Neurodegenerative Diseases最新文献

Introduction: People with Parkinson's disease (PwPD) often experience difficulty performing dual-tasks (DT), negatively impacting mobility, fall risk and quality of life. The influence of task complexity on DT performance remains unclear. This study examined the effects of gait complexity and cognitive/speaking task on DT effects (DTE) in PwPD and healthy older adults.

Methods: Forty-one PwPD and eleven healthy older adults completed two gait tasks-straight walking (simple) and figure-8 walking with obstacle crossing (complex)-on a pressure-sensitive walkway, paired with four cognitive/speaking tasks: oral trail making, counting, diadochokinetic task, and spontaneous speech. Each combination was performed three times for 20 seconds. Single-task (ST) and DT performance were assessed for gait parameters (step length, step length coefficient of variation) and cognitive/speaking task response rate. Motor DTE (mDTE), cognitive DTE (cogDTE), combined DTE (cDTE), and modified attention allocation index (mAAI) were calculated. A 2×5 repeated measures ANOVA tested effects of gait complexity and cognitive/speaking task on raw gait metrics, and a 2×4 ANOVA tested effects on DTE metrics.

Results: In PwPD, complex walking resulted in shorter step length and greater step length coefficient of variation compared to simple walking (ps < .001), whereas cognitive/speaking task did not affect raw gait metrics. For DTEs, cognitive/speaking task influenced step length-based mDTE, cDTE, and mAAI (ps < .05) and step length coefficient of variation-based mAAI (p < .05). In healthy older adults, gait complexity led to greater step length coefficient of variation (p < .001) while step length was unchanged. Cognitive/speaking task significantly influenced step length-based cogDTE, cDTE, and mAAI, as well as step length coefficient of variation-based cogDTE and mAAI (ps < .05). No significant interactions were observed.

Conclusion: In PwPD, gait complexity influenced raw gait performance, whereas DTEs were more sensitive to cognitive/speaking task. In healthy older adults, gait complexity primarily affected step length variability, while DTEs were also influenced by cognitive/speaking task. These findings emphasize the value of diverse DT paradigms and the importance of assessing both raw performance and DTEs. Tailoring assessments to include a variety of motor and cognitive challenges may improve sensitivity in evaluating gait and fall risk, supporting more personalized interventions.

Background: Dementia with Lewy Bodies (DLB) is a distinct form of dementia characterized by the accumulation of alpha-synuclein in the brain. Early presentations are often heterogeneous, and the impact of this variability on disease progression remains poorly understood. This study explored the initial clinical presentation of DLB among Peruvian patients and its influence on the clinical course.

Methods: We conducted a retrospective study of patients diagnosed with DLB and Alzheimer's disease (AD) using standard clinical criteria. Cognitive function was assessed using MMSE, INECO Frontal Screening (IFS), and Uniform Data Set (UDS). We classified DLB patients based on their initial symptoms (hallucinations or parkinsonism) and compared their clinical and neuropsychological characteristics. Statistical analyses (ANOVA, chi-squared, Wilcoxon tests, and multivariate linear regression) were used to evaluate group differences and examine how initial symptoms influenced disease progression and cognitive decline.

Results: Forty-six patients with probable DLB between June 2018 and May 2023 were included. The median time from symptom onset to diagnosis was five years. Cognitive symptoms were the most frequent initial presentation, followed by motor and behavioral signs. No significant clinical or neuropsychological differences were found between presentation subgroups at evaluation. Compared to AD patients, those with DLB scored higher on cognitive measures (MMSE, RUDAS) and behavioral symptoms (NPI). Neuropsychological testing revealed DLB patients had more pronounced deficits in visuospatial and executive functions than those with AD.

Conclusions: In our cohort, patients in the cognitive-onset group reached the threshold for dementia more rapidly. However, the initial presenting symptoms did not result in worse severity across specific cognitive or behavioral domains.

Introduction: Task-oriented circuit training (TOCT) is known to improve balance and gait in people with Parkinson's disease. This study aimed to examine whether post-TOCT myofascial release with foam roller (FR) could extend this effect by improving gait parameters, balance performance, and joint range of motion (ROM) in Parkinson's disease (PD).

Methods: The study was conducted in the neurological rehabilitation unit and involved 36 participants with PD who were randomised into an intervention group (IG, n = 18) and a sham group (SG, n = 18). Both groups received TOCT for 3 days and 8 weeks. After exercise, myofascial release was applied to the neck, trunk, and lumbar region using three sets of 60-s FR in both groups. Participants' spatiotemporal gait parameters, balance, cervical, trunk, and ankle dorsiflexion ROM, motor symptoms, stability limits, functional mobility, quality of life, and goal attainment level were assessed before and after the procedure.

