Pub Date : 2024-02-02DOI: 10.1038/s41582-024-00929-z
David M. Greer, Ariane Lewis, Matthew P. Kirschen
The declaration of brain death (BD), or death by neurological criteria (DNC), is medically and legally accepted throughout much of the world. However, inconsistencies in national and international policies have prompted efforts to harmonize practice and central concepts, both between and within countries. The World Brain Death Project was published in 2020, followed by notable revisions to the Canadian and US guidelines in 2023. The mission of these initiatives was to ensure accurate and conservative determination of BD/DNC, as false-positive determinations could have major negative implications for the medical field and the public’s trust in our ability to accurately declare death. In this Review, we review the changes that were introduced in the 2023 US BD/DNC guidelines and consider how these guidelines compare with those formulated in Canada and elsewhere in the world. We address controversies in BD/DNC determination, including neuroendocrine function, consent and accommodation of objections, summarize the legal status of BD/DNC internationally and discuss areas for further BD/DNC research. This Review reviews changes introduced into the US brain death/death by neurological criteria (BD/DNC) guidelines in 2023 and compares these guidelines with those formulated elsewhere in the world. The authors highlight controversies and legal challenges in BD/DNC determination and discuss future research priorities.
{"title":"New developments in guidelines for brain death/death by neurological criteria","authors":"David M. Greer, Ariane Lewis, Matthew P. Kirschen","doi":"10.1038/s41582-024-00929-z","DOIUrl":"10.1038/s41582-024-00929-z","url":null,"abstract":"The declaration of brain death (BD), or death by neurological criteria (DNC), is medically and legally accepted throughout much of the world. However, inconsistencies in national and international policies have prompted efforts to harmonize practice and central concepts, both between and within countries. The World Brain Death Project was published in 2020, followed by notable revisions to the Canadian and US guidelines in 2023. The mission of these initiatives was to ensure accurate and conservative determination of BD/DNC, as false-positive determinations could have major negative implications for the medical field and the public’s trust in our ability to accurately declare death. In this Review, we review the changes that were introduced in the 2023 US BD/DNC guidelines and consider how these guidelines compare with those formulated in Canada and elsewhere in the world. We address controversies in BD/DNC determination, including neuroendocrine function, consent and accommodation of objections, summarize the legal status of BD/DNC internationally and discuss areas for further BD/DNC research. This Review reviews changes introduced into the US brain death/death by neurological criteria (BD/DNC) guidelines in 2023 and compares these guidelines with those formulated elsewhere in the world. The authors highlight controversies and legal challenges in BD/DNC determination and discuss future research priorities.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":null,"pages":null},"PeriodicalIF":38.1,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139659971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-23DOI: 10.1038/s41582-024-00930-6
Maria C. Carrillo, Simin Mahinrad
An analysis based on datasets from four studies of memory and ageing reveals differences in the relationship of cognition with cerebrospinal fluid, but not imaging, biomarkers for Alzheimer disease between self-identified Black and White participants. These findings highlight the importance of precision medicine to address Alzheimer disease disparities across diverse populations. A study now reveals that CSF, but not imaging, biomarkers for Alzheimer disease show weaker correlation to cognitive measures in Black people than in White people. The findings offer insights into Alzheimer disease biomarker utility across racially diverse groups.
{"title":"Navigating complexities of racial disparities in Alzheimer disease biomarkers","authors":"Maria C. Carrillo, Simin Mahinrad","doi":"10.1038/s41582-024-00930-6","DOIUrl":"10.1038/s41582-024-00930-6","url":null,"abstract":"An analysis based on datasets from four studies of memory and ageing reveals differences in the relationship of cognition with cerebrospinal fluid, but not imaging, biomarkers for Alzheimer disease between self-identified Black and White participants. These findings highlight the importance of precision medicine to address Alzheimer disease disparities across diverse populations. A study now reveals that CSF, but not imaging, biomarkers for Alzheimer disease show weaker correlation to cognitive measures in Black people than in White people. The findings offer insights into Alzheimer disease biomarker utility across racially diverse groups.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":null,"pages":null},"PeriodicalIF":38.1,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139542852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-16DOI: 10.1038/s41582-023-00920-0
R. Ryan Darby, Ciaran Considine, Robert Weinstock, William C. Darby
Neurological evidence is increasingly used in criminal cases to argue that a defendant is less responsible for their behaviour, is not competent to stand trial or should receive a reduced punishment for the crime. Unfortunately, neurologists are rarely involved in such cases despite having the expertise to help to inform these decisions in court. In this Perspective, we advocate for the development of ‘forensic neurology’, a subspecialty of neurology focused on using neurological clinical and scientific expertise to address legal questions for the criminal justice system. We review literature suggesting that the incidence of criminal behaviour is higher in people with certain neurological disorders than the general public and that undiagnosed neurological abnormalities are common in people who commit crimes. We discuss the need for forensic neurologists in criminal cases to provide an opinion on what neurological diagnoses are present, the resulting symptoms and ultimately whether the symptoms affect legal determinations such as criminal responsibility or competency. In this Perspective, the authors discuss the need for neurologists to assist in court cases involving criminal behaviour that was potentially influenced by a neurological disorder. The authors review evidence linking neurological disorders with criminal activity, and advocate for the development of forensic neurology as a subspecialty of the field.
