Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. Given the conflicting evidence regarding the impact of adherence to the Mediterranean diet (MedDiet) on MS development and the lack of a systematic review on this topic, this study aimed to examine this association.
Methods
Following the PRISMA and JBI methods, a search of electronic databases was conducted through PubMed, Embase, Web of Science, and Scopus up to March 2024. Clinical original studies assessing the association between the MedDiet adherence and MS development were included. Risk of bias was evaluated using JBI critical appraisal tools. Meta-analyses were performed using CMA4 software.
Results
Out of 202 screened records, eight studies, including five case-control and three cohort studies, met the inclusion criteria. Retrospective evidence from three case-control studies suggested that MedDiet adherence is associated with decreased odds of MS, whereas cohort studies showed no significant relationship. Based on the meta-analysis, there was a significant association between high adherence to the MedDiet and reduced odds of MS (fixed-effect OR: 0.275, 95% CI: 0.11-0.72, p-value <0.01, least MedDiet adherence as the reference).
Discussion
Although the meta-analysis showed a significant inverse association between higher adherence to the MedDiet and the odds of MS, the overall body of evidence does not provide strong support for a preventive role of the MedDiet. Considering the limited number of included studies, the predominantly retrospective design, the high risk of bias in several studies, and the substantial observed heterogeneity, further well-designed prospective studies are needed.
背景：多发性硬化症（MS）是一种中枢神经系统慢性炎症性脱髓鞘疾病。鉴于关于坚持地中海饮食（MedDiet）对多发性硬化症发展的影响的相互矛盾的证据，以及缺乏对该主题的系统综述，本研究旨在研究这种关联。方法：采用PRISMA和JBI方法，检索截至2024年3月的PubMed、Embase、Web of Science和Scopus等电子数据库。评估MedDiet依从性与MS发展之间关系的临床原始研究被纳入。使用JBI关键评估工具评估偏倚风险。采用CMA4软件进行meta分析。结果：在202份筛选记录中，8项研究（包括5项病例对照研究和3项队列研究）符合纳入标准。来自三个病例对照研究的回顾性证据表明，MedDiet依从性与MS发病率降低有关，而队列研究显示无显著相关性。基于荟萃分析，高依从性MedDiet与MS发生率降低之间存在显著相关性（固定效应OR: 0.275, 95% CI: 0.11-0.72， p值）。讨论：尽管荟萃分析显示高依从性MedDiet与MS发生率之间存在显著的负相关，但总体证据并未为MedDiet的预防作用提供强有力的支持。考虑到纳入的研究数量有限、主要采用回顾性设计、若干研究存在较高的偏倚风险以及观察到的大量异质性，需要进一步精心设计的前瞻性研究。
{"title":"Association between Mediterranean Diet and Development of Multiple Sclerosis: A Systematic Review and Meta-Analysis","authors":"Fatemeh Shakouri, Morteza Lotfi, Ali Rostami, Mahnaz Talebi, Sarvin Sanaie, Amirreza Naseri","doi":"10.1002/brb3.71205","DOIUrl":"10.1002/brb3.71205","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. Given the conflicting evidence regarding the impact of adherence to the Mediterranean diet (MedDiet) on MS development and the lack of a systematic review on this topic, this study aimed to examine this association.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following the PRISMA and JBI methods, a search of electronic databases was conducted through PubMed, Embase, Web of Science, and Scopus up to March 2024. Clinical original studies assessing the association between the MedDiet adherence and MS development were included. Risk of bias was evaluated using JBI critical appraisal tools. Meta-analyses were performed using CMA4 software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 202 screened records, eight studies, including five case-control and three cohort studies, met the inclusion criteria. Retrospective evidence from three case-control studies suggested that MedDiet adherence is associated with decreased odds of MS, whereas cohort studies showed no significant relationship. Based on the meta-analysis, there was a significant association between high adherence to the MedDiet and reduced odds of MS (fixed-effect OR: 0.275, 95% CI: 0.11-0.72, <i>p</i>-value <0.01, least MedDiet adherence as the reference).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Although the meta-analysis showed a significant inverse association between higher adherence to the MedDiet and the odds of MS, the overall body of evidence does not provide strong support for a preventive role of the MedDiet. Considering the limited number of included studies, the predominantly retrospective design, the high risk of bias in several studies, and the substantial observed heterogeneity, further well-designed prospective studies are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9081,"journal":{"name":"Brain and Behavior","volume":"16 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mahdis Purzolfi, Cyrus Taghizadeh Delkhoush, Majid Mirmohammadkhani
Background
Progressive balance exercises may change corticomotor excitability during the learning process of postural stability control. The primary purpose of the present study was to assess corticomotor excitability corresponding to the peroneus longus muscle under transcranial magnetic stimulation following 6 weeks of progressive balance exercises in individuals with chronic ankle instability.
Methods
Eligible volunteers diagnosed with chronic ankle instability were randomly assigned to either the intervention group or the control group. The intervention group practiced progressive balance exercises every other day for 6 weeks, while the control group continued their daily activities. The corticomotor excitability outcome measures included the active and resting corticomotor thresholds, the motor evoked potential, and the cortical silent period of the peroneus longus muscle, which were measured using an electromyography device under a transcranial magnetic stimulator. The outcome measures were measured in the intervention group before and after progressive balance exercises, and in the control group at baseline and again after a 6-week interval.
Results
The corticomotor thresholds and cortical silent period of the peroneus longus muscle were significantly decreased within groups (p-values < 0.001; η2p > 0.580). In addition, the normalized motor evoked potential of the peroneus longus muscle exhibited a significant increase within groups (p-value < 0.001; η2p = 0.265). Interestingly, a significant interaction effect was revealed between the within-group and between-group effects for the corticomotor excitability outcome measures related to the peroneus longus muscle (p-values < 0.001; η2p > 0.311).
Conclusions
Six weeks of progressive balance exercises significantly increased corticomotor excitability corresponding to the peroneus longus muscle in individuals with chronic ankle instability.
