Infarct volume on diffusion-weighted imaging (DWI) is a promising imaging marker for clinical outcomes in patients with acute stroke treated with mechanical thrombectomy (MT), but its predictive value has not been well evaluated, especially in consecutive patients. The present study aimed to elucidate the relationship between infarct volume and its change and favorable functional outcomes in consecutive patients with acute stroke who underwent MT.
Method
Of patients with consecutive acute stroke who underwent MT from September 2014 through December 2019, those who were pre-morbidly independent were enrolled. Infarct volume on DWI was measured at admission (DWIinitial) and 24 h after admission (DWI24h) with semi-automated imaging software. Infarct growth (IG) was calculated as the difference between DWI24h and DWIinitial. Factors associated with a favorable outcome (mRS score 0–2) 3 months after stroke onset were assessed by multivariable analyses. Model performance was evaluated with the C-statistic.
Results
A total of 251 patients (165 male [66 %], median age 75 [IQR 67–81] years, median NIHSS score 15 [7–21]) were enrolled in the present study. Multivariable logistic regression analysis showed that DWI24h (OR 0.74, 95 % CI 0.62–0.87 for every 10-mL increment) and IG (0.74, 0.62–0.88 for every 10-mL increment) were independently and negatively associated with a favorable outcome. These associations were observed in patients with diverse vessel occlusions. Adding DWI24h or IG to the conventional predictors of favorable outcomes improved predictive accuracy (p < 0.05).
Conclusion
DWI infarct volume 24 h after admission and IG can be strong imaging predictors of favorable outcomes after MT.
背景：弥散加权成像（DWI）是急性脑卒中机械取栓（MT）患者临床预后的一种很有前景的影像学指标，但其预测价值尚未得到很好的评估，特别是在连续患者中。本研究旨在阐明急性脑卒中患者连续行MT的梗死面积及其变化与良好功能结局的关系。方法纳入2014年9月至2019年12月连续行MT的急性脑卒中患者，患者为发病前独立患者。在入院时（DWIinitial）和入院后24小时（DWI24h）用半自动成像软件测量DWI上的梗死体积。梗死生长（IG）以DWI24h与DWIinitial之差计算。通过多变量分析评估卒中发作3个月后预后良好的相关因素（mRS评分0-2）。用c统计量评价模型性能。结果共纳入251例患者，其中男性165例[66%]，中位年龄75 [IQR 67-81]岁，中位NIHSS评分15[7-21]。多变量logistic回归分析显示，DWI24h （OR 0.74, 95% CI 0.62-0.87，每增加10 ml）和IG（0.74, 0.62-0.88，每增加10 ml）与预后良好独立负相关。在不同血管闭塞的患者中观察到这些关联。将DWI24h或IG加入常规预后预测因子可提高预测准确性(p <；0.05)。结论入院后24 h dwi梗死体积和IG是预测术后预后的重要影像学指标。
{"title":"Acute DWI volume is a strong imaging predictor of favorable outcomes in patients with acute stroke and treated with mechanical thrombectomy","authors":"Yuki Sakamoto, Junya Aoki, Yuji Nishi, Sotaro Shoda, Ryutaro Kimura, Tomonari Saito, Takuya Kanamaru, Kentaro Suzuki, Takehiro Katano, Akihito Kutsuna, Shinichiro Numao, Takashi Shimoyama, Kazumi Kimura","doi":"10.1016/j.jns.2024.123334","DOIUrl":"10.1016/j.jns.2024.123334","url":null,"abstract":"<div><h3>Background</h3><div>Infarct volume on diffusion-weighted imaging (DWI) is a promising imaging marker for clinical outcomes in patients with acute stroke treated with mechanical thrombectomy (MT), but its predictive value has not been well evaluated, especially in consecutive patients. The present study aimed to elucidate the relationship between infarct volume and its change and favorable functional outcomes in consecutive patients with acute stroke who underwent MT.</div></div><div><h3>Method</h3><div>Of patients with consecutive acute stroke who underwent MT from September 2014 through December 2019, those who were pre-morbidly independent were enrolled. Infarct volume on DWI was measured at admission (DWI<sub>initial</sub>) and 24 h after admission (DWI<sub>24h</sub>) with semi-automated imaging software. Infarct growth (IG) was calculated as the difference between DWI<sub>24h</sub> and DWI<sub>initial</sub>. Factors associated with a favorable outcome (mRS score 0–2) 3 months after stroke onset were assessed by multivariable analyses. Model performance was evaluated with the C-statistic.</div></div><div><h3>Results</h3><div>A total of 251 patients (165 male [66 %], median age 75 [IQR 67–81] years, median NIHSS score 15 [7–21]) were enrolled in the present study. Multivariable logistic regression analysis showed that DWI<sub>24h</sub> (OR 0.74, 95 % CI 0.62–0.87 for every 10-mL increment) and IG (0.74, 0.62–0.88 for every 10-mL increment) were independently and negatively associated with a favorable outcome. These associations were observed in patients with diverse vessel occlusions. Adding DWI<sub>24h</sub> or IG to the conventional predictors of favorable outcomes improved predictive accuracy (<em>p</em> < 0.05).</div></div><div><h3>Conclusion</h3><div>DWI infarct volume 24 h after admission and IG can be strong imaging predictors of favorable outcomes after MT.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"468 ","pages":"Article 123334"},"PeriodicalIF":3.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756996","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}
Pub Date : 2024-11-28DOI: 10.1016/j.jns.2024.123330
Mark Katson , Alon Gorenshtein , Jack Pepys , Yair Mina , Shahar Shelly
Background and objectives
Herpes simplex virus-1 (HSV-1) encephalitis is the most prevalent form of viral encephalitis worldwide. Consensus statements on the rate of mortality are lacking, with most studies emphasizing short-term mortality risks
. We aimed to describe variables effecting mortality for HSV-1 encephalitis in a long term well defined HSV cohorts.
