BACKGROUND: Social cognition, with emotion recognition (ER) being a key component, is recognized as a core cognitive domain, yet research on ER post-stroke remains limited. This exploratory pilot study aimed to provide p...BACKGROUND: Social cognition, with emotion recognition (ER) being a key component, is recognized as a core cognitive domain, yet research on ER post-stroke remains limited. This exploratory pilot study aimed to provide preliminary estimates of long-term ER impairment after stroke and to examine its association with lesion volume and location. METHODS: We invited patients <65 years, admitted for endovascular treatment (EVT) and included in a prospective cohort; the Oslo Acute Reperfusion Stroke Study, to participate in a 4-year follow-up study, and a healthy control (HC) group. ER was assessed using the "Pictures of Facial Affect" (PFA) test, impairment defined as performance ≥1.5 SD below HC mean. Linear regression analysis examined relationship between baseline predictors and ER at follow-up. Voxel-based lesion-symptom mapping (VLSM) were used to identify brain regions associated with ER, complemented by disconnectome mapping. RESULTS: Of 109 participants included, 40 completed a 4-year follow-up including the PFA test (24 (60%) women, mean age 51 (SD ± 10) years). ER impairment was detected in 9 (23%) patients. Stroke lesion volume was significantly associated with PFA scores in both univariable and multivariable analysis, adjusted for sex, education, and time to recanalization. VLSM revealed associations between right-hemisphere cortical regions and lower PFA scores, notably the inferior parietal lobule and and adjacent perisylvian cortex. CONCLUSIONS: Emotion recognition impairment was identified in more than one in five stroke patients four years after EVT. These preliminary findings identify stroke lesion burden and location as candidate group-level prognostic markers that warrant confirmation in larger studies of this under-researched cognitive domain.
AIM: To investigate the prevalence and cancer-specific patterns of subjective cognitive decline (SCD) among U.S. cancer survivors and its associated risk factors. METHODS: Data were obtained from the Behavioral Risk Fact...AIM: To investigate the prevalence and cancer-specific patterns of subjective cognitive decline (SCD) among U.S. cancer survivors and its associated risk factors. METHODS: Data were obtained from the Behavioral Risk Factor Surveillance System (BRFSS) 2017-2024, including 34,222 cancer survivors and 477,988 adults without a history of cancer. SCD was defined as self-reported confusion or memory loss. Multivariable logistic regression models were used to evaluate associations between SCD and sociodemographic, lifestyle, health-related, and survivorship factors. All analyses accounted for survey weights. RESULTS: The prevalence of SCD was higher among cancer survivors (16.0%) than among adults without a history of cancer (13.1%). After adjustment for potential confounders, cancer survivors had higher odds of reporting SCD compared with non-cancer adults (adjusted OR = 1.27, 95% CI = 1.20-1.35). Within cancer survivors, higher odds of SCD were observed among those with three or more cancer diagnoses compared with those with a single diagnosis, and among those reporting cancer-related pain compared with those without pain. Higher odds of SCD were also observed among unaccompanied individuals, smokers, physically inactive individuals, and those with depression. Patterns of SCD varied across cancer types. CONCLUSION: Approximately one in six U.S. cancer survivors reported SCD. Factors associated with SCD included cancer type, being unaccompanied, unhealthy lifestyle behaviors, depression, multiple cancer diagnoses, and cancer-related pain. These findings suggest that SCD reflects increased vulnerability among cancer survivors, highlighting the need for clinical attention.
The epidemiology of varicella-zoster virus (VZV) meningitis, including its optimal management, in Asia remains unclear. This study aimed to clarify the incidence, treatment patterns, and outcomes of VZV meningitis in Jap...The epidemiology of varicella-zoster virus (VZV) meningitis, including its optimal management, in Asia remains unclear. This study aimed to clarify the incidence, treatment patterns, and outcomes of VZV meningitis in Japan. We identified 1680 patients with VZV meningitis between April 2011 and March 2023 using the Diagnosis Procedure Combination (DPC), a national inpatient database in Japan. The annual incidence of VZV meningitis was calculated as the number of patients with VZV meningitis divided by the annual population, and adjusted for the proportion of acute-care hospitals covered by the DPC. We described the eligible patients' treatment regimens (including antiviral agents) and clinical outcomes (in-hospital mortality and Barthel Index at discharge). The average annual incidence was 0.25 per 100,000 person-years, increasing from 0.13 in 2011 to 0.46 in 2022. Overall, 96.4% of patients initially received high-dose intravenous acyclovir therapy with a median duration of 11 days. Of the patients treated with intravenous acyclovir, 89.3% received long-course treatment (≥7 days). The in-hospital mortality was 0.8%, and the Barthel Index at discharge was ≥90 in 87.4% of patients. The incidence of VZV meningitis has more than tripled in Japan in the last 12 years. Most patients were treated with long-course intravenous acyclovir and had favorable outcomes at discharge.
