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Demyelinating neuropathy as the initial presentation of familial E200K Creutzfeldt–Jakob disease in two patients 脱髓鞘神经病变作为家族性E200K克雅氏病两例患者的初始表现
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-12 DOI: 10.1002/acn3.52296
Cécile Delorme, Antoine Pégat, Julian Theuriet, Jean-Philippe Brandel, Emmanuel Roze, Karine Viala, Julie Zyss, Stéphane Thobois, Anthony Fourier, Emilien Bernard, Juliette Svahn, Chloé Laurencin, Paul Jaulent, Christophe Vandendries, Isabelle Quadrio, Virginie Desestret, David Meyronet, Thierry Maisonobe, Stéphane Haïk, Danielle Seilhean

Objective

To describe peripheral neuropathy associated with familial Creutzfeldt-Jakob disease.

Methods

We report two unrelated patients with genetic Creutzfeldt–Jakob disease with demyelinating peripheral neuropathy as initial presentation, with a comprehensive clinical, electrophysiological and neuropathological description.

Results

Both patients exhibited gait disturbance and paresthesia. Electrodiagnostic studies revealed demyelinating abnormalities with motor conduction blocks suggestive of chronic inflammatory demyelinating polyradiculoneuropathy, with abnormal plexus MRI and elevated CSF protein levels. One of them had pes cavus and a late-onset Charcot–Marie-Tooth (CMT) disease was also initially hypothesized. Central nervous system involvement manifested 1–2 years after the onset of peripheral symptoms. Both patients had a heterozygous E200K mutation in the PRNP gene. Postmortem neuropathological examinations showed PrPSc deposits in the peripheral nervous system, particularly in Schwann cells. Interpretation: Peripheral neuropathy in E200K genetic forms of Creutzfeldt-Jakob disease can be inaugural and mimic chronic inflammatory demyelinating polyradiculoneuropathy.

目的:探讨与家族性克雅氏病相关的周围神经病变。方法:我们报告了两例不相关的遗传性克雅氏病合并脱髓鞘周围神经病变的首发表现,并进行了全面的临床、电生理和神经病理描述。结果:两例患者均表现出步态障碍和感觉异常。电诊断显示脱髓鞘异常,运动传导阻滞提示慢性炎性脱髓鞘性多根神经病变,神经丛MRI异常,脑脊液蛋白水平升高。其中一人患有足弓足,并最初假设为迟发性腓骨肌痛(CMT)病。外周症状出现后1-2年中枢神经系统受累。两例患者均存在PRNP基因的杂合E200K突变。死后神经病理学检查显示PrPSc沉积于周围神经系统,尤其是雪旺细胞。解释:E200K遗传型克雅氏病的周围神经病变可能是初始的,类似慢性炎症性脱髓鞘性多神经根神经病变。
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引用次数: 0
Interaction between riluzole treatment and dietary glycemic index in the disease progression of amyotrophic lateral sclerosis 利鲁唑治疗与饮食血糖指数在肌萎缩侧索硬化疾病进展中的相互作用。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-09 DOI: 10.1002/acn3.52294
Ikjae Lee, Hiroshi Mitsumoto, Seonjoo Lee, Edward Kasarskis, Michael Rosenbaum, Pam Factor-Litvak, Jeri W. Nieves

Objective

We examined whether riluzole treatment modifies the associations between the dietary glycemic index (GI) and load (GL) and disease progression in amyotrophic lateral sclerosis (ALS).

Methods

Sporadic ALS patients in the Multicenter Cohort Study of Oxidative Stress who completed a baseline food frequency questionnaire were included (n = 304). Interactions between baseline riluzole treatment and GI/GL on functional decline and tracheostomy-free survival were examined using linear regression and Cox proportional hazard models adjusted for covariates. Age, sex, disease duration, diagnostic certainty, body mass index, bulbar onset, revised ALS functional rating scale (ALSFRS-r) total score, and forced vital capacity, from baseline were included as covariates.

