Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association最新文献

{"title":"Tele-Based Ischemic Conditioning for Chronic Stroke: Safety, Feasibility, and Preliminary Neurophysiological and Motor Effects.","authors":"Sangeetha Madhavan, Mark Cummings, Danny Mathew","doi":"10.1016/j.jstrokecerebrovasdis.2026.108772","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2026.108772","url":null,"abstract":"<p><p>To examine the safety and feasibility of a two-week (seven-session) tele-based ischemic conditioning (tele-IC) intervention in individuals with chronic stroke and to explore secondary neurophysiological and motor outcomes.</p><p><strong>Methods: </strong>Ten individuals with chronic stroke (8 males; age 61.7 ± 7.3 years; time since stroke 11.5 ± 7.5 years; Fugl-Meyer Lower Extremity score 20.5 ± 6.6) completed tele-IC. The primary outcomes were safety and feasibility. Safety was assessed through monitoring of IC-related adverse events and side effects across sessions; feasibility was evaluated through screening-to-enrollment, retention, intervention adherence, tolerability, and acceptability. Secondary exploratory outcomes included corticomotor excitability, transcallosal inhibition, lower-limb strength, paretic ankle motor control, and gait speed. Outcomes were assessed before and 24 hours after the intervention.</p><p><strong>Results: </strong>Across 70 tele-IC sessions, no serious adverse events occurred, and all 10 participants completed all seven sessions. Acceptability was high, including ratings for safety (4.9/5), remote assistance (4.8/5), and overall satisfaction (4.8/5). Exploratory analyses showed increased transcallosal inhibition (d_z = 0.929, p = 0.017), changes in bilateral lower-limb strength (d_z = 0.873-1.756), and shorter paretic ankle reaction time (d_z = 0.844, p = 0.049). Corticomotor excitability and gait speed did not significantly change.</p><p><strong>Conclusions: </strong>In this small, uncontrolled pilot study, synchronously supervised tele-IC was delivered with complete intervention adherence, no serious adverse events, and high participant acceptability. Exploratory secondary neurophysiological and motor findings require confirmation in larger controlled trials.</p>","PeriodicalId":520692,"journal":{"name":"Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association","volume":" ","pages":"108772"},"PeriodicalIF":1.8,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"White Matter Hyperintensities of Presumed Vascular Origin: Current Understanding of Development and Progression.","authors":"Ty Shang","doi":"10.1016/j.jstrokecerebrovasdis.2026.108771","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2026.108771","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and purpose: &lt;/strong&gt;White matter hyperintensities (WMH) of presumed vascular origin are among the most common MRI manifestations of cerebral small vessel disease and are a major contributor to vascular contributions to cognitive impairment and dementia. Although WMH have traditionally been attributed to chronic ischemia resulting from small vessel pathology, the biological mechanisms underlying their development and, more importantly, their progression remain incompletely understood. Recent advances in longitudinal neuroimaging, quantitative MRI, pathology, genetics, and physiological imaging have substantially expanded our understanding of WMH progression, making this an appropriate time to evaluate current concepts and synthesize emerging evidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Observations: &lt;/strong&gt;We review contemporary evidence regarding the biological processes implicated in WMH development and progression, including hypertension and vascular risk factors, acute ischemic injury, chronic hypoperfusion, blood-brain barrier (BBB) dysfunction, endothelial activation and vascular inflammation, arterial stiffness, intracranial artery dolichoectasia (IADE), altered cerebral fluid dynamics and genetic susceptibility. Longitudinal studies demonstrate that WMH exhibit dynamic trajectories characterized by progression, stability, and partial regression, indicating that lesion evolution is not uniformly irreversible. Pathological and advanced neuroimaging studies show that WMH represent heterogeneous tissue injury involving demyelination, axonal loss, gliosis, interstitial fluid accumulation, and microvascular abnormalities. Hypertension and blood pressure variability are consistently associated with greater WMH burden and progression, whereas baseline WMH burden is the strongest predictor of future lesion expansion. Acute ischemic lesions detected by diffusion-weighted imaging contribute to, but account for only a minority of WMH progression. Longitudinal studies evaluating cerebral perfusion, BBB permeability, inflammation, arterial stiffness, IADE