Results: Compared with the SG, gait speed, balance, stability limits, dynamic sitting balance, and trunk control improved in the IG; neck, trunk, and ankle ROM increased; and motor symptom severity decreased (p < 0.05). There was no statistically significant difference in quality of life and goal attainment scores between groups (p > 0.05).

Conclusion: FR is an effective method of supporting TOCT to improve gait speed, balance, and ROM in PD. Our findings support the inclusion of myofascial release in PD rehabilitation programmes.

Clinical trial number: NCT05900934 (ClinicalTrials.gov).

Introduction: This study introduces a novel and simple radiomics approach to identify highly sensitive and interpretable imaging biomarkers for tracking Alzheimer's disease (AD) progression using FDG-positron emission tomography (PET) imaging. Our unique focus is on a custom-defined hippocampal-amygdala border region. We hypothesize that this specific small, anatomically and biologically critical, yet underexplored interface region can effectively capture subtle, early stage metabolic deterioration indicative of AD progression.

Methods: We leveraged 18F-FDG-PET scans from 513 participants across the AD spectrum (control normal [CN], mild cognitive impairment [MCI], AD) from the Alzheimer's Disease Neuroimaging Initiative database. Building on the established involvement of the hippocampus, amygdala, and entorhinal cortex, we innovatively defined the hippocampal-amygdala connecting region using a distance transform approach to specifically capture the metabolic interplay between these vital structures. A rigorous radiomics pipeline was then applied, involving systematic evaluation of eight feature selection techniques combined with six classification models to identify the most effective predictive framework.

Results: Our findings demonstrate the high discriminatory power of the hippocampal-amygdala border region for AD diagnosis and monitoring of disease progression. A concise set of radiomic features derived from this single, novel region of interest (ROI) exhibited high predictive accuracy across various diagnostic distinctions: two features (specifically, shape MeshVolume Right and gldm SmallDependenceLowGrayLevelEmphasis left) distinguished AD from CN with ROC AUC = 0.914; two distinct features predicted MCI from AD with ROC AUC = 0.796; and two other features (shape LeastAxisLength left and glszm LargeAreaEmphasis left) differentiated CN from MCI with ROC AUC = 0.691. Crucially, the mean values of these identified features consistently demonstrated statistically significant incremental deterioration (p < 0.05) across consecutive AD stages (CN to MCI, MCI to AD), underscoring their sensitivity to disease progression.

Conclusion: This study establishes the clinical potential of radiomics in providing highly sensitive and interpretable biomarkers for monitoring AD progression, specifically by targeting the novel, biologically informed hippocampal-amygdala border ROI on FDG-PET. By identifying distinct, parsimonious sets of robust radiomic features for different disease stages, our approach offers an efficient, noninvasive, and clinically translatable tool that balances diagnostic power with interpretability, paving the way for its integration into existing clinical workflows for AD.

In the article "Compensation of Postural Control in Demyelinating Neuropathies: Better Visual Integration in Charcot-Marie-Tooth Type 1A than in Chronic Inflammatory Demyelinating Polyradiculoneuropathy" [Neurodegener Dis. 2025; https://doi.org/10.1159/000547256] by Dupont et al., a wrong copyright license was displayed. It was corrected to a CC-BY 4.0 license. The section title was also corrected to Research Article.The original online article has been updated to reflect this.

Introduction: The Swiss Society for Neuroradiology (SSNR) has established clinical practice recommendations to guide the use of neuroimaging techniques in the enrollment and disease monitoring of patients undergoing anti-amyloid immunotherapies for Alzheimer's disease (AD). In Switzerland, anti-amyloid immunotherapy (AAT) has not been approved by Swissmedic ahead of this publication. This paper therefore reflects the existing international standards of care and will be updated after market clearance of AATs in Switzerland.

Background and rationale: Neuroimaging is a key requirement to assess therapeutic responses and manage potential adverse effects, particularly amyloid-related imaging abnormalities (ARIA). The SSNR recommendations specify the appropriate use of MRI biomarkers to support therapy inclusion, routine monitoring and decision-making in case of manifestations of ARIA-E and ARIA-H during treatment.

Conclusions: This paper reviews the required image protocols and neuroimaging criteria for patient eligibility and discusses the key findings of ARIA-E and ARIA-H. These findings are required to be recognized by the practicing radiologist to ensure patient safety. The practice recommendations of the SSNR align with previous published recommendations of the American Society of Neuroradiology and the European Society of Neuroradiology. We also provide practical recommendations for workflows and candidate selection to continue or discontinue therapy.