Methods
This is a retrospective study, encephalitis patients who were HSV-positive (HSV- 1,HSV-2 and VZV) in the cerebrospinal fluid (CSF) in 23 years' time frame were compared. Clinical, electrophysiological, imaging, and laboratory data were analyzed.
Results
We identified 47 HSV-1, 8 HSV-2 and 216 with VZV patients with a molecular CSF PCR diagnosis. The median age at diagnosis was 63.3 (interquartile range(IQR) 50.42–72.52) for HSV-1, 46.79 (IQR 36.55–55.05) for HSV-2 and 60.33.
(IQR 33.78–74.11) for VZV (p = 0.14). The mean follow up time was 6.25 ± 5.92 years for the group as whole. Among HSV-1 patients, during the follow-up period, 26 patients (55.31 %) died. Ten deaths occurred within the first year, with a median age of death of 70.6 [63.53–75.39]. Patients who died were older (70.6 [63.53–75.39 vs.
48.59 [37.88–61.71], p < 0.001), had a longer time to treatment initiation (4.01 ± 5.69 vs. 1.96 ± 3.58 days, p = 0.026), with cancer comorbidities more prevalent (42.3 % vs. 0 %, p < 0.001). Univariate analysis showed older age (HR 1.07, 95 % CI 1.03–1.10, p < 0.01), and cancer comorbidity (HR 5.55, 95 % CI 2.31–13.33, p < 0.001) were associated with significantly higher risk for mortality. Multivariate analysis confirmed that older age (HR 1.096, 95 % CI 1.04–1.15, p < 0.001), cancer comorbidity (HR 11.02, 95 % CI 2.76–43.9, p < 0.001) and lower lymphocyte count (HR 0.97, 95 % CI 0.95–0.99, p = 0.032) influenced mortality risk. The optimal cut-off age to predict mortality based on AUC-ROC curve was 63.29 (AUC = 0.83, sensitivity = 0.76, specificity = 0.80, PPV = 0.83, NNV = 0.73, p < 0.001). Patients above this age cutoff had a significantly greater cumulative incidence of mortality than did those aged 50–63 years (p < 0.01).
Discussion
Mortality due to HSV-1 was high and highest in patients >63 years or immunocompromised patients. Favorable outcomes were associated with increased lymphocyte levels in CSF, and early antiviral treatment. These finding may help explain the wide discrepancies in reported mortality rates for HSV encephalitis patients.
背景与目的单纯疱疹病毒1型（HSV-1）脑炎是世界范围内最常见的病毒性脑炎。缺乏关于死亡率的共识声明，大多数研究强调短期死亡风险。我们的目的是描述在长期定义明确的HSV队列中影响HSV-1脑炎死亡率的变量。方法对23年脑脊液中HSV阳性（HSV- 1、HSV-2和VZV）的脑炎患者进行回顾性研究。对临床、电生理、影像学和实验室数据进行分析。结果经分子脑脊液PCR诊断为1型单纯疱疹病毒47例，2型单纯疱疹病毒8例，伴有VZV病毒216例。HSV-1、HSV-2和HSV-2的中位诊断年龄分别为63.3岁（四分位数间距（IQR） 50.42 ~ 72.52）、46.79岁（IQR 36.55 ~ 55.05）和60.33岁。（IQR 33.78-74.11） （p = 0.14）。全组平均随访时间为6.25±5.92年。1型单纯疱疹患者随访期间死亡26例（55.31%）。1年内死亡10例，死亡年龄中位数为70.6岁[63.53-75.39]。死亡患者年龄较大(70.6 [63.53-75.39]vs.48.59 [37.88-61.71], p <；0.001)，开始治疗时间较长（4.01±5.69天对1.96±3.58天，p = 0.026），癌症合并症更普遍(42.3%对0%，p <；0.001)。单因素分析显示年龄较大(HR 1.07, 95% CI 1.03-1.10, p <；0.01)和癌症合并症(HR 5.55, 95% CI 2.31-13.33, p <；0.001)与死亡风险显著增高相关。多因素分析证实年龄较大(HR 1.096, 95% CI 1.04-1.15, p <；0.001)，癌症合并症(HR 11.02, 95% CI 2.76-43.9, p <；0.001)和较低的淋巴细胞计数（HR 0.97, 95% CI 0.95-0.99, p = 0.032）影响死亡风险。AUC- roc曲线预测死亡率的最佳截止年龄为63.29岁(AUC = 0.83，敏感性= 0.76，特异性= 0.80,PPV = 0.83, NNV = 0.73, p <；0.001)。超过这一年龄界限的患者的累积死亡率明显高于50-63岁的患者(p <；0.01)。单纯疱疹病毒1型的死亡率很高，在63岁或免疫功能低下的患者中死亡率最高。良好的结果与脑脊液淋巴细胞水平升高和早期抗病毒治疗相关。这些发现可能有助于解释报道的HSV脑炎患者死亡率的巨大差异。
{"title":"Mortality and prognosis in herpes simplex Virus-1 encephalitis long-term follow up study","authors":"Mark Katson , Alon Gorenshtein , Jack Pepys , Yair Mina , Shahar Shelly","doi":"10.1016/j.jns.2024.123330","DOIUrl":"10.1016/j.jns.2024.123330","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Herpes simplex virus-1 (HSV-1) encephalitis is the most prevalent form of viral encephalitis worldwide. Consensus statements on the rate of mortality are lacking, with most studies emphasizing short-term mortality risks</div><div>. We aimed to describe variables effecting mortality for HSV-1 encephalitis in a long term well defined HSV cohorts.</div></div><div><h3>Methods</h3><div>This is a retrospective study, encephalitis patients who were HSV-positive (HSV- 1,HSV-2 and VZV) in the cerebrospinal fluid (CSF) in 23 years' time frame were compared. Clinical, electrophysiological, imaging, and laboratory data were analyzed.</div></div><div><h3>Results</h3><div>We identified 47 HSV-1, 8 HSV-2 and 216 with VZV patients with a molecular CSF PCR diagnosis. The median age at diagnosis was 63.3 (interquartile range(IQR) 50.42–72.52) for HSV-1, 46.79 (IQR 36.55–55.05) for HSV-2 and 60.33.</div><div>(IQR 33.78–74.11) for VZV (<em>p</em> = 0.14). The mean follow up time was 6.25 ± 5.92 years for the group as whole. Among HSV-1 patients, during the follow-up period, 26 patients (55.31 %) died. Ten deaths occurred within the first year, with a median age of death of 70.6 [63.53–75.39]. Patients who died were older (70.6 [63.53–75.39 vs.</div><div>48.59 [37.88–61.71], <em>p</em> < 0.001), had a longer time to treatment initiation (4.01 ± 5.69 vs. 1.96 ± 3.58 days, <em>p</em> = 0.026), with cancer comorbidities more prevalent (42.3 % vs. 0 %, <em>p</em> < 0.001). Univariate analysis showed older age (HR 1.07, 95 % CI 1.03–1.10, <em>p</em> < 0.01), and cancer comorbidity (HR 5.55, 95 % CI 2.31–13.33, <em>p</em> < 0.001) were associated with significantly higher risk for mortality. Multivariate analysis confirmed that older age (HR 1.096, 95 % CI 1.04–1.15, <em>p</em> < 0.001), cancer comorbidity (HR 11.02, 95 % CI 2.76–43.9, p < 0.001) and lower lymphocyte count (HR 0.97, 95 % CI 0.95–0.99, <em>p</em> = 0.032) influenced mortality risk. The optimal cut-off age to predict mortality based on AUC-ROC curve was 63.29 (AUC = 0.83, sensitivity = 0.76, specificity = 0.80, PPV = 0.83, NNV = 0.73, <em>p</em> < 0.001). Patients above this age cutoff had a significantly greater cumulative incidence of mortality than did those aged 50–63 years (<em>p</em> < 0.01).