Neuroepidemiology最新文献

Introduction: Myasthenia gravis (MG) presents a substantial clinical burden, characterized by increased incidence of myasthenic crises, heterogeneity in treatment response, significant functional impairment, and gradually increasing mortality rates with marked geographical heterogeneity across China. While improving quality of life (QOL) is the focus of MG management, multifactorial determinants of QOL impairment remain unclear, especially in socioeconomically underrepresented regions, particularly Southwestern China. This study aimed to explore myasthenia-specific risk factors for QOL and develop a parsimonious prediction model.

Methods: This study performed univariate and multivariate regression analyses on 310 MG patients diagnosed at the First Affiliated Hospital of Chongqing Medical University between January 2022 and February 2025 from Southwestern China. The QOL of patients was evaluated with the 15-item Myasthenia Gravis Quality of Life (MG-QOL15). Disease severity was evaluated with current Myasthenia Gravis Foundation of America (MGFA) classification, MG-related activity of daily living (MG-ADL) score and quantitative myasthenia gravis (QMG) score. Relevant clinical and demographic data were included in the analysis.

Results: In the analysis of basic characteristics, higher ADL (p < 0.001), worse MGFA classification (p < 0.001), lower education level (p = 0.006), thymic abnormalities (p = 0.004), and treatment (p = 0.003) were significantly correlated with poor QOL. However, factors such as age of onset, gender, and antibody status showed no significant impact. The multivariate models (Model 1-6) further confirmed that MG-ADL (OR = 8.397), QMG score (OR = 4.357), MGFA classification, and thymus histology (thymic hyperplasia OR = 4.505, thymoma OR = 2.472) were independent risk factors for QOL. Corticosteroids combined with immunotherapy were found to significantly improve QOL compared to monotherapy. Model validation indicated that Model 5, which incorporates MG-ADL, MGFA classification, thymus histology, and education level, had the optimal overall performance (area under the curve = 0.835, specificity 0.917), balancing predictive accuracy and clinical applicability.

Conclusion: By identifying key predictors, including clinical severity, thymic abnormalities, and education level, this study developed a multidimensional prediction model for QOL in MG patients.

Introduction: Early medical complications following acute ischemic stroke (AIS) are common and might increase poststroke morbidity and mortality. This study aimed to evaluate trends in the prevalence of early medical complications over almost 2 decades and their impact on 3-month functional outcome and mortality.

Methods: A total of 181,704 AIS patients from the Austrian Stroke Unit Registry (2006-2024) were analyzed. Early medical complications included decompensated heart failure, cardiac arrhythmia, sepsis, pneumonia, urinary tract infection (UTI), deep vein thrombosis, and pulmonary embolism. Functional outcomes were assessed using the modified Rankin Scale (mRS) after 3 months, with favorable outcome defined as mRS ≤1. Associations between early medical complications and mRS were analyzed using multivariable Poisson regression models.

Results: Among all patients, 16,279 (9.0%) had early medical complications. Pneumonia (4.2%), UTI (2.9%), cardiac arrhythmia (1.4%), and decompensated heart failure (1.4%) were most common, with significant declines in prevalence over time. Admission NIHSS scores decreased, and the use of intravenous thrombolysis and mechanical thrombectomy increased. Decompensated heart failure (RR = 1.85, 95% CI: 1.73-1.97, p < 0.001), sepsis (RR = 1.75, 95% CI: 1.53-1.99, p < 0.001), pulmonary embolism (RR = 1.67, 95% CI: 1.33-2.10, p < 0.001), and pneumonia (RR = 1.64, 95% CI: 1.57-1.72, p < 0.001) were significantly associated with 3-month mortality. Furthermore, the complications least associated with a favorable outcome were pneumonia (RR = 0.36, 95% CI: 0.32-0.41, p < 0.001), decompensated heart failure (RR = 0.38, 95% CI: 0.32-0.46, p < 0.001), and sepsis (RR = 0.59, 95% CI: 0.45-0.77, p < 0.001). The effect sizes did not change significantly through the observed years.

Conclusions: This study observed a significant reduction in the prevalence of early medical complications after AIS, especially decompensated heart failure, pneumonia, sepsis, and pulmonary embolism which continue to substantially affect mortality and functional outcome in AIS patients.

Introduction: Nummular headache (NH) is a rare primary headache disorder which was first described in 2002. This meta-analysis aimed to evaluate the prevalence and relative frequencies of clinical features of NH.

