Neuroepidemiology最新文献

{"title":"Weight change and ischemic stroke risk among participants in the Atherosclerosis Risk in Communities (ARIC) Study.","authors":"Logan Cowan, Joana Tome, Cyrille Kouambo Beckodro, Pamela Lutsey, Kamakshi Lakshminarayan, Michel Johansen, Jakita Baldwin","doi":"10.1159/000547807","DOIUrl":"https://doi.org/10.1159/000547807","url":null,"abstract":"<p><p>Introduction Conflicting findings exist between weight change and ischemic stroke risk. Studying the association between body weight change and ischemic stroke risk helps clarify the true nature of the association and supports future health promotion and stroke prevention strategies. Methods We longitudinally assessed data from 10,985 ARIC visit 4 participants (1996-1998). After excluding individuals with missing data on previous stroke or coronary heart disease at baseline (visit 4), we classified 9-year weight change (visit 4 minus visit 1 weight) into quintiles of weight change and weight loss (> -2.7 kg), no change (-2.7 to +2.7 kg), and weight gain (> +2.7 kg) categories. We used crude and adjusted Cox regression models to assess ischemic stroke hazard. We also performed an analysis stratified by BMI status to see if the weight change-stroke risk relationship differed by baseline BMI. Results Among 9,574 participants, 676 developed ischemic stroke during the 20-year follow-up. Most participants at baseline were female (58.25%) and drinkers (50.52%), with mean age of 62 and mean BMI of 28.78 kg/m2. Compared to participants with no change, those who gained weight had 23% lower hazards of ischemic stroke (hazard ratio (HR) = 0.77 (95% confidence interval (CI) = 0.60, 0.99)), while those who lost weight had 30% higher hazards (HR=1.30 (95% CI =1.05,1.62)). Conclusion Weight change showed minimal association with stroke risk overall, with moderate weight gain potentially lowering the risk, while weight loss increased it. These results emphasize the intricate relationship between weight dynamics and cerebrovascular health and the potential complex implications of the degree and direction of weight change for stroke prevention.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-21"},"PeriodicalIF":4.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Herpes Simplex Virus Infection and Risk of Alzheimer&apos;s Disease: A Systematic Review and Meta-Analysis.","authors":"Qianqian Ji, Weishan Lian, Weifeng Liu, Lu Tang, Zhao Hu, Liuqing Li, Yunzhang Wang, Enxiang Tao, Yiqiang Zhan","doi":"10.1159/000548365","DOIUrl":"https://doi.org/10.1159/000548365","url":null,"abstract":"<p><strong>Introduction: </strong>The relationship between Herpes Simplex Virus (HSV) infection and the risk of Alzheimer's Disease (AD) remains unclear.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted to investigate this potential association. Observational studies were sourced from PubMed, Embase, Web of Science, and the Cochrane Library up to July 31, 2024. The analysis utilized the generic inverse variance method with a random effects model. Effect sizes were calculated as odds ratios (OR) or hazard ratios (HR) with corresponding 95% confidence intervals (CI).</p><p><strong>Results: </strong>A total of 26 original studies, encompassing 1,213,193 participants, were included in the meta-analysis. The findings indicated a 32% higher likelihood of AD in individuals with HSV infection in case-control studies (OR = 1.32; 95% CI: 1.12, 1.55; I2 = 22.7%) and a 20% increased risk in cohort studies (HR = 1.20; 95% CI: 1.10, 1.31; I2 = 11.0%). Specifically, HSV-1 infection was associated with 46% higher odds of AD (OR = 1.46; 95% CI: 1.14, 1.86; I2 = 3.1%).</p><p><strong>Conclusion: </strong>This meta-analysis demonstrates an association between HSV infection and increased risk of AD, particularly for HSV-1. Given the high global prevalence of HSV-1 and the heterogeneity of existing evidence, these findings should be regarded as hypothesis-generating, underscoring the need for rigorous, biomarker-informed studies to clarify causality and identify susceptible subgroups.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-25"},"PeriodicalIF":4.