Pub Date : 2025-10-15DOI: 10.1016/s1474-4422(25)00287-x
E Ray Dorsey, Briana R De Miranda, Sarrah Hussain, Bastiaan R Bloem, Alexis Elbaz, Jorge Llibre-Guerra, Raymond Y Lo, Samuel M Goldman, Caroline M Tanner
The global burden of Parkinson's disease is rising. Large-scale genetic studies have confirmed that extrinsic or environmental factors, rather than genetic predisposition, play a dominant role in its cause. Increasing evidence implicates three classes of toxicants—certain pesticides, the dry-cleaning chemicals trichloroethylene and perchloroethylene, and air pollution—in the development of Parkinson's disease. These toxicants are widely prevalent, impair mitochondrial or lysosomal function, or both, and contribute to, if not cause, the disease. Parkinson's disease could be thus largely preventable. Uncertainties remain regarding the relevant doses, timing, and routes of exposure, the nature of genetic and environmental interactions, the effects of combined exposures, the role of the microbiome, and the identity of other environmental risks. Methodological limitations and structural challenges hinder our understanding. However, improved measurement of toxicant exposure in individuals and the environment, long-term prospective studies, increased funding for prevention, and policy changes can precipitate the fall of the burden of Parkinson's disease.
{"title":"Environmental toxicants and Parkinson's disease: recent evidence, risks, and prevention opportunities","authors":"E Ray Dorsey, Briana R De Miranda, Sarrah Hussain, Bastiaan R Bloem, Alexis Elbaz, Jorge Llibre-Guerra, Raymond Y Lo, Samuel M Goldman, Caroline M Tanner","doi":"10.1016/s1474-4422(25)00287-x","DOIUrl":"https://doi.org/10.1016/s1474-4422(25)00287-x","url":null,"abstract":"The global burden of Parkinson's disease is rising. Large-scale genetic studies have confirmed that extrinsic or environmental factors, rather than genetic predisposition, play a dominant role in its cause. Increasing evidence implicates three classes of toxicants—certain pesticides, the dry-cleaning chemicals trichloroethylene and perchloroethylene, and air pollution—in the development of Parkinson's disease. These toxicants are widely prevalent, impair mitochondrial or lysosomal function, or both, and contribute to, if not cause, the disease. Parkinson's disease could be thus largely preventable. Uncertainties remain regarding the relevant doses, timing, and routes of exposure, the nature of genetic and environmental interactions, the effects of combined exposures, the role of the microbiome, and the identity of other environmental risks. Methodological limitations and structural challenges hinder our understanding. However, improved measurement of toxicant exposure in individuals and the environment, long-term prospective studies, increased funding for prevention, and policy changes can precipitate the fall of the burden of Parkinson's disease.","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"150 1","pages":"976-986"},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-15DOI: 10.1016/s1474-4422(25)00265-0
Gabriel J E Rinkel, Ynte M Ruigrok, Timo Krings, Nima Etminan, Mervyn D I Vergouwen
The clinical evaluation and decision making associated with the management of unruptured intracranial aneurysms are complex. In the past 5 years, studies have evaluated the benefits of screening in people at high-risk, such as those with a family history of aneurysmal subarachnoid haemorrhage or unruptured intracranial aneurysms, people with genetic or other disorders associated with intracranial aneurysms, and people who smoke and have hypertension. If an aneurysm is detected during screening or incidentally, prediction models now allow for estimating the risk of complications from preventive aneurysm occlusion. Other prediction models can estimate the risk of aneurysm growth and the risk of rupture after growth. Thus, screening and management strategies are shifting towards a personalised approach. Uncertainties remain regarding the value of screening in some individuals, the long-term benefits of preventive occlusion, and the effectiveness of medical treatment strategies to prevent aneurysm growth and rupture.