Methods: PubMed, Embase, Medline, and ScienceDirect were thoroughly searched for observational studies reporting the relevant data regarding NH diagnosed in accordance with ICHD-2, ICHD-3β, ICHD-3, or Pareja's original study. Random-effects meta-analysis was performed in order to calculate the pooled prevalence estimates (PPEs) and the I2 statistics was used to measure the between-study heterogeneity. The PRISMA guidelines were strictly followed by the study's structure. The Joanna Briggs Institute Checklist for Studies Reporting Prevalence Data was used to evaluate the risk of bias of included studies.

Results: Out of initial 2,441 records, 17 studies met all of the inclusion criteria. The pooled mean age of onset of NH was 46.91 (95% confidence interval [95% CI]: 43.85-49.96). The PPE of NH in adult patients evaluated for a headache in a clinic-based setting was 0.7% (95% CI: 0.2-2.4), with slight female predominance (females = 0.5%, 95% CI: 0.2-1.4 vs. males = 0.3%, 95% CI: 0.1-0.8). The majority of patients (69.4%, 95% CI: 58.1-78.8) experience chronic course of NH. The shape of the headache was round/circular in 78.4% (95% CI: 71.9-83.7) and oval/elliptical in 21.6% (95% CI: 16.3-28.1) of patients. In 7.5% (95% CI: 2.7-19.0) of individuals, pain had multifocal location and 59.1% (95% CI: 49.7-68.0) of NH patients experienced pain exacerbations. The pain was most prevalent in the strictly parietal region (43.0%, 95% CI: 37.4-48.7) of the cranium and had pressing quality (51.4%, 95% CI: 41.6-61.1). Migraine has been diagnosed in 29.3% (95% CI: 18.5-42.9) of patients prior to NH diagnosis, and 42.4% (95% CI: 33.5-51.8) of patients experience a complete remission, with or without medication, of headache.

Conclusion: The results of our study showed that NH is a very distinct and relatively rare to encounter headache disorder. Due to its unique clinical phenotype, physicians need to be aware when a patient presents with a small, well-localized round/oval headache in the cranium region.

Introduction: Stroke and dementia have common modifiable risk factors. Current prevention strategies primarily focus on high-risk populations, leaving a gap in addressing the broader population. We report the protocol for a randomized controlled trial (RCT) that aims to evaluate the feasibility, tolerability, and effectiveness of a polypill (valsartan 80 mg, amlodipine 5 mg, and rosuvastatin 10 mg), with and without use of the Stroke Riskometer app, on systolic blood pressure (SBP) and other cardiovascular disease (CVD) risk factors at 9 months after randomization in a population of low to borderline CVD risk.

Methods: A prospective, pragmatic, multicentre, factorial, phase III, placebo-controlled, cluster RCT in low to moderate CVD risk (10-year risk <20%) individuals aged 50-75 years with no prior history of hypertension, diabetes mellitus, stroke, or other CVD, with a SBP of 121-139 mm Hg and at least one lifestyle-related CVD risk factor. Primary care units in Porto Alegre, Brazil, were centrally randomized to either use of the Stroke Riskometer app or standard care for lifestyle modification. All eligible individuals underwent a 28-day open run-in phase using the active medication. Participants who tolerated and had high adherence were randomized to either polypill or placebo, using a minimization process according to age, sex, SBP, cholesterol, and education level. The dual primary outcomes were change in SBP and Life's Simple 7 (LS7) score at 9 months post-randomization. A sample of 354 participants was estimated to provide 80% statistical power (two-sided α = 0.05, β = 0.20) for 6 clusters with intra-cluster correlation of 0.01 to detect a clinically significant 2.5-mm Hg (SD ± 8) difference in SBP change and 0.65 points (SD ± 1.61) difference in the LS7 score at 9 months post-randomization between the polypill/Stroke Riskometer group and placebo/usual care group, assuming 10% lost to follow-up. All analyses were conducted according to the intention-to-treat principle. Regression analysis models (ANCOVA) assessed the differences among the four groups concerning changes in SBP, cholesterol levels, cognitive function, and behavioural risk factors over time.

Conclusion: The findings will provide critical information to allow the development of primary stroke and CVD prevention strategies in low to borderline CVD risk adults.

Background: Australian Medicare funded policies to support General Practtitioners (GPs) to coordinate multidisciplinary care (MDC) with other healthcare providers have potential to benefit survivors of stroke/transient ischaemic attack (TIA). However, the effectiveness of these policies is unknown. We aimed to determine the population effect of such policies in improving long-term outcomes following stroke/TIA, by impairment grouping.