{"title":"Corticomotor Excitability Changes Induced by Progressive Balance Exercises in Chronic Ankle Instability: a Randomized Clinical Trial","authors":"Mahdis Purzolfi, Cyrus Taghizadeh Delkhoush, Majid Mirmohammadkhani","doi":"10.1002/brb3.71222","DOIUrl":"10.1002/brb3.71222","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Progressive balance exercises may change corticomotor excitability during the learning process of postural stability control. The primary purpose of the present study was to assess corticomotor excitability corresponding to the peroneus longus muscle under transcranial magnetic stimulation following 6 weeks of progressive balance exercises in individuals with chronic ankle instability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Eligible volunteers diagnosed with chronic ankle instability were randomly assigned to either the intervention group or the control group. The intervention group practiced progressive balance exercises every other day for 6 weeks, while the control group continued their daily activities. The corticomotor excitability outcome measures included the active and resting corticomotor thresholds, the motor evoked potential, and the cortical silent period of the peroneus longus muscle, which were measured using an electromyography device under a transcranial magnetic stimulator. The outcome measures were measured in the intervention group before and after progressive balance exercises, and in the control group at baseline and again after a 6-week interval.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The corticomotor thresholds and cortical silent period of the peroneus longus muscle were significantly decreased within groups (<i>p</i>-values < 0.001; <i>η</i><sup>2</sup><i>p</i> > 0.580). In addition, the normalized motor evoked potential of the peroneus longus muscle exhibited a significant increase within groups (<i>p</i>-value < 0.001; <i>η</i><sup>2</sup><i>p</i> = 0.265). Interestingly, a significant interaction effect was revealed between the within-group and between-group effects for the corticomotor excitability outcome measures related to the peroneus longus muscle (<i>p</i>-values < 0.001; <i>η</i><sup>2</sup><i>p</i> > 0.311).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Six weeks of progressive balance exercises significantly increased corticomotor excitability corresponding to the peroneus longus muscle in individuals with chronic ankle instability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9081,"journal":{"name":"Brain and Behavior","volume":"16 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Secondary hemophagocytic lymphohistiocytosis (sHLH) with central nervous system (CNS) involvement poses significant diagnostic and therapeutic challenges. This study aimed to characterize the clinical features, laboratory profiles, and prognostic impact of neurological involvement in adult-onset sHLH.
Methods
We analyzed 130 adult sHLH patients, comparing 28 with CNS involvement to 102 without neurological manifestations. Clinical parameters, neuroimaging, cerebrospinal fluid (CSF) profiles, cytokine levels, treatment responses, and survival outcomes were evaluated.
Results
Patients with CNS involvement were older (median age, 54 vs. 46 years; p = 0.013) and had higher disease severity (median HScore, 250 vs. 210; p < 0.001). Malignancy-associated sHLH was more prevalent in the CNS-positive group (42.9% vs. 29.4%; p = 0.038). Neurological manifestations included altered mental status, impaired consciousness, and seizures. Neuroimaging revealed abnormalities in 71.4% of the cases, primarily T2-weighted fluid-attenuated inversion recovery hyperintensities and leptomeningeal enhancement. CNS-positive patients exhibited markedly elevated inflammatory markers, most notably CSF Interleukin-6 (p < 0.001). In multivariable analysis adjusted for malignancy, age, ferritin, and HScore, CNS involvement independently predicted mortality (adjusted HR = 2.0, 95% CI: 1.1–3.7, p = 0.023), with a significantly shorter median overall survival (6.5 vs. 11.5 months, p < 0.0001). Malignancy-associated etiology and HScore ≥ 250 were also independent prognostic factors. The DEP (dexamethasone, etoposide, and polyethylene glycol-asparaginase) regimen achieved a faster median time to initial response than the HLH-94 protocol (9 vs. 14 days, p = 0.02).
Conclusions
CNS involvement defines a severe phenotype of adult-onset sHLH, characterized by malignancy-prone etiology, intense neuroinflammation, and poor prognosis. We establish CNS involvement as an independent predictor of mortality, underscoring the critical need for early recognition and CNS-directed therapies.
背景：累及中枢神经系统（CNS）的继发性噬血细胞性淋巴组织细胞病（sHLH）是诊断和治疗的重大挑战。本研究旨在描述成人发病sHLH的临床特征、实验室资料和神经系统受累的预后影响。方法：我们分析了130例成人sHLH患者，其中28例有中枢神经系统受累，102例无神经系统表现。评估临床参数、神经影像学、脑脊液（CSF）谱、细胞因子水平、治疗反应和生存结果。结果：中枢神经系统受累的患者年龄较大（中位年龄，54比46岁；p = 0.013），疾病严重程度较高（中位HScore， 250比210；p < 0.001）。恶性相关sHLH在cns阳性组中更为普遍（42.9% vs 29.4%; p = 0.038）。神经学表现包括精神状态改变、意识受损和癫痫发作。71.4%的病例神经影像学显示异常，主要是t2加权液体衰减反转恢复高信号和脑膜薄增强。cns阳性患者表现出明显升高的炎症标志物，最明显的是CSF白细胞介素-6 （p < 0.001）。在对恶性肿瘤、年龄、铁蛋白和HScore进行校正的多变量分析中，中枢神经系统受累独立预测死亡率（校正HR = 2.0, 95% CI: 1.1-3.7, p = 0.023），中位总生存期显著缩短（6.5个月vs 11.5个月，p < 0.0001）。恶性肿瘤相关病因和HScore≥250也是独立的预后因素。DEP（地塞米松、依托泊苷和聚乙二醇-天冬酰胺酶）方案比HLH-94方案获得更快的中位初始反应时间（9天对14天，p = 0.02）。结论：中枢神经系统受累定义了成人发病sHLH的严重表型，其特点是易恶性病因，强烈的神经炎症和预后差。我们建立了中枢神经系统受累作为死亡率的独立预测因子，强调早期识别和中枢神经系统定向治疗的迫切需要。
{"title":"Neurological Involvement in Adult-Onset Secondary Hemophagocytic Lymphohistiocytosis: Clinical Features and Prognostic Implications","authors":"Xue Wang, Yingying Zhao, Yanfei Han, Yongbo Zhang","doi":"10.1002/brb3.71228","DOIUrl":"10.1002/brb3.71228","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Secondary hemophagocytic lymphohistiocytosis (sHLH) with central nervous system (CNS) involvement poses significant diagnostic and therapeutic challenges. This study aimed to characterize the clinical features, laboratory profiles, and prognostic impact of neurological involvement in adult-onset sHLH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed 130 adult sHLH patients, comparing 28 with CNS involvement to 102 without neurological manifestations. Clinical parameters, neuroimaging, cerebrospinal fluid (CSF) profiles, cytokine levels, treatment responses, and survival outcomes were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Patients with CNS involvement were older (median age, 54 vs. 46 years; <i>p</i> = 0.013) and had higher disease severity (median HScore, 250 vs. 210; <i>p</i> < 0.001). Malignancy-associated sHLH was more prevalent in the CNS-positive group (42.9% vs. 