</div></div><div><h3>Discussion</h3><div>Mortality due to HSV-1 was high and highest in patients >63 years or immunocompromised patients. Favorable outcomes were associated with increased lymphocyte levels in CSF, and early antiviral treatment. These finding may help explain the wide discrepancies in reported mortality rates for HSV encephalitis patients.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"468 ","pages":"Article 123330"},"PeriodicalIF":3.6,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756995","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}
Pub Date : 2024-11-26DOI: 10.1016/j.jns.2024.123329
Laurent Puy , Nils Jensen Boe , Melinda Maillard , Gregory Kuchcinski , Charlotte Cordonnier
Spontaneous intracerebral hemorrhage (ICH) is defined by the rupture of a cerebral blood vessel and the entry of blood into the brain parenchyma. With a global incidence of around 3.5 million, ICH accounts for almost 30 % of all new strokes worldwide. It is also the deadliest form of acute stroke and survivors are at risk of poor functional outcome. The pathophysiology of ICH is a dynamic process with key stages occurring at successive times: vessel rupture and initial bleeding; hematoma expansion, mechanical mass effect and secondary brain injury (peri-hematomal edema). While deep perforating vasculopathy and cerebral amyloid angiopathy are responsible for 80 % of ICH, a prompt diagnostic work-up, including advanced imaging is require to exclude a treatable cause. ICH is a neurological emergency and simple therapeutic measures such as blood pressure lowering and anticoagulant reversal should be implemented as early as possible as part of a bundle of care. Although ICH is still devoided of specific treatment, recent advances give hope for a cautious optimism. Therapeutic approaches under the scope are focusing on fighting against hemorrhage expansion, promoting hematoma evacuation by minimally invasive surgery, and reducing secondary brain injury. Among survivors, the global vascular risk is now better established, but optimal secondary prevention is still unclear and is based on an individual benefit-risk balance evaluation.
{"title":"Recent and future advances in intracerebral hemorrhage","authors":"Laurent Puy , Nils Jensen Boe , Melinda Maillard , Gregory Kuchcinski , Charlotte Cordonnier","doi":"10.1016/j.jns.2024.123329","DOIUrl":"10.1016/j.jns.2024.123329","url":null,"abstract":"<div><div>Spontaneous intracerebral hemorrhage (ICH) is defined by the rupture of a cerebral blood vessel and the entry of blood into the brain parenchyma. With a global incidence of around 3.5 million, ICH accounts for almost 30 % of all new strokes worldwide. It is also the deadliest form of acute stroke and survivors are at risk of poor functional outcome. The pathophysiology of ICH is a dynamic process with key stages occurring at successive times: vessel rupture and initial bleeding; hematoma expansion, mechanical mass effect and secondary brain injury (peri-hematomal edema). While deep perforating vasculopathy and cerebral amyloid angiopathy are responsible for 80 % of ICH, a prompt diagnostic work-up, including advanced imaging is require to exclude a treatable cause. ICH is a neurological emergency and simple therapeutic measures such as blood pressure lowering and anticoagulant reversal should be implemented as early as possible as part of a bundle of care. Although ICH is still devoided of specific treatment, recent advances give hope for a cautious optimism. Therapeutic approaches under the scope are focusing on fighting against hemorrhage expansion, promoting hematoma evacuation by minimally invasive surgery, and reducing secondary brain injury. Among survivors, the global vascular risk is now better established, but optimal secondary prevention is still unclear and is based on an individual benefit-risk balance evaluation.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"467 ","pages":"Article 123329"},"PeriodicalIF":3.6,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748070","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}
Pub Date : 2024-11-25DOI: 10.1016/j.jns.2024.123328
Marc Garbey , Quentin Lesport , Gülşen Öztosun , Veda Ghodasara , Henry J. Kaminski , Elham Bayat
Background
Patients with ALS often face difficulties expressing emotions due to impairments in facial expression, speech, body language, and cognitive function. This study aimed to develop non-invasive AI tools to detect and quantify emotional responsiveness in ALS patients, providing objective insights. Improved understanding of emotional responses could enhance patient-provider communication, telemedicine effectiveness, and clinical trial outcome measures.