{"title":"Forensic neurology: a distinct subspecialty at the intersection of neurology, neuroscience and law","authors":"R. Ryan Darby, Ciaran Considine, Robert Weinstock, William C. Darby","doi":"10.1038/s41582-023-00920-0","DOIUrl":"10.1038/s41582-023-00920-0","url":null,"abstract":"Neurological evidence is increasingly used in criminal cases to argue that a defendant is less responsible for their behaviour, is not competent to stand trial or should receive a reduced punishment for the crime. Unfortunately, neurologists are rarely involved in such cases despite having the expertise to help to inform these decisions in court. In this Perspective, we advocate for the development of ‘forensic neurology’, a subspecialty of neurology focused on using neurological clinical and scientific expertise to address legal questions for the criminal justice system. We review literature suggesting that the incidence of criminal behaviour is higher in people with certain neurological disorders than the general public and that undiagnosed neurological abnormalities are common in people who commit crimes. We discuss the need for forensic neurologists in criminal cases to provide an opinion on what neurological diagnoses are present, the resulting symptoms and ultimately whether the symptoms affect legal determinations such as criminal responsibility or competency. In this Perspective, the authors discuss the need for neurologists to assist in court cases involving criminal behaviour that was potentially influenced by a neurological disorder. The authors review evidence linking neurological disorders with criminal activity, and advocate for the development of forensic neurology as a subspecialty of the field.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":null,"pages":null},"PeriodicalIF":38.1,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139474306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-16DOI: 10.1038/s41582-024-00928-0
Sam Nightingale, Paola Cinque, Ameet Dravid, Anna J. Dreyer, Magnus Gisslén, John A. Joska, Judith Kwasa, Ana-Claire Meyer, Nombeko Mpongo, Noeline Nakasujja, Roger Pebody, Anton Pozniak, Richard W. Price, Deanna Saylor, Kevin G. F. Thomas, Jonathan Underwood, Jaime H. Vera, Alan Winston
{"title":"Reply to ‘Cognitive criteria in HIV: greater consensus is needed’","authors":"Sam Nightingale, Paola Cinque, Ameet Dravid, Anna J. Dreyer, Magnus Gisslén, John A. Joska, Judith Kwasa, Ana-Claire Meyer, Nombeko Mpongo, Noeline Nakasujja, Roger Pebody, Anton Pozniak, Richard W. Price, Deanna Saylor, Kevin G. F. Thomas, Jonathan Underwood, Jaime H. Vera, Alan Winston","doi":"10.1038/s41582-024-00928-0","DOIUrl":"10.1038/s41582-024-00928-0","url":null,"abstract":"","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":null,"pages":null},"PeriodicalIF":38.1,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41582-024-00928-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139479014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-16DOI: 10.1038/s41582-024-00927-1
Lucette A. Cysique, Bruce J. Brew, Jane Bruning, Desiree Byrd, Jane Costello, Kirstie Daken, Ronald J. Ellis, Pariya L. Fazeli, Karl Goodkin, Hetta Gouse, Robert K. Heaton, Scott Letendre, Jules Levin, Htein Linn Aung, Monica Rivera Mindt, David Moore, Amy B. Mullens, Sérgio Monteiro de Almeida, Jose A. Muñoz-Moreno, Chrispher Power, Reuben N. Robbins, John Rule, Reena Rajasuriar, Micah J. Savin, Jeff Taylor, Mattia Trunfio, David E. Vance, Pui Li Wong, Steven P. Woods, Edwina J. Wright, Sean B. Rourke
{"title":"Cognitive criteria in HIV: greater consensus is needed","authors":"Lucette A. Cysique, Bruce J. Brew, Jane Bruning, Desiree Byrd, Jane Costello, Kirstie Daken, Ronald J. Ellis, Pariya L. Fazeli, Karl Goodkin, Hetta Gouse, Robert K. Heaton, Scott Letendre, Jules Levin, Htein Linn Aung, Monica Rivera Mindt, David Moore, Amy B. Mullens, Sérgio Monteiro de Almeida, Jose A. Muñoz-Moreno, Chrispher Power, Reuben N. Robbins, John Rule, Reena Rajasuriar, Micah J. Savin, Jeff Taylor, Mattia Trunfio, David E. Vance, Pui Li Wong, Steven P. Woods, Edwina J. Wright, Sean B. Rourke","doi":"10.1038/s41582-024-00927-1","DOIUrl":"10.1038/s41582-024-00927-1","url":null,"abstract":"","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":null,"pages":null},"PeriodicalIF":38.1,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41582-024-00927-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139479012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-16DOI: 10.1038/s41582-023-00921-z
Morgan L. Prust, Rachel Forman, Bruce Ovbiagele