{"title":"Advances in screening and management of unruptured intracranial aneurysms","authors":"Gabriel J E Rinkel, Ynte M Ruigrok, Timo Krings, Nima Etminan, Mervyn D I Vergouwen","doi":"10.1016/s1474-4422(25)00265-0","DOIUrl":"https://doi.org/10.1016/s1474-4422(25)00265-0","url":null,"abstract":"The clinical evaluation and decision making associated with the management of unruptured intracranial aneurysms are complex. In the past 5 years, studies have evaluated the benefits of screening in people at high-risk, such as those with a family history of aneurysmal subarachnoid haemorrhage or unruptured intracranial aneurysms, people with genetic or other disorders associated with intracranial aneurysms, and people who smoke and have hypertension. If an aneurysm is detected during screening or incidentally, prediction models now allow for estimating the risk of complications from preventive aneurysm occlusion. Other prediction models can estimate the risk of aneurysm growth and the risk of rupture after growth. Thus, screening and management strategies are shifting towards a personalised approach. Uncertainties remain regarding the value of screening in some individuals, the long-term benefits of preventive occlusion, and the effectiveness of medical treatment strategies to prevent aneurysm growth and rupture.","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-15DOI: 10.1016/s1474-4422(25)00306-0
Ask T Nordestgaard, M Vinayaga Moorthy, Nancy R Cook, Nader Rifai, I-Min Lee, Julie E Buring, Paul M Ridker
<h3>Background</h3>Primary stroke prevention guidelines recommend routine screening of individuals for elevated LDL cholesterol from the age of 40 years, but recommendations are ambiguous for high-sensitivity C-reactive protein (hsCRP) and lipoprotein(a). We aimed to examine correlations between hsCRP, LDL cholesterol, and lipoprotein(a) and 30-year risk of stroke in healthy women.<h3>Methods</h3>In this prospective, longitudinal cohort study, participants who were enrolled in the Women's Health Study (a randomised controlled trial of aspirin and vitamin E for the prevention of cardiovascular disease and cancer in women in the USA that completed in 2004) were prospectively followed for up to 30 years via annual questionnaires. Healthy women (ie, without cardiovascular disease and cancer) aged 45 years and older were eligible for the original trial. Individuals with available baseline measurements for hsCRP, LDL cholesterol, or lipoprotein(a) were included in our analyses. We constructed cumulative incidence curves and calculated hazard ratios (HRs) for total, ischaemic, and haemorrhagic stroke across biomarker quintiles and for combined elevation of all biomarkers from age-adjusted and multivariable-adjusted cause-specific Cox models.<h3>Findings</h3>Between September, 1992 and May, 1995, 39 876 women were enrolled in the Women's Health Study, of whom 28 345 consented to participate in further follow-up and provided a baseline blood sample. Baseline concentrations of hsCRP and LDL cholesterol were available for 27 939 participants, with lipoprotein(a) measurements also reported for most participants. At enrolment, median age was 53 years (IQR 49–59), median BMI was 25 kg/m<sup>2</sup> (22–28), 3252 (12%) were current smokers, 7026 (25%) had hypertension, and 685 (2%) had a history of diabetes. 1345 stroke events accrued during a median of 27·7 years (IQR 23·1–29·0) of follow-up. Baseline hsCRP concentrations increasing from the lowest quintile (<0·7 mg/L) to the highest quintile (≥5·2 mg/L) were associated with an increasing cumulative incidence of total stroke. Only individuals in the highest LDL cholesterol (≥3·4 mmol/L) and lipoprotein(a) quintiles (≥44·1 mg/dL) had higher cumulative incidences of total stroke than those in the lowest quintiles (<2·5 mmol/L and <3·6 mg/dL, respectively). Multivariable-adjusted hazard ratios (HRs) for total and ischaemic stroke for quintile five versus quintile one were 1·32 (95% CI 1·07–1·61) and 1·56 (1·22–1·99), respectively, for hsCRP; 1·05 (0·88–1·25) and 1·17 (0·95–1·45), respectively, for LDL cholesterol; and 1·23 (1·04–1·45) and 1·27 (1·05–1·55), respectively, for lipoprotein(a). Women with three versus no biomarkers in the fifth quintile had HRs of 1·60 (1·10–2·34) for total stroke and 1·79 (1·23–2·61) for ischaemic stroke. None of the biomarkers correlated with risk of haemorrhagic stroke.<h3>Interpretation</h3>Elevated plasma concentrations of hsCRP, LDL cholesterol, and lipoprotein(a), indi