Methods
In this preliminary exploratory study, fourteen patients with ALS had audio recordings performed during routine clinic visits while wearing a wireless pulse oximeter. Emotion-triggering questions related to symptom progression, breathing, mobility, feeding tube, and financial burden were randomly asked. The same questions were posed in separate psychiatric evaluations. Natural language processing (NLP) was used to analyze transcriptions, topic classifications, sentiment, and emotional states, combining pulse and speech data. AI-generated reports summarized the findings.
Results
Pulse alterations consistent with emotional arousal were identified, with longer consultations and positive communication reducing pulse fluctuations. Financial concerns triggered the strongest emotional response, while discussions about breathing, mobility, and feeding tube increased anxiety. AI-generated reports prioritized patient concerns and streamlined documentation for providers.
Conclusions
This study introduces a novel approach to linking pulse and speech analysis to evaluate emotional responses in ALS patients. AI and affective computing provide valuable insights into emotional responses and disease progression, with potential applications for other neurological disorders. This approach could augment clinical trial outcomes by offering a more comprehensive view of patient well-being.
{"title":"Improving care for amyotrophic lateral sclerosis with artificial intelligence and affective computing","authors":"Marc Garbey , Quentin Lesport , Gülşen Öztosun , Veda Ghodasara , Henry J. Kaminski , Elham Bayat","doi":"10.1016/j.jns.2024.123328","DOIUrl":"10.1016/j.jns.2024.123328","url":null,"abstract":"<div><h3>Background</h3><div>Patients with ALS often face difficulties expressing emotions due to impairments in facial expression, speech, body language, and cognitive function. This study aimed to develop non-invasive AI tools to detect and quantify emotional responsiveness in ALS patients, providing objective insights. Improved understanding of emotional responses could enhance patient-provider communication, telemedicine effectiveness, and clinical trial outcome measures.</div></div><div><h3>Methods</h3><div>In this preliminary exploratory study, fourteen patients with ALS had audio recordings performed during routine clinic visits while wearing a wireless pulse oximeter. Emotion-triggering questions related to symptom progression, breathing, mobility, feeding tube, and financial burden were randomly asked. The same questions were posed in separate psychiatric evaluations. Natural language processing (NLP) was used to analyze transcriptions, topic classifications, sentiment, and emotional states, combining pulse and speech data. AI-generated reports summarized the findings.</div></div><div><h3>Results</h3><div>Pulse alterations consistent with emotional arousal were identified, with longer consultations and positive communication reducing pulse fluctuations. Financial concerns triggered the strongest emotional response, while discussions about breathing, mobility, and feeding tube increased anxiety. AI-generated reports prioritized patient concerns and streamlined documentation for providers.</div></div><div><h3>Conclusions</h3><div>This study introduces a novel approach to linking pulse and speech analysis to evaluate emotional responses in ALS patients. AI and affective computing provide valuable insights into emotional responses and disease progression, with potential applications for other neurological disorders. This approach could augment clinical trial outcomes by offering a more comprehensive view of patient well-being.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"468 ","pages":"Article 123328"},"PeriodicalIF":3.6,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745009","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}
The Frontal Assessment Battery (FAB) is widely used to assess executive dysfunction in patients with amnestic mild cognitive impairments due to Alzheimer's disease (aMCI-AD), but its neurobiological meaning is unclear. To elucidate this, we examined the relationship between the FAB score and three key imaging biomarkers: gray matter volume, amyloid-beta (Aβ) deposition, and glucose metabolism.
Methods
Twenty Aβ- and tau-positive aMCI-AD patients and age-matched controls underwent structural magnetic resonance imaging and positron emission tomography with [11C]PiB and [18F]FDG. Voxel-based morphometry and statistical parametric mapping analyses were performed to elucidate the relationships between FAB scores and regional gray matter volume, [11C]PiB uptake for Aβ deposition, and [18F]FDG uptake for glucose metabolism.
Results
FAB scores were significantly lower in aMCI-AD than in controls (p < 0.001). In aMCI-AD, FAB was significantly correlated with right inferior frontal gray matter volume and right medial and left middle frontal glucose metabolism (family-wise error p < 0.05). However, there was no correlation between Aβ deposition and FAB (family-wise error p < 0.05).
Conclusions
The decreased FAB score is linked more with frontal-lobe neurodegeneration than with Aβ pathology in aMCI-AD. The FAB could be an early marker for neurodegeneration related to frontal-lobe executive dysfunction.
{"title":"Frontal neurodegeneration associated with Frontal Assessment Battery in early Alzheimer's disease","authors":"Tatsuhiro Terada , Manabu Kubota , Jun Miyata , Tomokazu Obi , Hirotsugu Takashima , Takashi Matsudaira , Tomoyasu Bunai , Yasuomi Ouchi , Toshiya Murai","doi":"10.1016/j.jns.2024.123327","DOIUrl":"10.1016/j.jns.2024.123327","url":null,"abstract":"<div><h3>Background</h3><div>The Frontal Assessment Battery (FAB) is widely used to assess executive dysfunction in patients with amnestic mild cognitive impairments due to Alzheimer's disease (aMCI-AD), but its neurobiological meaning is unclear. To elucidate this, we examined the relationship between the FAB score and three key imaging biomarkers: gray matter volume, amyloid-beta (Aβ) deposition, and glucose metabolism.</div></div><div><h3>Methods</h3><div>Twenty Aβ- and tau-positive aMCI-AD patients and age-matched controls underwent structural magnetic resonance imaging and positron emission tomography with [<sup>11</sup>C]PiB and [<sup>18</sup>F]FDG. Voxel-based morphometry and statistical parametric mapping analyses were performed to elucidate the relationships between FAB scores and regional gray matter volume, [<sup>11</sup>C]PiB uptake for Aβ deposition, and [<sup>18</sup>F]FDG uptake for glucose metabolism.</div></div><div><h3>Results</h3><div>FAB scores were significantly lower in aMCI-AD than in controls (<em>p</em> < 0.001). In aMCI-AD, FAB was significantly correlated with right inferior frontal gray matter volume and right medial and left middle frontal glucose metabolism (family-wise error <em>p</em> < 0.05). However, there was no correlation between Aβ deposition and FAB (family-wise error p < 0.05).</div></div><div><h3>Conclusions</h3><div>The decreased FAB score is linked more with frontal-lobe neurodegeneration than with Aβ pathology in aMCI-AD. The FAB could be an early marker for neurodegeneration related to frontal-lobe executive dysfunction.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"467 ","pages":"Article 123327"},"PeriodicalIF":3.6,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748066","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}
Pub Date : 2024-11-23DOI: 10.1016/j.jns.2024.123318
Dandan Zhang , Yuefei Zhou , Yang Liu , Shaoze Wu
Background
Most studies have focused on the effects of individual environmental risk factors on cognitive function; however, none have evaluated the association between residential environmental quality and cognitive impairment.
