Neuroepidemiology最新文献

Introduction: Pediatric stroke, though less common than in the elderly population, imposes a significant societal burden. With the increasing impact of climate change, this study aimed to assess the burden of different pediatric stroke subtypes attributable to non-optimal temperatures in the United States and estimate future trends.

Methods: This study analyzed data from the Global Burden of Disease (GBD) Database 2019. The pediatric stroke burden attributable to non-optimal temperatures was estimated by sex, age, and subtypes. R and Joinpoint were used to conduct the statistical analyses in this study. A p-value <0.05 was considered statistically significant.

Results: Nationally, there has been a decrease in pediatric stroke death rate and DALY rate attributable to non-optimal temperature from 1990 to 2019, with an AAPC of -2.36 (95% UI: -3.06--1.66, p-value<0.05) for death and -2.45 (95% UI: -3.10--1.80,p-value<0.05) for DALY. Similar trends were observed across sexes, age groups, stroke subtypes, and most states.

Conclusion: This study highlighted the pediatric stroke burden attributable to non-optimal temperature in the United States. More resources should be directed to address the geographic health disparities observed in this study.

Introduction: Gut dysbiosis is one of the environmental factors that might contribute to the development of Parkinson's disease (PD). The potential impact of antimicrobial agents on PD risk, particularly through dysbiosis and neuroinflammation, is an area of ongoing investigation, though findings remain inconsistent.

Methods: This systematic review and meta-analysis aimed to assess the relationship between antimicrobial use and PD risk. After searching PubMed, Scopus, Web of Science, and Embase, ten studies involving 3,755,583 participants, including 52,974 PD patients, were included.

Results: Antibacterial use was not significantly correlated with PD risk (O.R = 1.14; 95% C.I.: 0.97-1.33; P = 0.11, I² = 84%). After excluding one study, the odds of PD became significantly higher (O.R = 1.22; 95% C.I.: 1.04-1.44; P = 0.01). Specific antibacterial classes, such as tetracyclines, and macrolides, showed no significant associations with PD. However, cephalosporins had a protective effect (O.R = 0.86; P = 0.04), while antifungal use increased PD risk (O.R = 1.16; P = 0.001). Regarding antiviral use, a significant reduction in PD risk was observed in patients with hepatitis C virus undergoing antiviral treatment (H.R = 0.69; P = 0.0008).

Conclusion: The findings indicate complex relationships between antimicrobial use and PD risk. While antibacterials, in general, tend to increase PD risk, specific antibacterial may offer a protective effect, while antifungal agents appear to increase PD risk. Antiviral therapy may reduce PD risk in HCV patients. Further research is needed to confirm our results.

Introduction: To provide a comprehensive assessment of temporal trends in migraine prevalence among women of childbearing age (WCBA) at global, regional and national levels from 1992 to 2021, with particular emphasis on examining the associations between prevalence patterns and age, period and birth cohort effects across different sociodemographic index (SDI) regions.

Methods: We conducted a secondary analysis of data from the Global Burden of Disease Study 2021. Migraine prevalence estimates and 95% uncertainty intervals (UI) for WCBA were extracted. An age-period-cohort model was employed to estimate the net drift (primary outcomes), local drift, age/period/cohort relative risks (secondary outcomes).

Results: The global number of WCBA with migraine reached 493,937,856.01 (95% UI: 420,683,360.54 to 577,874,600.76) in 2021. The highest burden was found in India (95.7 million) and China (68.1 million), together accounting for substantial proportion of global prevalence. The global net drift showed minimal change 0.01% (95% CI: 0.00-0.02, p<0.01) per year, with variations across sociodemographic index (SDI) regions ranging from -0.03% per year, (95% CI: -0.04 to -0.02, p<0.01) in low-middle SDI regions to 0.16% (95% CI: 0.15-0.17, p<0.01) in middle-SDI regions. Local drift analysis reveals that migraine prevalence increases across young age groups (15-19 years) in high-SDI regions, while lower-SDI regions generally display stable rates. Globally, increases in migraine prevalence among young adults within WCBA are notably persistent. Across SDI regions, age effects follow similar patterns, with risk rising with age and peaking in the mid-reproductive years (ages 30-39). Over time, period risks and unfavorable trends across successive birth cohorts have intensified, particularly in high, high-middle, and middle-SDI regions.

Conclusion: Although global migraine prevalence among WCBA remains stable, an unfavorable upward trend in younger age groups (15-19 years) in high, high-middle, and middle SDI regions, alongside worsening period/cohort risks, highlights current gaps in prevention and management. Improved strategies are expected to reduce risks for younger birth cohorts and all age groups over time.

Introduction: The relationship between thyroid disorders and neurodegenerative diseases remains poorly understood. This large-scale retrospective cohort study aimed to investigate the association between thyroid disorders and various neurodegenerative diseases, as well as the potential impact of thyroidectomy.