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol-Related and Non-Alcohol-Related Wernicke Encephalopathy: A Systematic Review and Meta-Analysis of Epidemiology and Clinical Features.","authors":"David Puertas-Miranda, Erik Gabriel Díaz-Avila, Claudia Llamas-Alonso, Ignacio Novo-Veleiro, Antonio-J Chamorro, Miguel Marcos","doi":"10.1159/000547806","DOIUrl":"https://doi.org/10.1159/000547806","url":null,"abstract":"<p><p>Introduction To characterize the epidemiology, risk factors, and clinical presentation of Wernicke encephalopathy (WE), and analyze differences between cases with and without excessive alcohol consumption. Methods A systematic search was conducted in PubMed, Scopus, and Web of Science up to April 1st, 2025. The included studies provided data on prevalence, risk factors, clinical and radiological findings, mortality, and prognosis in patients with WE. Pooled proportions and weighted means were calculated using random-effect models with Freeman-Tukey transformation. Heterogeneity was assessed using the I² statistic. Subgroup comparisons were performed based on the presence or absence of excessive alcohol consumption. Results A total of 12 studies comprising 5,510 patients were analyzed. Overall, 65.4% (95% CI: 56.0-74.2) were male, with a weighted mean age of 60.7 years. Among cases related to excessive alcohol consumption, 78.7% were male (mean age 55.2); in cases not related to such consumption, 52.6% were male (mean age 63.5). The classic triad was present in 32.7% of cases (95% CI: 19.2-47.7). Among patients evaluated by magnetic resonance imaging, typical lesions were identified in 82.0%, and atypical lesions in 44.8%. Overall mortality was 5.1% (95% CI: 2.3-8.8%) and higher in non-alcohol-related cases (8.8%). Alcohol consumption was the main risk factor (90.7%); among non-alcohol-related cases, the most frequent clinical settings were malnutrition (30.2%), infections (25.1%), and psychiatric disorders (15.4%). Conclusions WE is a multifactorial syndrome that extends beyond alcohol misuse, with wide clinical and pathophysiological variability. These findings underscore the importance of early recognition and prompt thiamine replacement, particularly in non-alcohol-related cases.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-23"},"PeriodicalIF":4.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pace of Memory Decline in Older Adults without a Neurocognitive Disorder: Results from 22 Years of Follow-Up in a Nationally Representative Sample.","authors":"Zachary J Kunicki, Emma Nichols, Alyssa N De Vito, Cyrus M Kosar, Adea Rich, Emily M Briceño, Douglas Tommet, Alden L Gross, Richard N Jones","doi":"10.1159/000548005","DOIUrl":"10.1159/000548005","url":null,"abstract":"<p><strong>Introduction: </strong>The pace of cognitive change is one of the major questions in cognitive aging. The Children of the Depression Age (CODA) cohort of the Health and Retirement Study (HRS) is uniquely suited to study cognitive aging because it has a long follow-up (22 years) and a narrow age range at baseline (67-74 years) and presents a unique opportunity to study this topic.</p><p><strong>Methods: </strong>We examined delayed recall data over the 22 years of follow-up in a nationally representative sample of the USA (HRS-CODA; N = 2,295 at baseline and N = 263 at the final follow-up wave), examining results for the entire sample and omitting participants with self-reported dementia. Data were analyzed using latent growth curve models, adjusting for baseline age, sex, years of education, and race/ethnicity.</p><p><strong>Results: </strong>Respondents were predominantly female (62%), white (86%), and 71 years old on average at baseline. Our results suggest the pace of normative (defined as the absence of a dementia diagnosis over the follow-up period) memory decline is about -0.05 standard deviations per year (SD/y) but is better characterized by age-specific estimates of -0.04 SD/y, -0.10 SD/y, and -0.15 SD/y for an individual who was 75, 85, and 95, respectively.</p><p><strong>Discussion: </strong>Memory decline, in the absence of a recognized dementia and without a confounding of baseline age differences and longitudinal age changes, would be present but almost imperceptible to an individual in their eighth decade, but noticeable in their ninth and quite impairing in their tenth decade. Future research is needed to examine other cognitive domains and with more robust measures.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-8"},"PeriodicalIF":4.0,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12440226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ambient Temperature and Risk of Ischaemic Stroke: Some Comments.","authors":"Juanli Zhong, Lvyun Liu, Xinghuo Zhang","doi":"10.1159/000548273","DOIUrl":"10.1159/000548273","url":null,"abstract":"","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-2"},"PeriodicalIF":4.