Methods
Data from the China Health and Retirement Longitudinal Study (CHARLS) were used to include 12,801 participants in a cross-sectional study and 8781 participants in a cohort study. Residential environmental quality was assessed using indicators such as particulate matter, types of household fuel, water sources, indoor temperature, and building types. Based on the residential environment quality score, participants were classified into three groups: comfortable (0–1 points), moderate (2–3 points), and poor (4–6 points). To evaluate the association between residential environmental quality and cognitive scores in the cross-sectional study, as well as the development of mild cognitive impairment (MCI) in the cohort study, ordinary least squares (OLS) regression and logistic regression models were applied.
Results
In the cross-sectional study, cognitive scores and performance across four dimensions—orientation, computation, memory, and drawing—showed a significant decline from the comfortable to the poor residential environment groups. In the fully adjusted OLS regression model, scores across these dimensions were significantly reduced in the moderate and poor groups compared to the comfortable group (P for trend <0.001). The incidence of MCI from 2011 to 2018 was 10.1 %, 16.8 %, and 18.8 % for participants living in comfortable, moderate, and poor environments, respectively, with statistically significant differences among groups (all P < 0.07). Logistic regression analysis revealed an odds ratio of 1.25 (95 % CI: 1.02–1.53) for the moderate group and 1.31 (95 % CI: 1.04–1.65) for the poor group, compared to the comfortable group (P for trend<0.05).
Conclusions
An inferior residential environment is associated with lower cognitive scores and a higher rik of developing MCI in middle-aged and older Chinese adults.
{"title":"Association between residential environment quality with mild cognitive impairment among middle and elderly adults in China","authors":"Dandan Zhang , Yuefei Zhou , Yang Liu , Shaoze Wu","doi":"10.1016/j.jns.2024.123318","DOIUrl":"10.1016/j.jns.2024.123318","url":null,"abstract":"<div><h3>Background</h3><div>Most studies have focused on the effects of individual environmental risk factors on cognitive function; however, none have evaluated the association between residential environmental quality and cognitive impairment.</div></div><div><h3>Methods</h3><div>Data from the China Health and Retirement Longitudinal Study (CHARLS) were used to include 12,801 participants in a cross-sectional study and 8781 participants in a cohort study. Residential environmental quality was assessed using indicators such as particulate matter, types of household fuel, water sources, indoor temperature, and building types. Based on the residential environment quality score, participants were classified into three groups: comfortable (0–1 points), moderate (2–3 points), and poor (4–6 points). To evaluate the association between residential environmental quality and cognitive scores in the cross-sectional study, as well as the development of mild cognitive impairment (MCI) in the cohort study, ordinary least squares (OLS) regression and logistic regression models were applied.</div></div><div><h3>Results</h3><div>In the cross-sectional study, cognitive scores and performance across four dimensions—orientation, computation, memory, and drawing—showed a significant decline from the comfortable to the poor residential environment groups. In the fully adjusted OLS regression model, scores across these dimensions were significantly reduced in the moderate and poor groups compared to the comfortable group (<em>P</em> for trend <0.001). The incidence of MCI from 2011 to 2018 was 10.1 %, 16.8 %, and 18.8 % for participants living in comfortable, moderate, and poor environments, respectively, with statistically significant differences among groups (all <em>P</em> < 0.07). Logistic regression analysis revealed an odds ratio of 1.25 (95 % CI: 1.02–1.53) for the moderate group and 1.31 (95 % CI: 1.04–1.65) for the poor group, compared to the comfortable group (<em>P</em> for trend<em><</em>0.05).</div></div><div><h3>Conclusions</h3><div>An inferior residential environment is associated with lower cognitive scores and a higher rik of developing MCI in middle-aged and older Chinese adults.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"467 ","pages":"Article 123318"},"PeriodicalIF":3.6,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748069","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}
Pub Date : 2024-11-23DOI: 10.1016/j.jns.2024.123326
Youming Wang , Weibing Jia , Minjia Wang , Xiaoli Yang , Xinli Gao , Yao Zhang
Objective
To describe the clinical characteristics, therapeutic approaches, and prognostic outcomes of osmotic demyelination syndrome (ODS) in cancer patients.
Methods
A comprehensive literature search (January 1950–March 2024) using PubMed, Embase, Cochrane Library, and Web of Science. Keywords included “osmotic demyelination and cancer”, “central pontine myelinolysis and cancer”, and “extrapontine myelinolysis and cancer”, “Osmotic demyelination and malignancy,” “Central pontine myelinolysis and malignancy,” and “Extrapontine myelinolysis and malignancy.” References from selected articles were manually reviewed for inclusion. Studies involving benign lesions, surgical interventions, non-malignant ODS, and ODS of unknown etiology without malignancy were excluded.