and cerebral fluid dynamics have yielded variable findings but, together with genetic evidence, support roles of BBB leakage, vascular inflammation, chronic hypoperfusion, arterial and extracellular-matrix remodeling, and impaired interstitial fluid clearance in WMH progression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Emerging evidence supports a paradigm in which WMH are viewed as a dynamic manifestation of progressive neurovascular dysfunction rather than the consequence of chronic ischemia alone. Current data suggest that early neurovascular injury evolves into a potentially self-reinforcing process characterized by persistent BBB disruption, vascular inflammation, chronic hypoperfusion, altered fluid dynamics, and recurrent ischemic injury, collectively contributes to WMH progression. Future multimodal longitudinal studies integrating cerebral hemodynamics, neurovascular function and intracranial ","PeriodicalId":520692,"journal":{"name":"Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association","volume":" ","pages":"108771"},"PeriodicalIF":1.8,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterogeneity in Time-Outcome Associations After Endovascular Thrombectomy: A Binational Registry Study.","authors":"Chun-Jen Lin, Yong Soo Kim, Chung-Han Yang, Yi-Chen Hsieh, Jong-Moo Park, Chih-Hao Chen, Kyusik Kang, Pi- Shan Sung, Soo Joo Lee, Yu-Wei Chen, Jae-Kwan Cha, Kuan-Hung Lin, Tai Hwan Park, Chih-Wei Tang, Kyungbok Lee, Hai-Jui Chu, Jun Lee, Chuan-Hsiu Fu, Keun-Sik Hong, Chao-Liang Chou, Kyung-Ho Yu, Ching-Huang Lin, Dong-Eog Kim, Shang-Yih Yen, Joon-Tae Kim, Po-Lin Chen, Jay Chol Choi, Jee Hyun Kwon, Dong-Ick Shin, Sung-Il Sohn, Hung-Yi Chiou, Chulho Kim, Kwang-Yeol Park, Chi Kyung Kim, Li-Ming Lien, Sung Hyuk Heo, Jiunn-Tay Lee, Lung Chan, Sung-Chun Tang, Beom Joon Kim, Chih-Ping Chung, Jiann-Shing Jeng, Hee-Joon Bae","doi":"10.1016/j.jstrokecerebrovasdis.2026.108770","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2026.108770","url":null,"abstract":"<p><strong>Background: </strong>Although \"time is brain\" remains a core principle in acute stroke care, the association between treatment timing and functional outcomes after endovascular thrombectomy (EVT) varies across patients. Some individuals treated in extended time windows still achieve favorable outcomes, a phenomenon termed the \"late window paradox.\" Differences in stroke pathophysiology across etiologies may contribute to heterogeneity in the time-outcome relationship after EVT. We investigated factors associated with heterogeneity in time-dependent EVT responsiveness, with particular attention to stroke etiology.</p><p><strong>Methods: </strong>We analyzed data from two multicenter registries in Korea (CRCS-K) and Taiwan (TREAT-AIS) from January 2019 to April 2023. Patients with anterior circulation acute ischemic stroke due to cardioembolism (CE) or large artery atherosclerosis (LAA) were included. Multivariable regression and interaction analyses were performed to evaluate the association between onset-to-puncture (OTP) time and 90-day functional outcomes and to identify effect modifiers.</p><p><strong>Results: </strong>Among 4,719 patients (mean age 72.0 years; 42.9% women; median NIHSS 15), longer OTP time was associated with lower odds of 90-day functional independence (adjusted OR per hour, 0.97; 95% CI, 0.96-0.98; p=0.001). The impact of OTP time varied by stroke characteristics. CE etiology, MCA occlusion, higher NIHSS, and male sex were associated with greater time sensitivity. In CE strokes, each hour of delay reduced the odds of functional independence by 4% (aOR, 0.96; 95% CI, 0.94-0.97; p<0.001), whereas no significant association was observed in LAA strokes (P_{_interaction}=0.028).</p><p><strong>Conclusion: </strong>The association between EVT timing and functional outcome varies according to stroke etiology and clinical characteristics, highlighting heterogeneity in time-outcome relationships among EVT-treated patients and providing observational insight into outcome variability in extended treatment windows.</p>","PeriodicalId":520692,"journal":{"name":"Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association","volume":" ","pages":"108770"},"PeriodicalIF":1.8,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Outcomes After Endovascular Treatment of Basilar Artery Occlusion: Points for Consideration.","authors":"Kaan Kırımlı","doi":"10.1016/j.jstrokecerebrovasdis.2026.108769","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2026.108769","url":null,"abstract":"","PeriodicalId":520692,"journal":{"name":"Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association","volume":" ","pages":"108769"},"PeriodicalIF":1.