Neuroepidemiology最新文献

Background: Spinal cord injury (SCI) attributable to falls and road injuries imposes a significant burden on working-age individuals; however, its temporal and geographic patterns in this demographic remain underexplored. This study aimed to evaluate the global, regional, and national burden of SCI attributable to falls (SCIFs) and road injuries (SCIR) among working-age individuals (aged 15-64 years) from 1990 to 2021 and project trends through 2040.

Methods: Using Global Burden of Disease (GBD) 2021 data, global, regional, and national age-standardized incidence rates (ASIR), prevalence rates (ASPR), and years lived with disability rates (ASYR) were assessed according to global parameters and sociodemographic stratification. Trends were quantified by the average annual percentage change (AAPC) and future burdens projected using Bayesian age-period-cohort (BAPC) models.

Results: From 1990 to 2021, global ASIR, ASPR, and ASYR for SCIR declined markedly (AAPC -1.54 [95% confidence interval -1.54 to -1.53], -1.88 [-1.89 to -1.87], and -2.03 [-2.05 to -2.01]), whereas SCIF showed modest or stagnant reductions with regional increases (AAPC -0.24 [-0.27 to -0.22], -0.39 [-0.41 to -0.36], and -0.67 [-0.69 to -0.65]). Males exhibited higher burdens than females, with SCIF increasing with age and peaking at 60-64 years, whereas SCIR shifted toward older groups. High-sociodemographic index (SDI) regions experienced declines in both, whereas middle-SDI areas saw SCIF increases, despite SCIR decreases; low-SDI regions showed slight SCIF rises. Regionally, Western Europe displayed steady reductions, whereas Central Asia experienced an increase in SCIF and Sub-Saharan Africa showed stable or slightly increasing SCIF indicators. National variations were pronounced, with burdens often exceeding SDI expectations in rapidly developing countries. Projections to 2040 indicate a modest rise in SCIF burden (predicted ASIR 3.72 [95% uncertainty interval 1.82-5.63] per 100,000) but a decrease in SCIR (predicted ASIR 1.22 [0.73-1.72] per 100,000).

Conclusions: Although the burden of SCIR has declined substantially from 1990 to 2021 and is projected to continue decreasing, persistent or rising SCIF trends - expected to modestly increase by 2040 - alongside male predominance, age shifts, and socioeconomic disparities emphasize the urgency for tailored prevention: enhanced road-safety measures and occupational reforms targeting falls in high-risk groups to reduce inequities and socioeconomic costs.

Introduction: As one of the most prevalent neurological disorders, epilepsy imposes a major health burden. Emerging evidence suggests a possible association between air pollution and epilepsy incidence, but its effect on epilepsy-related deaths remains unknown.

Methods: We conducted an individual-level time-stratified case-crossover study in Jiangsu province, China (2015-2022) to explore the associations between short-term exposure to air pollution and epilepsy deaths, focusing on fine particulate matter (PM_2.5), inhalable particulate matter (PM₁₀₎, sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), and ozone (O₃). Exposure at each subject's residential address was assessed by extracting concentrations from ChinaHighAirPollutants, a series of validated gridded datasets with a high spatial resolution (1 km × 1 km). Conditional logistic regression models were fitted to quantify exposure-response associations. The attributable fraction and attributable number from air pollution were calculated to estimate their disease burden.

Results: Each interquartile range (IQR) increase in exposure to PM_2.5 (IQR: 32.6 μg/m3), PM₁₀ (IQR: 51.3 μg/m3), SO₂ (IQR: 8.5 μg/m3), NO₂ (IQR: 20.8 μg/m3), and CO (IQR: 0.3 mg/m3) was significantly associated with a 10.6% (95% CI: 2.9%, 18.9%), 10.5% (2.8%, 18.8%), 9.9% (0.5%, 20.1%), 9.8% (1.2%, 19.2%), and 8.5% (0.5%, 17.1%) higher odds of epilepsy death (all p < 0.05). The association between PM_2.5 exposure and epilepsy deaths was significantly stronger among individuals <50 years. Up to 12.3% of epilepsy deaths were attributable to air pollution.

Conclusion: Exposure to ambient air pollution was significantly associated with increased odds of epilepsy death, especially for younger individuals.