Methods: We analyzed data from 3,719,666 patients with thyroid disorders and 2,945,438 controls from 120 healthcare organizations. After propensity score matching, each group included 2,033,096 patients. We compared the risk of neurodegenerative diseases between these groups and examined the effect of thyroidectomy in a subgroup analysis of 31,753 matched pairs.

Results: Patients with thyroid disorders showed significantly higher risks of Alzheimer's disease (RR=1.15, 95%CI: 1.110-1.195), Parkinson's disease (RR=1.25, 95%CI: 1.187-1.318), amyotrophic lateral sclerosis (RR=1.35, 95%CI: 1.131-1.622), frontotemporal dementia (RR=1.44, 95%CI: 1.219-1.702), Lewy body dementia (RR=1.15, 95%CI: 1.107-1.186), progressive supranuclear palsy (RR=1.41, 95%CI: 1.095-1.819), vascular dementia (RR=1.32, 95%CI: 1.266-1.369), Niemann-Pick disease type C (RR=1.34, 95%CI: 1.092-1.638), and Wilson's disease (RR=1.26, 95%CI: 1.056-1.507). Interestingly, the risk of multiple sclerosis was lower (RR=0.80, 95%CI: 0.738-0.862). Thyroidectomy was associated with a 44.2% lower risk of Lewy body dementia (RR=0.558, 95%CI: 0.339-0.919, p=0.020).

Conclusion: Thyroid disorders are significantly associated with an increased risk of several neurodegenerative diseases. Thyroidectomy may have a protective effect against Lewy body dementia. These findings suggest a complex relationship between thyroid function and neurodegeneration, emphasizing the need for neurological monitoring in patients with thyroid disorders and further research into thyroid-brain interactions.

Introduction: The aim of this study was to estimate the prevalence of possible rapid eye movement (REM) sleep without atonia (RWA) in the general population.

Methods: The study was based on data from the São Paulo Epidemiologic Sleep Study (EPISONO) 4th edition, a non-clinical population-based sleep study performed in the city of São Paulo, Brazil, between 2018 and 2019. All individuals underwent type-I polysomnography (PSG) with the addition of bilateral electromyography (EMG) of the flexor digitorum superficialis (FDS) muscles. The FDS activity index was calculated as the percentage of 30s REM sleep epochs containing at least 5 3-s miniepochs with phasic muscle activity, with a threshold of 7.7% being applied to identify possible RWA cases. The adjusted prevalence of possible RWA was calculated as the proportion of cases above the diagnostic threshold, corrected by the estimated specificity values according to the REM-specific apnea-hypopnea index - AHI (85% for REM AHI<15, and 60% for REM AHI≥15).

Results: The final sample comprised 632 participants (376 females, 59.49%), and 68 possible RWA cases were identified. The adjusted prevalence of RWA in the whole sample was 8.24% (CI95%: 6.09%-10.38%). The adjusted prevalence stratified by sex was 10.63% among men (CI95%: 6.85%-14.40%) and 6.61% among women (CI95%: 4.10%-9.12%) (p=0.013), resulting in a male/female prevalence ratio of 1.61. Possible RWA prevalence was similar between men and women in the 20-39 and 40-59 age ranges, but significantly higher among men aged 60-80 (16.57%, CI95%: 6.66%-26.49%) than women in the same age range (7.35%, CI95%: 2.62%-12.81%) (p=0.022).

Conclusions: The prevalence of possible RWA in the sample was 8.24%, and was similar between the sexes in most age ranges, but became more frequent among men from the age of 60 years old.

Background: The neutrophil-to-lymphocyte ratio (NLR) is widely regarded as a proxy for system inflammation. The previous study indicated that the NLR might be higher in Parkinson's disease (PD) compared to healthy controls (HC). The study aimed to assess the role of system inflammation indicated by NLR in the incidence and progression of PD.

Methods: We included participants from the longitudinal population-based cohort, UK Biobank, to analyze the association of NLR and the risk of PD. We conducted the Cox proportional hazards analyses as the primary analysis to determine the association between baseline NLR value and the risk of PD in UK Biobank. Then we further used data from a disease-specific longitudinal cohort, Parkinson's Progression Markers Initiative (PPMI), to evaluate the differences between individuals with higher PD risk, and early-stage PD patients in the values of NLR. Patients with PD were divided into two groups according to the median value of NLR (2.35). Linear mixed models (random intercept and random slope) were used to evaluate the relationship between the high/low NLR groups and the disease progression.

Results: A number of 288837 participants from UK Biobank were included and 1429 were diagnosed with incident PD. Among them, higher NLR was associated with an increased risk of incident PD in HC (per SD increment hazard ratio [HR], 1.041; P < 0.001). A total of 349 early-stage PD patients, 438 individuals with higher PD risk, and 207 HC were included from PPMI. PD patients and individuals with higher PD risk had a significantly higher NLR compared to healthy controls. Higher NLR group was associated with a faster deterioration of the Montreal Cognitive Assessment score in PD patients in two years (β [SE] = -0.225 [0.080], P = 0.005).