Stroke is the second leading cause of death and the third leading cause of disability worldwide. Though the burden of stroke worldwide seems to have declined in the past three decades, much of this effect reflects decreases in high-income countries (HICs). By contrast, the burden of stroke has grown rapidly in low-income and middle-income countries (LMICs), where epidemiological, socioeconomic and demographic shifts have increased the incidence of stroke and other non-communicable diseases. Furthermore, even in HICs, disparities in stroke epidemiology exist along racial, ethnic, socioeconomic and geographical lines. In this Review, we highlight the under-acknowledged disparities in the burden of stroke. We emphasize the shifting global landscape of stroke risk factors, critical gaps in stroke service delivery, and the need for a more granular analysis of the burden of stroke within and between LMICs and HICs to guide context-appropriate capacity-building. Finally, we review strategies for addressing key inequalities in stroke epidemiology, including improvements in epidemiological surveillance and context-specific research efforts in under-resourced regions, development of the global workforce of stroke care providers, expansion of access to preventive and treatment services through mobile and telehealth platforms, and scaling up of evidence-based strategies and policies that target local, national, regional and global stroke disparities. Though the burden of stroke has declined, it has grown rapidly in low-income and middle-income countries, and disparities still exist within high-income countries. In this Review, the authors highlight under-acknowledged disparities in the burden of stroke and review strategies for addressing key inequalities.
{"title":"Addressing disparities in the global epidemiology of stroke","authors":"Morgan L. Prust, Rachel Forman, Bruce Ovbiagele","doi":"10.1038/s41582-023-00921-z","DOIUrl":"10.1038/s41582-023-00921-z","url":null,"abstract":"Stroke is the second leading cause of death and the third leading cause of disability worldwide. Though the burden of stroke worldwide seems to have declined in the past three decades, much of this effect reflects decreases in high-income countries (HICs). By contrast, the burden of stroke has grown rapidly in low-income and middle-income countries (LMICs), where epidemiological, socioeconomic and demographic shifts have increased the incidence of stroke and other non-communicable diseases. Furthermore, even in HICs, disparities in stroke epidemiology exist along racial, ethnic, socioeconomic and geographical lines. In this Review, we highlight the under-acknowledged disparities in the burden of stroke. We emphasize the shifting global landscape of stroke risk factors, critical gaps in stroke service delivery, and the need for a more granular analysis of the burden of stroke within and between LMICs and HICs to guide context-appropriate capacity-building. Finally, we review strategies for addressing key inequalities in stroke epidemiology, including improvements in epidemiological surveillance and context-specific research efforts in under-resourced regions, development of the global workforce of stroke care providers, expansion of access to preventive and treatment services through mobile and telehealth platforms, and scaling up of evidence-based strategies and policies that target local, national, regional and global stroke disparities. Though the burden of stroke has declined, it has grown rapidly in low-income and middle-income countries, and disparities still exist within high-income countries. In this Review, the authors highlight under-acknowledged disparities in the burden of stroke and review strategies for addressing key inequalities.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":null,"pages":null},"PeriodicalIF":38.1,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139478918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-15DOI: 10.1038/s41582-023-00918-8
Javier Pagonabarraga, Helena Bejr-Kasem, Saul Martinez-Horta, Jaime Kulisevsky
Parkinson disease (PD) psychosis (PDP) is a spectrum of illusions, hallucinations and delusions that are associated with PD throughout its disease course. Psychotic phenomena can manifest from the earliest stages of PD and might follow a continuum from minor hallucinations to structured hallucinations and delusions. Initially, PDP was considered to be a complication associated with dopaminergic drug use. However, subsequent research has provided evidence that PDP arises from the progression of brain alterations caused by PD itself, coupled with the use of dopaminergic drugs. The combined dysfunction of attentional control systems, sensory processing, limbic structures, the default mode network and thalamocortical connections provides