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Premature ischemic stroke mortality in China to 2030: age- and sex-specific trends and projections.","authors":"Gaoquan Luo, Yuan Zhang, Liu Liu, Ruibin Fu","doi":"10.1016/j.jstrokecerebrovasdis.2026.108767","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108767","url":null,"abstract":"<p><strong>Background: </strong>Age-specific evidence is needed to describe premature ischemic stroke mortality in China and to support transparent surveillance through 2030.</p><p><strong>Methods: </strong>We analyzed GBD 2023 estimates for China from 1990 to 2023 in eight five-year age groups from 30 to 34 to 65-69 years. Age-specific mortality rates were the primary outcomes. Temporal trends were estimated with log-linear segmented regression. Candidate ARIMA models were compared using rolling-origin validation, information criteria, and residual diagnostics. A 30-69-year study-specific normalized weighted mortality rate was retained only as a secondary sensitivity analysis.</p><p><strong>Results: </strong>Mortality rates declined across all eight age groups for males, females, and both sexes. In 2023, both-sex rates ranged from 0.44 per 100,000 in ages 30-34 years to 100.03 per 100,000 in ages 65-69 years. Age-specific 2030 forecasts ranged from 0.10 to 35.09 per 100,000 for females and from 0.46 to 107.67 per 100,000 for males. Under the secondary project-existing weighting scheme, the 2030 composite forecasts were 17.46 (95% prediction interval 7.92-27.00) per 100,000 for males, 5.47 (2.34-8.60) for females, and 11.80 (6.64-16.96) for both sexes. These composite estimates are not official GBD age-standardized rates.</p><p><strong>Conclusions: </strong>The primary evidence shows substantial age heterogeneity and consistently higher male rates. Conditional forecasts support continued age- and sex-specific surveillance, but they do not establish causal mechanisms, intervention effects, or policy-target attainment.</p>","PeriodicalId":520692,"journal":{"name":"Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association","volume":" ","pages":"108767"},"PeriodicalIF":1.8,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphological, Clinical, and Procedural Determinants of Embolization Outcomes in Non-Cavernous Cerebral Dural Arteriovenous Fistulas: A Retrospective Study.","authors":"Luc Defreyne, Lynn Huyck, Peter Vanlangenhove, Wouter De Coninck, Edward Baert, Dimitri Hemelsoet, Elisabeth Dhondt","doi":"10.1016/j.jstrokecerebrovasdis.2026.108763","DOIUrl":"https://doi.org/10.1016/j.jstrokecerebrovasdis.2026.108763","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this retrospective study was to determine whether dAVF (dural arteriovenous fistula) characteristics influences treatment indication, embolization techniques, complications, radiation burden, and outcome.</p><p><strong>Methods and materials: </strong>Patients treated by embolization for a brain dAVF were included. Excluded were cavernous sinus and surgically treated dAVF. Patients' demographics, clinical and treatment data were retrieved. dAVF clusters were formed: haemorrhagic versus non-haemorrhagic onset and sinus versus non-sinus type and impact on treatment indication, complications, radiation burden, functional and angiographic outcome was analyzed.</p><p><strong>Results: </strong>In a study involving 119 dAVF in 115 patients, 33 patients (mean age 62 years ± 1.8, 72.7% males) presented with a haemorrhagic onset, while 82 (mean age 58 years ± 1.6, 57.3% females) exhibiting 86 dAVF had no bleeding. The sigmoid sinus was over-represented in the latter (52.3%), whereas a cerebrocortical occipital vein was frequently involved in the former group (27,3%). All but one haemorrhagic dAVF demonstrated a Borden-III classification. At six months, the prevalence of mRS class \"0\" was significantly higher in the non-haemorrhagic dAVF group (70.7% versus 32.3%) compared to the sinus-type clusters, where no such difference was observed. Six months angiography revealed occlusion in 88.2% of 102 catheterized fistulae, similar for all groups. Onyx volume and injection time was significantly higher in non-haemorrhagic and sinus-type dAVF. In non-haemorrhagic dAVF, fluoroscopy time (66.16 versus 40.48 minutes) and the number of acquisitions (68 versus 50) was significantly higher, but not radiation exposure. Although rare, mortality occurred only in sinus-type non-haemorrhagic dAVF. Facial nerve palsy was the major adverse event in non-haemorrhagic dAVF.</p><p><strong>Conclusion: </strong>Employing comparable techniques, occluding non-haemorrhagic onset dAVF takes longer and requires a larger embolic volume, yet it presents a higher likelihood of achieving an excellent functional outcome. Occlusion rates are high in all dAVF clusters. Managing non-haemorrhagic, sinus-type dAVFs requires careful attention.