Results
A total of 22 cases of cancer-complicated ODS were identified in the literature. The median age of onset was 55 years, with no observed gender differences. Clinical presentations ranged from completely asymptomatic (4.5 %,1/22) to disorders of consciousness (27.3 %, 6/22). Notably, 22.7 % (5/22) of patients initially presented with either no symptoms or non-specific symptoms (seizures, abnormal mental behavior) that could be mistaken for hyponatremia itself. Furthermore, 90 % of patients did not experience rapid sodium correction, and 59.1 % received only symptomatic therapy or treatment of the primary cancer. Only 9.1 % of patients received immunoglobulin or plasma exchange, which may improve outcomes.
Conclusions
Osmotic demyelination syndrome represents a potential complication in cancer patients, potentially arising from complex interactions. Clinical manifestations are highly variable and often under-recognized, particularly by non-neurologists. Traditional sodium correction protocols may still induce ODS in cancer patients, suggesting a need for cautious sodium management. Timely diagnosis and appropriate intervention are crucial for determining patient prognosis.
目的探讨肿瘤患者渗透性脱髓鞘综合征（ODS）的临床特点、治疗方法及预后。方法利用PubMed、Embase、Cochrane Library和Web of Science进行文献检索（1950年1月~ 2024年3月）。关键词包括“渗透性脱髓鞘与癌症”、“桥桥中央髓鞘溶解与癌症”、“桥桥外髓鞘溶解与癌症”、“渗透性脱髓鞘与恶性肿瘤”、“桥桥中央髓鞘溶解与恶性肿瘤”、“桥桥外髓鞘溶解与恶性肿瘤”。对选定文章的参考文献进行了人工审查以纳入。包括良性病变、手术干预、非恶性ODS和病因不明的无恶性ODS的研究被排除在外。结果文献共发现22例肿瘤合并ODS。中位发病年龄为55岁，没有观察到性别差异。临床表现从完全无症状（4.5%,1/22）到意识障碍（27.3%,6/22）不等。值得注意的是，22.7%（5/22）的患者最初表现为无症状或非特异性症状（癫痫发作、异常精神行为），这些症状可能被误认为低钠血症本身。此外，90%的患者没有经历快速的钠矫正，59.1%的患者只接受了对症治疗或原发癌症的治疗。只有9.1%的患者接受了免疫球蛋白或血浆交换，这可能会改善预后。结论渗透性脱髓鞘综合征是肿瘤患者的一种潜在并发症，可能由复杂的相互作用引起。临床表现是高度可变的，经常被忽视，特别是非神经科医生。传统的钠校正方案仍可能诱发癌症患者的ODS，提示需要谨慎的钠管理。及时诊断和适当干预是确定患者预后的关键。
{"title":"Osmotic demyelination syndrome in cancer patients: Risk even without rapid sodium correction - a scoping review","authors":"Youming Wang , Weibing Jia , Minjia Wang , Xiaoli Yang , Xinli Gao , Yao Zhang","doi":"10.1016/j.jns.2024.123326","DOIUrl":"10.1016/j.jns.2024.123326","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the clinical characteristics, therapeutic approaches, and prognostic outcomes of osmotic demyelination syndrome (ODS) in cancer patients.</div></div><div><h3>Methods</h3><div>A comprehensive literature search (January 1950–March 2024) using PubMed, Embase, Cochrane Library, and Web of Science. Keywords included “osmotic demyelination and cancer”, “central pontine myelinolysis and cancer”, and “extrapontine myelinolysis and cancer”, “Osmotic demyelination and malignancy,” “Central pontine myelinolysis and malignancy,” and “Extrapontine myelinolysis and malignancy.” References from selected articles were manually reviewed for inclusion. Studies involving benign lesions, surgical interventions, non-malignant ODS, and ODS of unknown etiology without malignancy were excluded.</div></div><div><h3>Results</h3><div>A total of 22 cases of cancer-complicated ODS were identified in the literature. The median age of onset was 55 years, with no observed gender differences. Clinical presentations ranged from completely asymptomatic (4.5 %,1/22) to disorders of consciousness (27.3 %, 6/22). Notably, 22.7 % (5/22) of patients initially presented with either no symptoms or non-specific symptoms (seizures, abnormal mental behavior) that could be mistaken for hyponatremia itself. Furthermore, 90 % of patients did not experience rapid sodium correction, and 59.1 % received only symptomatic therapy or treatment of the primary cancer. Only 9.1 % of patients received immunoglobulin or plasma exchange, which may improve outcomes.</div></div><div><h3>Conclusions</h3><div>Osmotic demyelination syndrome represents a potential complication in cancer patients, potentially arising from complex interactions. Clinical manifestations are highly variable and often under-recognized, particularly by non-neurologists. Traditional sodium correction protocols may still induce ODS in cancer patients, suggesting a need for cautious sodium management. Timely diagnosis and appropriate intervention are crucial for determining patient prognosis.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"467 ","pages":"Article 123326"},"PeriodicalIF":3.6,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748064","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}
Pub Date : 2024-11-23DOI: 10.1016/j.jns.2024.123319
Bin Zhou, Masanori Fukushima, The Alzheimer's Disease Neuroimaging Initiative
Backgrounds
People with elevated beta amyloid have different risk and progress speed to Alzheimer's disease.
Purpose
The research is to validate the risk classification of AD developed in the Shanghai mild cognitive impairment (MCI) cohort study using ADNI data.
Methods
The risk classification of AD in MCI was based on several optimal cut-off points of a novel parameter Cog_Vol.
Results
In total, 843 subjects with MCI were included, of whom 220 had elevated PET beta amyloid. 273 (32.3 %) and 70 (31.8 %) progressed to AD in all subjects and in those with elevated PET beta amyloid, respectively. The risk of AD in subjects whose Cog_Vol >340 was very low, while the risk for those with Cog_Vol less than 101 indicated a super high within 4 years of follow-up.
Discussion
Risk classification using Cog_Vol at an optimal value was able to detect subjects among those with PET-amyloid-elevated MCI were at greater risk of developing AD and were unlikely to develop AD within 4 years of follow-up.