Results

Baseline higher GI and GL were associated with less decline of ALSFRS-r total score at 3-month follow-up in the riluzole treatment group (RTG) but not in the no-riluzole group (NRG). When quartile groups were used, GI second [β = −1.9, 95% CI (−4.1, −0.2), p = 0.07], third [β = −3.0, 95% CI (−5.1, −0.8), p < 0.01] and fourth [β = −2.2, 95% CI (−4.3, −0.01), p < 0.05] quartile groups were associated with less ALSFRS-r decline at 3-months compared to the first quartile group (GI < 47.2) among the RTG. Similarly, GL fourth quartile group (GL > 109.5) was associated with less ALSFRS-r decline at 3 months compared to the first quartile group [β = −2.6, 95% CI (−4.7, −0.5), p < 0.05] among the RTG. In NRG, no statistically significant differences in ALSFRS-r decline were found among GI/GL quartile groups.

Interpretation

High dietary GI and GL are associated with a slower functional decline only among ALS patients taking riluzole.

目的:研究利鲁唑治疗是否能改变肌萎缩性侧索硬化症(ALS)患者饮食血糖指数(GI)和负荷(GL)与疾病进展之间的关系。方法:纳入多中心队列氧化应激研究中完成基线食物频率问卷调查的散发性ALS患者(n = 304)。采用线性回归和Cox比例风险模型对协变量进行校正,检验利鲁唑基线治疗与GI/GL对功能下降和气管造口无生存的相互作用。从基线开始,年龄、性别、病程、诊断确定性、体重指数、球发病、修订的ALS功能评定量表(ALSFRS-r)总分和用力肺活量被纳入协变量。结果:利鲁唑治疗组(RTG) 3个月随访时基线较高的GI和GL与ALSFRS-r总分下降较少相关,而非利鲁唑组(NRG)则不然。当使用四分位数组时,与第一个四分位数组相比,GI第二组[β = -1.9, 95% CI (-4.1, -0.2), p = 0.07], GI第三组[β = -3.0, 95% CI (-5.1, -0.8), p 109.5]与3个月时ALSFRS-r下降较少相关[β = -2.6, 95% CI (-4.7, -0.5), p]解释:高饮食GI和GL仅与服用利鲁唑的ALS患者较慢的功能下降有关。
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引用次数: 0
Tofersen treatment leads to sustained stabilization of disease in SOD1 ALS in a “real-world” setting 在“现实世界”环境中,托佛森治疗可使SOD1型ALS患者的病情持续稳定。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-09 DOI: 10.1002/acn3.52264
Sean E. Smith, Kelly McCoy-Gross, Amber Malcolm, Jeri Oranski, Jesse W. Markway, Timothy M. Miller, Robert C. Bucelli

Objective

Patients with amyotrophic lateral sclerosis (ALS) caused by superoxide dismutase 1 (SOD1) gene mutations (SOD1 ALS) treated with tofersen have shown slowing of disease progression, and disease stabilization with recovery of function in some patients. We report our clinical experience with treating patients with SOD1 ALS and the effects of tofersen on outcome measures.

Methods

This was a single-center observational study of patients with SOD1 ALS receiving treatment with tofersen. The effects of tofersen treatment on neurofilament levels, muscle strength, and clinical outcome measures were assessed. Several patients had outpatient neuromuscular rehabilitation in addition to tofersen treatment and we report changes in functional outcomes.

Results

Seven SOD1 ALS patients received treatment at our institution. All patients showed robust and sustained declines in serum NfL and CSF pNFH (mean change serum NfL: −57.9%; mean change CSF pNFH: −67.6%). There was apparent disease stabilization as assessed by the ALSFRS-R total score, mean change 1.1 (SD = 0.7). There was notable improvement in functional independence measured by the FIM motor score, mean change 5.13 points (SD = 3.85).

Interpretation

This study provides evidence that tofersen treatment in SOD1 ALS can lead to meaningful preservation of function and suggestions of sustained improvement in neurologic function in some patients, and strongly supports the role of neurofilaments as therapeutic biomarkers.

