Neuroepidemiology最新文献

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.

Background: This study aimed to quantify the stroke burden attributable to anxiety at global, regional, and national levels, from 1990 to 2021.

Methods: We systematically searched PubMed, Embase, and MEDLINE from inception to July 24, 2024, for longitudinal studies reporting the association between anxiety and the subsequent stroke risk. Pooled hazard ratios (HRs) were calculated using random-effects meta-analysis. Anxiety prevalence and stroke-related disability-adjusted life years (DALYs) for adults aged 20 and older were obtained from the Global Burden of Disease Study 2021. Within a comparative risk assessment framework, we computed population attributable fractions, age-standardized DALY rates (ASDRs) and assessed cross-country inequalities using the slope index of inequality (SII) and concentration index.

Results: Of 5,343 initially identified records, six studies met inclusion criteria, yielding a pooled HR of 1.25 (95% confidence interval [CI]: 1.07-1.45). The global anxiety-attributable stroke burden remained substantial, with ASDR per 100,000 population declining from 195.94 (95% CI: 145.67-252.55) in 2000 to 133.50 (95% CI: 100.07-171.72) in 2021. Regionally, the middle sociodemographic index (SDI) region and Eastern Mediterranean Region exhibited the highest ASDRs in 2021. Countries with low and low-middle SDI accounted for the highest ASDRs. Inequality metrics confirmed greater burden in lower-SDI countries for males (SII: -111.52, 95% CI: -131.75 to -91.28; concentration index: -0.0921, 95% CI: -0.1333 to -0.0509) and females (SII: -148.95, 95% CI: -177.35 to -120.55; concentration index: -0.1193, 95% CI: -0.1629 to -0.0756) in 2021.

Conclusions: Our findings underscore the association between anxiety and the risk of stroke, demonstrating the anxiety-associated stroke burden. Integrating mental health management into public health policies and clinical practice might have the potential to reduce the stroke burden and improve health outcomes.

Aim: The aim of the study was to describe the design, the neuroimaging protocol as well as the baseline characteristics of the participants from Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), which will be part of an extensive investigation of the determinants of brain aging based on high-resolution neuroimaging 3T and 7T magnetic resonance imaging (MRI) conceptualized by the Ageing and Brain Working Study Group from ELSA-Brasil.

Methods: A representative sample of 2,165 participants (mean age = 60.3 [9.9] years, 55.5% female) for further neuroimaging and study with the protocol described here was selected from ELSA-Brasil. The criteria used for selection into this protocol were cognitive status and age in wave 3 (2017-2019), and participants were split into two subsamples: (1) a randomized sample of participants with <70 years at wave 3 (2017-2019) categorized in three groups based on their global cognitive trajectories from wave 1 to wave 3 - (1) below the average (z-score <-1, n = 620), (2) average (z-score = -1 to +1, n = 835), and (3) above-average performance (z-score >+1, n = 215); and (2) all participants with ≥70 years at wave 3 were classified as SuperAgers cases (n = 171) and their matched controls (n = 324) based on delayed memory (wave 3). Both samples will be scanned using a 3T MRI, and an additional 7T MRI exam will be conducted in the SuperAgers study to further evaluate brain connectivity. An extensive dataset of sociodemographic, lifestyle, cognitive, mental health, frailty, and other laboratory and clinical exams collected since the baseline of the main study will be considered as predictors of structural and functional patterns of brain aging. The main characteristics of participants and the MRI protocol are described here.

Results: Among those under 70 years, the above-average group for cognition showed better cognitive and mental health scores than the other groups (most p values <0.001). Considering the elderly who were 70 years or older, SuperAgers showed higher scores for delayed recall memory, better global cognition, and verbal fluency than controls at wave 3 (all p values <0.001).

Conclusion: The ELSA-Brasil study will be a unique opportunity to unravel the determinants of brain aging in an admixed sample in Latin America.

Objective: The aim of the study to evaluate global trends in Parkinson's disease (PD) burden (measured by disability-adjusted life years, DALYs) among individuals aged ≥60 years from 1990 to 2021, and project future trends to 2046.

Methods: Using Global Burden of Disease (GBD) 2021 data, we analyzed age-standardized DALY rates (ASDR) via Joinpoint regression. Age-Period-Cohort (APC) modeling disentangled age, period, and birth cohort effects. Decomposition analysis quantified contributions of population growth, aging, and epidemiological changes. Bayesian APC (BAPC) projected DALYs to 2046.