29.4%; <i>p</i> = 0.038). Neurological manifestations included altered mental status, impaired consciousness, and seizures. Neuroimaging revealed abnormalities in 71.4% of the cases, primarily T2-weighted fluid-attenuated inversion recovery hyperintensities and leptomeningeal enhancement. CNS-positive patients exhibited markedly elevated inflammatory markers, most notably CSF Interleukin-6 (<i>p</i> < 0.001). In multivariable analysis adjusted for malignancy, age, ferritin, and HScore, CNS involvement independently predicted mortality (adjusted HR = 2.0, 95% CI: 1.1–3.7, <i>p</i> = 0.023), with a significantly shorter median overall survival (6.5 vs. 11.5 months, <i>p</i> < 0.0001). Malignancy-associated etiology and HScore ≥ 250 were also independent prognostic factors. The DEP (dexamethasone, etoposide, and polyethylene glycol-asparaginase) regimen achieved a faster median time to initial response than the HLH-94 protocol (9 vs. 14 days, <i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CNS involvement defines a severe phenotype of adult-onset sHLH, characterized by malignancy-prone etiology, intense neuroinflammation, and poor prognosis. We establish CNS involvement as an independent predictor of mortality, underscoring the critical need for early recognition and CNS-directed therapies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9081,"journal":{"name":"Brain and Behavior","volume":"16 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yaofeng Zhu, Zean Du, Liping Sun, Ziyun Huang, Linju Jia, Tao Chen, Xuefeng Zheng, Wanlong Lei
Background
High-mobility group protein 1 (HMGB1) is a ligand known to bind to the receptor for advanced glycation end products (RAGE), and it can activate nuclear factor-κB (NF-κB) to mediate cellular damage. RAGE and Parkinson's disease (PD) are closely associated, but it remains unclear whether the HMGB1/RAGE/NF-κB signaling pathway contributes to the pathophysiology of PD.
Methods
PD was induced by administration of 6-hydroxydopamine (6-OHDA), while RAGE was inhibited using an inhibitor, FPS-ZM1. The grip strength test and Morris water maze were used to evaluate sensorimotor and memory skills. Then detect the expression levels of RAGE, HMGB1, and NF-κB in the striatal sample using immunohistochemistry, western blotting, and RT-qPCR.
Results
(1) In PD rats, treatment with FPS-ZM1 improved learning and memory ability and alleviated sensorimotor deficits. (2) The striatum of PD rats exhibited a significant increase in the number of HMGB1-, RAGE-, and NF-κB-positive cells, which could be reduced through the administration of FPS-ZM1. Immunofluorescence double-labeling results indicated that NeuN-positive neurons were the primary sites of HMGB1-, RAGE-, and NF-κB-positive responses. Furthermore, these double-labeled neurons demonstrated a significant increase following 6-OHDA-induced depletion of striatal dopamine (DA). However, the FPS-ZM1 administration considerably attenuated these changes. (3) The treatment of FPS-ZM1 significantly reduced the increase in protein expression of HMGB1, RAGE, and NF-κB that followed striatal DA depletion. Similarly, NF-κB and RAGE mRNA expression were increased by striatal DA deprivation; however, injection of FPS-ZM1 significantly reduced these changes.
Conclusion
The HMGB1/RAGE/NF-κB signaling pathway plays a critical role in the pathogenesis of striatal neuronal damage in PD, highlighting its potential as a therapeutic target.
{"title":"High-mobility Group Protein 1/ Receptor for Advanced Glycation End Products/ Nuclear Factor-κB Signalling Pathway Contributes to the Pathogenic Process of Striatal Neuron Impairment in the Rat Model of Parkinson's Disease","authors":"Yaofeng Zhu, Zean Du, Liping Sun, Ziyun Huang, Linju Jia, Tao Chen, Xuefeng Zheng, Wanlong Lei","doi":"10.1002/brb3.71133","DOIUrl":"10.1002/brb3.71133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>High-mobility group protein 1 (HMGB1) is a ligand known to bind to the receptor for advanced glycation end products (RAGE), and it can activate nuclear factor-κB (NF-κB) to mediate cellular damage. RAGE and Parkinson's disease (PD) are closely associated, but it remains unclear whether the HMGB1/RAGE/NF-κB signaling pathway contributes to the pathophysiology of PD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PD was induced by administration of 6-hydroxydopamine (6-OHDA), while RAGE was inhibited using an inhibitor, FPS-ZM1. The grip strength test and Morris water maze were used to evaluate sensorimotor and memory skills. Then detect the expression levels of RAGE, HMGB1, and NF-κB in the striatal sample using immunohistochemistry, western blotting, and RT-qPCR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>(1) In PD rats, treatment with FPS-ZM1 improved learning and memory ability and alleviated sensorimotor deficits. (2) The striatum of PD rats exhibited a significant increase in the number of HMGB1-, RAGE-, and NF-κB-positive cells, which could be reduced through the administration of FPS-ZM1. Immunofluorescence double-labeling results indicated that NeuN-positive neurons were the primary sites of HMGB1-, RAGE-, and NF-κB-positive responses. Furthermore, these double-labeled neurons demonstrated a significant increase following 6-OHDA-induced depletion of striatal dopamine (DA). However, the FPS-ZM1 administration considerably attenuated these changes. (3) The treatment of FPS-ZM1 significantly reduced the increase in protein expression of HMGB1, RAGE, and NF-κB that followed striatal DA depletion. Similarly, <i>NF-κB</i> and <i>RAGE</i> mRNA expression were increased by striatal DA deprivation; however, injection of FPS-ZM1 significantly reduced these changes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The HMGB1/RAGE/NF-κB signaling pathway plays a critical role in the pathogenesis of striatal neuronal damage in PD, highlighting its potential as a therapeutic target.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9081,"journal":{"name":"Brain and Behavior","volume":"16 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Postoperative delirium (POD) is a common acute cognitive disorder among older adults following elective surgery. It prolongs hospitalization, increases the risk of complications and readmission, and may contribute to long-term cognitive decline, thereby reducing patients' quality of life. Although various preventive strategies have been developed, single interventions often yield limited efficacy. This study systematically evaluates, through meta-analysis, the effectiveness of multicomponent interventions in preventing POD among older adults undergoing elective surgery.