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Quality of Life in Myasthenia Gravis Patients from Southwestern China: Validation of Clinical and Socioenvironmental Determinants.","authors":"Sisi Jing, Zhihan Zhang, Yuchuan Zhou, Wei Zheng, Rui Fan, Wenjun Que, Linqi Liu, Dan Lu, Shiyi Liu, Yaoqi Gan, Fei Xiao","doi":"10.1159/000548274","DOIUrl":"10.1159/000548274","url":null,"abstract":"<p><strong>Introduction: </strong>Myasthenia gravis (MG) presents a substantial clinical burden, characterized by increased incidence of myasthenic crises, heterogeneity in treatment response, significant functional impairment, and gradually increasing mortality rates with marked geographical heterogeneity across China. While improving quality of life (QOL) is the focus of MG management, multifactorial determinants of QOL impairment remain unclear, especially in socioeconomically underrepresented regions, particularly Southwestern China. This study aimed to explore myasthenia-specific risk factors for QOL and develop a parsimonious prediction model.</p><p><strong>Methods: </strong>This study performed univariate and multivariate regression analyses on 310 MG patients diagnosed at the First Affiliated Hospital of Chongqing Medical University between January 2022 and February 2025 from Southwestern China. The QOL of patients was evaluated with the 15-item Myasthenia Gravis Quality of Life (MG-QOL15). Disease severity was evaluated with current Myasthenia Gravis Foundation of America (MGFA) classification, MG-related activity of daily living (MG-ADL) score and quantitative myasthenia gravis (QMG) score. Relevant clinical and demographic data were included in the analysis.</p><p><strong>Results: </strong>In the analysis of basic characteristics, higher ADL (p < 0.001), worse MGFA classification (p < 0.001), lower education level (p = 0.006), thymic abnormalities (p = 0.004), and treatment (p = 0.003) were significantly correlated with poor QOL. However, factors such as age of onset, gender, and antibody status showed no significant impact. The multivariate models (Model 1-6) further confirmed that MG-ADL (OR = 8.397), QMG score (OR = 4.357), MGFA classification, and thymus histology (thymic hyperplasia OR = 4.505, thymoma OR = 2.472) were independent risk factors for QOL. Corticosteroids combined with immunotherapy were found to significantly improve QOL compared to monotherapy. Model validation indicated that Model 5, which incorporates MG-ADL, MGFA classification, thymus histology, and education level, had the optimal overall performance (area under the curve = 0.835, specificity 0.917), balancing predictive accuracy and clinical applicability.</p><p><strong>Conclusion: </strong>By identifying key predictors, including clinical severity, thymic abnormalities, and education level, this study developed a multidimensional prediction model for QOL in MG patients.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-11"},"PeriodicalIF":4.0,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and Impact of Early Medical Complications in Acute Ischemic Stroke: Data from the Austrian Stroke Unit Registry.","authors":"Julian Frederic Hotz, Lavinia Ritscher, Lisa Kaindl, Stefan Krebs, Lisa Schneider, Dominika Mikšová, Maximilian Bichler, Melanie Baumgartinger, Alexandra Bernegger, Moritz Staudacher, Wilfried Lang, Julia Ferrari, Marek Sykora","doi":"10.1159/000548193","DOIUrl":"https://doi.org/10.1159/000548193","url":null,"abstract":"<p><p>Introduction Early medical complications following acute ischemic stroke (AIS) are common and might increase post-stroke morbidity and mortality. This study aimed to evaluate trends in the prevalence of early medical complications over almost two decades and their impact on three-month functional outcome and mortality. Methods A total of 181,704 AIS patients from the Austrian Stroke Unit Registry (2006-2024) were analyzed. Early medical complications included decompensated heart failure, cardiac arrythmia, sepsis, pneumonia, urinary tract infection (UTI), deep vein thrombosis, and pulmonary embolism. Functional outcomes were assessed using the modified Rankin Scale (mRS) after three-months, with favorable outcome defined as mRS ≤1. Associations between early medical complications and mRS were analyzed using multivariable Poisson regression models. Results Among all patients, 16,279 (9.0%) had early medical complications. Pneumonia (4.2%), UTI (2.9%), cardiac arrhythmia (1.4%), and decompensated heart failure (1.4%) were most common, with significant declines in prevalences over time. Admission NIHSS scores decreased, and the use of intravenous thrombolysis and mechanical thrombectomy increased. Decompensated heart failure (RR = 1.85, 95% CI 1.73-1.97, p <0.001), sepsis (RR = 1.75, 95% CI 1.53-1.99, p <0.001), pulmonary embolism (RR = 1.67, 95% CI 1.33-2.10, p <0.001), and pneumonia (RR = 1.64, 95% CI 1.57-1.72, p <0.001) were significantly associated with three-month mortality. Furthermore, the complications least associated with a favorable outcome were pneumonia (RR = 0.36, 95% CI 0.32-0.41, p <0.001), decompensated heart failure (RR = 0.38, 95% CI 0.32-0.46, p <0.001), and sepsis (RR = 0.59, 95% CI 0.45-0.77, p <0.001). The effect sizes didn't change significantly through the observed years. Conclusions This study observed a significant reduction in the prevalence of early medical complications after acute ischemic stroke. Especially decompensated heart failure, pneumonia, sepsis, and pulmonary embolism continue to substantially affect mortality and functional outcome in AIS patients.