Neuroepidemiology最新文献

Introduction: Multiple sclerosis (MS) is a debilitating condition, which results in increased mortality rates in people with MS compared to general population (GP). Recent data suggest a potential rise in survival over the past 20 years.

Objectives: Objectives of the study were to evaluate the 20-year (2001-2021) survival rate and assess clinical factors associated with mortality among people with MS in Verona, Italy.

Methods: We evaluated all the prevalent cases of MS residing in Verona, Italy, on December 31, 2001. We retrospectively investigated the survival state of each patient on December 31, 2021, through the consultation of medical records to assess if patients were still on follow-up; for those with no records, we surveyed the death certificates from Verona municipality to verify death notification and date. The groups of survived and deceased patients were compared by sex, variables related to disease onset (age, clinical phenotype, number and type of functional systems involved, oligoclonal bands), or collected at prevalence date (clinical phenotype, disease duration, exposure to disease-modifying treatment, EDSS, annual relapse rate).

Results: Of the 273 prevalent MS cases (189 females) as of December 31, 2001, 73 patients (48 females) had died by December 31, 2021. Mean life expectancy deviation of deceased MS patients was 17.0 ± 12.4 years compared to the GP. Deceased patients had a higher mean age at onset (36.4 ± 12.5 vs. 30.5 ± 10.0 years; p < 0.001) and a higher median EDSS score at prevalence date compared to survived patients (6.5, range 1.0-9.5 vs. 2.0, range 0-8.0; p < 0.001). The relapsing-remitting phenotype was more prevalent in survived patients both at onset (92.2%, p < 0.001) and prevalence date (76.2%, p < 0.001). Visual or sensory impairments were more common in survivors (82.5%, p = 0.023). The survival rate was significantly lower in patients with primary progressive MS (PPMS) or an EDSS score greater than 3 at prevalence date. Multivariate Cox regression analysis revealed that a progressive disease type at prevalence date (PPMS or secondary progressive MS), longer disease duration at prevalence date, and older age at onset were independently associated with lower survival.

Conclusions: After 20 years from initial observation, the 2001 Verona cohort of MS prevalent cases showed a lower life expectancy compared to the GP. Higher age at disease onset, longer disease duration, and a progressive clinical course were independent risk factors of shorter survival of patients with MS.

Introduction: Febrile seizures, the most common childhood seizures, raise concerns about their impact on neurodevelopment due to their overlap with central nervous system development. This study examined the influence of febrile seizures on neurodevelopment.

Methods: Data were analyzed from the Korean National Health Insurance System for children born between 2009 and 2011. The cohort included 10,442 exposed children with febrile seizures, compared to 291,724 unexposed children. Exposure was defined as visiting the emergency room or hospitalized with a main diagnosis of febrile seizures. Neurodevelopmental outcomes at age 6 were assessed across domains such as gross and fine motor skills, cognition, language, sociality, and self-care. Multivariable logistic regression was employed in the main analysis, controlling for multiple confounders.

Results: Of 10,442 children with febrile seizures (53.5% male; median age 24.75 months [IQR: 14-32]), 332 (3.18%) demonstrated fine motor skills issues, compared to 7,375 out of 291,724 (2.53%) unexposed children (absolute risk difference 6.5; 95% CI: 3.4-9.6/1,000 person). Compared with the unexposed children, the children with febrile seizure observed increased the risk of fine motor skills deficits (OR: 1.18; 95% CI: 1.05-1.33). These differences remained consistent even with partial adjustment for confounders and altering subject selection with a sophisticated statistical method. Risk was more pronounced in cases of single occurrences, subsequent nonfebrile seizures, and those occurring in summer or winter.

Conclusion: Delays in fine motor skill development were observed at 6 years of age in children with a history of febrile seizures.

Introduction: Idiopathic childhood epilepsy is a major global health challenge with severe outcomes such as depression, intellectual disability, and increased suicide risk. It is vital to understand epidemiological trends and risk factors to effectively address the condition's burden.

Methods: This cross-sectional study utilized data from the Global Burden of Disease (GBD) study, covering 204 countries from 1990 to 2021, focusing on children aged 0-14 years with idiopathic epilepsy. We analyzed trends in incidence, mortality, and disability-adjusted life years (DALYs), examining variations across different demographics and Sociodemographic Indices (SDI).