Conclusion: In conclusion, increased NLR in HC was linked with a higher risk of incident PD, and higher NLR was associated with a faster cognitive decline in PD patients, which indicated that inflammation was involved in the incidence of PD and the cognitive decline in early-stage PD.

Introduction: Considering the globally growing population and the rising incidence of dementia, it is important to understand the proportion of dementia cases affected by vascular brain disease. We aimed to study the incidence of vascular dementia (VD) and other dementias in a defined population in Finland to better understand VD's contribution to the total incidence of dementias and to assess the sensitivity of their diagnostics.

Methods: We aimed to collect all dementia diagnoses made in Northern Savo, Finland, in 2020. The memory disorder diagnoses were identified using the International Classification Codes 10th Revision (ICD-10) diagnoses codes. Finally, we studied the diagnoses in relation to demographic data, focusing on VD.

Results: The total number of new diagnoses of dementia with a vascular component or vascular alone was 202, with 20 cases attributable to pure VD. The annual incidence of dementias with a vascular component in Northern Savo was 81.4 per 100,000 across the population and 310.8 per 100,000 in the age group of  65. In our study population, 23.8% of all incident dementia cases were associated with vascular disease.

Conclusion: According to our findings, dementia associated with vascular pathology has the second highest incidence after Alzheimer's disease (AD), while pure VD is rarely diagnosed. Our findings align with previous international studies and a recent national registry study. Future studies with a prospective study setting, potentially incorporating extensive neuroimaging, would be critical in further understanding the epidemiology of VD.

The COVID-19 pandemic has had a major impact on health care. Shifts in inpatient and outpatient case numbers and morbidity have been quantified in other medical specialties (e.g., oncology and psychiatry). Such an analysis is lacking in neurological cases. Thus, we performed an anonymized, retrospective, multicenter analysis of administrative data from a network of 86 hospitals in Germany. Over 350,000 neurological cases admitted between January 2019 and December 2022 were included. The main outcome measures were: 1) deficit in inpatient hospital admissions during the pandemic compared to changes in outpatient cases; 2) morbidity, mortality, and complication rates during the pandemic; and 3) length of stay for inpatients. There was an evident deficit in inpatient admissions between -11% and -20%, which was not compensated for by outpatient cases. Furthermore, hospitalized patients exhibited several significantly increased measures of mortality (3.7% vs. 3.2%, p < 0.001) and morbidity compared to the pre-pandemic period. Interestingly, the proportion of patients with specific chronic comorbidities at risk for severe COVID-19, such as congestive heart failure, was lower during the pandemic (10% vs. 12%, p < 0.001). Finally, the length of hospital stay was shorter during the pandemic (i.e., 6.5 vs. 6.4 days during wildtype period, p < 0.001). These findings suggest a significant shift in hospital utilization patterns among neurology departments during the COVID-19 pandemic. While overall admissions decreased, average case severity was significantly higher. The latter was due to a selection bias because elective cases, less urgent and less morbid patients avoided hospital admission, or because their admission may have been delayed. A shorter length of stay was indicative of more efficient treatment. The avoidance of hospital care by patients with severe comorbidities could indicate a changed prioritization and utilization pattern but could also point to unmet health care needs. These observations underline the necessity for healthcare systems to adapt resource allocation and patient management strategies to ensure continuous quality of care during a pandemic.

Introduction: The study uniquely focuses on the global incidence, mortality, and temporal trends of brain and central nervous system (CNS) cancer from 1992 to 2021. It explores the association between the disease burden and factors such as age, period, and birth cohorts, and provides forecasts for future incidence and mortality.

Methods: Leveraging the Global Burden of Disease 2021 data from 1992 to 2021, we calculated incidence, and deaths and their age-standardized rates (ASRs) and assessed temporal trends using the average annual percent change derived from joinpoint regression analysis. To explore the impacts of age, period, and birth cohort in greater depth, we applied an age-period-cohort model. Additionally, a Nordpred age-period-cohort analysis was conducted to forecast the global epidemiological trends from 2022 to 2031.

Results: The global incidence of brain and CNS cancer has increased from 2,831,075 in 1992 to 3,420,786 in 2021, and the number of mortalities has risen by 80.62%. The incidence ASR was highest in high sociodemographic index (SDI) regions and showed an increasing trend. Conversely, the mortality ASR displayed downward trends in high-middle and high SDI regions. Notably, the age-period-cohort model suggests a recent increase in incidence risk and a decline in mortality. From 2022 to 2031, the global mortality ASR was predicted to decrease whereas the incidence ASR increases slowly.

Conclusion: The global trends in brain and CNS cancer incidence and mortality generally showed an increasing trend with considerable heterogeneity. Furtherly, high SDI regions were displayed where healthcare systems could conduct earlier and better medical interventions with better outcome for brain and CNS cancer.