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-16"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and Clinical Characteristics of Nummular Headache in Observational Studies: A Systematic Review and Meta-Analysis.","authors":"Maksymilian Osiowski, Dominik Taterra, Aleksander Osiowski","doi":"10.1159/000547805","DOIUrl":"10.1159/000547805","url":null,"abstract":"<p><strong>Introduction: </strong>Nummular headache (NH) is a rare primary headache disorder which was first described in 2002. This meta-analysis aimed to evaluate the prevalence and relative frequencies of clinical features of NH.</p><p><strong>Methods: </strong>PubMed, Embase, Medline, and ScienceDirect were thoroughly searched for observational studies reporting the relevant data regarding NH diagnosed in accordance with ICHD-2, ICHD-3β, ICHD-3, or Pareja's original study. Random-effects meta-analysis was performed in order to calculate the pooled prevalence estimates (PPEs) and the I2 statistics was used to measure the between-study heterogeneity. The PRISMA guidelines were strictly followed by the study's structure. The Joanna Briggs Institute Checklist for Studies Reporting Prevalence Data was used to evaluate the risk of bias of included studies.</p><p><strong>Results: </strong>Out of initial 2,441 records, 17 studies met all of the inclusion criteria. The pooled mean age of onset of NH was 46.91 (95% confidence interval [95% CI]: 43.85-49.96). The PPE of NH in adult patients evaluated for a headache in a clinic-based setting was 0.7% (95% CI: 0.2-2.4), with slight female predominance (females = 0.5%, 95% CI: 0.2-1.4 vs. males = 0.3%, 95% CI: 0.1-0.8). The majority of patients (69.4%, 95% CI: 58.1-78.8) experience chronic course of NH. The shape of the headache was round/circular in 78.4% (95% CI: 71.9-83.7) and oval/elliptical in 21.6% (95% CI: 16.3-28.1) of patients. In 7.5% (95% CI: 2.7-19.0) of individuals, pain had multifocal location and 59.1% (95% CI: 49.7-68.0) of NH patients experienced pain exacerbations. The pain was most prevalent in the strictly parietal region (43.0%, 95% CI: 37.4-48.7) of the cranium and had pressing quality (51.4%, 95% CI: 41.6-61.1). Migraine has been diagnosed in 29.3% (95% CI: 18.5-42.9) of patients prior to NH diagnosis, and 42.4% (95% CI: 33.5-51.8) of patients experience a complete remission, with or without medication, of headache.</p><p><strong>Conclusion: </strong>The results of our study showed that NH is a very distinct and relatively rare to encounter headache disorder. Due to its unique clinical phenotype, physicians need to be aware when a patient presents with a small, well-localized round/oval headache in the cranium region.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-9"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Polypill and RiskOMeter to Prevent StrOke and CogniTive ImpairmEnt in Primary Health Care (PROMOTE) Randomized Clinical Trial: Rationale and Design.","authors":"Sheila Ouriques Martins, Michael Brainin, Craig S Anderson, Philip M Bath, Graeme J Hankey, Luciano A Sposato, Arthur Pille, Octávio Marques Pontes-Neto, Gisele Sampaio Silva, Luiz Antonio Nasi, Diogo O Souza, Valery L Feigin, Renato D Lopes, Otávio Berwanger, Aline Palmeira Pires, Thaís Leite Secchi, Brunna Jaeger Teló, Franciele P Santos, Jaqueline Radin, Juliana Ellwanger, Magda Ouriques Martins, Danielle A Pereira, Francine W Quadros, Larissa Vitoria Silva, Marcelo Rodrigues Gonçalves, Gabriel Paulo Mantovani, Manoela Ceretta, João Eduardo Bastianello, Guilherme B Andrade, Caroline Schirmer, Aline R Zimmer, Eduardo R Zimmer, Márcio Rodrigues, Maicon Falavigna","doi":"10.1159/000547359","DOIUrl":"10.1159/000547359","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke and dementia have common modifiable risk factors. Current prevention strategies primarily focus on high-risk populations, leaving a gap in addressing the broader population. We report the protocol for a randomized controlled trial (RCT) that aims to evaluate the feasibility, tolerability, and effectiveness of a polypill (valsartan 80mg, amlodipine 5mg, and rosuvastatin 10mg), with and without use of the Stroke Riskometer app, on systolic blood pressure (SBP) and other cardiovascular disease (CVD) risk factors at 9 months after randomization in a population of low to borderline CVD risk.