Neuroepidemiology最新文献

Instruction: Traumatic spinal cord injury (TSCI) can cause severe health loss because of premature mortality and long-term disabilities. This study estimated the global, regional, and national incidence, prevalence, and years lived with disability (YLDs) of TSCI using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021.

Methods: DisMod-MR2.1 was utilized to derive case number and age-standardized rate (ASR) with 95% uncertainty intervals (95% UIs) for the incidence (ASIR), prevalence (ASPR), and YLDs (ASYRs) for SCI from 1990 to 2021 for the whole world, 21 GBD regions, and 204 countries. Estimated annual percentage change was determined using a linear regression mode. Spearman rank order correlation was performed to identify the correlations between sociodemographic index (SDI) and the burden of TSCI.

Results: Globally, there were 574,502 (95% UI 440,219-757,445) incident cases, 15,400,682 (95% UI, 17,075,106-14,009,114) prevalent cases, and 1,305,142 (95% UI, 1,726,419-917,167) YLDs of total TSCI in 2021. From 1990, the number of incidences, prevalence, and YLDs cases showed an upward trend, while the ASIR, ASPR, and ASYR showed a downward trend. Males had higher ASIR, ASPR, and ASYR, and the ASIR, ASPR, and ASYR increased with age. Cervical SCI had higher ASIR and ASYR than SCI below neck level. It showed positive correlations between SDI and ASIR (rho = 0.4670, p < 0.01), ASPR (rho = 0.4035, p < 0.01), and ASYR (rho = 0.2727, p = 0.003) in 2021.

Conclusion: The absolute counts of incidence, prevalence, and burden of TSCI substantially increased from 1990 to 2021, despite the decrease in corresponding ASRs. TSCI happened in the most active periods of individuals globally, which were shifting toward older age-groups over time. TSCI had larger effects on the elderly and males than younger populations and females.

Introduction: This study explored the association between the frequency of individual outdoor activity and the risk of incident dementia in an elderly population in China. We aimed to provide scientific evidence to support non-pharmaceutical strategies for preventing or delaying the onset of dementia.

Methods: A total of 8,758 participants (median age: 85 years) from the Chinese Longitudinal Healthy Longevity Survey were included in the analyses. We assessed the association between the frequency of individual outdoor activity and the risk of incident dementia using the Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses were performed, stratified by age, sex, and residence. Additionally, a sensitivity analysis was conducted to evaluate the robustness of the findings after excluding participants who, at baseline, had a Mini-Mental State Examination (MMSE) score <18 or had been diagnosed with stroke, other cerebrovascular diseases, diabetes mellitus, cancer, or Parkinson's disease.

Results: Over a median follow-up period of 4.33 years, 637 participants (7.27%) developed dementia. Compared with those who almost never engaged in outdoor activities, participants who engaged almost daily had a reduced risk of incident dementia by approximately 25% (HR: 0.75, 95% CI: 0.62-0.92). Subgroup analyses showed significant associations in females and participants living in cities and towns, whereas no significant differences were observed between age groups. The sensitivity analysis yielded results consistent with the primary analysis.

Conclusion: Frequent participation in individual outdoor activity may be associated with a reduced risk of dementia among the elderly in China. These findings support outdoor activity as a potential non-pharmaceutical strategy to delay cognitive decline and prevent dementia.

Introduction: Adolescent neurological disorders remain a leading cause of the global disease burden. This study aimed to provide an updated assessment and insights into the burden trends from 1990 to 2021.

Methods: We calculated the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for common 10 prevalent neurological diseases in adolescents and young adults globally from 1990 to 2021. Data were presented by total numbers, sex, age, year, location, risk factors, Socio-Demographic Index (SDI), and expressed in counts and rates.