Results: In 2021, there were approximately 1.23 million cases of childhood idiopathic epilepsy worldwide, marking a 26.34% increase from 1990. During the same period, deaths attributed to idiopathic epilepsy decreased from 25,768 to 18,171. The global incidence rate rose from 55.85 to 61.00 per 100,000 population, while the mortality rate declined from 1.48 to 0.90 per 100,000. The lowest SDI regions recorded the highest mortality rate in 2021 (1.46 per 100,000). Regionally, Southern Latin America saw the largest increase in incidence (EAPC, 0.49), and Eastern Europe observed the most significant mortality decrease (EAPC, -4.65). Ecuador reported the highest incidence rate, Tajikistan the highest mortality, and Zambia the highest DALYs in 2021.

Conclusions: The global incidence of idiopathic childhood epilepsy continues to rise, presenting an ongoing public health challenge. Although there is a global decline in DALYs and mortality rates, the absolute number of affected individuals remains high, particularly in lower SDI regions. This study underlines the need for enhanced understanding and targeted interventions to manage and prevent idiopathic epilepsy effectively.

Introduction: The disease burden of dementia varies in different economic development regions. This study provides a comprehensive overview of Alzheimer's disease and other dementias (ADOD) trends across regions with varying socioeconomic statuses and forecasts global incidence rates from 2022 to 2046.

Methods: Based on the Global Burden of Disease (GBD) study, we utilized an age-period-cohort (APC) model to analyze annual changes in incidence and the risk factors associated with age, period, and birth cohort across different socio-demographic index (SDI) regions. Additionally, a log-linear APC model was employed to project global trends in ADOD incidence from 2022 to 2046.

Results: Between 1992 and 2021, we estimated that the net drift of the incidence of ADOD is 0.03(95% CI: 0.01-0.04). High-middle SDI regions demonstrated the highest net drift (0.22, 95% CI: 0.18-0.26). At the country level, the net drift was highest in China, at 0.36 (95% CI: 0.32-0.40), and we found a global upward trend in the incidence of the disease in people aged 50-64 years, especially in regions with high SDI. By 2046, there will be 21.24 million cases of ADOD worldwide. The age-standardized incidence rate for all patients with ADOD will increase slowly and is projected to be 120.8 per 100,000 population by 2046.

Conclusion: We found a steady increase in incidence worldwide, with the greatest increase in high-middle SDI regions. The incidence is declining in areas with high SDI, and higher levels of socioeconomic development have a protective effect against ADOD. Incidence is increasing in younger age groups. Therefore, we believe that improving the level of social and economic development and formulating relevant targeted policies are helpful for the prevention of ADOD. Focusing on the trends in disease incidence across different economic development regions will enable more targeted strategies to address the burden of disease.

Introduction: Pediatric stroke, though less common than in the elderly population, imposes a significant societal burden. With the increasing impact of climate change, this study aimed to assess the burden of different pediatric stroke subtypes attributable to nonoptimal temperatures in the USA.

Methods: This study analyzed data from the Global Burden of Disease (GBD) Database 2019. The pediatric stroke burden attributable to nonoptimal temperatures was estimated by sex, age, and subtypes. R and Joinpoint were used to conduct the statistical analyses in this study. A p value <0.05 was considered statistically significant.

Results: Nationally, there has been a decrease in pediatric stroke death rate and DALY rate attributable to nonoptimal temperature from 1990 to 2019, with an AAPC of -2.36 (95% UI: -3.06 to -1.66, p value <0.05) for death and -2.45 (95% UI: -3.10 to -1.80, p value <0.05) for DALY. Similar trends were observed across sexes, age groups, stroke subtypes, and most states.

Conclusion: This study highlighted the pediatric stroke burden attributable to nonoptimal temperature in the USA. More resources should be directed to address the geographic health disparities observed in this study.

Introduction: Gut dysbiosis is one of the environmental factors that might contribute to the development of Parkinson's disease (PD). The potential impact of antimicrobial agents on PD risk, particularly through dysbiosis and neuroinflammation, is an area of ongoing investigation, though findings remain inconsistent.

Methods: This systematic review and meta-analysis aimed to assess the relationship between antimicrobial use and PD risk. After searching PubMed, Scopus, Web of Science, and Embase, ten studies involving 3,755,583 participants, including 52,974 PD patients, were included.