Introduction: Early-onset dementia (EOD) and late-onset dementia (LOD) differ in etiology, clinical presentation, and societal impact. Characterizing their global burden and associated risk factors is essential for guiding targeted interventions and resource allocation.

Methods: We analyzed data from the Global Burden of Disease (GBD) 2021 study (1990-2021) to estimate incidence, mortality, and disability-adjusted life years (DALYs) for EOD (ages 40-64) and LOD (≥65 years) across 204 countries and territories. Age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) were calculated. Risk factors examined included smoking, high fasting plasma glucose (FPG), and high body mass index. Associations with the sociodemographic index (SDI) were assessed, and Bayesian age-period-cohort model was used to project trends to 2050.

Results: In 2021, global age-standardized incidence rates (ASIRs) were 63.58 per 100,000 for EOD and 1,173.19 per 100,000 for LOD. Corresponding age-standardized mortality rates (ASMRs) and age-standardized DALY (AS-DALY) rates were substantially higher for LOD. Point estimates for ASRs were consistently higher for females than for males across all metrics. From 1990 to 2021, the burden of EOD increased (ASIR EAPC = 0.13; ASMR EAPC = 0.08; AS-DALY EAPC = 0.08), while LOD trends remained largely stable. Regional variation was observed, with EOD burden highest in China, Canada, Brazil, and the USA and LOD in China, Germany, Italy, and Lebanon. Metabolic risks, particularly high FPG, were major contributors to LOD. SDI was positively correlated with LOD burden (r = 0.176; p < 0.001), indicating a weak but statistically significant association. Projections indicate that EOD cases will increase by 160% and LOD cases by 479% by 2050.

Conclusions: The global dementia burden is rising, with distinct epidemiological patterns for EOD and LOD. Age- and region-specific risk factor profiles highlight the need for tailored prevention strategies, informed healthcare planning, and differentiated clinical management.

Background: Driven by population ageing, the burden of Alzheimer's disease and other dementias (ADOD) continues to rise. A comprehensive assessment of the ADOD burden at global, regional, and national levels is critical for public health.

Methods: Based on the Global Burden of Disease Study 2021, we assessed the ADOD burden. Temporal trends were analysed using Joinpoint regression; inequalities among countries were evaluated via Lorenz curves; and future trends were projected employing an age-period-cohort model.

Results: In 2021, the age-standardised rates for ADOD were 694.01 (95% uncertainty intervals [UIs]: 602.88 to 794.08) for prevalence, 119.76 (95% UI: 104.96 to 135.89) for incidence, and 481.70 (95% UI: 228.79 to 1,023.96) for disability-adjusted life years (DALYs). Females exhibited a higher ADOD burden than males across all age groups, with an age-standardised prevalence rate of 769.94 (95% UI: 670.71 to 877.57) in females compared to 589.47 (95% UI: 507.48 to 678.79) in males. The slope inequality index of crude DALY rate increased from 315.23 (95% confidence intervals [CIs]: 310.43 to 437.87) in 1990 to 758.29 (95% CI: 692.48 to 908.29) in 2021 at the country level. The Lorenz curves for the crude DALY rate of ADOD in 1990 and 2021 lay below the equality line, indicating a higher burden among countries and territories with a higher socio-demographic index (SDI) ranking. By 2046, global prevalence is projected to reach 124.89 million, a 119.67% increase from 2021.

Conclusion: The ADOD burden has increased globally, with significant regional disparities. Urgent action is required to prevent ADOD, especially among females and in high-SDI regions.

Introduction: While botulinum toxin type A (BoNT-A) is effective for poststroke spasticity, its accessibility in older adults remains unclear. We aimed to examine the association between BoNT-A use and age among stroke survivors.

Methods: This nationwide, population-based, retrospective cohort study analyzed data from the French National Hospital Discharge Database. Stroke survivors admitted between 2014 and 2016 were followed until 2020. BoNT-A use was assessed across different age groups (18-64, 65-74, 75-84, ≥85 years). Multivariable logistic regression was performed to examine the association between BoNT-A use and age, adjusting for potential confounders, including sex, comorbidities, stroke unit hospitalization, and rehabilitation.

