Neuroepidemiology最新文献

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: 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.

Introduction: The aims of this study were to define the incidence and prevalence of amyotrophic lateral sclerosis (ALS) in two north-western regions in Finland and to assess clinical ALS phenotypes in these areas.

Methods: We conducted a retrospective epidemiologic study by using hospital discharge registers in the regions of Central Ostrobothnia (population 68,158 in 2019) and Northern Ostrobothnia (population 412,830). All patients diagnosed with ALS during 2010-2019 and living in either region were included in the incidence study. The prevalence day was December 31, 2019. All ALS diagnoses were retrospectively re-evaluated and the clinical phenotype data reviewed and reassessed.

Results: In total, 214 ALS patients were identified. The age-adjusted 10-year incidence of ALS was 5.4/100,000 person-years in Central Ostrobothnia and 4.6/100,000 person-years in Northern Ostrobothnia. The age-adjusted prevalence rates were 13.1 and 14.6/100,000, respectively. The mean survival after the diagnosis was 16.8 months. Frontotemporal dementia (FTD) was identified in 15% of all patients. ALS-FTD was relatively more common among patients with bulbar- or respiratory-onset ALS (25%) than among those with limb-onset ALS (8%). Approximately 13% of the ALS patients had a positive family history for ALS. Genetic testing had been performed in 53% of all cases and the most tested mutations were C9orf72 hexanucleotide repeat expansion (32%) and D90A-SOD1 (40%). C9orf72 repeat expansion was detected in 8% and a D90A-SOD1 mutation in 6% of all cases, that is, 26% and 14% of all tested cases, respectively.

Conclusion: The incidence and prevalence rates of ALS in Finland are among the highest in the world. ALS-FTD seems to be more common among patients with bulbar- or respiratory-onset ALS than among those with spinal-onset disease. Cognitive evaluation of ALS patients and offering a possibility to genetic testing should be systematic in clinical practice.

Introduction: The impact of early-life tobacco smoke exposure on epilepsy remains underexplored. Our study examined the associations between maternal smoking during pregnancy (MSDP), age of smoking initiation (ASI), and epilepsy risk, while investigating the mediating role of insulin-like growth factor 1 (IGF-1).

Methods: We analyzed data from 427,285 participants for MSDP and 428,178 for ASI from the UK Biobank. Accelerated failure time (AFT) models and Cox proportional hazard models with time-dependent covariates were applied to evaluate the associations between MSDP and ASI and epilepsy onset. Mediation analyses were conducted to assess the role of IGF-1.

Results: Our study involved 427,258 participants in survival analyses for MSDP and 428,178 for ASI. Participants exposed to MSDP had an 8% shorter epilepsy-free time (time ratio: 0.92, 95% confidence interval [CI]: 0.87-0.98, p < 0.01) and significantly higher epilepsy risk (hazard ratio: 9.25, 95% CI: 1.91-44.83, p < 0.01). Compared with never-smokers, childhood, adolescent, and adult smoking initiation shortened epilepsy-free time by 27%, 18%, and 13%, respectively, according to AFT models (p < 0.001). Cox models indicated a 62%, 33%, and 22% higher risk of epilepsy for smoking initiation during childhood, adolescence, and adulthood (p < 0.001). IGF-1 mediated 9% (95% CI: 5%-39%) of the effect for MSDP and 5% (95% CI: 3%-11%) for ASI.

Conclusion: Smoking exposure in the early-life stages, encompassing both prenatal and postnatal periods, accelerates the onset and increases the risk of epilepsy, with IGF-1 serving as a potential mediator. Further research is needed to elucidate these mechanisms.

Introduction: Microplastic (MP) has been proposed as a potential risk factor for cardiovascular disease (CVD), but the available epidemiological evidence remains limited and inconclusive. This study aimed to evaluate the association between dietary MP exposure and the global burden of CVD and all-cause outcomes.

Methods: We conducted a global analysis using data from 109 countries and regions between 2018 and 2021 to assess the association between dietary MP intake and global CVD burden. Outcomes included age-standardized mortality rate (ASMR), age-standardized disability-adjusted life years rate (ASDR), and age-standardized incidence rate (ASR) for both all-cause and CVD. Multivariable linear mixed models were used to estimate associations, supported by nonlinear exposure-response analysis and stratified subgroup evaluations by demographic indicators, sociodemographic index (SDI), and geographic location.

Results: Dietary MP intake varied widely across regions, with the highest levels observed in low and low-middle SDI countries, particularly in coastal areas of Asia and Africa. Between 2018 and 2021, all-cause ASMR and ASDR increased globally, while CVD-related ASMR and ASDR showed a slight decline. After full adjustment, each 1 mg per capita per day increase in dietary MP intake was associated with an increase of 0.347 per 100,000 in CVD ASMR (p < 0.001) and 7.165 per 100,000 in CVD ASDR (p < 0.001). For all-cause outcomes, dietary MP intake was significantly associated with increased ASR. Subgroup analyses indicated stronger associations among older adults, populations in low SDI countries, and European regions.

Conclusion: Dietary MP exposure is significantly associated with increased global CVD burden, especially in socioeconomically disadvantaged populations. These findings highlight the growing health risks of MP pollution and support the necessity for global efforts to reduce exposure and guide public environmental health strategies.

Introduction: Many systematic reviews summarize research on interventions for multiple sclerosis (MS), yet concerns persist about their methodological quality. Assessing the certainty of evidence is a crucial step to ensure transparency and reliability in decision-making. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach is a widely accepted framework for this purpose; however, its application in MS systematic reviews remains unclear.

Methods: A comprehensive search was conducted across the MEDLINE, Cochrane Database of Systematic Reviews, and Epistemonikos databases. The included reviews were assessed for their use of GRADE and the summary of findings (SoFs) table.

Results: We assessed 276 systematic reviews and observed a growing trend in publication over the past decade. Only 15% (42/276) applied the GRADE approach, of which 83% included a SoF table with explanations for evidence downgrades. Half of these were Cochrane reviews, where a SoF table is mandatory.

Conclusion: This meta-research study highlights gaps in methodological rigor in systematic reviews of MS. Strengthening adherence to best practices in evidence synthesis, particularly systematic certainty assessments using the GRADE approach, is essential for improving the reliability of recommendations and supporting evidence-based decision-making in MS care.