{"title":"High-sensitivity C-reactive protein, LDL cholesterol, lipoprotein(a) and 30-year risk of stroke in healthy women: a prospective, longitudinal cohort study","authors":"Ask T Nordestgaard, M Vinayaga Moorthy, Nancy R Cook, Nader Rifai, I-Min Lee, Julie E Buring, Paul M Ridker","doi":"10.1016/s1474-4422(25)00306-0","DOIUrl":"https://doi.org/10.1016/s1474-4422(25)00306-0","url":null,"abstract":"<h3>Background</h3>Primary stroke prevention guidelines recommend routine screening of individuals for elevated LDL cholesterol from the age of 40 years, but recommendations are ambiguous for high-sensitivity C-reactive protein (hsCRP) and lipoprotein(a). We aimed to examine correlations between hsCRP, LDL cholesterol, and lipoprotein(a) and 30-year risk of stroke in healthy women.<h3>Methods</h3>In this prospective, longitudinal cohort study, participants who were enrolled in the Women's Health Study (a randomised controlled trial of aspirin and vitamin E for the prevention of cardiovascular disease and cancer in women in the USA that completed in 2004) were prospectively followed for up to 30 years via annual questionnaires. Healthy women (ie, without cardiovascular disease and cancer) aged 45 years and older were eligible for the original trial. Individuals with available baseline measurements for hsCRP, LDL cholesterol, or lipoprotein(a) were included in our analyses. We constructed cumulative incidence curves and calculated hazard ratios (HRs) for total, ischaemic, and haemorrhagic stroke across biomarker quintiles and for combined elevation of all biomarkers from age-adjusted and multivariable-adjusted cause-specific Cox models.<h3>Findings</h3>Between September, 1992 and May, 1995, 39 876 women were enrolled in the Women's Health Study, of whom 28 345 consented to participate in further follow-up and provided a baseline blood sample. Baseline concentrations of hsCRP and LDL cholesterol were available for 27 939 participants, with lipoprotein(a) measurements also reported for most participants. At enrolment, median age was 53 years (IQR 49–59), median BMI was 25 kg/m<sup>2</sup> (22–28), 3252 (12%) were current smokers, 7026 (25%) had hypertension, and 685 (2%) had a history of diabetes. 1345 stroke events accrued during a median of 27·7 years (IQR 23·1–29·0) of follow-up. Baseline hsCRP concentrations increasing from the lowest quintile (<0·7 mg/L) to the highest quintile (≥5·2 mg/L) were associated with an increasing cumulative incidence of total stroke. Only individuals in the highest LDL cholesterol (≥3·4 mmol/L) and lipoprotein(a) quintiles (≥44·1 mg/dL) had higher cumulative incidences of total stroke than those in the lowest quintiles (<2·5 mmol/L and <3·6 mg/dL, respectively). Multivariable-adjusted hazard ratios (HRs) for total and ischaemic stroke for quintile five versus quintile one were 1·32 (95% CI 1·07–1·61) and 1·56 (1·22–1·99), respectively, for hsCRP; 1·05 (0·88–1·25) and 1·17 (0·95–1·45), respectively, for LDL cholesterol; and 1·23 (1·04–1·45) and 1·27 (1·05–1·55), respectively, for lipoprotein(a). Women with three versus no biomarkers in the fifth quintile had HRs of 1·60 (1·10–2·34) for total stroke and 1·79 (1·23–2·61) for ischaemic stroke. None of the biomarkers correlated with risk of haemorrhagic stroke.<h3>Interpretation</h3>Elevated plasma concentrations of hsCRP, LDL cholesterol, and lipoprotein(a), indi","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-15DOI: 10.1016/s1474-4422(25)00308-4
Cécile Préterre, Aurélie Gaultier, Michael Obadia, Catherine Vignal, Isabelle Mourand, Julien Plat, Denis Sablot, Marie Gaudron, Gilles Rodier, Gaëlle Godeneche, Cédric Urbanczyk, Guillaume Marc, Evelyne Massardier, Sarah Adam, Marion Boulanger, Sébastien Marcel, Laura Mechtouff, Thomas Ronzière, Lionel Calvière, Sophie Godard-Ducceschi, Catherine Cochard
Background
Central retinal artery occlusion (CRAO) is a subtype of ischaemic stroke that results in acute monocular vision loss. Although open-label studies and meta-analyses have suggested that early intravenous thrombolysis might improve visual acuity, no randomised controlled trials have yet confirmed this benefit. We aimed to compare the safety and efficacy of intravenous alteplase with oral aspirin in patients with CRAO treated within 4·5 h of onset of severe vision loss.