Results: Global PD DALYs increased from 2.55 million (95% uncertainty interval: 2.33-2.79) in 1990 to 6.80 million (6.04-7.49) in 2021. ASDR rose annually by 0.31% (average annual percent change = 0.31%, 95% CI: 0.29-0.33), with pronounced male predominance (male ASDR 2021: 861.9 vs. female: 498.9; male-to-female ratio: 1.73). The highest ASDR occurred in high-middle socio-demographic index (SDI) regions (683.7) and the lowest occurred in low SDI (612.9). APC analysis revealed disease risk peaked at ages 85-94 and increased with successive birth cohorts. Decomposition identified population growth as the primary driver of DALY increases (81.55% globally), exceeding contributions from aging (8.74%) and epidemiological shifts (9.71%). BAPC projections indicated rising absolute DALYs (+104% by 2046) but declining ASDR (607.3 by 2046), with widening gender disparities.

Conclusion: PD burden escalates globally due to demographic aging and population growth. Urgent international collaboration is needed for targeted interventions, particularly in high-burden regions and for older males.

Introduction: Thyroid disease has been implicated in the pathology of neurodegenerative diseases. However, its role in amyotrophic lateral sclerosis (ALS) is unclear. This study aimed to investigate the association between thyroid disease, including hypothyroidism and hyperthyroidism, and the risk of ALS.

Methods: We used a matched cohort design to evaluate UK Biobank data on participants enrolled between 2006 and 2010 who were followed up until 2022. We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: The study cohort comprised 42,684 patients with thyroid disease (females: 80%). Thyroid disease was moderately associated with an increased risk of ALS development (HR: 1.44, 95% CI: 1.02-2.02), and this association remained similar following adjustment for comparative height at the age of 10 years (HR: 1.44, 95% CI: 1.03-2.03). Hyperthyroidism showed a potential association with an increased risk of ALS development among individuals aged ≤60 years (HR: 21.22, 95% CI: 1.64-274.46) and in females (HR: 3.02, 95% CI: 1.13-8.08).

Conclusion: Our findings demonstrate that thyroid disease is associated with a moderately increased risk of ALS development. Given the multifunctional role of the thyroid gland, further in-depth studies examining the relationship between thyroid conditions and ALS are warranted.

Background: Multiple sclerosis (MS) is a chronic neurological disorder that primarily affects young adults and is characterized by inflammation of the central nervous system. Although genetic, immunological, and environmental factors contribute to MS risk, the role of diet remains underexplored in the Kuwaiti population. This case-control study evaluated the dietary and lifestyle factors associated with MS risk in Kuwait.

Methods: A total of 152 confirmed MS cases, diagnosed according to the revised McDonald criteria, and 279 controls were enrolled from private hospitals and a public office setting. Data on demographics, medical history, sun exposure, physical activity, supplement use, and dietary intake were collected using a structured electronic questionnaire. Nutrient intake was estimated using food frequency data and nutrient databases. Multivariable logistic regression was used to identify dietary and lifestyle factors independently and significantly (p < 0.05) associated with MS risk.

Results: Compared with controls, MS cases were more likely to be Kuwaiti nationals (adjusted OR = 7.85, 95% CI: 2.85-21.60), have lifelong history of obesity (adjusted OR = 3.12, 95% CI: 1.34-7.25), or exceed recommended sodium intake (adjusted OR = 5.05, 95% CI: 2.22-11.51). MS cases also showed inadequate vitamin C intake (adjusted OR = 3.45, 95% CI: 1.64-7.27), irregular vitamin D supplement use (adjusted OR = 0.27, 95% CI: 0.14-0.54), or insufficient vitamin B2 intake (adjusted OR = 2.25, 95% CI: 1.05-4.83). Regular light physical activity (≥3 times per week) was associated with significantly reduced MS risk (adjusted OR = 0.23, 95% CI: 0.10-0.53).

Conclusion: This study identified high sodium intake, inadequate vitamin B2 consumption, and obesity as significant risk factors for MS, while regular light physical activity appeared to lower MS risk. Public health initiatives addressing these factors may help reduce MS risk in Kuwait and other similar settings. Future studies are needed to confirm these findings.

Introduction: This study aims to quantify the global, regional, and national incidence, mortality, and disability-adjusted life years (DALYs) of intracerebral hemorrhage (ICH) among youth (15-49 years) from 1990 to 2021 and to evaluate the contributions of major attributable risk factors using the Global Burden of Disease (GBD) 2021 framework. The findings are intended to provide an updated descriptive overview that may inform future research and offer reference points for public health planning.