Study design
A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) published through July 2025. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess intervention effects, and pooled analyses were performed using a random-effects model.
Study results
Eleven RCTs comprising 3857 patients undergoing elective surgery were included in the final analysis. Multicomponent interventions significantly reduced POD incidence in older adults (RR: 0.71; 95% CI: 0.59–0.85; p < 0.001), representing a 29% risk reduction. Between-study heterogeneity was low (I2 = 18.0%, p = 0.272). Sensitivity analyses supported the robustness of results. Subgroup analyses indicated a greater effect in Eastern populations compared to Western populations (interaction p = 0.045).
Conclusions
Multicomponent interventions are effective in reducing POD incidence in older adults undergoing elective surgery, with geographical variation influencing effect size. These findings support broader clinical adoption of such interventions for POD prevention.
背景与假设：术后谵妄（POD）是老年人择期手术后常见的急性认知障碍。它延长住院时间，增加并发症和再入院的风险，并可能导致长期认知能力下降，从而降低患者的生活质量。虽然制定了各种预防战略，但单一的干预措施往往产生有限的效果。本研究通过荟萃分析，系统评估了多组分干预措施在老年人择期手术中预防POD的有效性。研究设计：系统检索PubMed、Embase、Web of Science和Cochrane Library，检索截至2025年7月发表的随机对照试验（rct）。计算95%置信区间（ci）的风险比（rr）来评估干预效果，并采用随机效应模型进行合并分析。研究结果：11项随机对照试验包括3857例接受择期手术的患者纳入最终分析。多组分干预显著降低老年人POD发病率（RR: 0.71; 95% CI: 0.59-0.85; p < 0.001），风险降低29%。研究间异质性较低（I2 = 18.0%, p = 0.272）。敏感性分析支持结果的稳健性。亚组分析表明，与西方人群相比，东方人群的影响更大（相互作用p = 0.045）。结论：多组分干预可有效降低择期手术老年人POD发病率，地域差异影响效果大小。这些发现支持更广泛的临床采用这种干预措施来预防POD。
{"title":"Prevention of Postoperative Delirium in Patients Undergoing Elective Surgery Using Multicomponent Interventions: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","authors":"Xu Yang, Huachun Zhang, Sheng Peng","doi":"10.1002/brb3.71131","DOIUrl":"10.1002/brb3.71131","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and hypothesis</h3>\u0000 \u0000 <p>Postoperative delirium (POD) is a common acute cognitive disorder among older adults following elective surgery. It prolongs hospitalization, increases the risk of complications and readmission, and may contribute to long-term cognitive decline, thereby reducing patients' quality of life. Although various preventive strategies have been developed, single interventions often yield limited efficacy. This study systematically evaluates, through meta-analysis, the effectiveness of multicomponent interventions in preventing POD among older adults undergoing elective surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study design</h3>\u0000 \u0000 <p>A systematic search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) published through July 2025. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated to assess intervention effects, and pooled analyses were performed using a random-effects model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study results</h3>\u0000 \u0000 <p>Eleven RCTs comprising 3857 patients undergoing elective surgery were included in the final analysis. Multicomponent interventions significantly reduced POD incidence in older adults (RR: 0.71; 95% CI: 0.59–0.85; <i>p</i> < 0.001), representing a 29% risk reduction. Between-study heterogeneity was low (<i>I</i><sup>2</sup> = 18.0%, <i>p</i> = 0.272). Sensitivity analyses supported the robustness of results. Subgroup analyses indicated a greater effect in Eastern populations compared to Western populations (interaction <i>p</i> = 0.045).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Multicomponent interventions are effective in reducing POD incidence in older adults undergoing elective surgery, with geographical variation influencing effect size. These findings support broader clinical adoption of such interventions for POD prevention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9081,"journal":{"name":"Brain and Behavior","volume":"16 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abigail Link, Sarah Iribarren, Paul Bohjanen, Mark Okwir, David Meya, Betty Nabongo, Danuta Kasprzyk
<div> <section> <h3> Background</h3> <p>Inflammation in and around the brain in patients with meningitis can lead to confusion, cognitive dysfunction, and behavioral changes associated with mental health disorders. Stigma associated with HIV or mental illness can complicate meningitis, leading to misdiagnosis or delays in diagnosis and care. The frequency of misdiagnosis and/or co-occurrence of meningitis and mental illness among people living with HIV (PLWH) remains uncertain. We explored the experiences of meningitis patients and the barriers and facilitators to care related to HIV stigma and mental illness.</p> </section> <section> <h3> Methods</h3> <p>We conducted a convergent mixed-methods study to evaluate experiences of patients who were hospitalized with HIV-associated meningitis from February 2017 to May 2022 at Lira Regional Referral Hospital in Uganda. Experiences among patients who survived and family members of patients who died were explored. Surveys were conducted to obtain demographic information, investigate stigma, and assess symptoms of mental illness. Semi-structured interviews probed the overall experience of patients with HIV and meningitis regarding social support, mental health, and stigma.</p> </section> <section> <h3> Results</h3> <p>Twenty-four patients with HIV-associated meningitis and 20 family members of deceased meningitis patients were enrolled. Family members reported that 80% of deceased patients experienced stigma, whereas 29.2% of surviving patients reported experiencing stigma. Combined responses from surviving patients and family members identified 31.8% of patients with mental illness symptoms described as overthinking, depression, and/or anxiety, while 60.8% experienced HIV-related stigma. Among participants who died, family members reported mental illness symptoms in 40%, compared to self-reports of 25% in survivors. Barriers to HIV care included (a) lack of HIV education, (b) mental illness symptoms, (c) lack of social support, and (d) stigma or shame. While common facilitators were (a) access to HIV clinics and ART medication, (b) having a life purpose, and (c) social support.</p> </section> <section> <h3> Conclusion</h3> <p>Stigma and symptoms of mental illness were common among patients with HIV and meningitis, which likely affected antiretroviral therapy (ART) adherence and HIV care. Recommendations include (1) adding mental health screening during hospital admission for all meningitis patients, especially among PLWH, for early evaluation and treatment and (2) increasing community awareness to dispel m