</p>","PeriodicalId":520692,"journal":{"name":"Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association","volume":" ","pages":"108763"},"PeriodicalIF":1.8,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of brain-computer interface-based training on post-stroke lower limb rehabilitation: A systematic review and meta-analysis of randomized controlled trials.","authors":"Xingyu Liu, Peng Huang, Linjie Wu, Lifei Cai","doi":"10.1016/j.jstrokecerebrovasdis.2026.108711","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2026.108711","url":null,"abstract":"<p><strong>Background: </strong>Lower-limb motor dysfunction after stroke severely compromises mobility and quality of life. Brain-computer interface (BCI) technology, which employs a \"central-peripheral-central\" closed-loop to promote neuroplasticity, offers a promising rehabilitation approach. However, its optimal dosing parameters remain unclear.</p><p><strong>Objective: </strong>This study aimed to evaluate the efficacy of BCI-based training on lower-limb motor function, balance, walking capacity, and activities of daily living (ADL) after stroke, and to explore the impact of total training dose, session duration, and stroke phase.</p><p><strong>Methods: </strong>We systematically searched major databases for randomized controlled trials (RCTs) published up to April 2026. All included studies were RCTs. Methodological quality was assessed using the PEDro scale. A meta-analysis was conducted using RevMan 5.4 to calculate mean differences (MD) and 95% confidence intervals (CI).</p><p><strong>Results: </strong>Ten RCTs involving 366 participants were included. BCI training significantly improved lower-limb motor function (Fugl-Meyer Assessment for Lower Extremity: MD = 2.38, 95% CI 1.72 to 3.04, P < 0.00001). Although this mean difference is below the anchor-based Minimal Clinically Important Difference (MCID) of 6 points reported for chronic stroke populations, it represents a statistically robust and consistent improvement across RCTs, suggesting potential clinical relevance, particularly in subacute patients or specific intervention subgroups.</p><p><strong>Conclusions: </strong>BCI-based training effectively improves lower-limb motor recovery after stroke. Subgroup analyses suggested that a moderate total dose (401-800 minutes) combined with 20-40-minute sessions may represent a potentially optimal regimen, although these findings are based on limited RCTs and require confirmation in larger studies.</p>","PeriodicalId":520692,"journal":{"name":"Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association","volume":" ","pages":"108711"},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148687547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of endothelial dysfunction in the age-related poor prognosis of stroke patients undergoing endovascular treatment.","authors":"Patricia de la Riva, Jon Rodríguez-Antigüedad, Juan Marta-Enguita, Virginia Gómez, Gorka Arenaza, Ana Gorostidi, Noemi Díez, Ana de Arce, Eñaut Garmendia, Eider Zumeta, Jose Angel Larrea, Alberto Bergareche, Adolfo López de Munain Arregui","doi":"10.1016/j.jstrokecerebrovasdis.2025.108412","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108412","url":null,"abstract":"<p><strong>Background: </strong>Age is a well-established predictor of poor prognosis in patients with ischemic stroke (IS) undergoing endovascular treatment (EVT). The endothelium plays a central role in the pathophysiology of IS, and its function can be evaluated using various methods. This study aims to investigate the relationship between endothelial dysfunction, age, and clinical outcomes in IS patients treated with EVT METHODS: Patients with IS treated with EVT were included in the study. Ninety-day prognosis was evaluated using the modified Rankin Scale (mRS). Endothelial function was assessed through flow-mediated dilation (FMD) measured by brachial artery ultrasound, and by quantifying pre-EVT arterial serum levels of arginine metabolites, homoarginine (hArg), symmetric dimethylarginine (SDMA), and asymmetric dimethylarginine (ADMA), using ultra-performance liquid chromatography coupled with tandem mass spectrometry. Clinical, radiological, and EVT procedural data were recorded as independent variables. The outcome variable is good functional outcome by dichotomized mRS<2. Bivariate, multivariate, and mediation analyses were conducted to explore associations.</p><p><strong>Results: </strong>A total of 150 stroke patients were included in the analysis (median age was 77 years and 50.7 % were female). Older patients exhibited poorer endothelial function, reflected by lower FMD values and altered arginine metabolite profiles. They also showed worse clinical outcomes at 90 days. Among the metabolites, SDMA emerged as an independent predictor of poor prognosis (OR = 1.343 per 0.1 umol/l increase, p < 0.01). Moreover, SDMA was identified as a mediator in the relationship between age and unfavorable outcomes following EVT CONCLUSION: Endothelial dysfunction, as indicated by circulating biomarkers such as SDMA, may partially mediate the association between age and poorer outcomes in stroke patients treated with EVT.