a conceptual framework to explain how new incoming stimuli are incorrectly categorized, and how aberrant hierarchical predictive processing can produce false percepts that intrude into the stream of consciousness. The past decade has seen the publication of new data on the phenomenology and neurobiological basis of PDP from the initial stages of the disease, as well as the neurotransmitter systems involved in PDP initiation and progression. In this Review, we discuss the latest clinical, neuroimaging and neurochemical evidence that could aid early identification of psychotic phenomena in PD and inform the discovery of new therapeutic targets and strategies. Parkinson disease psychosis comprises a spectrum of illusions, hallucinations and delusions that emerge during the disease course. This Review considers clinical, neuroimaging and neurochemical evidence that might aid early identification of psychotic phenomena in people with Parkinson disease and inform new therapeutic strategies.
{"title":"Parkinson disease psychosis: from phenomenology to neurobiological mechanisms","authors":"Javier Pagonabarraga, Helena Bejr-Kasem, Saul Martinez-Horta, Jaime Kulisevsky","doi":"10.1038/s41582-023-00918-8","DOIUrl":"10.1038/s41582-023-00918-8","url":null,"abstract":"Parkinson disease (PD) psychosis (PDP) is a spectrum of illusions, hallucinations and delusions that are associated with PD throughout its disease course. Psychotic phenomena can manifest from the earliest stages of PD and might follow a continuum from minor hallucinations to structured hallucinations and delusions. Initially, PDP was considered to be a complication associated with dopaminergic drug use. However, subsequent research has provided evidence that PDP arises from the progression of brain alterations caused by PD itself, coupled with the use of dopaminergic drugs. The combined dysfunction of attentional control systems, sensory processing, limbic structures, the default mode network and thalamocortical connections provides a conceptual framework to explain how new incoming stimuli are incorrectly categorized, and how aberrant hierarchical predictive processing can produce false percepts that intrude into the stream of consciousness. The past decade has seen the publication of new data on the phenomenology and neurobiological basis of PDP from the initial stages of the disease, as well as the neurotransmitter systems involved in PDP initiation and progression. In this Review, we discuss the latest clinical, neuroimaging and neurochemical evidence that could aid early identification of psychotic phenomena in PD and inform the discovery of new therapeutic targets and strategies. Parkinson disease psychosis comprises a spectrum of illusions, hallucinations and delusions that emerge during the disease course. This Review considers clinical, neuroimaging and neurochemical evidence that might aid early identification of psychotic phenomena in people with Parkinson disease and inform new therapeutic strategies.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":null,"pages":null},"PeriodicalIF":38.1,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139472731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-11DOI: 10.1038/s41582-023-00917-9
David S. Goldstein
Following on from the COVID-19 pandemic is another worldwide public health challenge that is referred to variously as long COVID, post-COVID syndrome or post-acute sequelae of SARS-CoV-2 infection (PASC). PASC comes in many forms and affects all body organs. This heterogeneous presentation suggests involvement of the autonomic nervous system (ANS), which has numerous roles in the maintenance of homeostasis and coordination of responses to various stressors. Thus far, studies of ANS dysregulation in people with PASC have been largely observational and descriptive, based on symptom inventories or objective but indirect measures of cardiovascular function, and have paid little attention to the adrenomedullary, hormonal and enteric nervous components of the ANS. Such investigations do not consider the syndromic nature of autonomic dysfunction. This Review provides an update on the literature relating to ANS abnormalities in people with post-COVID syndrome and presents a theoretical perspective on how the ANS might participate in common features of PASC. Autonomic nervous system dysregulation contributes to the chronic, debilitating disorders referred to as ‘long COVID’ or post-acute sequelae of SARS-CoV-2 infection (PASC). Here, Goldstein describes a multisystem, multidisciplinary approach to understanding PASC-induced alterations in feedback-regulated, plastic networks that determine homeostasis and allostasis.