{"title":"Experiences of HIV–Related Stigma and Mental Illness Among HIV–Associated Meningitis Patients in Rural Uganda","authors":"Abigail Link, Sarah Iribarren, Paul Bohjanen, Mark Okwir, David Meya, Betty Nabongo, Danuta Kasprzyk","doi":"10.1002/brb3.71233","DOIUrl":"10.1002/brb3.71233","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Inflammation in and around the brain in patients with meningitis can lead to confusion, cognitive dysfunction, and behavioral changes associated with mental health disorders. Stigma associated with HIV or mental illness can complicate meningitis, leading to misdiagnosis or delays in diagnosis and care. The frequency of misdiagnosis and/or co-occurrence of meningitis and mental illness among people living with HIV (PLWH) remains uncertain. We explored the experiences of meningitis patients and the barriers and facilitators to care related to HIV stigma and mental illness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a convergent mixed-methods study to evaluate experiences of patients who were hospitalized with HIV-associated meningitis from February 2017 to May 2022 at Lira Regional Referral Hospital in Uganda. Experiences among patients who survived and family members of patients who died were explored. Surveys were conducted to obtain demographic information, investigate stigma, and assess symptoms of mental illness. Semi-structured interviews probed the overall experience of patients with HIV and meningitis regarding social support, mental health, and stigma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-four patients with HIV-associated meningitis and 20 family members of deceased meningitis patients were enrolled. Family members reported that 80% of deceased patients experienced stigma, whereas 29.2% of surviving patients reported experiencing stigma. Combined responses from surviving patients and family members identified 31.8% of patients with mental illness symptoms described as overthinking, depression, and/or anxiety, while 60.8% experienced HIV-related stigma. Among participants who died, family members reported mental illness symptoms in 40%, compared to self-reports of 25% in survivors. Barriers to HIV care included (a) lack of HIV education, (b) mental illness symptoms, (c) lack of social support, and (d) stigma or shame. While common facilitators were (a) access to HIV clinics and ART medication, (b) having a life purpose, and (c) social support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Stigma and symptoms of mental illness were common among patients with HIV and meningitis, which likely affected antiretroviral therapy (ART) adherence and HIV care. Recommendations include (1) adding mental health screening during hospital admission for all meningitis patients, especially among PLWH, for early evaluation and treatment and (2) increasing community awareness to dispel m","PeriodicalId":9081,"journal":{"name":"Brain and Behavior","volume":"16 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12856219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146084005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To compare the clinical outcomes among various infarct patterns and to investigate the associations between the morphological parameters of contralateral middle cerebral artery (cMCA) M1 segment and infarct patterns in ischemic stroke attributed to large vessel occlusion (LVO) in M1 segment caused by intracranial atherosclerotic disease (ICAD).
Methods
Patients with stroke attributed to M1-ICAD-LVO were enrolled. The infarct patterns were categorized into artery-to-artery embolism (AAE), large infarct, borderzone infarct (BZI), and perforating artery infarction (PAI). The morphological parameters of cMCA-M1 segment included proximal and distal diameter, arc, and chord length. The tortuosity index of cMCA-M1 segment was calculated by (arc length/chord length − 1) × 100%.
Results
A total of 171 participants were enrolled. Compared to AAE, the risk of poor outcome increased in BZI (odds ratio [OR] = 5.51, 95% confidence interval [CI] = 1.71–17.78, p = 0.004) and large infarct (OR = 10.92, 95% CI = 2.01–59.27, p = 0.006) and was comparable in PAI. The tortuosity index (OR = 2.85, 95% CI = 1.13–7.18, p = 0.026) and arc length (OR = 2.47, 95% CI = 1.02–5.97, p = 0.045) significantly increased in BZI than other three patterns. Participants other than BZI were categorized into large infarct (n = 32) and non-large-infarct (n = 46) groups, and the proximal diameter (OR = 0.22, 95% CI = 0.07–0.72, p = 0.012), arc length (OR = 0.88, 95% CI = 0.78–0.98, p = 0.018), and chord length (OR = 0.87, 95% CI = 0.77–0.995, p = 0.042) were associated with large infarct.
Conclusion
For patients with M1-ICAD-LVO, large infarct and BZI had poorer outcomes than PAI and AAE. The cMCA-M1 segment with elevated tortuosity and arc length was associated with BZI, whereas a thin and short M1 segment was correlated with large infarct in patients with a less tortuous cMCA trunk.