</p><p><strong>Methods: </strong>Prospective, pragmatic, multicentre, factorial, phase III, placebo-controlled, cluster RCT in low to moderate CVD risk (10-year risk <20%) individuals aged 50-75 years with no prior history of hypertension, diabetes mellitus, stroke, or other CVD, with a SBP of 121-139 mmHg and at least one lifestyle-related CVD risk factor. Primary Care Units in Porto Alegre, Brazil, were centrally randomized to either use of the Stroke Riskometer app or standard care for lifestyle modification. All eligible individuals underwent a 28-day open run-in phase using the active medication. Participants who tolerated and had high adherence were randomized to either polypill or placebo, using a minimization process according to age, sex, SBP, cholesterol, and education level. The dual primary outcomes were change in SBP and Life Simple 7 (LS7) score at 9 months post-randomization. A sample of 354 participants was estimated to provide 80% statistical power (two sided α=0.05, β =0.20) for 6 clusters with intra-cluster correlation of 0.01 to detect a clinically significant 2.5 mmHg (SD±8) difference in SBP change and 0.65 points (SD±1.61) difference in the LS7 score at 9 months post-randomization between the polypill/Stroke Riskometer group and placebo/usual care group, assuming 10% lost to follow-up. All analyses were conducted according to the intention-to-treat principle. Regression analysis models (ANCOVA) assessed the differences among the four groups concerning changes in SBP, cholesterol levels, cognitive function, and behavioral risk factors over time.</p><p><strong>Conclusion: </strong>The findings will provide critical information to allow the development of primary stroke and CVD prevention strategies in low to borderline CVD risk adults. The trial is registered at clinicaltrials.gov NCT05155137.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-16"},"PeriodicalIF":4.0,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General Practitioner Coordinated Multidisciplinary Care Improves Long-Term Survival following Stroke with Variation by Impairment.","authors":"Nadine E Andrew, David Ung, Monique F Kilkenny, Muideen T Olaiya, Lachlan L Dalli, Leonid Churilov, Taya Collyer, David A Snowdon, Joosup Kim, Velandai Srikanth, Dominique A Cadilhac, Vijaya Sundararajan, Amanda G Thrift, Mark R Nelson, Natasha A Lannin","doi":"10.1159/000547972","DOIUrl":"10.1159/000547972","url":null,"abstract":"<p><strong>Background: </strong>Australian Medicare funded policies to support General Practtitioners (GPs) to coordinate multidisciplinary care (MDC) with other healthcare providers have potential to benefit survivors of stroke/transient ischaemic attack (TIA). However, the effectiveness of these policies is unknown. We aimed to determine the population effect of such policies in improving long-term outcomes following stroke/TIA, by impairment grouping.</p><p><strong>Methods: </strong>Target trial emulation using observational data within a cohort of community-dwelling adults with stroke/TIA from the Australian Stroke Clinical Registry (January 2012-December 2016, 42 hospitals). Person-level Medicare, pharmacy, aged care, death, and hospital records were linked. The exposure was ≥1 Medicare GP-MDC claim 6-18 months post-stroke. Outcomes were survival and hospitalisations at 19-30 months. Impairment group (minimal, moderate, severe) was classified by latent class analysis of EQ-5D-3L questionnaire data obtained 90-180 days post-stroke. Analysis comprised multivariable, multilevel survival analysis with inverse probability treatment weights (42 covariates).</p><p><strong>Results: </strong>The cohort comprised 7,255 people with stroke (42% female, median age 71 years, 24% TIA, impairment: 39% minimal, 32% moderate, 29% severe, 29% had a MDC claim). More claims occurred with each increasing level of impairment group: minimal 22%; moderate 30%; severe 37%. Twelve-month mortality was reduced in those with ≥1 MDC claim (compared to those without) in the minimal (adjusted hazard ratio [aHR]: 0.50, 95% CI: 0.27, 0.91) and severe (aHR: 0.65, 95% CI: 0.46, 0.91) impairment groups, but not in the moderate group (aHR: 1.31, 95% CI: 0.86, 1.99). Compared to those without a claim, hospital presentations were greater in the minimal (aHR: 1.30, 95% CI: 1.06, 1.59) and moderate impairment groups (aHR: 1.40, 95% CI: 1.23, 1.60) but not the severe group (aHR: 1.05, 95% CI: 0.85, 1.30).</p><p><strong>Conclusions: </strong>Government policy incentives for GP-coordinated MDC were effective at the population level at improving long-term survival outcomes, in those with minimal and severe impairments.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"1-14"},"PeriodicalIF":4.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}