{"title":"Post-COVID dysautonomias: what we know and (mainly) what we don’t know","authors":"David S. Goldstein","doi":"10.1038/s41582-023-00917-9","DOIUrl":"10.1038/s41582-023-00917-9","url":null,"abstract":"Following on from the COVID-19 pandemic is another worldwide public health challenge that is referred to variously as long COVID, post-COVID syndrome or post-acute sequelae of SARS-CoV-2 infection (PASC). PASC comes in many forms and affects all body organs. This heterogeneous presentation suggests involvement of the autonomic nervous system (ANS), which has numerous roles in the maintenance of homeostasis and coordination of responses to various stressors. Thus far, studies of ANS dysregulation in people with PASC have been largely observational and descriptive, based on symptom inventories or objective but indirect measures of cardiovascular function, and have paid little attention to the adrenomedullary, hormonal and enteric nervous components of the ANS. Such investigations do not consider the syndromic nature of autonomic dysfunction. This Review provides an update on the literature relating to ANS abnormalities in people with post-COVID syndrome and presents a theoretical perspective on how the ANS might participate in common features of PASC. Autonomic nervous system dysregulation contributes to the chronic, debilitating disorders referred to as ‘long COVID’ or post-acute sequelae of SARS-CoV-2 infection (PASC). Here, Goldstein describes a multisystem, multidisciplinary approach to understanding PASC-induced alterations in feedback-regulated, plastic networks that determine homeostasis and allostasis.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":null,"pages":null},"PeriodicalIF":38.1,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139419978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-09DOI: 10.1038/s41582-023-00915-x
Kishore Aravind Ravichandran, Michael T. Heneka
Inflammasomes are molecular scaffolds that are activated by damage-associated and pathogen-associated molecular patterns and form a key element of innate immune responses. Consequently, the involvement of inflammasomes in several diseases that are characterized by inflammatory processes, such as multiple sclerosis, is widely appreciated. However, many other neurological conditions, including Alzheimer disease, Parkinson disease, amyotrophic lateral sclerosis, stroke, epilepsy, traumatic brain injury, sepsis-associated encephalopathy and neurological sequelae of COVID-19, all involve persistent inflammation in the brain, and increasing evidence suggests that inflammasome activation contributes to disease progression in these conditions. Understanding the biology and mechanisms of inflammasome activation is, therefore, crucial for the development of inflammasome-targeted therapies for neurological conditions. In this Review, we present the current evidence for and understanding of inflammasome activation in neurological diseases and discuss current and potential interventional strategies that target inflammasome activation to mitigate its pathological consequences. Increasing evidence suggests that inflammasome activation contributes to disease progression in a wide variety of neurological conditions. In this Review, Ravichandran and Heneka discuss current understanding of inflammasome activation in neurological disorders and consider interventional strategies that target inflammasome activation.
{"title":"Inflammasomes in neurological disorders — mechanisms and therapeutic potential","authors":"Kishore Aravind Ravichandran, Michael T. Heneka","doi":"10.1038/s41582-023-00915-x","DOIUrl":"10.1038/s41582-023-00915-x","url":null,"abstract":"Inflammasomes are molecular scaffolds that are activated by damage-associated and pathogen-associated molecular patterns and form a key element of innate immune responses. Consequently, the involvement of inflammasomes in several diseases that are characterized by inflammatory processes, such as multiple sclerosis, is widely appreciated. However, many other neurological conditions, including Alzheimer disease, Parkinson disease, amyotrophic lateral sclerosis, stroke, epilepsy, traumatic brain injury, sepsis-associated encephalopathy and neurological sequelae of COVID-19, all involve persistent inflammation in the brain, and increasing evidence suggests that inflammasome activation contributes to disease progression in these conditions. Understanding the biology and mechanisms of inflammasome activation is, therefore, crucial for the development of inflammasome-targeted therapies for neurological conditions. In this Review, we present the current evidence for and understanding of inflammasome activation in neurological diseases and discuss current and potential interventional strategies that target inflammasome activation to mitigate its pathological consequences. Increasing evidence suggests that inflammasome activation contributes to disease progression in a wide variety of neurological conditions. In this Review, Ravichandran and Heneka discuss current understanding of inflammasome activation in neurological disorders and consider interventional strategies that target inflammasome activation.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":null,"pages":null},"PeriodicalIF":38.1,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139403791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"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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