目的:豆腐素治疗由超氧化物歧化酶1 (SOD1)基因突变(SOD1 ALS)引起的肌萎缩性侧索硬化症(ALS)患者,可减缓疾病进展,部分患者病情稳定,功能恢复。我们报告了治疗SOD1 ALS患者的临床经验和托福素对结果测量的影响。方法:这是一项单中心观察性研究,研究对象是接受豆腐素治疗的SOD1 ALS患者。评估豆腐素治疗对神经丝水平、肌肉力量和临床结果的影响。一些患者除了接受托佛森治疗外,还接受了门诊神经肌肉康复治疗,我们报告了功能结果的变化。结果:7例SOD1 ALS患者在我院接受治疗。所有患者血清NfL和脑脊液pNFH均出现强劲且持续的下降(血清NfL平均变化:-57.9%;CSF pNFH平均变化:-67.6%)。通过ALSFRS-R总分评估,疾病明显稳定,平均变化1.1 (SD = 0.7)。FIM运动评分测量的功能独立性显著改善,平均变化5.13分(SD = 3.85)。解释:本研究提供的证据表明,豆腐素治疗SOD1 ALS可以导致有意义的功能保存,并提示一些患者神经功能持续改善,并强烈支持神经丝作为治疗性生物标志物的作用。
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引用次数: 0
Correction to “Infantile Krabbe disease (0–12 months), progression, and recommended endpoints for clinical trials” 修正为“婴儿克拉伯病(0-12个月)、进展和推荐的临床试验终点”。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-09 DOI: 10.1002/acn3.52275

Article AID: ACN352114

Table 1

On Page 4, age at first evaluation for HSCT asymptomatic group should have a maximum of 40.7 not 40.1.

For initial psychosine levels, please update natural history median to 22.3 and range to 0.99–82.3, symptomatic HSCT median to 28.1 and range to 4.09–54.0, and asymptomatic HSCT range to 1.03–29.1.

For initial GALC levels, please update symptomatic HSCT median to 0.01 and asymptomatic HSCT range to 0.02–0.23.

Table 2

On Page 5, please update heading to say, “Summary of the growth percentiles in Natural History, Symptomatic HSCT, and Asymptomatic HSCT patients, indicating percentages below the third percentile for head circumference and below the fifth percentile for height, weight, and body mass index.”

Sitting

On Page 8, please update the last sentence from “52%” to “53%,” and replace “Table S6” with “Table S7” in the last sentence.

Neurodevelopmental Function

On Pages 10–11, the last sentence in the first paragraph of Page 11 (“The Asympt HSCT group showed higher scores and greater gains over time than both the NH and Sympt HSCT groups for all domains (all p < 0.001) (Table S9).”) needs to be moved to Page 10 just after “(Figs. S2 and S3, Table S8).” and before “The group performed slightly better….”

Supporting Information

Table S4

Table S4 is incorrectly listed as Table S5.

Tables S7, S8, and S9

Table S7 is incorrectly listed as Table S9. Table S8 is incorrectly listed as Table S7. Table S9 is incorrectly listed as Table S8.

Additionally, the tables and figures under Supporting Information do not have numbers or legends when downloaded. To address all issues, we have prepared new, reformatted PDFs with correct figure numbers and legends to be included in Supporting Information. Please just replace those files with the new ones provided. Thank you!

We apologize for these errors.

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引用次数: 0
Psychiatric manifestations of encephalitis 脑炎的精神表现。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-07 DOI: 10.1002/acn3.52260
Paris Bean, Ashley Heck, Ralph Habis, Swathi Sowmitran, Zoe Cartaina, Rajesh Gupta, John Probasco, Rodrigo Hasbun, Arun Venkatesan

Objective

Encephalitis is a serious and potentially life-threatening condition of infectious or autoimmune cause. We aim to characterize the frequency and clinical spectrum of presenting psychiatric symptoms in encephalitis in order to inform earlier recognition and initiation of treatment.