Results: Antibacterial use was not significantly correlated with PD risk (odds ratio [OR] = 1.14; 95% CI: 0.97-1.33; p = 0.11, I2 = 84%). After excluding one study, the odds of PD became significantly higher (OR = 1.22; 95% CI: 1.04-1.44; p = 0.01). Specific antibacterial classes, such as tetracyclines and macrolides, showed no significant associations with PD. However, cephalosporins had a protective effect (OR = 0.86; p = 0.04), while antifungal use increased PD risk (OR = 1.16; p = 0.001). Regarding antiviral use, a significant reduction in PD risk was observed in patients with hepatitis C virus undergoing antiviral treatment (HR = 0.69; p = 0.0008).

Conclusion: The findings indicate complex relationships between antimicrobial use and PD risk. While antibacterials, in general, tend to increase PD risk, specific antibacterial may offer a protective effect, while antifungal agents appear to increase PD risk. Antiviral therapy may reduce PD risk in HCV patients. Further research is needed to confirm our results.

Introduction: The aim of this study was to provide a comprehensive assessment of temporal trends in migraine prevalence among women of childbearing age (WCBA) at global, regional, and national levels from 1992 to 2021, with particular emphasis on examining the associations between prevalence patterns and age, period, and birth cohort effects across different sociodemographic index (SDI) regions.

Methods: We conducted a secondary analysis of data from the Global Burden of Disease Study 2021. Migraine prevalence estimates and 95% uncertainty intervals (UIs) for WCBA were extracted. An age-period-cohort model was employed to estimate the net drift (primary outcomes), local drift, and age/period/cohort relative risks (secondary outcomes).

Results: The global number of WCBA with migraine reached 493,937,856.01 (95% UI: 420,683,360.54-577,874,600.76) in 2021. The highest burden was found in India (95.7 million) and China (68.1 million), together accounting for substantial proportion of global prevalence. The global net drift showed a minimal change of 0.01% (95% CI: 0.00-0.02) per year, with variations across sociodemographic index (SDI) regions ranging from -0.03% per year (95% CI: -0.04 to -0.02) in low-middle-SDI regions to 0.16% (95% CI: 0.15-0.17) in middle-SDI regions. Local drift analysis reveals that migraine prevalence increases across young age groups (15-19 years) in high-SDI regions, while lower-SDI regions generally display stable rates. Globally, increases in migraine prevalence among young adults within WCBA are notably persistent. Across SDI regions, age effects follow similar patterns, with risk rising with age and peaking in the mid-reproductive years (ages 30-39). Over time, period risks and unfavorable trends across successive birth cohorts have intensified, particularly in high-, high-middle-, and middle-SDI regions.

Conclusion: Although global migraine prevalence among WCBA remains stable, an unfavorable upward trend in younger age groups (15-19 years) in high-, high-middle-, and middle-SDI regions, alongside worsening period/cohort risks, highlights current gaps in prevention and management. Improved strategies are expected to reduce risks for younger birth cohorts and all age groups over time.

Background: The relationship between thyroid disorders and neurodegenerative diseases remains poorly understood. This large-scale retrospective cohort study aimed to investigate the association between thyroid disorders and various neurodegenerative diseases, as well as the potential impact of thyroidectomy.

Methods: We analyzed data from 3,719,666 patients with thyroid disorders and 2,945,438 controls from 120 healthcare organizations (TriNetX database). After propensity score matching, each group included 2,033,096 patients. We compared the risk of neurodegenerative diseases between these groups and examined the effect of thyroidectomy in a subgroup analysis of 31,753 matched pairs.

Results: Patients with thyroid disorders showed significantly higher risks of Alzheimer's disease (RR = 1.15, 95% CI: 1.110-1.195), Parkinson's disease (RR = 1.25, 95% CI: 1.187-1.318), amyotrophic lateral sclerosis (RR = 1.35, 95% CI: 1.131-1.622), frontotemporal dementia (RR = 1.44, 95% CI: 1.219-1.702), Lewy body dementia (RR = 1.15, 95% CI: 1.107-1.186), progressive supranuclear palsy (RR = 1.41, 95% CI: 1.095-1.819), vascular dementia (RR = 1.32, 95% CI: 1.266-1.369), Niemann-Pick disease type C (RR = 1.34, 95% CI: 1.092-1.638), and Wilson's disease (RR = 1.26, 95% CI: 1.056-1.507). Interestingly, the risk of multiple sclerosis was lower (RR = 0.80, 95% CI: 0.738-0.862). Thyroidectomy was associated with a 44.2% lower risk of Lewy body dementia (RR = 0.558, 95% CI: 0.339-0.919, p = 0.020).