Methods
THEIA was a multicentre, double-dummy, patient-blinded, assessor-blinded, randomised, controlled, phase 3 trial conducted across 16 hospitals with stroke units in France. Adults (aged ≥18 years) presenting with sudden, severe, and persistent monocular vision loss (Snellen <20/400) due to suspected non-arteritic acute CRAO were eligible for inclusion. Participants were randomly assigned (1:1), stratified by centre, to receive either 0·9 mg/kg of bodyweight intravenous alteplase and oral placebo (alteplase group) or 300 mg oral aspirin and intravenous saline placebo (aspirin group) within 4·5 h of symptom onset. Patients, outcome assessors, and the study sponsor were masked to treatment allocation; treating nurses and neurologists were unmasked. The primary efficacy outcome was improvement in visual acuity of at least 0·3 logarithm of the minimum angle of resolution (LogMAR) from baseline to 1 month, analysed in the full analysis set, which included all patients who received the complete intervention and a visual acuity assessment at baseline. Safety outcomes included serious adverse events, particularly intracranial and extracranial bleeding, analysed in all randomly assigned participants. This study is registered at ClinicalTrials.gov (NCT03197194) and is completed.
Findings
Between June 8, 2018, and Oct 2, 2023, 70 patients (mean age 70 years [SD 9]; 25 [36%] women and 45 [64%] men) were enrolled and randomly assigned to either the alteplase group (35 [50%]) or the aspirin group (35 [50%]). In total, 65 (93%) patients received the allocated treatment: 34 (97%) in the alteplase group and 31 (89%) in the aspirin group. Mean time from symptom onset to treatment initiation was 232·4 min (SD 43·6). Among 56 patients with available data on the primary endpoint, 19 (66%) of 29 patients in the alteplase group and 13 (48%) of 27 patients in the aspirin group showed an improvement in visual acuity of at least 0·3 LogMAR at 1 month (unadjusted risk difference 17·4 [95% CI –11·8 to 46·5]; adjusted odds ratio 1·1
背景：视网膜中央动脉闭塞（CRAO）是缺血性中风的一种亚型，可导致急性单眼视力丧失。尽管开放标签研究和荟萃分析表明早期静脉溶栓可能改善视力，但尚未有随机对照试验证实这一益处。我们的目的是比较静脉注射阿替普酶与口服阿司匹林在严重视力丧失发生后4.5小时内治疗的CRAO患者的安全性和有效性。theia是一项多中心、双盲、患者盲、评估盲、随机、对照的3期试验，在法国16家卒中科室医院进行。疑似非动脉性急性CRAO导致突发性、严重和持续性单眼视力丧失（Snellen <20/400）的成人（年龄≥18岁）符合纳入条件。参与者被随机分配（1:1），按中心分层，在症状出现后4.5小时内接受0.9 mg/kg体重静脉注射阿替普酶和口服安慰剂（阿替普酶组）或300 mg口服阿司匹林和静脉注射生理盐水安慰剂（阿司匹林组）。患者、结果评估者和研究发起者对治疗分配不知情；负责治疗的护士和神经科医生都被揭露了。主要疗效指标是从基线到1个月的视力改善至少为最小分辨角（LogMAR）的0.3对数，在完整的分析集中进行分析，其中包括所有接受完整干预和基线视力评估的患者。安全结局包括严重不良事件，特别是颅内和颅外出血，对所有随机分配的参与者进行分析。该研究已在ClinicalTrials.gov注册（NCT03197194）并已完成。在2018年6月8日至2023年10月2日期间，纳入了70例患者（平均年龄70岁[SD 9]；女性25例[36%]，男性45例[64%]），并随机分配到阿替普酶组（35例[50%]）或阿司匹林组（35例[50%]）。共有65例（93%）患者接受了分配的治疗：阿替普酶组34例（97%），阿司匹林组31例（89%）。从症状出现到开始治疗的平均时间为232·4 min （SD 43.6）。在56例有主要终点数据的患者中，29例阿替普酶组患者中有19例（66%），27例阿司匹林组患者中有13例（48%）在1个月时视力改善至少为0.3 LogMAR（未校正风险差为17.4 [95% CI - 11.8 ~ 46.5]；校正优势比为1.1 [95% CI 0.07 ~ 18.39]; p= 0.95）。在阿替普酶组中报告了一例与研究治疗相关的无症状颅内出血。11例患者共发生14例与治疗无关的严重不良事件（阿司匹林组6例[17%]，阿替普酶组5例[14%]）。没有与研究治疗相关的症状性出血或大出血的报道。解释：与阿司匹林相比，在CRAO发病后4.5 h内静脉给予阿替普酶与视力的显著改善无关，尽管阿替普酶组的改善率更高。然而，这项研究可能不足以发现统计上的差异。虽然没有发现与阿替普酶相关的安全性问题，但总体适度的恢复率强调了对即将进行的随机对照试验进行个体患者水平数据荟萃分析的必要性，以阐明溶栓或阿司匹林对急性CRAO患者的潜在益处。资助：法国卫生部和勃林格殷格翰公司。
