Neurology International最新文献

Background: Alzheimer's Disease (AD) is the most common form of dementia and is characterized by progressive cognitive decline and neurodegeneration. In Italy, AD represents a major public health and socio-economic challenge. This review aims to summarize current Italian research on pharmacological and non-pharmacological interventions, including preclinical studies, clinical trials, rehabilitative approaches, and emerging neuromodulation techniques, highlighting contributions and future directions.

Methods: A narrative review of the literature was conducted, focusing on Italian preclinical and clinical studies, observational and real-world evidence, cognitive and physical interventions, music therapy, non-invasive brain stimulation (rTMS, tDCS, tACS), and digital or home-based rehabilitation programs.

Results: Italian research has explored different pharmacological strategies, including multitarget compounds, eptastigmine, rotigotine, and combinatorial therapies (donepezil-memantine, citicoline addition). Non-pharmacological interventions, such as cognitive stimulation, motor rehabilitation, music therapy, and multidimensional programs, demonstrated benefits on cognition, behavior, daily functioning, and caregiver well-being. Non-invasive neuromodulation techniques, targeting the dorsolateral prefrontal cortex and precuneus, showed promising effects on memory, attention, and executive functions, especially when combined with cognitive training. Digital health technologies, including telerehabilitation and home-based brain stimulation programs, further enhanced accessibility and adherence. Challenges remain due to fragmented research, small sample sizes, and limited standardization.

Conclusions: Italian research on AD reflects a growing emphasis on integrated, multidimensional, and technologically advanced approaches. Strengthening preclinical studies, promoting multicenter collaborations, and combining pharmacological, cognitive, and neuromodulatory strategies may enhance therapeutic efficacy and patient quality of life. Continued investment in innovation and multidisciplinary research positions Italy to contribute meaningfully to global AD management and prevention.

Background: Neurodegenerative diseases remain a central topic in biomedical research, with Alzheimer's disease (AD) being the most extensively studied. Recent advances in multi-omics integration, particularly proteomics-based approaches, have enabled a deeper understanding of AD-related molecular pathways and their interconnections. However, challenges such as data heterogeneity and the complexity of large-scale datasets continue to hinder comprehensive integration and model interpretation.

Methods: A total of 792 publications were retrieved from PubMed, among which, 27 peer-reviewed studies from 2024 and 2025 focusing on proteomics-anchored multi-omics integration for AD were selected for detailed analysis. These papers were categorized based on their integration strategies, omics combinations, and analytical methodologies. Additionally, statistical analysis of 218 studies published in 2024-2025 was performed to identify dominant omics layers and common integration trends.

Results: Proteomics emerged as the most frequently studied omics layer and was most often integrated with transcriptomics in AD multi-omics studies. The analysis also revealed recurrent machine learning methods used for feature extraction and integration, along with key biological pathways implicated in AD pathogenesis, including amyloid metabolism, synaptic function, and neuroinflammation.

Conclusions: This review provides a systematic overview of recent trends in proteomics-based multi-omics integration for AD research. It highlights both the scientific advances and methodological limitations in current approaches, serving as a valuable reference for researchers seeking to refine analytical frameworks and design more interpretable, data-driven studies in neurodegenerative disease research.

Background/objectives: Relapsing-remitting multiple sclerosis (RRMS) is a chronic neurological disease that significantly impacts health-related quality of life (HRQoL). This study aimed to analyze the evolution of HRQoL in individuals with RRMS, identify associated factors, and determine predictive variables.

Methods: A prospective observational study was conducted with 35 participants diagnosed with RRMS at the Lucus Augusti University Hospital between January 2023 and March 2025. HRQoL was assessed using the MSQOL-54 questionnaire at baseline, 3 months, and 6 months. Data were analyzed using non-parametric tests to account for the small sample size and non-normal distribution of the variables.