目的：比较不同梗死类型的临床结果，探讨颅内动脉粥样硬化性疾病（ICAD）所致缺血性脑卒中对侧大脑中动脉（cMCA） M1段形态学参数与M1段大血管闭塞（LVO）梗死类型的关系。方法：纳入M1-ICAD-LVO脑卒中患者。梗死类型分为动脉-动脉栓塞（AAE）、大面积梗死、交界区梗死（BZI）和穿孔动脉梗死（PAI）。cMCA-M1节段的形态学参数包括近端直径、远端直径、弧度和弦长。用（弧长/弦长- 1）× 100%计算cMCA-M1段的扭转指数。结果：共纳入171名受试者。与AAE相比，BZI（优势比[OR] = 5.51, 95%可信区间[CI] = 1.71 ~ 17.78, p = 0.004）和大面积梗死（OR = 10.92, 95% CI = 2.01 ~ 59.27, p = 0.006）的不良预后风险增加，PAI的不良预后风险与AAE相当。BZI扭曲指数（OR = 2.85, 95% CI = 1.13 ~ 7.18, p = 0.026）和弧长（OR = 2.47, 95% CI = 1.02 ~ 5.97, p = 0.045）显著高于其他三种模式。除BZI外的参与者被分为大面积梗死（n = 32）和非大面积梗死（n = 46）组，近端直径（OR = 0.22, 95% CI = 0.07-0.72, p = 0.012）、弧长（OR = 0.88, 95% CI = 0.78-0.98, p = 0.018）和弦长（OR = 0.87, 95% CI = 0.77-0.995, p = 0.042）与大面积梗死相关。结论：对于M1-ICAD-LVO患者，大面积梗死和BZI预后较PAI和AAE差。弯曲度和弧长升高的cMCA-M1段与BZI相关，而细而短的M1段与cMCA主干弯曲度较低的患者的大面积梗死相关。
{"title":"The Correlations of Clinical Outcomes and Vascular Morphology With Infarct Patterns in Middle Cerebral Arterial Occlusion","authors":"ZhiRong Cai, Yuan Chen, ShaoQing Pei, Yue He, YaNan Zhu, Rui Zhang, JingWei Lin, Yi Yang, Ying Zhu","doi":"10.1002/brb3.71226","DOIUrl":"10.1002/brb3.71226","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To compare the clinical outcomes among various infarct patterns and to investigate the associations between the morphological parameters of contralateral middle cerebral artery (cMCA) M<sub>1</sub> segment and infarct patterns in ischemic stroke attributed to large vessel occlusion (LVO) in M<sub>1</sub> segment caused by intracranial atherosclerotic disease (ICAD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with stroke attributed to M<sub>1</sub>-ICAD-LVO were enrolled. The infarct patterns were categorized into artery-to-artery embolism (AAE), large infarct, borderzone infarct (BZI), and perforating artery infarction (PAI). The morphological parameters of cMCA-M<sub>1</sub> segment included proximal and distal diameter, arc, and chord length. The tortuosity index of cMCA-M<sub>1</sub> segment was calculated by (arc length/chord length − 1) × 100%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 171 participants were enrolled. Compared to AAE, the risk of poor outcome increased in BZI (odds ratio [OR] = 5.51, 95% confidence interval [CI] = 1.71–17.78, <i>p</i> = 0.004) and large infarct (OR = 10.92, 95% CI = 2.01–59.27, <i>p</i> = 0.006) and was comparable in PAI. The tortuosity index (OR = 2.85, 95% CI = 1.13–7.18, <i>p</i> = 0.026) and arc length (OR = 2.47, 95% CI = 1.02–5.97, <i>p</i> = 0.045) significantly increased in BZI than other three patterns. Participants other than BZI were categorized into large infarct (<i>n</i> = 32) and non-large-infarct (<i>n</i> = 46) groups, and the proximal diameter (OR = 0.22, 95% CI = 0.07–0.72, <i>p</i> = 0.012), arc length (OR = 0.88, 95% CI = 0.78–0.98, <i>p</i> = 0.018), and chord length (OR = 0.87, 95% CI = 0.77–0.995, <i>p</i> = 0.042) were associated with large infarct.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>For patients with M<sub>1</sub>-ICAD-LVO, large infarct and BZI had poorer outcomes than PAI and AAE. The cMCA-M<sub>1</sub> segment with elevated tortuosity and arc length was associated with BZI, whereas a thin and short M<sub>1</sub> segment was correlated with large infarct in patients with a less tortuous cMCA trunk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9081,"journal":{"name":"Brain and Behavior","volume":"16 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12848514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146059896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Trigeminal neuralgia (TN) patients are at risk for glymphatic dysfunction due to their prolonged headaches and sleep disturbances.
Objective
The aim of this study is to compare the glymphatic function changes in TN patients with healthy controls, to investigate whether there are differences in glymphatic function after decompression surgery, and to examine their relationship with clinical parameters.
Methods
The data for this hybrid design study were obtained from the OpenNeuro dataset titled “A large-scale dataset of pre- and post-surgical MRI data in patients with chronic trigeminal neuralgia.” The DTI-ALPS index values were calculated for 62 TN patients with normal brain MRIs and 35 age- and sex-matched healthy controls, as well as for 53 TN patients who had both preoperative and postoperative diffusion tensor imaging. Statistical analyses involved nonparametric tests and Spearman correlation to assess differences between groups and relationships with clinical variables such as age, disease duration, and Sindou grading.
Results
There were no significant differences in DTI-ALPS indices between TN patients and controls. Additionally, preoperative and postoperative comparisons in the TN cohort revealed no significant changes in glymphatic function following surgery. Furthermore, no correlations were observed between DTI-ALPS indices and clinical parameters, including patient age, disease duration, or the severity of neurovascular compression.
Conclusions
The findings of this preliminary study suggest that glymphatic dysfunction is not a contributing factor in the pathogenesis of TN and that microvascular decompression surgery does not alter glymphatic clearance. These results indicate that the underlying mechanisms of TN may be independent of glymphatic impairment, despite the presence of sleep disturbances in this population.