Methods

This was a retrospective study of adult patients who met the 2013 International Encephalitis Consortium (IEC) and/or 2016 Graus criteria between February 2005 and February 2023. The study included two hospital systems in Houston, Texas, and Baltimore, Maryland and included a total of 642 patients. Psychiatric manifestations were grouped into five high-level categories: behavior, psychosis, mood, sleep disturbances, and catatonia.

Results

In our cohort of 642 patients, 318 (49.6%) had psychiatric symptoms at the time of initial presentation, including 78.2% with autoimmune etiologies and 35.2% with viral etiologies (P < 0.001). Those with psychiatric symptoms were younger (median age 47.5 vs. 51.5; P < 0.001), and more likely to have a history of documented psychiatric disorders, as well as longer lengths of hospital stay, and poorer discharge outcomes. Of patients initially admitted to a psychiatric service (n = 28), most had autoimmune causes, although 3 out of 28 (10.7%) had herpes viral infections; admission to a psychiatric service was associated with substantially longer interval to initiation of antivirals and immunotherapy. Autoimmune and infectious etiologies differed in the spectrum and frequency of psychiatric manifestations.

Interpretation

Psychiatric symptoms are common across etiologies of encephalitis and are associated with longer lengths of hospital stay and worse clinical outcomes. Specific patterns and dimensionality of psychiatric symptoms distinguish autoimmune from infectious causes.

目的:脑炎是一种严重且可能危及生命的感染性或自身免疫性疾病。我们的目的是表征脑炎中出现精神症状的频率和临床谱,以便告知早期识别和开始治疗。方法:对2005年2月至2023年2月期间符合2013年国际脑炎联合会(IEC)和/或2016年Graus标准的成年患者进行回顾性研究。该研究包括德克萨斯州休斯顿和马里兰州巴尔的摩的两个医院系统,共包括642名患者。精神病学表现分为五个高级类别:行为、精神病、情绪、睡眠障碍和紧张症。结果:在我们的642例患者队列中,318例(49.6%)在首次就诊时出现精神症状,其中78.2%为自身免疫性病因,35.2%为病毒病因(P解释:精神症状在脑炎病因中很常见,并与较长的住院时间和较差的临床结果相关。精神症状的特定模式和维度将自身免疫与感染性病因区分开来。
{"title":"Psychiatric manifestations of encephalitis","authors":"Paris Bean,&nbsp;Ashley Heck,&nbsp;Ralph Habis,&nbsp;Swathi Sowmitran,&nbsp;Zoe Cartaina,&nbsp;Rajesh Gupta,&nbsp;John Probasco,&nbsp;Rodrigo Hasbun,&nbsp;Arun Venkatesan","doi":"10.1002/acn3.52260","DOIUrl":"10.1002/acn3.52260","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Encephalitis is a serious and potentially life-threatening condition of infectious or autoimmune cause. We aim to characterize the frequency and clinical spectrum of presenting psychiatric symptoms in encephalitis in order to inform earlier recognition and initiation of treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective study of adult patients who met the 2013 International Encephalitis Consortium (IEC) and/or 2016 Graus criteria between February 2005 and February 2023. The study included two hospital systems in Houston, Texas, and Baltimore, Maryland and included a total of 642 patients. Psychiatric manifestations were grouped into five high-level categories: behavior, psychosis, mood, sleep disturbances, and catatonia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In our cohort of 642 patients, 318 (49.6%) had psychiatric symptoms at the time of initial presentation, including 78.2% with autoimmune etiologies and 35.2% with viral etiologies (<i>P</i> &lt; 0.001). Those with psychiatric symptoms were younger (median age 47.5 vs. 51.5; <i>P</i> &lt; 0.001), and more likely to have a history of documented psychiatric disorders, as well as longer lengths of hospital stay, and poorer discharge outcomes. Of patients initially admitted to a psychiatric service (<i>n</i> = 28), most had autoimmune causes, although 3 out of 28 (10.7%) had herpes viral infections; admission to a psychiatric service was associated with substantially longer interval to initiation of antivirals and immunotherapy. Autoimmune and infectious etiologies differed in the spectrum and frequency of psychiatric manifestations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>Psychiatric symptoms are common across etiologies of encephalitis and are associated with longer lengths of hospital stay and worse clinical outcomes. Specific patterns and dimensionality of psychiatric symptoms distinguish autoimmune from infectious causes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":"12 2","pages":"405-414"},"PeriodicalIF":4.4,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52260","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142941801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reactivation and consolidation of memory traces during post-encoding rest across the adult lifespan 编码后休息期间记忆痕迹的再激活和巩固。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-07 DOI: 10.1002/acn3.52290
Destaw B. Mekbib, Ian M. McDonough