Results: Results showed overall stability in HRQoL (mean score: 62.4 ± 14.1 at baseline, 62.8 ± 12.7 at 3 months, and 62.4 ± 11.8 at 6 months), although significant declines were observed in emotional limitations (64.4 ± 23.0 at baseline to 58.9 ± 20.5 at 6 months) and social functioning (70.5 ± 16.7 at baseline to 65.5 ± 12.8 at 6 months). Improvements were noted in pain perception (78.9 ± 23.6 at baseline to 81.8 ± 20.5 at 6 months) and stress (44.3 ± 22.5 at baseline to 48.9 ± 17.8 at 6 months). Factors such as family history (associated with mental health at diagnosis, p = 0.028), autoimmune diseases (associated with physical function at diagnosis, p = 0.035), and lifestyle habits (e.g., tobacco use associated with physical limitations at 3 months, p = 0.045) were significantly associated with HRQoL. Baseline HRQoL emerged as a strong predictor of future scores (Spearman's correlations, p < 0.01), indicating that early assessments may guide interventions.

Conclusions: Although overall HRQoL remains stable in RRMS, specific domains such as emotional and social functioning exhibit progressive decline, highlighting the need for tailored interventions. The findings underscore the importance of integrating early psychosocial support and lifestyle interventions into routine care to mitigate vulnerabilities in emotional and social domains of HRQoL.

Background/Objectives: Despite the well-documented gender differences observed during hospitalisation, research in post-stroke recovery remains limited. This study aims to clarify this topic in subacute post-stroke patients undergoing rehabilitation, considering not only functional and cognitive outcomes but also nutritional status and food consumption. Methods: At admission (T0), patients were assessed for demographic, anamnestic, and clinical data and were diagnosed for malnutrition according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. At T0 and after a six-week rehabilitation program (T1), nutritional status was assessed by anthropometric measurements, serum analysis of albumin, glucose, lipidic, metal, and oxidative stress panel, and the calculation of the Geriatric Nutritional Risk Index; food consumption was recorded daily. Functional independence in Activities of Daily Living was measured at both T0 and T1 by the modified Barthel Index (mBI), and cognitive impairment was assessed by the Montreal Cognitive Assessment (MoCA), adjusted for age and education. Results: We enrolled 87 patients (mean age 69 ± 12 years; 42 women and 45 men); of these 52.4% of women were malnourished, compared to 33.3% of men. After rehabilitation (T1), women showed higher oxidative stress (549 ± 143 vs. 491 ± 121 UCARR; p = 0.041) and poorer functional outcomes (55.3 ± 26.1 vs. 67.1 ± 21.8; p = 0.032), despite similar cognitive improvements (19.5 ± 6.4 vs. 21.9 ± 5.2; p = 0.060) compared with men. Conclusions: This study highlights the importance of personalised treatment strategies that account for gender-specific differences to optimise recovery in post-stroke patients.

Background/objectives: Mild Encephalopathy with Reversible Splenial Lesion (MERS) is a potential complication of certain viral infections, but adult cases involving influenza are rare in the literature. Here, we report a case of a 31-year-old Chinese gentleman with an atypical presentation of Influenza B-associated mild encephalopathy with reversible splenial lesion (MERS).

Methods: This is a case report with a detailed chronology followed by a discussion of pathophysiology.

Results: The patient presented acutely to the tertiary hospital with a severe headache and a peculiar automatism pattern of behaviour involving intermittent screaming, involuntary jerking movements of the upper limbs, and incoherent speech, which culminated in an episode of tonic-clonic seizure lasting 3 min. Symptoms started on the day that the patient was diagnosed with Influenza B and given the antiviral Baloxavir by his GP. Clinically, there was high anion gap metabolic acidosis with hyperlactatemia, rhabdomyolysis, hepatitis transaminitis and absolute lymphopenia. Nasopharyngeal swab PCR and immunofluorescence was positive for Influenza B. EEG was normal, but an MRI of the brain showed a cytotoxic lesion of the splenium of the corpus callosum. The patient was started on Oseltamivir and made a complete neurological recovery, with a repeat MRI showing resolution of the splenial lesion at 3 months. MERS is a rare clinic-radiological syndrome characterized by a transient encephalopathy and a reversible lesion in the splenium of the corpus callosum, which has been reported mostly in the pediatric population.