{"title":"Intravenous alteplase versus oral aspirin for acute central retinal artery occlusion within 4·5 h of severe vision loss (THEIA): a multicentre, double-dummy, patient-blinded and assessor-blinded, randomised, controlled, phase 3 trial","authors":"Cécile Préterre, Aurélie Gaultier, Michael Obadia, Catherine Vignal, Isabelle Mourand, Julien Plat, Denis Sablot, Marie Gaudron, Gilles Rodier, Gaëlle Godeneche, Cédric Urbanczyk, Guillaume Marc, Evelyne Massardier, Sarah Adam, Marion Boulanger, Sébastien Marcel, Laura Mechtouff, Thomas Ronzière, Lionel Calvière, Sophie Godard-Ducceschi, Catherine Cochard","doi":"10.1016/s1474-4422(25)00308-4","DOIUrl":"https://doi.org/10.1016/s1474-4422(25)00308-4","url":null,"abstract":"<h3>Background</h3>Central retinal artery occlusion (CRAO) is a subtype of ischaemic stroke that results in acute monocular vision loss. Although open-label studies and meta-analyses have suggested that early intravenous thrombolysis might improve visual acuity, no randomised controlled trials have yet confirmed this benefit. We aimed to compare the safety and efficacy of intravenous alteplase with oral aspirin in patients with CRAO treated within 4·5 h of onset of severe vision loss.<h3>Methods</h3>THEIA was a multicentre, double-dummy, patient-blinded, assessor-blinded, randomised, controlled, phase 3 trial conducted across 16 hospitals with stroke units in France. Adults (aged ≥18 years) presenting with sudden, severe, and persistent monocular vision loss (Snellen <20/400) due to suspected non-arteritic acute CRAO were eligible for inclusion. Participants were randomly assigned (1:1), stratified by centre, to receive either 0·9 mg/kg of bodyweight intravenous alteplase and oral placebo (alteplase group) or 300 mg oral aspirin and intravenous saline placebo (aspirin group) within 4·5 h of symptom onset. Patients, outcome assessors, and the study sponsor were masked to treatment allocation; treating nurses and neurologists were unmasked. The primary efficacy outcome was improvement in visual acuity of at least 0·3 logarithm of the minimum angle of resolution (LogMAR) from baseline to 1 month, analysed in the full analysis set, which included all patients who received the complete intervention and a visual acuity assessment at baseline. Safety outcomes included serious adverse events, particularly intracranial and extracranial bleeding, analysed in all randomly assigned participants. This study is registered at <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> (<span><span>NCT03197194</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>) and is completed.<h3>Findings</h3>Between June 8, 2018, and Oct 2, 2023, 70 patients (mean age 70 years [SD 9]; 25 [36%] women and 45 [64%] men) were enrolled and randomly assigned to either the alteplase group (35 [50%]) or the aspirin group (35 [50%]). In total, 65 (93%) patients received the allocated treatment: 34 (97%) in the alteplase group and 31 (89%) in the aspirin group. Mean time from symptom onset to treatment initiation was 232·4 min (SD 43·6). Among 56 patients with available data on the primary endpoint, 19 (66%) of 29 patients in the alteplase group and 13 (48%) of 27 patients in the aspirin group showed an improvement in visual acuity of at least 0·3 LogMAR at 1 month (unadjusted risk difference 17·4 [95% CI –11·8 to 46·5]; adjusted odds ratio 1·1 ","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-15DOI: 10.1016/s1474-4422(25)00264-9
Nima Etminan, Ynte M Ruigrok, Katharina A M Hackenberg, Mervyn D I Vergouwen, Timo Krings, Gabriel J E Rinkel