{"title":"No Glymphatic Dysfunction in Trigeminal Neuralgia: A Preliminary Study","authors":"Barış Genç, Kerim Aslan","doi":"10.1002/brb3.70938","DOIUrl":"10.1002/brb3.70938","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Trigeminal neuralgia (TN) patients are at risk for glymphatic dysfunction due to their prolonged headaches and sleep disturbances.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The aim of this study is to compare the glymphatic function changes in TN patients with healthy controls, to investigate whether there are differences in glymphatic function after decompression surgery, and to examine their relationship with clinical parameters.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The data for this hybrid design study were obtained from the OpenNeuro dataset titled “A large-scale dataset of pre- and post-surgical MRI data in patients with chronic trigeminal neuralgia.” The DTI-ALPS index values were calculated for 62 TN patients with normal brain MRIs and 35 age- and sex-matched healthy controls, as well as for 53 TN patients who had both preoperative and postoperative diffusion tensor imaging. Statistical analyses involved nonparametric tests and Spearman correlation to assess differences between groups and relationships with clinical variables such as age, disease duration, and Sindou grading.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were no significant differences in DTI-ALPS indices between TN patients and controls. Additionally, preoperative and postoperative comparisons in the TN cohort revealed no significant changes in glymphatic function following surgery. Furthermore, no correlations were observed between DTI-ALPS indices and clinical parameters, including patient age, disease duration, or the severity of neurovascular compression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings of this preliminary study suggest that glymphatic dysfunction is not a contributing factor in the pathogenesis of TN and that microvascular decompression surgery does not alter glymphatic clearance. These results indicate that the underlying mechanisms of TN may be independent of glymphatic impairment, despite the presence of sleep disturbances in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9081,"journal":{"name":"Brain and Behavior","volume":"16 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12848371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146059853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Despite observational studies suggesting a link between asthma and delirium, establishing a definitive causal relationship has been challenging. This study aims to investigate the genetic causality between these conditions, with a particular focus on age-related genetic associations using data from large-scale genome-wide association studies (GWASs).
Methods
Bidirectional two-sample Mendelian Randomization (MR) analyses were performed using GWAS summary statistics to evaluate the genetic association between asthma (overall, adult-onset, childhood-onset, and age at asthma diagnosis) and delirium. The inverse variance-weighted (IVW) method was the primary analytic approach, supplemented by weighted median, weighted mode, and MR-Egger methods. Multivariable Mendelian Randomization (MVMR) analyses were conducted to adjust for major confounders, including smoking, body mass index (BMI), alcohol intake, and education. Sensitivity analyses included MR-Egger regression, MR-PRESSO outlier tests, Cochran's Q for heterogeneity, and leave-one-out analyses.
Results
The primary MR analyses found no evidence of a significant genetic causal relationship between asthma and delirium in either direction (asthma to delirium: IVW OR = 1.02, 95% CI: 0.79–1.32, p = 0.86; delirium to asthma: IVW OR = 1.05, 95% CI: 0.99–1.11, p = 0.13). Age-stratified MR analyses for adult-onset and childhood-onset asthma, as well as age at asthma diagnosis, also showed no significant associations with delirium risk. In MVMR analyses adjusting for smoking, BMI, alcohol intake, and education, the direct effects of asthma and its subtypes on delirium, and of delirium on asthma phenotypes, remained non-significant (all p > 0.05). Sensitivity analyses confirmed the robustness of these results, with no evidence of pleiotropy or heterogeneity.
Conclusion
These comprehensive bidirectional MR and MVMR analyses do not support a genetic causal association between asthma and delirium, even after adjusting for key confounders and across age-related asthma subtypes. These findings suggest that previously observed associations may be attributable to non-genetic factors. Future studies integrating clinical and biomarker data are warranted to further explore these relationships.
引言：尽管观察性研究表明哮喘和谵妄之间存在联系，但建立明确的因果关系一直具有挑战性。本研究旨在研究这些疾病之间的遗传因果关系，特别关注使用大规模全基因组关联研究（GWASs）数据的年龄相关遗传关联。方法：采用GWAS汇总统计进行双向双样本孟德尔随机化（MR）分析，评估哮喘（总体、成人发病、儿童期发病和哮喘诊断年龄）与谵妄之间的遗传关联。反方差加权（IVW）法是主要的分析方法，其次是加权中位数法、加权模式法和MR-Egger法。进行多变量孟德尔随机化（MVMR）分析以调整主要混杂因素，包括吸烟、体重指数（BMI）、饮酒和教育程度。敏感性分析包括MR-Egger回归、MR-PRESSO离群检验、Cochran’s Q异质性检验和留一分析。结果：初步MR分析未发现哮喘和谵妄之间存在显著的遗传因果关系（哮喘到谵妄：IVW OR = 1.02, 95% CI: 0.79-1.32, p = 0.86；谵妄到哮喘：IVW OR = 1.05, 95% CI: 0.99-1.11, p = 0.13）。成人发病和儿童发病哮喘的年龄分层MR分析，以及哮喘诊断时的年龄，也显示与谵妄风险无显著关联。在调整吸烟、BMI、饮酒和教育的MVMR分析中，哮喘及其亚型对谵妄的直接影响，以及谵妄对哮喘表型的直接影响仍然不显著（均p < 0.05）。敏感性分析证实了这些结果的稳健性，没有证据表明存在多效性或异质性。结论：这些全面的双向MR和MVMR分析不支持哮喘和谵妄之间的遗传因果关系，即使在调整了关键混杂因素和年龄相关哮喘亚型之后也是如此。这些发现表明，先前观察到的关联可能归因于非遗传因素。整合临床和生物标志物数据的未来研究有必要进一步探索这些关系。
{"title":"Age-Related Genetic Causal Association Between Asthma and Delirium: A Bidirectional Two-Sample Mendelian Randomization","authors":"Xiaopeng Wang, Guangquan Guo, Jinfeng Liu","doi":"10.1002/brb3.71198","DOIUrl":"10.1002/brb3.71198","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite observational studies suggesting a link between asthma and delirium, establishing a definitive causal relationship has been challenging. This study aims to investigate the genetic causality between these conditions, with a particular focus on age-related genetic associations using data from large-scale genome-wide association studies (GWASs).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Bidirectional two-sample Mendelian Randomization (MR) analyses were performed using GWAS summary statistics to evaluate the genetic association between asthma (overall, adult-onset, childhood-onset, and age at asthma diagnosis) and delirium. The inverse variance-weighted (IVW) method was the primary analytic approach, supplemented by weighted median, weighted mode, and MR-Egger methods. Multivariable Mendelian Randomization (MVMR) analyses were conducted to adjust for major confounders, including smoking, body mass index (BMI), alcohol intake, and education. Sensitivity analyses included MR-Egger regression, MR-PRESSO outlier tests, Cochran's Q for heterogeneity, and leave-one-out analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The primary MR analyses found no evidence of a significant genetic causal relationship between asthma and delirium in either direction (asthma to delirium: IVW OR = 1.02, 95% CI: 0.79–1.32, <i>p</i> = 0.86; delirium to asthma: IVW OR = 1.05, 95% CI: 0.99–1.11, <i>p</i> = 0.13). Age-stratified MR analyses for adult-onset and childhood-onset asthma, as well as age at asthma diagnosis, also showed no significant associations with delirium risk. In MVMR analyses adjusting for smoking, BMI, alcohol intake, and education, the direct effects of asthma and its subtypes on delirium, and of delirium on asthma phenotypes, remained non-significant (all <i>p</i> > 0.05). Sensitivity analyses confirmed the robustness of these results, with no evidence of pleiotropy or heterogeneity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These comprehensive bidirectional MR and MVMR analyses do not support a genetic causal association between asthma and delirium, even after adjusting for key confounders and across age-related asthma subtypes. These findings suggest that previously observed associations may be attributable to non-genetic factors. Future studies integrating clinical and biomarker data are warranted to further explore these relationships.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9081,"journal":{"name":"Brain and Behavior","volume":"16 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12848525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146059932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Stroke significantly impacts population health, and post-stroke depressive symptoms are highly prevalent. Although depression symptoms are linked to Type D personality, self-efficacy, and participation preferences in discharge planning, the mechanisms underlying these interactions remain unclear. This study aimed to examine the chain mediation effects of self-efficacy and discharge planning participation preferences on the relationship between Type D personality and depression symptoms in stroke patients.