Conclusions: This case report of an influenza B-triggered MERS in an adult highlights the importance of maintaining MERS as a differential for acute encephalopathy in adults with a viral prodrome.

Background: Cognitive decline is an escalating public health challenge with global population aging. Understanding the association between hobby engagement and cognitive function is crucial for developing effective interventions.

Methods: Utilizing data from waves 2 to 9 of the English Longitudinal Study of Ageing (ELSA), this study included 6854 community-dwelling adults aged 50 years and older. To comprehensively capture this relationship, we employed a multi-method analytical approach, encompassing multiple linear regression, linear mixed-effects models, group-based trajectory modeling (GBTM), and a comparison of machine learning algorithms to assess both associations and predictive performance.

Results: Cross-sectionally, hobby engagement was significantly associated with higher baseline global cognitive, memory, and executive function scores. Longitudinally, hobbies were associated with a slower rate of decline in orientation, but not in memory, executive function, or global cognition. Group-based trajectory modeling, which identifies distinct subgroups with heterogeneous cognitive pathways, revealed that hobby engagement was associated with a substantially lower risk of belonging to a "persistently low cognitive function" trajectory (OR = 0.46). Among predictive models, the Scikit-learn Gradient Boosting Regressor demonstrated superior performance (RMSE = 0.7517, R² = 0.3033), outperforming deep learning approaches.

Conclusions: Our findings suggest that hobby engagement may have domain-specific protective effects on cognitive health in older adults, most notably by drastically reducing the risk of a severely adverse cognitive trajectory. Promoting hobby participation therefore emerges as a potential viable, low-cost, and impactful public health strategy for preserving cognitive health in aging populations.

Background: Moyamoya syndrome is a moyamoya-like cerebrovascular condition associated with an identifiable underlying condition. Although head trauma has historically been considered a possible contributing factor, it is currently excluded from the Japanese diagnostic criteria. We report a rare case of progressive unilateral moyamoya-like vasculopathy that developed on the ipsilateral chronic subdural hematoma (CSDH) following head trauma, with a decade-long imaging follow-up. Anterior circulation basi-parallel anatomical scanning (BPAS) provided unique insights into the progressive vessel narrowing beyond the vascular lumen, suggesting its potential utility in evaluating such rare vasculopathies. Case Presentation: A 40-year-old man developed a left-sided CSDH after head trauma and underwent burr hole drainage. Although his symptoms resolved, serial magnetic resonance angiography (MRA) over the subsequent 10 years revealed progressive stenosis of the left middle cerebral artery (MCA), ultimately culminating in an occlusion-like appearance. BPAS revealed moyamoya-like collateral vessels in the same hemisphere, a significant reduction in the outer diameter of the left MCA, supporting the presence of structural arterial wall changes that were not apparent on conventional MRA. Single-photon emission computed tomography revealed mildly reduced cerebral blood flow on the affected side, with a difference of less than 5% compared to non-affected side. He remained neurologically non-symptomatic, with no history of transient ischemic attacks or overt ischemic stroke. Conclusions: This case highlights a rare clinical course of progressive ipsilateral moyamoya-like vascular changes following head trauma and burr-hole drainage for CSDH, potentially indicating an association between head trauma, CSDH, and subsequent moyamoya-like collateral vessel development, warranting further investigation. The use of the anterior circulation BPAS contributed to the detection of structural arterial changes that were not apparent on conventional MRA, suggesting its potential utility in evaluating such vascular abnormalities.

