Neurological Sciences最新文献

Background: The optimal timing for initiating direct oral anticoagulants (DOACs) after acute ischemic stroke or transient ischemic attack (TIA) in patients with nonvalvular atrial fibrillation (NVAF) remains uncertain.

Objective: To determine whether early initiation of DOACs is superior to delayed initiation in preventing new vascular events.

Methods: This guideline was developed using the GRADE approach and includes a systematic review and meta-analysis of four randomized controlled trials (TIMING, ELAN, OPTIMAS, START) enrolling 6,664 patients. Outcomes were selected via Delphi consensus. Meta-analyses used random-effects models, with certainty of evidence rated per GRADE methodology.

Results: Early DOAC initiation was associated with a trend toward fewer recurrent ischemic events (RR 0.77, 95% CI 0.52-1.14) and thromboembolic events (RR 0.73, 95% CI 0.50-1.06), with no increase in symptomatic intracranial hemorrhage (RR 0.93, 95% CI 0.44-1.97) or major extracranial bleeding (RR 0.84, 95% CI 0.42-1.69). Certainty of evidence was low due to imprecision. An individual patient data meta-analysis from CATALYST collaboration further supported early treatment in patients with minor to moderate stroke.

Recommendations: We recommend early DOAC initiation within 4 days in patients with minor to moderate stroke to prevent new vascular events. Early DOAC initiation over delayed treatment is indicated in patients with severe acute ischemic stroke to prevent new vascular events.

Conclusion: Early DOAC initiation appears safe and potentially more effective than delayed treatment, supporting a shift toward earlier anticoagulation in selected patients with NVAF and recent ischemic stroke.

Background: Vascular parkinsonism (VP) and the postural instability and gait difficulty (PIGD) subtype of Parkinson's disease (PD) exhibit similar gait characteristics. However, most research emphasizes lower-limb gait parameters, often neglecting the role of cognitive function in gait regulation. Therefore, this study investigates differences in cognitive-motor interactions between VP and PIGD to identifying specific gait biomarkers and develop a diagnostic model.

Methods: We recruited 37 PIGD patients and 37 VP patients between year 2022 to 2024 and used wearable devices to record gait parameters during single-task and dual-task paradigms. Demographic and clinical data were collected from all participants. Statistical analysis was conducted using R software with P < 0.05 as statistically significance.

Results: Multiple gait parameters significantly difference between VP and PIGD groups under both single-task and dual-task paradigms. In both single-task and dual-task gait comparisons, significant differences were observed between VP and PIGD in walk speed, shank swing speed, gait speed, phase coordination index (PCI), and trunk sway maximum (P < 0.05). Corresponding dual-task costs (DTC) also showed significant differences (P < 0.05). ROC curve analysis indicated a good diagnostic performance when combining multiple gait parameters and their DTC with MoCA scores (AUC 0.838, 95% CI 0.745-0.931; AUC 0.880, 95% CI 0.803-0.957). Correlation analysis revealed that several gait and DTC metrics were highly associated with cognitive performance in VP patients.

Conclusion: Our study demonstrates that gait parameters provide reliable diagnostic discrimination between VP and PIGD. Moreover, gait parameters were significantly associated with cognitive function in VP patients.

Objective: To analyze perioperative hormonal changes in male patients with non-functioning pituitary adenomas undergoing transsphenoidal surgery and establish a method for assessing adenopituitary function.

Methods: We retrospectively analyzed preoperative clinical and imaging data, and perioperative anterior pituitary hormone levels of 123 male non-functioning pituitary adenomas patients who underwent surgery from 2012 to 2022. Hormone scores were calculated using an inverse tangent function normalized to normal hormone levels (0-1). Total pituitary hormone score summed six hormones (GH, ACTH, TSH, PRL, FSH, LH) reflecting overall pituitary secretion. ROC curves and AUC were calculated for assessment.

Results: Most hormone levels (except GH, FSH) and total scores decreased postoperatively in large/giant adenoma groups, recovering by 3 months. Significant preoperative and postoperative differences were found in GH, TSH, LH, and total scores (P < 0.05). TSH, PRL, FSH, and total scores showed significant time-related changes, while GH, ACTH, and LH remained stable. Total scores differed significantly between patients with and without preoperative hypopituitarism (P < 0.001 for ACTH, FSH, LH, TSH). Prediction models had AUCs of 0.755 and 0.636 for patients without and with preoperative hypopituitarism, respectively.

Conclusions: Male non-functioning pituitary adenomas patients experienced immediate postoperative hormonal drops, followed by gradual recovery. The total hormone score efficiently assessed pituitary function, simplifying complex hormonal dynamics.

Introduction: Hereditary spastic paraparesis (HSP) are a group of disabling neurological disorders classically defined by progressive spasticity and weakness at lower limbs. Non-motor symptoms may be part of the clinical phenotype. Our aim was to evaluate cognitive abilities, especially executive functions and verbal memory, in different forms of HSP.

Material and methods: This study included 40 patients and 25 matched healthy controls (HC). Among the patients, 18 had SPG4, 6 SPG7, 2 SPG5, 3 SPG11, 3 SPG10, 3 SPG28, and one each had SPG3A, SPG9, SPG15, SPG17 and SPG21. Disease severity was assessed using the Spastic Paraplegia Rating Scale (SPRS). To evaluate cognitive domains, a defined neuropsychological battery was used. Statistical methods included Shapiro-Wilk testing to determine distribution, followed by t-tests, Mann-Whitney U, ANOVA, or Kruskal-Wallis tests as appropriate, with false discovery rate (FDR) correction. Effect sizes were calculated using Cohen's d, rank-biserial correlation (rb) or η². Pearson's (r) or Spearman's rank correlation coefficient (ρ) were used to explore associations.

Results: No significant differences emerged in age or education. While MMSE scores were slightly lower in patients, major impairments were found in executive function, attention, and memory (all p < 0.001, FDR-corrected). Cognitive deficits were independent of mood, fatigue, and pain. Patients with complicated HSP (cHSP) showed greater impairment than those with pure HSP (pHSP). SPG4 patients exhibited specific deficits despite preserved global cognition.

Conclusion: Cognitive impairment is a relevant but underrecognized feature in HSP. Comprehensive neuropsychological testing is critical, as global screening may miss relevant deficits.

Introduction: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system and a leading cause of disability in young adults. Traditional measures of MS-related disability primarily rely on objective clinical evaluations, often neglecting patients' subjective experiences, which are affected by physical, cognitive, and emotional factors. This study aimed to validate the Italian Perceived Disability Scale (IPDS), a 20-item self-report tool designed to assess perceived disability across physical, psychological, and social domains.

Methods: A cohort of 100 individuals with MS underwent the IPDS and a comprehensive clinical and neuropsychological assessment, including the Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS), Hamilton Depression and Anxiety Rating Scales (HAM-D and HAM-A), and the Brief Repeatable Battery of Neuropsychological Tests (BRB-N).

Results: Factor analysis confirmed the five-factor structure of the IPDS, accounting for 75% of the total variance, with excellent internal consistency (Cronbach's alpha = 0.90). The IPDS total score showed significant correlations with EDSS (r = 0.43, p < 0.001), FSS (r = 0.61, p < 0.001), HAM-A (r = 0.41, p < 0.001), and HAM-D (r = 0.48, p < 0.001).

Conclusions: These findings validate the IPDS as a reliable and valuable tool for assessing perceived disability in MS. By capturing patients'subjective experiences, the IPDS offers valuable insights for personalized care and supports the integration of patient-reported outcomes into routine clinical practice. Future research should investigate its sensitivity to longitudinal changes and its applicability across diverse MS populations.