Pub Date : 2024-11-15DOI: 10.1038/s41582-024-01035-w
David J. Seiffge, Simon Fandler-Höfler, Yang Du, Martina B. Goeldlin, Wilmar M. T. Jolink, Catharina J. M. Klijn, David J. Werring
Intracerebral haemorrhage (ICH) is a devastating condition associated with high mortality and substantial residual disability among survivors. Effective treatments for the acute stages of ICH are limited. However, promising findings from randomized trials of therapeutic strategies, including acute care bundles that target anticoagulation therapies, blood pressure control and other physiological parameters, and trials of minimally invasive neurosurgical procedures have led to renewed optimism that patient outcomes can be improved. Currently ongoing areas of research for acute treatment include anti-inflammatory and haemostatic treatments. The implementation of effective secondary prevention strategies requires an understanding of the aetiology of ICH, which involves vascular and brain parenchymal imaging; the use of neuroimaging markers of cerebral small vessel disease improves classification with prognostic relevance. Other data underline the importance of preventing not only recurrent ICH but also ischaemic stroke and cardiovascular events in survivors of ICH. Ongoing and planned randomized controlled trials will assess the efficacy of prevention strategies, including antiplatelet agents, oral anticoagulants or left atrial appendage occlusion (in patients with concomitant atrial fibrillation), and optimal management of long-term blood pressure and statin use. Together, these advances herald a new era of improved understanding and effective interventions to reduce the burden of ICH. Effective treatments for the acute stages of intracerebral haemorrhage are currently limited. In this Review, the authors consider advances in therapeutic strategies and neurosurgical procedures, including acute care bundles, that promise a new era of interventions.
脑内出血（ICH）是一种破坏性疾病，死亡率高，幸存者会留下严重残疾。针对 ICH 急性期的有效治疗方法非常有限。然而，治疗策略随机试验（包括针对抗凝疗法、血压控制和其他生理参数的急性期护理捆绑疗法）和微创神经外科手术试验取得了令人鼓舞的结果，使人们对改善患者预后重新燃起了乐观的希望。目前正在进行的急性期治疗研究领域包括抗炎和止血治疗。要实施有效的二级预防策略，就必须了解 ICH 的病因，这涉及血管和脑实质成像；使用脑小血管疾病的神经成像标志物可改善与预后相关的分类。其他数据强调，不仅要预防复发性 ICH，还要预防 ICH 存活者发生缺血性中风和心血管事件。正在进行和计划进行的随机对照试验将评估预防策略的效果，包括抗血小板药物、口服抗凝剂或左心房阑尾闭塞术（适用于合并心房颤动的患者），以及对长期血压和他汀类药物使用的优化管理。这些进展共同预示着一个新时代的到来，人们可以更好地了解并采取有效的干预措施来减轻 ICH 的负担。
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Pub Date : 2024-11-13DOI: 10.1038/s41582-024-01037-8
Lisa Kiani
{"title":"High prevalence of hepatitis B in NMOSD","authors":"Lisa Kiani","doi":"10.1038/s41582-024-01037-8","DOIUrl":"10.1038/s41582-024-01037-8","url":null,"abstract":"","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"20 12","pages":"692-692"},"PeriodicalIF":28.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601158","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 : 2024-11-13DOI: 10.1038/s41582-024-01044-9
Ian Fyfe
Sex differences in Alzheimer disease could be influenced by differences in immune responses, new research suggests.
新研究表明，阿尔茨海默病的性别差异可能受到免疫反应差异的影响。
{"title":"Immune responses influence sex differences in Alzheimer disease","authors":"Ian Fyfe","doi":"10.1038/s41582-024-01044-9","DOIUrl":"10.1038/s41582-024-01044-9","url":null,"abstract":"Sex differences in Alzheimer disease could be influenced by differences in immune responses, new research suggests.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"20 12","pages":"691-691"},"PeriodicalIF":28.2,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601159","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}
Parkinson disease (PD) is the fastest growing neurological disorder globally and poses substantial management challenges owing to progressive disability, emergence of levodopa-resistant symptoms, and treatment-related complications. In this Review, we examine the current state of research into PD therapies and outline future priorities for advancing our understanding and treatment of the disease. We identify two main research priorities for the coming years: first, slowing the progression of the disease through the integration of sensitive biomarkers and targeted biological therapies, and second, enhancing existing symptomatic treatments, encompassing surgical and infusion therapies, with the goal of postponing complications and improving long-term patient management. The path towards disease modification is impeded by the multifaceted pathophysiology and diverse mechanisms underlying PD. Ongoing studies are directed at α-synuclein aggregation, complemented by efforts to address specific pathways associated with the less common genetic forms of the disease. The success of these efforts relies on establishing robust end points, incorporating technology, and identifying reliable biomarkers for early diagnosis and continuous monitoring of disease progression. In the context of symptomatic treatment, the focus should shift towards refining existing approaches and fostering the development of novel therapeutic strategies that target levodopa-resistant symptoms and clinical manifestations that substantially impair quality of life. Parkinson disease (PD) poses substantial management challenges owing to progressive disability and emergence of levodopa-resistant symptoms and treatment-related complications. This Review examines the current state of research into symptomatic and disease-modifying PD therapies and outlines future priorities for advancing our understanding and treatment of the disease.