Episodic memory is a critical cognitive function that enables the encoding, storage, and retrieval of new information. Memory consolidation, a key stage of episodic memory, stabilizes this newly encoded information into long-lasting brain “storage.” Studies using fMRI to investigate post-encoding awake rest holds promise to shed light on early, immediate consolidation mechanisms. Here, we review fMRI studies during episodic memory to document common methods to investigate post-encoding consolidation, such as multivoxel pattern analysis (MVPA) and functional connectivity, and the current state of the science in both healthy younger and older adults. In young adults, post-encoding reactivation of stimuli-specific neural patterns in the hippocampus and its connectivity with cortical and subcortical areas (e.g., visual-temporal cortex, medial prefrontal, and medial parietal cortex) correlate with subsequent memory performance. Conversely, studies in older adults highlight the importance of large-scale brain networks during post-encoding rest, particularly the default mode network (DMN). Alterations in connectivity between the DMN and task-positive networks may help older adults maintain episodic memory. Furthermore, non-invasive brain stimulation techniques can enhance these post-encoding consolidation processes and improve memory performance in both younger and older adults. Notably, a lack of studies has investigated post-encoding memory consolidation in neurodegenerative disorders. This review underscores the importance of understanding how post-encoding neural reactivation and connectivity evolve with age to partially explain age-related declines in episodic memory performance and how such declines can be restored.

情景记忆是一种重要的认知功能,它使新信息的编码、存储和检索成为可能。记忆巩固是情景记忆的关键阶段,它将这些新编码的信息稳定在大脑的长期“存储”中。利用功能磁共振成像(fMRI)研究编码后的清醒休息,有望揭示早期、即时的巩固机制。在这里,我们回顾了情景记忆期间的fMRI研究,以记录研究编码后巩固的常用方法,如多体素模式分析(MVPA)和功能连接,以及健康年轻人和老年人的科学现状。在年轻人中,海马中刺激特异性神经模式的编码后再激活及其与皮层和皮层下区域(例如,视觉颞叶皮层、内侧前额叶皮层和内侧顶叶皮层)的连通性与随后的记忆表现相关。相反,对老年人的研究强调了编码后休息期间大规模大脑网络的重要性,特别是默认模式网络(DMN)。DMN和任务积极网络之间连接的改变可能有助于老年人维持情景记忆。此外,非侵入性脑刺激技术可以增强这些编码后巩固过程,并改善年轻人和老年人的记忆表现。值得注意的是,缺乏关于编码后记忆巩固在神经退行性疾病中的研究。这篇综述强调了理解编码后神经再激活和连接如何随着年龄的增长而进化的重要性,以部分解释与年龄相关的情景记忆表现下降以及如何恢复这种下降。
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引用次数: 0
Case of a 57-year-old woman with acute confusion and inability to recognize her husband 一名57岁妇女急性神志不清,认不出自己的丈夫。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-07 DOI: 10.1002/acn3.52289
Elizabeth Anderson