Methods: Target trial emulation using observational data within a cohort of community-dwelling adults with stroke/TIA from the Australian Stroke Clinical Registry (January 2012-December 2016, 42 hospitals). Person-level Medicare, pharmacy, aged care, death, and hospital records were linked. The exposure was ≥1 Medicare GP-MDC claim 6-18 months post-stroke. Outcomes were survival and hospitalisations at 19-30 months. Impairment group (minimal, moderate, severe) was classified by latent class analysis of EQ-5D-3L questionnaire data obtained 90-180 days post-stroke. Analysis comprised multivariable, multilevel survival analysis with inverse probability treatment weights (42 covariates).

Results: The cohort comprised 7,255 people with stroke (42% female, median age 71 years, 24% TIA, impairment: 39% minimal, 32% moderate, 29% severe, 29% had a MDC claim). More claims occurred with each increasing level of impairment group: minimal 22%; moderate 30%; severe 37%. Twelve-month mortality was reduced in those with ≥1 MDC claim (compared to those without) in the minimal (adjusted hazard ratio [aHR]: 0.50, 95% CI: 0.27, 0.91) and severe (aHR: 0.65, 95% CI: 0.46, 0.91) impairment groups, but not in the moderate group (aHR: 1.31, 95% CI: 0.86, 1.99). Compared to those without a claim, hospital presentations were greater in the minimal (aHR: 1.30, 95% CI: 1.06, 1.59) and moderate impairment groups (aHR: 1.40, 95% CI: 1.23, 1.60) but not the severe group (aHR: 1.05, 95% CI: 0.85, 1.30).

Conclusions: Government policy incentives for GP-coordinated MDC were effective at the population level at improving long-term survival outcomes, in those with minimal and severe impairments.

Introduction: High systolic blood pressure (HSBP) is a leading modifiable driver of the global ischemic stroke (IS) burden. We assessed the mortality impact of HSBP-related IS (HSBP-related IS) in Turkey and European subregions during 1990-2021 and produced projections for 2030.

Methods: Age-standardized mortality rates (ASMRs) and disability-adjusted life-years (ASDR) were extracted from the 2021 Global Burden of Disease dataset. Age-period-cohort (APC) models were used to identify demographic effects. A log-linear regression that included the sociodemographic index was used to generate the 2030 ASMR projections.

Results: Between 1990 and 2021, ASMR and ASDR fell in Western, Central and Eastern Europe and in Turkey. The steepest decline occurred in Western Europe (EAPC = -4.99; 95% CI: -5.17 to -4.82), whereas Eastern Europe retained the highest residual burden. Turkey ranked mid-range in 2021 yet is projected to experience a 66% drop in ASMR to 8.9 per 100,000 by 2030, consistent with the UN Sustainable Development Goal 3.4 target for premature mortality reduction. By contrast, Eastern Europe is expected to see its ASMR almost double over the same period. The rate of decline was higher in women than that in men. APC analysis showed marked cohort improvements in Western Europe but only limited gains among younger cohorts in Turkey. The country-level 2021 estimates range from the highest ASMR in North Macedonia to the lowest in Switzerland.

Conclusion: Although HSBP-related IS mortality generally decreased across Europe, substantial regional and sex disparities persisted. Turkey's projected gains should be consolidated by sustained salt reduction and hypertension-control programs, while Eastern Europe requires intensified risk-factor management and stroke care strengthening. Given the uncertainties in data quality and projection, the findings must be interpreted cautiously.

Introduction: Parkinson's disease (PD) is the second most common neurodegenerative disease with largely unknown etiology. Evaluating the association between a healthy lifestyle with PD and genetic risk is necessary.

Methods: The study included 438,241 participants from the UK Biobank, with lifestyle information collected via baseline questionnaires. Polygenic risk scores (PRS) were divided into quartiles. The healthy lifestyle, including alcohol consumption, body mass index, physical activity, sleep duration, sedentary time, social connections, and diet, was categorized into favorable (scoring 6-7), intermediate (scoring 4-5), and unfavorable (scoring ≤3) lifestyles.

Results: During an average follow-up of 9.34 years, 2,996 cases were diagnosed with PD. Compared to participants with an unfavorable lifestyle, those with a favorable lifestyle had a significantly lower risk (hazard ratio [HR] 0.862, 95% CI: 0.753-0.986), whereas those with an intermediate lifestyle had no difference in PD risk. Regular physical activity, adequate sleep, and appropriate social connection were protective factors for the risk of PD (HR 0.839, 95% CI: 0.779-0.905; HR 0.921, 95% CI: 0.851-0.997; HR 0.790, 95% CI: 0.698-0.893). Subgroup analysis by PRS showed that adhering to a healthy lifestyle reduced the risk of PD in all subgroups except the low genetic risk (HR 0.673, 95% CI: 0.510-0.889; HR 0.774, 95% CI: 0.611-0.982; HR 0.769, 95% CI: 0.633-0.935). There was an interaction between high genetic risk and lifestyle scores and sleep duration (p = 0.015 and p = 0.024, respectively) and also between sex and sedentary time (p = 0.002).