Background: Catheter ablation is an established rhythm-control strategy for atrial fibrillation (AF), yet peri-procedural embolic stroke may still occur despite uninterrupted NOAC therapy. Case presentation: A 49-year-old woman on dabigatran developed acute ischemic stroke three days after AF ablation, presenting with left hemiparesis and dysarthria. Idarucizumab (5 g) enabled safe intravenous thrombolysis followed by emergency endovascular thrombectomy (EVT), achieving complete recanalization (mTICI 3). Angiography revealed an incidental 7 mm right MCA aneurysm at the occlusion site. Dabigatran was resumed on day 4, and one month later, the aneurysm was successfully treated with stent-assisted coil embolization. She remained asymptomatic at two months. Conclusions: This case illustrates how idarucizumab reversal expands reperfusion options by enabling both IVT and EVT in NOAC-treated patients and highlights the diagnostic role of EVT in revealing underlying vascular pathology, emphasizing the need for individualized post-procedural antithrombotic management.

Background/Objectives: Risk-stratification tools, including the PHASES, UIATS, and ELAPSS, are commonly used to guide management of incidentally detected unruptured intracranial aneurysms (UIAs), but their predictive accuracy in real-world settings remains unclear. This study evaluated how these scores would have advised treatment in patients who subsequently presented with aneurysmal subarachnoid hemorrhage (aSAH). Methods: We retrospectively analyzed adults treated for aSAH at Copernicus Memorial Hospital (Łódź, Poland) between January 2022 and June 2024. For each ruptured aneurysm, we calculated PHASES (5-year rupture risk), UIATS recommendation, and ELAPSS (5-year growth risk) as if the lesion had been detected incidentally. Identical assessments were performed for UIAs that remained unruptured. Discrimination for rupture was evaluated using receiver-operating characteristic analysis (AUC). Results: Of 180 aneurysms (mean age 66.9 ± 11.3 years), 103 (57%) were ruptured. Patients with ruptured aneurysms were significantly older (69.9 vs. 64.0 years; p = 0.003), while sex, hypertension, smoking, and aneurysm morphology did not differ significantly. UIATS more frequently favored conservative management in ruptured aneurysms (56.3% vs. 39.0%; p = 0.046). PHASES (1.6% vs. 1.6%) and ELAPSS (3-year: 14.5% vs. 12.6%; 5-year: 22.6% vs. 20.0%) showed no significant differences between groups. Age was the only independent predictor of rupture (OR = 1.05/year; p < 0.001). The model's cross-validated AUC was 0.731. Conclusions: Most ruptured aneurysms would not have been recommended for treatment based on UIATS. PHASES, ELAPSS, and UIATS did not reliably discriminate between ruptured and unruptured aneurysms, emphasizing the need for more precise and individualized risk assessment tools.

Background: Extracranial vertebral artery aneurysms (EVAAs) are exceptionally rare vascular lesions and an uncommon cause of posterior circulation stroke. Their diagnosis is often delayed due to nonspecific symptoms, yet prompt recognition is essential to guide management. Objective: This study aimed to report a rare case of an extracranial vertebral artery dissecting aneurysm presenting as a posterior circulation stroke in a young adult, successfully managed with flow-diverter stenting. Clinical Case: A 33-year-old woman presented with sudden-onset dysarthria, vertigo, nausea, and vomiting. Brain magnetic resonance imaging revealed infarcts in the left occipital lobe, cerebellar peduncle, and both cerebellar hemispheres. Computed tomography angiography (CTA) demonstrated a fusiform aneurysm in the V2 segment of the left vertebral artery, and digital subtraction angiography (DSA) confirmed a dissecting aneurysm. The patient was successfully treated with a flow-diverting stent and remained stable at 6 months' follow-up with mRS 1. Results: EVAA are uncommon but can manifest as posterior circulation ischemic events in young patients. Endovascular treatment with flow-diverting stents has been reported as a feasible option in selected cases, although evidence remains limited to case reports and small series. Conclusions: This case underscores the importance of considering rare yet potentially treatable etiologies of vertebrobasilar stroke in young patients and highlights the value of a multidisciplinary approach to management.