{"title":"Parkinson disease therapy: current strategies and future research priorities","authors":"Fabrizio Stocchi, Daniele Bravi, Aron Emmi, Angelo Antonini","doi":"10.1038/s41582-024-01034-x","DOIUrl":"10.1038/s41582-024-01034-x","url":null,"abstract":"Parkinson disease (PD) is the fastest growing neurological disorder globally and poses substantial management challenges owing to progressive disability, emergence of levodopa-resistant symptoms, and treatment-related complications. In this Review, we examine the current state of research into PD therapies and outline future priorities for advancing our understanding and treatment of the disease. We identify two main research priorities for the coming years: first, slowing the progression of the disease through the integration of sensitive biomarkers and targeted biological therapies, and second, enhancing existing symptomatic treatments, encompassing surgical and infusion therapies, with the goal of postponing complications and improving long-term patient management. The path towards disease modification is impeded by the multifaceted pathophysiology and diverse mechanisms underlying PD. Ongoing studies are directed at α-synuclein aggregation, complemented by efforts to address specific pathways associated with the less common genetic forms of the disease. The success of these efforts relies on establishing robust end points, incorporating technology, and identifying reliable biomarkers for early diagnosis and continuous monitoring of disease progression. In the context of symptomatic treatment, the focus should shift towards refining existing approaches and fostering the development of novel therapeutic strategies that target levodopa-resistant symptoms and clinical manifestations that substantially impair quality of life. Parkinson disease (PD) poses substantial management challenges owing to progressive disability and emergence of levodopa-resistant symptoms and treatment-related complications. This Review examines the current state of research into symptomatic and disease-modifying PD therapies and outlines future priorities for advancing our understanding and treatment of the disease.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"20 12","pages":"695-707"},"PeriodicalIF":28.2,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142574393","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 : 2024-10-25DOI: 10.1038/s41582-024-01033-y
Mathias Holsey Gramkow, Gunhild Waldemar, Kristian Steen Frederiksen
Several major challenges, including an ageing population and declining workforce and the implementation of recent breakthrough therapies for Alzheimer disease, are prompting a necessary rethink of how people with neurodegenerative dementias are diagnosed and medically managed. Digital health technologies could play a pivotal part in this transformation, with new advances enabling the collection of millions of data points from a single individual. Possible applications include unobtrusive monitoring that aids early detection of disease and artificial intelligence-based health advice. To translate these advances to meaningful benefits for people living with a disease, technologies must be implemented within a system that retains the physician expert as a central figure in decision-making. This Perspective presents a new framework, termed the Digitized Memory Clinic, for the diagnostic pathway of neurodegenerative dementias that incorporates digital health technologies with currently available assessment tools, such as fluid and imaging biomarkers, in an interplay with the physician. The Digitized Memory Clinic will manage people across the entire disease spectrum, from the detection of risk factors for cognitive decline and the earliest symptoms to dementia, and will replace the present paradigm of a pure ‘brick-and-mortar’ memory clinic. Important ethical, legal and societal barriers associated with the implementation of digital health technologies in memory clinics need to be addressed. The envisioned Digitized Memory Clinic aims to improve diagnostics and enable precise disease-tracking prognostication for individuals with memory disorders and to open new possibilities, such as precision medicine for prevention and treatment. In this Perspective, the authors present the Digitized Memory Clinic, a new framework for the diagnostic pathway of neurodegenerative dementias that incorporates digital health technologies with currently available assessment tools, such as fluid and imaging biomarkers, in an interplay with the physician.
{"title":"The Digitized Memory Clinic","authors":"Mathias Holsey Gramkow, Gunhild Waldemar, Kristian Steen Frederiksen","doi":"10.1038/s41582-024-01033-y","DOIUrl":"10.1038/s41582-024-01033-y","url":null,"abstract":"Several major challenges, including an ageing population and declining workforce and the implementation of recent breakthrough therapies for Alzheimer disease, are prompting a necessary rethink of how people with neurodegenerative dementias are diagnosed and medically managed. Digital health technologies could play a pivotal part in this transformation, with new advances enabling the collection of millions of data points from a single individual. Possible applications include unobtrusive monitoring that aids early detection of disease and artificial intelligence-based health advice. To translate these advances to meaningful benefits for people living with a disease, technologies must be implemented within a system that retains the physician expert as a central figure in decision-making. This Perspective presents a new framework, termed the Digitized Memory Clinic, for the diagnostic pathway of neurodegenerative dementias that incorporates digital health technologies with currently available assessment tools, such as fluid and imaging biomarkers, in an interplay with the physician. The Digitized Memory Clinic will manage people across the entire disease spectrum, from the detection of risk factors for cognitive decline and the earliest symptoms to dementia, and will replace the present paradigm of a pure ‘brick-and-mortar’ memory clinic. Important ethical, legal and societal barriers associated with the implementation of digital health technologies in memory clinics need to be addressed. The envisioned Digitized Memory Clinic aims to improve diagnostics and enable precise disease-tracking prognostication for individuals with memory disorders and to open new possibilities, such as precision medicine for prevention and treatment. In this Perspective, the authors present the Digitized Memory Clinic, a new framework for the diagnostic pathway of neurodegenerative dementias that incorporates digital health technologies with currently available assessment tools, such as fluid and imaging biomarkers, in an interplay with the physician.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"20 12","pages":"738-746"},"PeriodicalIF":28.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142489365","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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