Results: In 2021, migraine (592.8 million, 95% UI 47.6-1,445.1), idiopathic epilepsy (204.8 million, 95% UI 152.8-279.5), and stroke (116.1 million, 95% UI 104.2-126.9) ranked as the top three neurological disorders globally in terms of DALYs. From 1990 to 2021, the absolute number of DALYs and deaths due to common neurological disorders significantly increased, although the age-standardized mortality rate slightly declined. Most disease burden increased with age, with a higher prevalence in females than in males. Furthermore, significant variations were observed between different diseases and regions, and the age-standardized DALY rates for most neurological disorders showed a significant positive correlation with the country's SDI value.

Conclusion: Neurological disorders ranked second in global adolescent and young adults' DALYs and remained a key mortality driver. Persistent absolute burden despite declining age-standardized rates urges prioritized prevention policies and care strategies amid population growth.

Introduction: Stroke is a leading cause of morbidity and mortality, particularly in older adults. Identifying lifestyle factors, such as physical activity (PA), that mitigate stroke risk is critical for stroke prevention, especially in postmenopausal women. We sought to determine the association between levels and types of recreational PA and risk of total, ischemic, and hemorrhagic stroke in postmenopausal women.

Methods: We performed a prospective cohort study conducted within the Women's Health Initiative from 1993 to 1998 with a mean follow-up of 8.5 years. We studied a total of 139,871 postmenopausal women aged 50-79 years without prior cardiovascular disease or stroke at enrollment. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Recreational PA was assessed via questionnaire, including total, light, moderate, and vigorous activities and walking. Incident total, ischemic, and hemorrhagic strokes were recored. HRs and 95% CIs were adjusted for sociodemographic, lifestyle, and clinical factors.

Results: During follow-up, 4,642 stroke occurred (3,496 ischemic and 728 hemorrhagic). Higher levels of total PA (per 1 SD MET-hr/wk: HR = 0.90, 95% CI: 0.87-0.93), walking (HR = 0.93, 95% CI: 0.90-0.96), and moderate PA (HR = 0.91, 95% CI: 0.88-0.94) were associated with reduced total stroke risk. Similar inverse associations were found for ischemic stroke. Vigorous PA demonstrated a J-shaped association with ischemic stroke, while light PA was not significantly associated with stroke risk. Total (HR = 0.90, 95% CI: 0.83-0.97) and vigorous PA (HR = 0.88, 95% CI: 0.81-0.96) were inversely associated with hemorrhagic stroke. Associations were consistent across subgroups defined by age, race/ethnicity, blood pressure, hormone therapy use, BMI, and dietary intake.

Conclusion: Increased recreational PA, particularly moderate, with cautious interpretation of vigorous activity due to its J-shaped association and potential risks, is associated with reduced risks of total and ischemic stroke in postmenopausal women. Our findings support promoting PA as a key strategy for stroke prevention in this population.

Introduction: Evaluating long-term trends for the incidence of intracerebral hemorrhage is a priority for primary prevention. It is also important to assess the trends in the proportions of bleeding sites because the pathogenesis, prognosis, and operative procedures differ among them.

Methods: A prospective community-wide stroke registry in two rural Japanese communities (Ikawa Town and Kyowa Town, with populations of approximately 5,000 and 15,000, respectively) was conducted. The age-adjusted incidence of intracerebral hemorrhage from 1985 to 2017 was calculated by the direct method using the World Standard Population. The proportions of intracerebral hemorrhage by bleeding sites (putamen, thalamus, lobes, cerebellum, and brain stem) based on neuroimaging were calculated in each of the following three periods: 1985-1995, 1996-2006, and 2007-2017.

Results: During the study period, 383 intracerebral hemorrhage events as first-ever strokes were registered. The age-adjusted incidence declined over time by 33%, with a large reduction between 1985-1989 and 1990-1994, but the magnitude of the decline has diminished since the 1990s. The proportions of bleeding sites were 37%, 29%, and 31% for the putamen in 1985-1995, 1996-2006, and 2007-2017, respectively; the corresponding proportions were 24%, 35%, and 18% for the thalamus; 10%, 10%, and 21% for lobes; 2%, 8%, and 12% for the cerebellum; and 8%, 6%, and 5% for the brain stem.