Introduction: Behavioral and psychological symptoms in dementia (BPSD) are highly prevalent in patients with Alzheimer's dementia (AD). We examined sex differences in the frequency and severity of BPSD in patients with AD living in long-term care homes or admitted to inpatient psychiatric units.

Methods: Data were obtained from the Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) study (ClinicalTrials.gov/NCT03672201). BPSD were assessed using the Neuropsychiatric Inventory-Clinician rating scale (NPI-C), and symptom clusters were clustered as follows: (1) psychosis (hallucinations and delusions), (2) emotional distress cluster A (depression and anxiety), (3) emotional distress cluster B (depression, anxiety, and apathy), and (4) agitation (agitation, aggression, irritability, aberrant motor behavior, and aberrant vocalizations). Sex differences in frequency and severity of individual BPSD and clusters were compared using chi-square and Mann-Whitney U tests and generalized linear models while controlling for age and place of residence.

Results: Females had higher frequency (males = 21.7% vs. females = 42.9%, χ2 = 8.83, N = 174, p = 0.003) and greater severity of delusions (mean [SD] males = 51.87 [44.15], mean [SD] females = 67.93 [70.53], U = 2,924, N = 174, p = 0.002). Males had higher frequency (males = 51.8% vs. females = 27.5%, χ2 = 10.80, N = 174, p = 0.001) and greater severity of sleep disorders (mean [SD] males = 2.94 [4.21], mean [SD] females = 1.76 [3.92], U = 2,885.50, N = 174, p = 0.002). After controlling for age and residence, sex differences remained significant for delusions (Wald χ2 = 3.97, N = 176, p = 0.046), but not for sleep disorders. There were no sex differences in the frequency or severity of any BPSD clusters.

Conclusions: We observed sex differences in the frequency and severity of specific BPSD. Future studies should aim to understand potential mechanisms underlying these differences and to study their relevance in screening, and for individualized sex-specific management of BPSD.

Introduction: Dementia is a growing global health concern, requiring a comprehensive approach to care. The CareMENS model is a non-pharmacological intervention designed to ensure continuity of care for individuals at the early stages of cognitive decline (CDR ≤1) or those with subjective cognitive complaints. It combines tailored neuropsychological, speech and language, and physical therapies with community-based leisure activities to sustain cognitive and physical function, promote social engagement and enhance overall patient well-being. A care manager - a new role introduced within Swiss memory clinics implementing the model - provides personalized and ongoing support.

Methods: This observational study was conducted across seven memory clinics in Western Switzerland between September 2020 and January 2024. It evaluated the acceptability and impact of the CareMENS model of care through the following outcomes: anxiety and depression symptoms (HADS), functional autonomy (DAD-6), global cognition (MoCA), and quality of life (WHOQOL). Pre-post analyses were performed in 184 patients (median age: 74 years old; 53.3% women) assessed at baseline (T0) and, on average, 324.2 days later (T1). Changes over time were evaluated using a linear mixed-effects model. A retrospective standard care group (N = 165) of patients aged ≥50 years (median age: 74 years old; 53.9% women) and with a dementia severity score (CDR) ≤1 was included for comparison of HADS, DAD-6, and MoCA outcomes.

Results: The CareMENS model was successfully implemented into routine clinical practices of the participating memory clinics. Compared to standard care, the CareMENS intervention was associated with greater improvements in HADS-depression overall scores (-0.853, 95% CI = -1.441 to -0.265; p = 0.005) and in HADS-anxiety scores among patients with high baseline anxiety (-1.134, 95% CI = -2.134 to -0.133; p = 0.027). No significant between-groups differences were found in MoCA (0.361, 95% CI = -0.32 to 1.04; p = 0.299) and DAD-6 scores (0.892, 95% CI = -3.5 to 5.28; p = 0.69). Following the intervention, we observed positive within-group changes in the WHOQOL mean total score (+2.67, 95% CI = 1.31 to 4.02; p < 0.001) and particularly in the social participation subdomain (+6.1, 95% CI = 3.82 to 8.32; p < 0.001).

Discussion: These findings indicate that the CareMENS model of care can be effectively implemented into clinical settings. It showed a significant reduction in mood symptoms and suggested positive benefits for quality of life. Integrating care management models into memory clinics may enhance patient outcomes and represents a promising direction for the evolution of current memory clinic practice.