Patient is a 57-year-old Hispanic female with a past medical history of hypertension, asthma, and type II diabetes mellitus who presented to the emergency room (ER) for evaluation of 7 days of altered mental status. Upon initial presentation, the patient had difficulty following one step commands and was not fully oriented. Additionally, she appeared to be responding to external auditory and visual stimuli. Magnetic resonance imaging (MRI) completed in the ER was without acute intracranial abnormality (Figure 1), and electroencephalogram (EEG) was significant for diffuse slowing but no epileptiform activity was noted. She was admitted to the neurology service for further workup and treatment for possible autoimmune encephalitis, plasma exchange (PLEX), high-dose steroids, as well as intravenous immunoglobulin (IVIG) treatments. However, despite treatments, the patient continued to remain altered. Therefore, psychiatry was consulted as well as a cognitive specialist. Per patient's husband, he was able to recall that she had in fact had several years of cognitive decline, periods of altered mental status, hallucinations, and slowed gait. During her admission she had periods of not recognizing her husband, and identified him as an imposter, consistent with Capgras syndrome.1 Given clinical findings, our cognitive team determined the patient's most likely diagnosis and started her on rivastigmine 1.5 mg bid with improvement.2

Lewy body dementia.

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引用次数: 0
Psoriasis and dementia: A population-based matched cohort study of adults in England 牛皮癣和痴呆:英国一项基于人群的成人匹配队列研究。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2025-01-01 DOI: 10.1002/acn3.52283
Julian Matthewman, Kathryn E. Mansfield, Sharon L. Cadogan, Katrina Abuabara, Catherine Smith, Krishnan Bhaskaran, Sinéad M. Langan, Charlotte Warren-Gash

Objective

Evidence for an association between psoriasis and dementia is limited and conflicting. We aimed to investigate the association using large and representative population-based data and describe risk by dementia subtype and over time.

Methods

We compared dementia risk between people with and without psoriasis using an age-, sex- and primary care practice-matched cohort of adults aged ≥40 years from the Clinical Practice Research Datalink Aurum in England (1997–2021) linked to hospital admissions data, analysed with stratified Cox regression.

Results

Among 360,014 individuals with psoriasis and 1,799,617 without, psoriasis was associated with a small increased risk of all-cause dementia (adjusted hazard ratio [aHR] 1.06, 95% CI 1.04–1.08; absolute rate difference 24 per 100,000 person-years). Strength of association increased with time since psoriasis diagnosis (e.g. aHR 0.99, 0.96–1.03 within 0 to 5 years; 1.20, 1.05–1.37 within 20 to 25 years). The association was stronger for vascular dementia (aHR 1.10, 1.06–1.14) than Alzheimer's dementia (aHR 1.03, 1.00–1.06). Hazard ratios were larger for severe psoriasis (all-cause aHR 1.32, 1.25–1.39; vascular aHR 1.58, 1.44–1.74; Alzheimer's aHR 1.11, 1.02–1.21).

Interpretation

Long-term risk of all-cause dementia and vascular dementia, but not Alzheimer's dementia, was slightly higher in people with psoriasis, but absolute risk differences were small. Risks were more substantially raised with time since psoriasis diagnosis and in severe psoriasis compared to mild to moderate psoriasis, suggesting a potential dose–response relationship.