Conclusion: The age-adjusted incidence declined by 33% from the 1990s, with a large reduction in the early 1990s in Japanese rural communities. Among intracerebral hemorrhages, the proportion of bleeding sites decreased for the putamen, thalamus, and brain stem and increased for lobes and the cerebellum.

Introduction: Moyamoya angiopathy (MMA) has been reported in the ethnically diverse Auckland region of New Zealand, but the sociodemographic burden and clinical outcomes remain poorly characterised. This study aimed to determine age, sex, and prevalence of MMA stratified by ethnicity and assess clinical outcomes in adults residing in Auckland (population 1.9 million).

Methods: A retrospective review of patient records and radiology reports from 2008 to 2025 was conducted using ICD codes and keyword searches. Prevalence was estimated using national census data. Primary outcomes were functional independence (modified Rankin Score 0-2) and the composite of stroke or transient ischaemic attack. Associations were assessed using univariate and multivariate Cox regression. A pooled analysis of published cohorts was also performed for context.

Results: A total of 100 patients were identified (73% female; mean age 38.5 years, SD 17). Period prevalence was highest among Pacific peoples (11/100,000), followed by Māori (6/100,000), Asians (4/100,000), and Europeans (2/100,000). Overall prevalence increased from 0.8 to 4.5 per 100,000 between 2001 and 2025 (p ≤ 0.0001). During a median follow-up of 4.2 years, 39% experienced a cerebrovascular event, at a median of 647 days from diagnosis. Two-thirds remained functionally independent. Bilateral internal carotid artery involvement (hazard ratio [HR] 0.52, 95% confidence interval [CI]: 0.30-0.91) and recurrent cerebrovascular events (HR 0.54, 95% CI: 0.31-0.94) were associated with a reduced likelihood of functional independence, while antithrombotic use was protective (HR 2.1, 95% CI: 1.11-3.9). Functional outcomes were consistent with other international cohorts.

Conclusion: This population-based study highlights marked ethnic variation in MMA prevalence, with the highest rates in Pacific peoples, and an elevated risk of early cerebrovascular events. These findings have implications for timely diagnosis and targeted management in diverse populations.

Introduction: Conflicting findings exist between weight change and ischemic stroke risk. Studying the association between body weight change and ischemic stroke risk helps clarify the true nature of the association and supports future health promotion and stroke prevention strategies.

Methods: We longitudinally assessed data from 10,985 ARIC visit 4 participants (1996-1998). After excluding individuals with missing data on previous stroke or coronary heart disease at baseline (visit 4), we classified 9-year weight change (visit 4 minus visit 1 weight) into quintiles of weight change and weight loss (>-2.7 kg), no change (-2.7 to +2.7 kg), and weight gain (>+2.7 kg) categories. We used crude and adjusted Cox regression models to assess ischemic stroke hazard. We also performed an analysis stratified by body mass index (BMI) status to see if the weight change-stroke risk relationship differed by baseline BMI.

Results: Among 9,574 participants, 676 developed ischemic stroke during the 20-year follow-up. Most participants at baseline were female (58.25%) and drinkers (50.52%), with mean age of 62 and mean BMI of 28.78 kg/m2. Compared to participants with no change, those who gained weight had 23% lower hazards of ischemic stroke (hazard ratio [HR] = 0.77 (95% confidence interval [CI] = 0.60, 0.99)), while those who lost weight had 30% higher hazards (HR = 1.30 [95% CI = 1.05, 1.62]).

Conclusion: Weight change showed minimal association with stroke risk overall, with moderate weight gain potentially lowering the risk, while weight loss increased it. These results emphasize the intricate relationship between weight dynamics and cerebrovascular health and the potential complex implications of the degree and direction of weight change for stroke prevention.

Introduction: The relationship between herpes simplex virus (HSV) infection and the risk of Alzheimer's disease (AD) remains unclear.

Methods: A systematic review and meta-analysis were conducted to investigate this potential association. Observational studies were sourced from PubMed, Embase, Web of Science, and the Cochrane Library up to July 31, 2024. The analysis utilized the generic inverse variance method with a random-effects model. Effect sizes were calculated as odds ratios (ORs) or hazard ratios (HRs) with corresponding 95% confidence intervals.