背景β -淀粉样蛋白升高的人群患阿尔茨海默病的风险和进展速度不同。目的利用ADNI数据验证上海轻度认知障碍（MCI）队列研究中AD的风险分类。方法基于新参数Cog_Vol的几个最优截断点对MCI患者AD的风险进行分类。结果共纳入843例轻度认知损伤患者，其中PET - β淀粉样蛋白升高220例。所有受试者中273例（32.3%）和70例（31.8%）进展为AD， PET β淀粉样蛋白升高的受试者中分别有273例（32.3%）和70例（31.8%）进展为AD。Cog_Vol >；340的受试者患AD的风险非常低，而Cog_Vol < 101的受试者在随访4年内患AD的风险非常高。使用Cog_Vol的最佳值进行风险分类能够检测出pet -淀粉样蛋白升高的MCI患者患AD的风险更高，并且在随访4年内不太可能患AD。
{"title":"Differential risk of Alzheimer's disease in MCI subjects with elevated Abeta","authors":"Bin Zhou, Masanori Fukushima, The Alzheimer's Disease Neuroimaging Initiative","doi":"10.1016/j.jns.2024.123319","DOIUrl":"10.1016/j.jns.2024.123319","url":null,"abstract":"<div><h3>Backgrounds</h3><div>People with elevated beta amyloid have different risk and progress speed to Alzheimer's disease.</div></div><div><h3>Purpose</h3><div>The research is to validate the risk classification of AD developed in the Shanghai mild cognitive impairment (MCI) cohort study using ADNI data.</div></div><div><h3>Methods</h3><div>The risk classification of AD in MCI was based on several optimal cut-off points of a novel parameter Cog_Vol.</div></div><div><h3>Results</h3><div>In total, 843 subjects with MCI were included, of whom 220 had elevated PET beta amyloid. 273 (32.3 %) and 70 (31.8 %) progressed to AD in all subjects and in those with elevated PET beta amyloid, respectively. The risk of AD in subjects whose Cog_Vol >340 was very low, while the risk for those with Cog_Vol less than 101 indicated a super high within 4 years of follow-up.</div></div><div><h3>Discussion</h3><div>Risk classification using Cog_Vol at an optimal value was able to detect subjects among those with PET-amyloid-elevated MCI were at greater risk of developing AD and were unlikely to develop AD within 4 years of follow-up.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"467 ","pages":"Article 123319"},"PeriodicalIF":3.6,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748065","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}
Pub Date : 2024-11-22DOI: 10.1016/j.jns.2024.123322
Cynthia Z. Qi , Yilu Lin , Yuebing Li , Tuan Vu , Femke De Ruyck , Deborah Gelinas , Lizheng Shi
Purpose
This retrospective cohort study describes the characteristics of patients with myasthenia gravis (MG) who developed exacerbations (MG-E) and compares their healthcare utilization (HRU) to patients who did not experience exacerbations (MG-O).
Method
De-identified data from patients who had ≥2 MG-related diagnostic code submissions were extracted from the National Veterans Affairs Health Care Network electronic health records between 1999 and 2022. Descriptive statistics, Kaplan-Meier analysis, and per-patient per-year (PPPY) HRU were used to compare the two patient groups.
Results
About 34 % (3603/10,718) of patients with MG developed exacerbations over a median follow-up of 6.8 years. Approximately 52 % of the MG-E cohort had 3 or more exacerbations over the study period, averaging 1.34 (SD 2.50) exacerbations per year. The MG-E cohort had a higher incidence of early-onset MG (7.72 % vs. 4.05 %; p < 0.0001) and higher mean Charlson Comorbidity Index scores before a diagnosis of MG (0.86 vs. 0.59; p < 0.0001). Relative to patients of other racial groups with MG-E, Hispanic and African Americans had higher cumulative incidence of exacerbations over time (p < 0.0001). Additionally, MG-E patients were five times more likely to be intubated compared to MG-O patients (p < 0.0001). Increased PPPY HRU was observed in patients with MG-E compared to patients with MG-O (outpatient visit: 25.05 vs. 14.08; inpatient admission: 0.47 vs. 0.14; ED visit: 0.69 vs. 0.26; ICU stay: 0.08 vs. 0.02, respectively; p < 0.001).
Conclusion
Approximately one-third of patients diagnosed with MG experienced exacerbations, with higher incidences seen among Hispanic and African Americans. MG-E was associated with higher HRU and a higher intubation risk.