Methods: Data were obtained from the GBD study conducted in 2021. Time trends in the incidence, mortality, and DALYs among youth with ICH were assessed using estimated annual percentage changes. Risk factors associated with ICH were selected, including six environmental/occupational factors, eight behavioral risks, and four metabolic factors. Age-standardized rates and the percentages of DALYs attributable to these risk factors were calculated.

Results: In 2021, there were 610,000 cases, 260,000 deaths, and 13.79 million DALYs due to ICH globally. Between 1990 and 2021, age-standardized rates of incidence, mortality, and DALYs decreased, while the absolute numbers of incidence, deaths, and DALYs increased. Globally, approximately 79.68% of the age-standardized DALY rates for ICH among individuals aged 15-49 years was attributable to the risk factors listed in the GBD 2021 dataset. In 2021, the primary risk factors for ICH among youth were high systolic blood pressure (46.59%), smoking (21.37%), ambient particulate matter pollution (14.92%), household air pollution from solid fuels (14.64%), and diet low in fruits (13.53%). Among them, a high body mass index (BMI) had the greatest increase in impact on ICH.

Conclusion: The burden of ICH remains substantial among young individuals, with metabolic risk factors identified as the primary contributors. These findings provide updated comparative evidence that may inform future research and offer reference points for public health planning.

Background/objective: Cranial (i.e., head and voice) tremors are highly prevalent in essential tremor (ET). They may be disabling, and they often drive treatment. Furthermore, their appearance may provide insights into disease severity and staging. Several features of these tremors make self-report data complex. There are no data on the validity of self-reported information on cranial tremors in ET. We evaluated the validity of self-reported cranial tremor in ET.

Methods: ET cases, enrolled in a prospective evaluation, were queried about the presence of head and voice tremors. A detailed neurological examination was performed, and the presence of head or voice tremor was assessed by an experienced movement disorders neurologist.

Results: There were 185 ET cases. The prevalence of voice tremor on examination was 50.8%, and of head tremor was 49.7%. Cases underreported voice and head tremors (sensitivity = 13.8%-59.3%); however, the positive predictive value of self-reported voice and head tremor was moderate (61.9%-84.2%). Overall, the validity of self-reported data was lower for voice tremor than for head tremor. Self-reported voice tremor was the least valid when that tremor was mild.

Conclusions: We provide the only data we are aware of on the validity of self-reported cranial tremors in ET. Self-reports were a poor screen to ascertain cranial tremors; however, if a case did report these tremors, the information was likely to be valid. These data emphasize the importance of a thorough neurological examination. Although this requires a greater investment of time/resources, it reduces the number of false negatives.

Background: Spontaneous intracerebral hemorrhage (ICH) is a leading cause of disability and death worldwide. Understanding temporal trends in the burden of the disease is critical to evaluate the effectiveness of preventive strategies and identify targets for action. This study aimed to assess long-term temporal trends in incidence, attack rates, and early case fatality of ICH.

Methods: All cases of ICH among residents of Dijon, France, were prospectively recorded between 1985 and 2022 using a population-based registry. Annual incidence and attack rates were assessed, and temporal trends were analyzed by calculating incidence rate ratio (IRR) and attack rate ratio (ARR). Case fatality was measured at 30 days.

Results: A total of 1,015 ICH cases (mean age 73.5 ± 16.4 years old, 52.7% women) were recorded including 815 patients with a first-ever ICH and 200 cases of ICH as stroke recurrences. Age-standardized incidence increased progressively from 12.6/100,000/year in 1985-1991 to 20.8/100,000/year in 2011-2016 (IRR: 1.96, p < 0.001). A slight decrease was observed during period 2017-2022 (18.9/100,000/year, IRR: 0.81; 95% CI: 0.61-1.06, p = 0.11). A similar trend was noted in attack rates, with a peak during 2011-2016 (27.9/100,000/year; ARR: 1.79; 95% CI: 1.47-2.20, p < 0.001) and a decrease in the most recent period (23.2/100,000/year; ARR: 0.83; 95% CI: 0.69-0.99, p = 0.04). In men, a significant increase in incidence and attack rates was observed from 1985-1991 to 2011-2016, followed by a slight decline. In contrast, women showed a delayed increase in rates, with no decline in the most recent period. The 30-day case fatality rate declined between 1985 and 2010 (from 40.3% to 26.3%), followed by an increase thereafter, reaching 38.8% during the last study period.

Conclusion: Our study revealed an overall increase in incidence and attack rates of ICH followed by a slight decline in recent years. Sex differences in trends warrant further investigation into the contributing factors and emphasize the continued need for prevention strategies to further reduce the burden of ICH. The recent increase in early case fatality rates highlights the need for specific acute-phase treatments of ICH.