Results: BoNT-A use was reported in 1,757 (2.88%), 862 (0.99%), and 183 (0.22%) of 60,928, 86,917, and 82,725 stroke survivors aged 65-74, 75-84, and ≥85 years, respectively. These rates were significantly lower than BoNT-A use in those aged <65 years (5.13%) (p < 0.001). After adjustment, the inverse relationship between age and BoNT-A use was maintained, demonstrating an age-dependent association in the 65-74, 75-84, and ≥85 age groups vs. 18-64 years. Odds ratios (ORs) (95% confidence intervals [CIs]) were 0.49 (0.47-0.53), 0.18 (0.17-0.19), and 0.05 (0.04-0.06), respectively. Stroke unit stays (OR, 1.33; 95% CI, 1.26-1.41) and neurological rehabilitation unit stays (OR, 16.69; 95% CI, 15.59-17.87) were significantly associated with a higher probability of receiving BoNT-A.

Conclusions: BoNT-A use is notably low in older stroke survivors, highlighting the need to enhance equitable access to BoNT-A injections for this population.

Introduction: Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system affecting 2.9 million people worldwide. MS symptom variety can have a significant impact on the economic and occupational participation of people with MS (pwMS). The objective of this study was to investigate the trends in the employment (EMP) status change of pwMS over a 2-year period and to identify the associated sociodemographic, clinical and symptom-specific factors.

Methods: The present longitudinal observational study analysed real-world registry data from pwMS characterised by ≥1 documented data set during 2014-2023, an age of 18-60 years, ≥2 data sets during a 2-year period (±2 months) and a documented EMP status change. The transition from EMP to non-employment (NEMP) or vice versa within a 2-year period was investigated during two visits: baseline (pre-transition) and follow-up (post-transition). Univariable and multivariable logistic regression models were utilised to identify associated variables.

Results: The study population (N = 940) was classified into NEMP-to-EMP patients (n = 269) and EMP-to-NEMP patients (n = 671). EMP-to-NEMP patients were found to be older in median (45.6 vs. 39.3 years) and more likely to have chronic progressive MS at baseline (14.2% vs. 4.8%) than NEMP-to-EMP patients. Moderate/severe disability level emerged as the most robust predictor of EMP-to-NEMP switches (odds ratio [OR] = 1.89, p = 0.005). Pain (baseline: OR = 1.96, p = 0.017; follow-up: OR = 5.57, p = 0.025) and cognitive impairment (baseline: OR = 1.78, p = 0.048; follow-up: OR = 10.47, p = 0.005) were significant symptomatic predictors of EMP-to-NEMP transitions.

Conclusion: The results emphasise the particular importance of pain and cognitive impairment as independent symptomatic predictors, whose impact on work ability may be underestimated.

Introduction: Dementia with symptom onset before the age of 65 is referred to as early-onset dementia (EOD). Many gaps exist regarding EOD etiology, including the role of environmental factors.

Methods: We conducted a population-based case-control study in Modena province, Northern Italy, enrolling and geocoding 326 EOD cases and 1,941 sex- and age-matched controls, to investigate the association of traffic-related benzene, green spaces around the place of residence, and exposure to artificial outdoor light at night (LAN). We used nonlinear modeling to assess the relation between environmental variables and disease risk, overall, and separately for Alzheimer's dementia (AD) and non-AD.

Results: Green spaces generally showed an inverse association with EOD risk that was almost linear for AD and inverted U-shaped for non-AD. We observed a weak positive association between traffic-related benzene exposure and EOD risk that seemed limited to AD, with little change in risk for non-AD. Exposure to LAN showed an inverse linear association with small differences across the two disease subgroups. Analyses stratified by sex and age showed generally stronger (but statistically imprecise) associations in females and older individuals.

Conclusion: Overall, these results are consistent with some environmental influences on EOD risk, particularly with a beneficial effect of green spaces and LAN, as well as a possible adverse role of air pollution, particularly for AD.

Introduction: Studies of Parkinson's disease (PD) caregiver stress have examined many contributing factors, but a clear understanding of the impact of Parkinson's disease psychosis (PDP) on caregiver burden has been difficult to ascertain from existing evidence. The evidence has been collected primarily in small, heterogeneous studies that do not lend themselves to meta-analysis.