Conclusion: A healthy lifestyle was associated with a lower risk of PD, and it is important to identify the effect of genetic risk and sex on PD significantly influenced by lifestyle.

Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide, with varying epidemiological trends across regions and demographics. Updated global assessments are needed to inform prevention and care strategies.

Materials and methods: Data on the age-standardized prevalence, incidence, and years lived with disability (YLDs) of TBI and its leading causes were retrieved from the Global Burden of Disease (GBD) 2021 project for 204 countries and territories, between 1990 and 2021. The counts and rates per 100,000 population, along with 95% uncertainty intervals (UIs), were presented for each estimate.

Results: In 2021, 37.92 million (37,928,494) prevalent cases of TBI were reported globally, with TBI accounting for 20.83 million (20,837,466) incident cases and 5.48 million (5,480,354) YLDs cases. The global age-standardized point prevalence, incidence, and YLD rates for TBI were 448 (95% UIs: 429.3-469.7), 259 (225.5-296.2), and 64.8 (45.7-86.7) per 100,000 population, which were 16.5%, 20.2%, 16.2% lower than in 1990, respectively. In 2021, the Kingdom of Saudi Arabia (1,218.2) had the highest age-standardized point prevalence of TBI (per 100,000). Kingdom of Saudi Arabia (680.7) had the highest age-standardized incidence of TBI (per 100,000). Syrian Arab Republic (83.5%) showed the largest increases in age-standardized point prevalence across the study period. Kingdom of Saudi Arabia (177.8) and the Republic of Madagascar (25.8) had the highest and lowest age-standardized YLD rates per 100,000, respectively. Among men, the global YLD rate of TBI increased up to age 80-84 years and then decreased with advancing age, whereas for women the rate increased up to age 90-94 years and then decreased with advancing age. Causes at the global level contributing most to the YLD rates for TBI were road injuries (21.4%), other transport injuries (13.2%), and interpersonal violence (11.4%).

Conclusion: Despite some evidence pointing to the decreasing burden of TBI, this injury remains a serious public health and social problem concerning peace and war, especially in countries of Eastern Europe and Central Europe with high-medium sociodemographic index. Our findings highlight road injuries as a key target for prevention and underscore the importance of fall prevention strategies - particularly for older adults and other vulnerable groups. Preventive strategies should concentrate on enhancing public awareness of road safety, improving laws and regulations on road traffic safety management, stabilizing impetuous and restless social emotions, stopping the war, and defending world peace to reduce the burden of TBI further.

Background: Recent studies show an increase in the incidence of cerebral venous thrombosis (CVT), with varying patterns across age and sex subgroups. This study analyzes hospital discharges with a primary diagnosis of CVT in Spain, examining year-on-year trends, demographic variations, and in-hospital mortality rates.

Methods: A retrospective analysis of CVT cases from 2005 to 2021 was conducted using data from the Hospital Morbidity Survey provided by the National Statistics Institute of Spain. The CVT incidence rates were standardized using the European Standard Population.

Results: Among 76,793,382 hospital discharges, 4,293 were primarily diagnosed with CVT, with a mean age of 45.1 years (SD 20.4). Women represented 61.4% of CVT diagnoses. The standardized incidence increased from 0.41 cases per 100,000 inhabitants in 2005 to 0.84 in 2021. The rise occurred mainly among older adults, especially in men over 50 years of age (+4.6 cases/year) and women over 50 years of age (+3.1), whereas younger women, despite the highest incidence rates, showed the smallest increase (+0.8). Segmented regression revealed an acceleration in trends after 2016, notably in men over 50 years of age (+8.0/year post-2016 vs. +1.4 pre-2016, p = 0.019) and a reversal in younger women from decline to growth (+10.9/year post-2016, p = 0.074). Time series analysis showed a proportional decrease in younger women (p < 0.001) and a rising relative burden in older men (p < 0.001). Overall, in-hospital mortality was 2.96%, with no significant differences between sexes.

Conclusions: Trends in hospital discharges with a primary diagnosis of CVT in Spain vary by age and sex. The incidence rates have shown an overall increase, primarily driven by rising cases among adults aged ≥50 years, especially men. Although younger women continue to exhibit the highest incidence, their relative contribution has declined over time.