Methods
This study used a convenience sampling method to recruit 318 stroke patients from the Department of Neurology at the First People's Hospital of Changzhou. Participants were assessed using the Type D personality scale (DS14), stroke self-efficacy questionnaire (SSEQ), patient participation preferences assessment (PPPA), and self-rating depression scale (SDS). Statistical analyses included descriptive analysis, Spearman's rank correlation analysis, and chain mediation analysis; these analyses were performed using SPSS 25.0 and PROCESS v3.5 (Model 6).
Results
A total of 311 stroke patients were included in this study. Type D personality, self-efficacy, participation preferences, and depression symptoms are significantly correlated with each other (all P < 0.001). Self-efficacy and participation preferences acted as significant mediators between Type D personality and depression symptoms. The total indirect effect accounted for 46.51% of the total effect, and the chain pathway contributed 7.23% (chain indirect effect = 0.030, 95% CI 0.014–0.050).
Conclusion
Type D personality indirectly influences depression symptoms through the chain mediation effects of self-efficacy and participation preferences in stroke patients. This study demonstrates the intrinsic mechanisms by which Type D personality contributes to depression symptoms, providing insights for healthcare professionals to prevent and clinically intervene in stroke patients with depression.
背景：卒中显著影响人群健康，卒中后抑郁症状非常普遍。尽管抑郁症状与D型人格、自我效能和出院计划中的参与偏好有关，但这些相互作用的机制尚不清楚。本研究旨在探讨自我效能感和出院计划参与偏好在脑卒中患者D型人格与抑郁症状关系中的链式中介作用。方法：本研究采用方便抽样方法，选取常州市第一人民医院神经内科318例脑卒中患者。采用D型人格量表（DS14）、卒中自我效能问卷（SSEQ）、患者参与偏好评估（PPPA）和抑郁自评量表（SDS）对参与者进行评估。统计分析包括描述性分析、Spearman秩相关分析和链式中介分析；使用SPSS 25.0和PROCESS v3.5进行分析（模型6）。结果：共纳入311例脑卒中患者。D型人格、自我效能感、参与偏好和抑郁症状之间存在显著相关（均P < 0.001）。自我效能感和参与偏好在D型人格与抑郁症状之间起显著中介作用。总间接效应占总效应的46.51%，链式途径占7.23%（链式间接效应= 0.030,95% CI 0.014 ~ 0.050）。结论：D型人格通过自我效能感和参与偏好的链式中介效应间接影响脑卒中患者抑郁症状。本研究揭示了D型人格影响抑郁症状的内在机制，为卒中合并抑郁患者的预防和临床干预提供了参考。
{"title":"The Relationship between Type D Personality and Depression Symptoms in Stroke Patients: The Chain Mediating Effect of Self-Efficacy and Participation Preferences","authors":"Huipin Zhang, Suying Yu, Yun Ye","doi":"10.1002/brb3.71209","DOIUrl":"10.1002/brb3.71209","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Stroke significantly impacts population health, and post-stroke depressive symptoms are highly prevalent. Although depression symptoms are linked to Type D personality, self-efficacy, and participation preferences in discharge planning, the mechanisms underlying these interactions remain unclear. This study aimed to examine the chain mediation effects of self-efficacy and discharge planning participation preferences on the relationship between Type D personality and depression symptoms in stroke patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study used a convenience sampling method to recruit 318 stroke patients from the Department of Neurology at the First People's Hospital of Changzhou. Participants were assessed using the Type D personality scale (DS14), stroke self-efficacy questionnaire (SSEQ), patient participation preferences assessment (PPPA), and self-rating depression scale (SDS). Statistical analyses included descriptive analysis, Spearman's rank correlation analysis, and chain mediation analysis; these analyses were performed using SPSS 25.0 and PROCESS v3.5 (Model 6).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 311 stroke patients were included in this study. Type D personality, self-efficacy, participation preferences, and depression symptoms are significantly correlated with each other (all <i>P</i> < 0.001). Self-efficacy and participation preferences acted as significant mediators between Type D personality and depression symptoms. The total indirect effect accounted for 46.51% of the total effect, and the chain pathway contributed 7.23% (chain indirect effect = 0.030, 95% CI 0.014–0.050).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Type D personality indirectly influences depression symptoms through the chain mediation effects of self-efficacy and participation preferences in stroke patients. This study demonstrates the intrinsic mechanisms by which Type D personality contributes to depression symptoms, providing insights for healthcare professionals to prevent and clinically intervene in stroke patients with depression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":9081,"journal":{"name":"Brain and Behavior","volume":"16 2","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12848520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146059923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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