About 3% of adults have an unruptured intracranial aneurysm and this prevalence can increase to 10% in high-risk groups. Aneurysms are not congenital, but develop throughout life. New evidence has established that genetic, anatomical, inflammatory, and modifiable risk factors interact in the formation, growth, and rupture of aneurysms. Genome-wide association studies have found an association with genetic risk variants in 17 loci. Furthermore, circle of Willis variations predispose to aneurysm formation and cluster within families. These variations, plus modifiable risk factors, such as hypertension and smoking, result in haemodynamic stress and inflammatory reactions in the vessel and aneurysm wall but, in people at high risk, aneurysms can also form in the absence of hypertension or smoking. These research advances provide knowledge bases for the individualised concepts of identifying individuals who can have an aneurysm or patients with aneurysms at increased risk of rupture, and for pharmacological treatments for patients who do not require immediate preventive repair.
{"title":"Epidemiology, pathogenesis, and emerging concepts in unruptured intracranial aneurysms","authors":"Nima Etminan, Ynte M Ruigrok, Katharina A M Hackenberg, Mervyn D I Vergouwen, Timo Krings, Gabriel J E Rinkel","doi":"10.1016/s1474-4422(25)00264-9","DOIUrl":"https://doi.org/10.1016/s1474-4422(25)00264-9","url":null,"abstract":"About 3% of adults have an unruptured intracranial aneurysm and this prevalence can increase to 10% in high-risk groups. Aneurysms are not congenital, but develop throughout life. New evidence has established that genetic, anatomical, inflammatory, and modifiable risk factors interact in the formation, growth, and rupture of aneurysms. Genome-wide association studies have found an association with genetic risk variants in 17 loci. Furthermore, circle of Willis variations predispose to aneurysm formation and cluster within families. These variations, plus modifiable risk factors, such as hypertension and smoking, result in haemodynamic stress and inflammatory reactions in the vessel and aneurysm wall but, in people at high risk, aneurysms can also form in the absence of hypertension or smoking. These research advances provide knowledge bases for the individualised concepts of identifying individuals who can have an aneurysm or patients with aneurysms at increased risk of rupture, and for pharmacological treatments for patients who do not require immediate preventive repair.","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-15DOI: 10.1016/s1474-4422(25)00305-9
Emerging evidence indicates that sustainable lifestyle changes—such as increasing physical activity, adopting healthy dietary patterns, and managing s…
新出现的证据表明，可持续的生活方式改变，如增加体育活动，采用健康的饮食模式，以及管理健康。
{"title":"The role of lifestyle interventions in symptom management and disease modification in Parkinson's disease","authors":"","doi":"10.1016/s1474-4422(25)00305-9","DOIUrl":"https://doi.org/10.1016/s1474-4422(25)00305-9","url":null,"abstract":"Emerging evidence indicates that sustainable lifestyle changes—such as increasing physical activity, adopting healthy dietary patterns, and managing s…","PeriodicalId":22676,"journal":{"name":"The Lancet Neurology","volume":"93 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145295373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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