目的：本回顾性队列研究描述了重症肌无力（MG）患者发生加重（MG- e）的特征，并比较了他们的医疗保健利用率（HRU）与未发生加重（MG- o）的患者。方法从1999年至2022年的国家退伍军人事务卫生保健网络电子健康记录中提取≥2例mg相关诊断代码提交的患者的识别数据。采用描述性统计、Kaplan-Meier分析和人均年HRU （PPPY）对两组患者进行比较。结果在中位随访6.8年期间，约34% (3603/10,718)MG患者出现加重。大约52%的MG-E队列在研究期间有3次或3次以上的加重，平均每年加重1.34次（标准差2.50）。MG- e组早发性MG发生率较高(7.72% vs 4.05%；p & lt;0.0001)和MG诊断前较高的Charlson共病指数(0.86 vs 0.59；p & lt;0.0001)。相对于其他种族的MG-E患者，西班牙裔和非裔美国人随着时间的推移有更高的累积恶化发生率(p <；0.0001)。此外，MG-E患者插管的可能性是MG-O患者的5倍(p <；0.0001)。MG-E患者与MG-O患者相比，PPPY HRU升高(门诊访问量：25.05 vs 14.08；住院率：0.47 vs. 0.14；ED访视：0.69 vs 0.26；ICU住院时间：分别为0.08 vs 0.02；p & lt;0.001)。结论：大约三分之一被诊断为MG的患者经历了急性发作，其中西班牙裔和非裔美国人的发病率更高。MG-E与较高的HRU和插管风险相关。
{"title":"Characteristics and healthcare utilization of patients with myasthenia gravis exacerbation","authors":"Cynthia Z. Qi , Yilu Lin , Yuebing Li , Tuan Vu , Femke De Ruyck , Deborah Gelinas , Lizheng Shi","doi":"10.1016/j.jns.2024.123322","DOIUrl":"10.1016/j.jns.2024.123322","url":null,"abstract":"<div><h3>Purpose</h3><div>This retrospective cohort study describes the characteristics of patients with myasthenia gravis (MG) who developed exacerbations (MG-E) and compares their healthcare utilization (HRU) to patients who did not experience exacerbations (MG-O).</div></div><div><h3>Method</h3><div>De-identified data from patients who had ≥2 MG-related diagnostic code submissions were extracted from the National Veterans Affairs Health Care Network electronic health records between 1999 and 2022. Descriptive statistics, Kaplan-Meier analysis, and per-patient per-year (PPPY) HRU were used to compare the two patient groups.</div></div><div><h3>Results</h3><div>About 34 % (3603/10,718) of patients with MG developed exacerbations over a median follow-up of 6.8 years. Approximately 52 % of the MG-E cohort had 3 or more exacerbations over the study period, averaging 1.34 (SD 2.50) exacerbations per year. The MG-E cohort had a higher incidence of early-onset MG (7.72 % vs. 4.05 %; <em>p</em> < 0.0001) and higher mean Charlson Comorbidity Index scores before a diagnosis of MG (0.86 vs. 0.59; <em>p</em> < 0.0001). Relative to patients of other racial groups with MG-E, Hispanic and African Americans had higher cumulative incidence of exacerbations over time (<em>p</em> < 0.0001). Additionally, MG-E patients were five times more likely to be intubated compared to MG-O patients (<em>p</em> < 0.0001). Increased PPPY HRU was observed in patients with MG-E compared to patients with MG-O (outpatient visit: 25.05 vs. 14.08; inpatient admission: 0.47 vs. 0.14; ED visit: 0.69 vs. 0.26; ICU stay: 0.08 vs. 0.02, respectively; <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Approximately one-third of patients diagnosed with MG experienced exacerbations, with higher incidences seen among Hispanic and African Americans. MG-E was associated with higher HRU and a higher intubation risk.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"468 ","pages":"Article 123322"},"PeriodicalIF":3.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745008","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}
Given the opposing properties of uric acid (UA), which are intracellular prooxidant action and extracellular antioxidant action, the association of circulating UA levels with dementia remains controversial. We aimed to ascertain whether both lower and higher plasma UA levels are associated with the risk of incident dementia among middle-aged and older population.
Methods
1685 participants (530 men and 1155 women) aged 40–69 years at baseline (1990–1993) were randomly selected for plasma UA measurement from base cohort participants who responded to the baseline questionnaire and provided blood samples. They were followed for dementia (disabling dementia requiring care; hereinafter dementia) from 2006 to 2016 using certification records for national long-term care insurance in Japan. A Cox proportional hazards model adjusted for various lifestyle factors and past medical history (cardiometabolic disease) was applied for overall participants and sex.
Results
Dementia was diagnosed in 240 participants (14.2 % overall: 16.0 % in men and 13.4 % in women). No statistically significant association with plasma UA was found in overall participants. Compared to participants with UA of 5.1–6.0 mg/dL, men with ≥6.1 mg/dL showed fully adjusted hazard ratios of 1.46 (95 % confidence interval: 0.78–2.75) for 6.1–7.0 mg/dL and 1.89 (0.97–3.66) for ≥7.1 mg/dL, while women with ≥6.1 mg/dL showed 1.13 (0.54–2.38).
Conclusions
No statistically significant association between plasma UA level and risk of dementia was found in overall participants or by sex.
{"title":"Plasma uric acid levels and risk of dementia in a population-based cohort study","authors":"Yoko Shimizu , Taiki Yamaji , Manami Inoue , Nobufumi Yasuda , Kazumasa Yamagishi , Norie Sawada , Shoichiro Tsugane , Motoki Iwasaki","doi":"10.1016/j.jns.2024.123323","DOIUrl":"10.1016/j.jns.2024.123323","url":null,"abstract":"<div><h3>Background</h3><div>Given the opposing properties of uric acid (UA), which are intracellular prooxidant action and extracellular antioxidant action, the association of circulating UA levels with dementia remains controversial. We aimed to ascertain whether both lower and higher plasma UA levels are associated with the risk of incident dementia among middle-aged and older population.</div></div><div><h3>Methods</h3><div>1685 participants (530 men and 1155 women) aged 40–69 years at baseline (1990–1993) were randomly selected for plasma UA measurement from base cohort participants who responded to the baseline questionnaire and provided blood samples. They were followed for dementia (disabling dementia requiring care; hereinafter dementia) from 2006 to 2016 using certification records for national long-term care insurance in Japan. A Cox proportional hazards model adjusted for various lifestyle factors and past medical history (cardiometabolic disease) was applied for overall participants and sex.</div></div><div><h3>Results</h3><div>Dementia was diagnosed in 240 participants (14.2 % overall: 16.0 % in men and 13.4 % in women). No statistically significant association with plasma UA was found in overall participants. Compared to participants with UA of 5.1–6.0 mg/dL, men with ≥6.1 mg/dL showed fully adjusted hazard ratios of 1.46 (95 % confidence interval: 0.78–2.75) for 6.1–7.0 mg/dL and 1.89 (0.97–3.66) for ≥7.1 mg/dL, while women with ≥6.1 mg/dL showed 1.13 (0.54–2.38).</div></div><div><h3>Conclusions</h3><div>No statistically significant association between plasma UA level and risk of dementia was found in overall participants or by sex.</div></div>","PeriodicalId":17417,"journal":{"name":"Journal of the Neurological Sciences","volume":"467 ","pages":"Article 123323"},"PeriodicalIF":3.6,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142748063","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}
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