目的:银屑病和痴呆之间关联的证据有限且相互矛盾。我们的目的是使用大量和具有代表性的基于人群的数据来调查这种关联,并描述痴呆亚型和随时间变化的风险。方法:我们比较牛皮癣患者和非牛皮癣患者的痴呆风险,使用年龄、性别和初级保健实践匹配的队列,该队列来自英国临床实践研究数据链Aurum(1997-2021),与住院数据相关,并使用分层Cox回归分析。结果:在360,014名牛皮癣患者和1,799,617名无牛皮癣患者中,牛皮癣与全因痴呆风险小幅增加相关(校正风险比[aHR] 1.06, 95% CI 1.04-1.08;绝对比率差24 / 100,000人年)。自银屑病诊断以来,关联强度随时间增加(例如,0 ~ 5年内aHR为0.99,0.96 ~ 1.03;1.20, 20至25年内1.05-1.37)。血管性痴呆(aHR 1.10, 1.06-1.14)比阿尔茨海默氏痴呆(aHR 1.03, 1.00-1.06)的相关性更强。严重牛皮癣的风险比更大(全因aHR 1.32, 1.25-1.39;血管aHR 1.58, 1.44-1.74;阿尔茨海默病aHR 1.11, 1.02-1.21)。解释:牛皮癣患者患全因痴呆和血管性痴呆的长期风险略高,但不包括阿尔茨海默氏痴呆,但绝对风险差异很小。自牛皮癣确诊以来,与轻度至中度牛皮癣相比,严重牛皮癣的风险随着时间的推移而增加,这表明可能存在剂量-反应关系。
{"title":"Psoriasis and dementia: A population-based matched cohort study of adults in England","authors":"Julian Matthewman,&nbsp;Kathryn E. Mansfield,&nbsp;Sharon L. Cadogan,&nbsp;Katrina Abuabara,&nbsp;Catherine Smith,&nbsp;Krishnan Bhaskaran,&nbsp;Sinéad M. Langan,&nbsp;Charlotte Warren-Gash","doi":"10.1002/acn3.52283","DOIUrl":"10.1002/acn3.52283","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Evidence for an association between psoriasis and dementia is limited and conflicting. We aimed to investigate the association using large and representative population-based data and describe risk by dementia subtype and over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We compared dementia risk between people with and without psoriasis using an age-, sex- and primary care practice-matched cohort of adults aged ≥40 years from the Clinical Practice Research Datalink Aurum in England (1997–2021) linked to hospital admissions data, analysed with stratified Cox regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 360,014 individuals with psoriasis and 1,799,617 without, psoriasis was associated with a small increased risk of all-cause dementia (adjusted hazard ratio [aHR] 1.06, 95% CI 1.04–1.08; absolute rate difference 24 per 100,000 person-years). Strength of association increased with time since psoriasis diagnosis (e.g. aHR 0.99, 0.96–1.03 within 0 to 5 years; 1.20, 1.05–1.37 within 20 to 25 years). The association was stronger for vascular dementia (aHR 1.10, 1.06–1.14) than Alzheimer's dementia (aHR 1.03, 1.00–1.06). Hazard ratios were larger for severe psoriasis (all-cause aHR 1.32, 1.25–1.39; vascular aHR 1.58, 1.44–1.74; Alzheimer's aHR 1.11, 1.02–1.21).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Interpretation</h3>\u0000 \u0000 <p>Long-term risk of all-cause dementia and vascular dementia, but not Alzheimer's dementia, was slightly higher in people with psoriasis, but absolute risk differences were small. Risks were more substantially raised with time since psoriasis diagnosis and in severe psoriasis compared to mild to moderate psoriasis, suggesting a potential dose–response relationship.</p>\u0000 </section>\u0000 </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":"12 2","pages":"393-404"},"PeriodicalIF":4.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.52283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Inflammatory disease in people with multiple sclerosis treated with immune checkpoint inhibitors 免疫检查点抑制剂治疗多发性硬化症患者的炎症性疾病
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-31 DOI: 10.1002/acn3.52287
Saira Afzal, Yadi Li, Brittany Lapin, Le H. Hua, Lucy Boyce Kennedy, Wen Wee Ma, Marisa McGinley, Jeffrey A. Cohen, Amy Kunchok

This study evaluated disease activity in people with Multiple Sclerosis (PwMS) who received immune checkpoint inhibitors (ICIs) compared to PwMS not treated with ICIs. There were 108 PwMS included (27 PwMS+ICIs and 81 PwMS controls), matched on age, sex, disease duration, DMTs, and MS disease course. Of 27 PwMS+ICIs, one (4%) had a relapse and four (15%) developed new MRI lesions without clinical symptoms. Time to relapse and MRI activity were compared using Kaplan–Meier curves and Cox regression models. There was no significant difference for either time to relapse (p = 0.34) or MRI activity (p = 0.15) in PwMS+ICIs compared to controls.