</p>","PeriodicalId":520692,"journal":{"name":"Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association","volume":" ","pages":"108412"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of repetitive transcranial magnetic stimulation on cognitive impairment in stroke patients: A meta-analysis of randomized controlled trials.","authors":"Zhi-Qiang Zhao, Huai-Nan Li, Yun Ye, Jun-Lin Wang, Peng Xu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108415","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108415","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of repetitive transcranial magnetic stimulation (rTMS) on cognitive impairment in stroke patients using meta-analysis.</p><p><strong>Methods: </strong>Electronic databases (PubMed, Web of Science, Cochrane Library, and Embase) were systematically searched up to October 20, 2024. Randomized controlled trials assessing the effect of rTMS on cognitive impairment in stroke patients were included. Pooled effect sizes were calculated using standardized mean differences (SMD) or mean differences (MD) based on fixed or random effects models.</p><p><strong>Results: </strong>Fourteen studies involving 597 stroke patients were included in this meta-analysis. The results showed that rTMS significantly improved global cognitive function in stroke patients (SMD: 0.54; 95 % CI: 0.28, 0.79), particularly with high-intensity rTMS (SMD: 0.41; 95 % CI: 0.07, 0.76) and intermittent theta-burst stimulation (iTBS) (SMD: 0.94; 95 % CI: 0.62, 1.27). In terms of different rating scales, rTMS significantly increased scores on the Modified Barthel Index (MBI) (MD: 10.54; 95 % CI: 4.85, 16.23) and the Montreal Cognitive Assessment (MoCA) (MD: 1.96; 95 % CI: 0.91, 3.01), while the effects on the Mini-Mental State Examination (MMSE), Rivermead Behavioral Memory Test (RBMT), and Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) were not statistically significant.</p><p><strong>Conclusion: </strong>This meta-analysis confirms that rTMS can effectively improve cognitive function in stroke patients. However, due to the limited number of studies included, further high-quality research is needed to substantiate our findings.</p>","PeriodicalId":520692,"journal":{"name":"Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association","volume":" ","pages":"108415"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global, regional, and national burden and trends of of stroke in adolescents and young adults from 1992 to 2021.","authors":"Yang Li, Yushi Wang, Shuning Wang, Hui Zhu","doi":"10.1016/j.jstrokecerebrovasdis.2025.108414","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2025.108414","url":null,"abstract":"<p><strong>Background and purpose: </strong>This study aims to examine the global, regional, and national burden of stroke in young adults from 1992 to 2021.</p><p><strong>Method: </strong>We conducted a comprehensive assessment of stroke metrics among individuals aged 15-49 using data from the 2021 Global Burden of Disease (GBD) database, covering 204 countries at global, regional, and national levels. The metrics evaluated included age-standardized incidence rates (ASIR), death rates (ASDR), disability-adjusted life years (DALYs), average annual percentage changes (AAPCs), and joinpoint regression analysis.</p><p><strong>Results: </strong>Between 1992 and 2021, the ASIR, ASDR, and DALYs for ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) among young adults globally decreased. The incidence, mortality, and DALYs for all three stroke types declined in both young females and males. In countries with low-middle and middle Socio-demographic Index (SDI), the ASIR for IS showed an upward trend, while the ASIR for ICH and SAH decreased across different SDI countries. Nationally, the incidence, death, and DALYs for all three types of stroke decreased in the vast majority of countries, with only a few countries showing an increased trend.</p><p><strong>Conclusion: </strong>From 1992 to 2021, the overall trend in stroke burden among young adults was downward. However, in certain countries and regions, incidence, death, and DALYs related to stroke still rose. It is crucial for nations around the globe to adopt comprehensive, easily accessible, and cost-effective strategies aimed at improving stroke monitoring, prevention, emergency treatment, and rehabilitative care, ultimately alleviating the impact of stroke.</p>","PeriodicalId":520692,"journal":{"name":"Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association","volume":" ","pages":"108414"},"PeriodicalIF":1.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}