Results: A total of 26 original studies, encompassing 1,213,193 participants, were included in the meta-analysis. The findings indicated a 32% higher likelihood of AD in individuals with HSV infection in case-control studies (OR = 1.32; 95% CI: 1.12, 1.55; I2 = 22.7%) and a 20% increased risk in cohort studies (HR = 1.20; 95% CI: 1.10, 1.31; I2 = 11.0%). Specifically, HSV-1 infection was associated with 46% higher odds of AD (OR = 1.46; 95% CI: 1.14, 1.86; I2 = 3.1%).

Conclusion: This meta-analysis demonstrates an association between HSV infection and increased risk of AD, particularly for HSV-1. Given the high global prevalence of HSV-1 and the heterogeneity of existing evidence, these findings should be regarded as hypothesis-generating, underscoring the need for rigorous, biomarker-informed studies to clarify causality, and identify susceptible subgroups.

Introduction: The aim of this study was to characterize the epidemiology, risk factors, and clinical presentation of Wernicke encephalopathy (WE) and analyze differences between cases with and without excessive alcohol consumption.

Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science up to April 1, 2025. The included studies provided data on prevalence, risk factors, clinical and radiological findings, mortality, and prognosis in patients with WE. Pooled proportions and weighted means were calculated using random-effect models with Freeman-Tukey transformation. Heterogeneity was assessed using the I2 statistic. Subgroup comparisons were performed based on the presence or absence of excessive alcohol consumption.

Results: A total of 12 studies comprising 5,510 patients were analyzed. Overall, 65.4% (95% CI: 56.0-74.2) were male, with a weighted mean age of 60.7 years. Among cases related to excessive alcohol consumption, 78.7% were male (mean age 55.2); in cases not related to such consumption, 52.6% were male (mean age 63.5). The classic triad was present in 32.7% of cases (95% CI: 19.2-47.7). Among patients evaluated by magnetic resonance imaging, typical lesions were identified in 82.0%, and atypical lesions were identified in 44.8%. Overall mortality was 5.1% (95% CI: 2.3-8.8%) and higher in non-alcohol-related cases (8.8%). Alcohol consumption was the main risk factor (90.7%); among non-alcohol-related cases, the most frequent clinical settings were malnutrition (30.2%), infections (25.1%), and psychiatric disorders (15.4%).

Conclusion: WE is a multifactorial syndrome that extends beyond alcohol misuse, with wide clinical and pathophysiological variability. These findings underscore the importance of early recognition and prompt thiamine replacement, particularly in non-alcohol-related cases.

Introduction: The pace of cognitive change is one of the major questions in cognitive aging. The Children of the Depression Age (CODA) cohort of the Health and Retirement Study (HRS) is uniquely suited to study cognitive aging because it has a long follow-up (22 years) and a narrow age range at baseline (67-74 years) and presents a unique opportunity to study this topic.

Methods: We examined delayed recall data over the 22 years of follow-up in a nationally representative sample of the USA (HRS-CODA; N = 2,295 at baseline and N = 263 at the final follow-up wave), examining results for the entire sample and omitting participants with self-reported dementia. Data were analyzed using latent growth curve models, adjusting for baseline age, sex, years of education, and race/ethnicity.

Results: Respondents were predominantly female (62%), white (86%), and 71 years old on average at baseline. Our results suggest the pace of normative (defined as the absence of a dementia diagnosis over the follow-up period) memory decline is about -0.05 standard deviations per year (SD/y) but is better characterized by age-specific estimates of -0.04 SD/y, -0.10 SD/y, and -0.15 SD/y for an individual who was 75, 85, and 95, respectively.

Discussion: Memory decline, in the absence of a recognized dementia and without a confounding of baseline age differences and longitudinal age changes, would be present but almost imperceptible to an individual in their eighth decade, but noticeable in their ninth and quite impairing in their tenth decade. Future research is needed to examine other cognitive domains and with more robust measures.