Objective: The aim of this study was to understand current evidence on the association between PDP and caregiver burden despite the heterogeneity of populations studied and methods used.

Methods: Following PRISMA guidelines, PubMed, Embase, and ClinicalTrials.gov were searched from inception through April 1, 2025, for English-language articles using predefined search terms. Eligible original research included individuals with PD, assessment of psychosis symptoms, defined caregivers, and evaluation of the association between psychosis and caregiver burden. Data were extracted independently, and study quality was assessed using the Newcastle Ottawa Scale. The exposure was PDP, and the outcome was caregiver burden.

Results: Twenty-six articles met inclusion criteria. Most studies enrolled fewer than 100 participants; 9 of these (34.6%) had low risk of bias. Psychosis symptoms were assessed via validated questionnaires in 17 studies, self-report in 7, and unspecified methods in 2. Definitions of caregiver varied, with 4 studies including paid caregivers. Among 10 studies adjusting for confounders, 6 (60%) reported a significant positive association between PDP symptoms and caregiver burden. Of the 4 multivariate studies without a significant association, 3 found positive relationships between other patient psychiatric symptoms and this burden.

Conclusion: While the quality of research is variable and studies include an array of different population definitions and measurement approaches, higher quality studies indicate PDP is associated with greater caregiver burden. To facilitate the well-being of patients with PDP and their caregivers, it is important to identify and address the specific caregiver challenges due to psychosis symptoms in PD.

Background: The systematic assessment of the burden of common neurological disorders in Europe based on latest epidemiological data remains lacking.

Methods: We extracted data on disability-adjusted life years (DALYs), mortality, prevalence, and incidence of neurological disorders from the Global Burden of Disease 2021 study from 1990 to 2021. Future trends over the next 15 years were projected using autoregressive integrated moving average modeling.

Results: In 2021, the age-standardized DALYs rates (ASDRs) of neurological disorders in Europe (1,502.3/100,000 population) were significantly higher than the global average (1,385.1/100,000 population). Among them, the ASDRs in Western Europe (1,584.23/100,000 population) were notably higher than that in Central Europe (1,354.65/100,000 population) and Eastern Europe (1,375.03/100,000 population). Ischemic stroke (31.98%) and Alzheimer's disease (20.24%) were the major contributors to the disease burden in Europe. Age-stratified analysis revealed that the elderly population (≥65 years old) bore the burden of stroke and Alzheimer's disease and other dementia. The overall disease burden was higher in females. From 1990 to 2021, data indicated a significant decline in the disease burden of ischemic stroke, Alzheimer's disease and other dementias, encephalitis, idiopathic epilepsy, intracerebral hemorrhage, and meningitis. Conversely, Parkinson's disease and other neurological disorders showed an upward trend. ARIMA forecast analysis suggested that from 2021 to 2036, the predicted ASDRs for neurological disorders would be lower compared to previous levels.

Conclusion: Neurological disorders impose a greater burden in Europe than globally, primarily driven by ischemic stroke and Alzheimer's disease, with Western Europe, elderly, and female populations being disproportionately affected.

Introduction: The Pathology, Alzheimer's and Related Dementias Study (PARDoS) is a community-based clinical-pathologic study of aging and dementia in a large and diverse sample of Brazilians. Its long-term objective was to identify the environmental, genetic, and molecular drivers of common conditions across the adult life span with an emphasis on Alzheimer's disease and related disorders clinical and neuropathologic traits.

Methods: From July 31, 2021, through February 11, 2025, 4,790 brains were collected at two autopsy centers and a major hospital system in the State of São Paulo, Brazil. Samples of other organs are also being collected. Their mean age was 71.7 years (range 18-106), 40.2% were black/mixed, 52.7% were male, their mean education was 6.3 years (range 0-25). Among those aged 65+, 32.9% had dementia and 18.8% had mild cognitive impairment. Neuropathologic data collection is ongoing.

Conclusion: PARDoS fills several major gaps among clinical-pathologic studies given the large numbers and its unique age and education range and socioeconomic status, race, sex, and other organ collection. Here, we present the study design, demographic characteristics of the first 4,790 autopsied participants, and clinical characteristics of the first 4,283 with informant interviews.