Conclusions: Thyroid disorders are significantly associated with an increased risk of several neurodegenerative diseases. Thyroidectomy may have a protective effect against Lewy body dementia. These findings suggest a complex relationship between thyroid function and neurodegeneration, emphasizing the need for neurological monitoring in patients with thyroid disorders and further research into thyroid-brain interactions.

Introduction: The aim of this study was to estimate the prevalence of possible rapid eye movement (REM) sleep without atonia (RWA) in the general population.

Methods: The study was based on data from the São Paulo Epidemiologic Sleep Study (EPISONO) 4th edition, a non-clinical population-based sleep study performed in the city of São Paulo, Brazil, between 2018 and 2019. All individuals underwent type-I polysomnography with the addition of bilateral electromyography of the flexor digitorum superficialis (FDS) muscles. The FDS activity index was calculated as the percentage of 30-s REM sleep epochs containing at least five 3-s mini-epochs with phasic muscle activity, with a threshold of 7.7% being applied to identify possible RWA cases. The adjusted prevalence of possible RWA was calculated as the proportion of cases above the diagnostic threshold, corrected by the estimated specificity values according to the REM-specific apnea-hypopnea index (AHI; 85% for REM AHI <15 and 60% for REM AHI ≥15).

Results: The final sample comprised 632 participants (376 females, 59.49%), and 68 possible RWA cases were identified. The adjusted prevalence of RWA in the whole sample was 8.24% (95% CI: 6.09%-10.38%). The adjusted prevalence stratified by sex was 10.63% among men (95% CI: 6.85%-14.40%) and 6.61% among women (95% CI: 4.10%-9.12%) (p = 0.013), resulting in a male/female prevalence ratio of 1.61. Possible RWA prevalence was similar between men and women in the 20-39 and 40-59 age ranges, but significantly higher among men aged 60-80 (16.57%, 95% CI: 6.66%-26.49%) than women in the same age range (7.35%, 95% CI: 2.62%-12.81%) (p = 0.022).

Conclusions: The prevalence of possible RWA in the sample was 8.24% and was similar between the sexes in most age ranges but became more frequent among men from the age of 60 years old.

Introduction: The neutrophil-to-lymphocyte ratio (NLR) is widely regarded as a proxy for system inflammation. The previous study indicated that the NLR might be higher in Parkinson's disease (PD) compared to healthy controls (HC). The study aimed to assess the role of system inflammation indicated by NLR in the incidence and progression of PD.

Methods: We included participants from the longitudinal population-based cohort, UK Biobank, to analyze the association of NLR and the risk of PD. We conducted the Cox proportional hazards analyses as the primary analysis to determine the association between baseline NLR value and the risk of PD in UK Biobank. Then we further used data from a disease-specific longitudinal cohort, Parkinson's Progression Markers Initiative (PPMI), to evaluate the differences between individuals with higher PD risk, and early-stage PD patients in the values of NLR. Patients with PD were divided into two groups according to the median value of NLR (2.35). Linear mixed models (random intercept and random slope) were used to evaluate the relationship between the high/low NLR groups and the disease progression.

Results: A number of 288,837 participants from UK Biobank were included and 1,429 were diagnosed with incident PD. Among them, higher NLR was associated with an increased risk of incident PD in HC (per SD increment hazard ratio [HR], 1.041; p < 0.001). A total of 349 early-stage PD patients, 438 individuals with higher PD risk, and 207 HC were included from PPMI. PD patients and individuals with higher PD risk had a significantly higher NLR compared to HCs. Higher NLR group was associated with a faster deterioration of the Montreal Cognitive Assessment score in PD patients in 2 years (β [SE] = -0.225 [0.080], p = 0.005).

Conclusion: Increased NLR in HC was linked with a higher risk of incident PD, and higher NLR was associated with a faster cognitive decline in PD patients, which indicated that inflammation was involved in the incidence of PD and the cognitive decline in early-stage PD.