a higher level of PCB was related to higher cognitive executive complaints and lower MC quality of life. ROC curves based on the difference between employed and unemployed patients allowed for determining cutoff values of 32 for the total score, 37 for PB, and 27 for PCB. This study allowed the validation of the MSWDQ-23 in the French language and is the first to propose a cutoff. Determining the cutoff value enables identifying patients needing intervention and targets the limitations that MS patients may encounter in the workplace. This easy-to-use instrument provides the opportunity to propose an adapted rehabilitation program or work adjustments to improve the quality of life in patients with MS.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 4","pages":"Pages 349-362"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lack of efficacy of sofosbuvir in Human Pegivirus associated neurological disorders","authors":"V. Pourcher ,&nbsp;M. Boudot de La Motte ,&nbsp;M. Touat ,&nbsp;R. Deschamps ,&nbsp;C. Dehais ,&nbsp;C. Houillier ,&nbsp;F. Domont ,&nbsp;S. Bonnin ,&nbsp;M.-B. Le Stang ,&nbsp;C. Rodriguez ,&nbsp;M. Eloit ,&nbsp;G. Peytavin ,&nbsp;E. Maillart","doi":"10.1016/j.neurol.2025.02.002","DOIUrl":"10.1016/j.neurol.2025.02.002","url":null,"abstract":"","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 4","pages":"Pages 363-364"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing high and low amyloid producers in Alzheimer's disease: An in-depth analysis","authors":"Mélanie Leroy ,&nbsp;Anne Laure Aziz ,&nbsp;Susanna Schraen ,&nbsp;Vincent Deramecourt ,&nbsp;Emilie Skrobala ,&nbsp;Simon Lecerf ,&nbsp;Florence Pasquier ,&nbsp;Vincent Huin ,&nbsp;Maxime Bertoux ,&nbsp;Thibaud Lebouvier","doi":"10.1016/j.neurol.2025.02.004","DOIUrl":"10.1016/j.neurol.2025.02.004","url":null,"abstract":"<div><h3>Background</h3><div>The cerebrospinal fluid (CSF) Aβ_42/40 ratio has proven to be a more reliable biomarker for amyloid pathology than CSF Aβ₄₂ in Alzheimer's disease (AD), helping to correctly classify patients with positive tau biomarkers (T+) that would otherwise have remained outside of the AD continuum. It was shown that the Aβ_42/40 ratio better captures a relative decrease of Aβ₄₂ in patients with high CSF Aβ. However, whether patients with high-amyloid (HiA) AD, in whom A+ is defined by the Aβ_42/40 ratio, exactly compare with their low-amyloid (LoA) counterparts, in whom A+ is defined by Aβ₄₂ solely, deserves further analysis.</div></div><div><h3>Methods</h3><div>We retrospectively included patients with A+T+ AD and evidence of cognitive and neurodegenerative changes (N+). LoA patients were operationally defined as patients with T+N+ and low CSF Aβ₄₂, while HiA patients were defined as patients with T+N+ and normal CSF Aβ₄₂ but abnormal Aβ_42/40 ratio. Tau CSF biomarkers, neuropsychological profile, rates of cognitive decline, structural and metabolic imaging, ApoE genotype and brain neuropathology were compared between the HiA and LoA groups.</div></div><div><h3>Results</h3><div>At the time of the lumbar puncture, LoA patients were significantly younger than the HiA patients (68.9<!--> <!-->±<!--> <!-->8.7<!--> <!-->years vs. 71.8<!--> <!-->±<!--> <!-->9.4; <em>P</em> <!-->=<!--> <!-->0.0015) and had a lower Mini-Mental Status Examination (MMSE) (18.7<!--> <!-->±<!--> <!-->6.4 vs. 20.7<!--> <!-->±<!--> <!-->6.2; <em>P</em> <!-->=<!--> <!-->0.0005). There was no difference in the neuropsychological profile nor in the annual rates of cognitive decline between the two groups with early AD. No differences were retrieved between groups on CSF Tau and P-Tau biomarkers, atrophy and brain metabolism, distribution of the <em>APOE4</em> allele and <em>APOE4</em>/<em>E4</em> genotype, and neuropathology.</div></div><div><h3>Conclusions</h3><div>Overall, our study supports the surrogate use of the Aβ_42/40 ratio as an equivalent to Aβ₄₂ to define AD. We showed that HiA CSF profiles were not associated with differences in cognition, brain structures and metabolism, <em>APOE</em> genotype tau CSF biomarkers or the rates of cognitive decline, but may be the associated with later-onset and early-stage AD.</div></div>","PeriodicalId":21321,"journal":{"name":"Revue neurologique","volume":"181 4","pages":"Pages 332-341"},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}