本研究评估了接受免疫检查点抑制剂(ICIs)治疗的多发性硬化症(PwMS)患者与未接受ICIs治疗的PwMS患者的疾病活动性。纳入108例PwMS(27例PwMS+ICIs和81例PwMS对照),年龄、性别、病程、DMTs和MS病程相匹配。在27例PwMS+ICIs中,1例(4%)复发,4例(15%)出现新的MRI病变,无临床症状。采用Kaplan-Meier曲线和Cox回归模型比较复发时间和MRI活动。与对照组相比,PwMS+ICIs患者的复发时间(p = 0.34)或MRI活性(p = 0.15)均无显著差异。
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引用次数: 0
Refractory myasthenia gravis treated with autologous hematopoietic stem cell transplantation 自体造血干细胞移植治疗难治性重症肌无力。
IF 4.4 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-12-31 DOI: 10.1002/acn3.52246
Benjamin Beland, Jan Storek, Liam Quartermain, Christopher Hahn, C. Elizabeth Pringle, Pierre R. Bourque, Michael Kennah, Natasha Kekre, Christopher Bredeson, David Allan, Kareem Jamani, Christopher White, Harold Atkins

Objectives

Patients with refractory myasthenia gravis (MG) have few treatment options. Autologous hematopoietic stem cell transplantation (HSCT) has been used to treat immune diseases; however, its use in the treatment of MG is not broadly considered. Our objective is to report on the efficacy and safety of HSCT in refractory MG.

Methods

Twenty-one patients who underwent HSCT for MG were retrospectively reviewed. All patients had severe MG refractory to multiple therapies. Stem cells were mobilized with cyclophosphamide and granulocyte colony-stimulating factor. The grafts were depleted of immune cells by selecting CD34+ cells. HSCT conditioning consisted of high-dose cytoreductive therapy and anti-thymocyte globulin. The primary efficacy outcome was achieving clinically stable remission or minimal manifestations without treatment and remaining as such until most recent follow-up.

Results

The median time from MG diagnosis to HSCT was 4.0 years. The primary outcome was reached in 16 of 18 evaluable patients (89%) at a median of 1.7 years and maintained with a median follow-up of 6.7 years (range 1.0–21.9 years). Three patients were not evaluable for the primary outcome: one due to confounding illness and two died within 12 months of transplant. The transplant-related mortality at 100 days was 9.5%. Two late deaths occurred, with uncertain relation to the HSCT.

Interpretation

After HSCT for refractory MG, most patients achieved sustained disease remission. However, HSCT-related mortality in medically complex MG patients may be high. Prospective studies investigating the efficacy and safety of HSCT in the treatment of refractory MG are warranted.

目的:难治性重症肌无力(MG)患者的治疗选择很少。自体造血干细胞移植(HSCT)已被用于治疗免疫性疾病;然而,其在MG治疗中的应用并没有得到广泛的考虑。我们的目的是报道HSCT治疗难治性MG的疗效和安全性。方法:回顾性分析21例MG肝移植患者的临床资料。所有患者均为重度MG,多重治疗难治性。用环磷酰胺和粒细胞集落刺激因子动员干细胞。通过选择CD34+细胞来清除移植物的免疫细胞。HSCT治疗包括大剂量细胞减少治疗和抗胸腺细胞球蛋白。主要疗效指标是在不治疗的情况下达到临床稳定缓解或最小表现,并保持到最近的随访。结果:从MG诊断到HSCT的中位时间为4.0年。18例可评估患者中有16例(89%)达到了主要结局,中位随访时间为1.7年,中位随访时间为6.7年(1.0-21.9年)。3例患者无法评估主要结果:1例因混杂疾病,2例在移植后12个月内死亡。100天的移植相关死亡率为9.5%。2例晚期死亡,与HSCT的关系不确定。解释:对难治性MG患者进行HSCT后,大多数患者获得了持续的疾病缓解。然而,在医学复杂的MG患者中,hsct相关的死亡率可能很高。对HSCT治疗难治性MG的有效性和安全性进行前瞻性研究是有必要的。
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Annals of Clinical and Translational Neurology
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