BACKGROUND: Glutamate dysregulation is a key mechanism underlying seizure generation and epileptogenesis, yet non-invasive imaging methods capable of capturing dynamic glutamate-related changes in vivo remain limited. Th...BACKGROUND: Glutamate dysregulation is a key mechanism underlying seizure generation and epileptogenesis, yet non-invasive imaging methods capable of capturing dynamic glutamate-related changes in vivo remain limited. This study aimed to characterize time-dependent hippocampal glutamate-related signal changes following kainic acid-induced acute seizures using Glutamate-weighted CEST (GluCEST) MRI. METHODS: Acute seizures were induced in rats by intraperitoneal administration of kainic acid. Time-resolved GluCEST MRI was performed at baseline, immediately after injection, and at 1, 3, and 5 h post-injection using a 7.0 T MRI system. GluCEST contrast in the hippocampus was quantified using magnetization transfer ratio asymmetry at 3.0 ppm and analyzed using a linear mixed-effects model. RESULTS: Hippocampal GluCEST contrast did not differ between groups at baseline or immediately after injection. In contrast, the seizure group showed a significant increase in GluCEST contrast beginning at 1 h post-injection, peaking at 3 h, and remaining elevated at 5 h, with a significant group-by-time interaction. CONCLUSIONS: Time-resolved GluCEST MRI revealed delayed and sustained hippocampal glutamate-related signal changes following acute seizures, supporting its utility for probing seizure-related metabolic dynamics in vivo.
BACKGROUND: Brain frailty, characterized by atrophy and/or chronic vascular lesions, is associated with worse outcomes after endovascular thrombectomy (EVT), but whether its impact differs by sex remains unclear. Therefo...BACKGROUND: Brain frailty, characterized by atrophy and/or chronic vascular lesions, is associated with worse outcomes after endovascular thrombectomy (EVT), but whether its impact differs by sex remains unclear. Therefore, we investigated sex differences in the association between imaging brain frailty markers and 90-day outcome after EVT. METHODS: We conducted a post-hoc analysis of the ESCAPE-NA1 randomized trial, which evaluated intravenous nerinetide in patients undergoing EVT for acute ischemic stroke due to large vessel occlusion. Brain frailty markers-including global cortical atrophy (GCA) scale, subcortical atrophy, Fazekas score, lacunes, and old infarctions-were assessed on baseline non-contrast CT (NCCT), and among those with follow-up MRI, perivascular spaces and microbleeds were also evaluated. The primary outcome was a modified Rankin Scale (mRS) score of 0-2 at 90 days. Multivariable logistic regression was performed, stratified by sex. RESULTS: Among 1102 patients with NCCT (568 with MRI), no significant sex interactions were identified between brain frailty markers and 90-day outcomes. However, exploratory sex-stratified analyses showed that several brain frailty markers were associated with a lower likelihood of achieving functional independence (mRS 0-2) at 90 days in women, whereas no clear associations were observed in men. For example, cortical atrophy was associated with a lower likelihood of achieving an mRS score of 0-2 in women but not in men (adjusted OR for GCA 1 vs. 0: 0.54, 95% CI 0.32-0.91 in women; 0.76, 95% CI 0.45-1.28 in men). Similar patterns were observed for subcortical atrophy. CONCLUSIONS: Although sex-stratified analyses suggested nominal differences, no statistically significant sex-by-brain frailty interactions were observed. Brain frailty should be considered a prognostic marker irrespective of sex, and these exploratory findings warrant further investigation in adequately powered studies.
INTRODUCTION: Neurophobia remains a barrier to medical students' commitment to neurology. Several causes, especially poor teaching, have been proposed, but correlations with student-related factors such as anxiety, depre...INTRODUCTION: Neurophobia remains a barrier to medical students' commitment to neurology. Several causes, especially poor teaching, have been proposed, but correlations with student-related factors such as anxiety, depression or burnout have not been formally documented in a large student cohort. This cross-sectional study aimed to assess the association between neurophobia and demographic and mental health variables in a large cohort of medical students. METHODS: Data were obtained from the ETMED-L project, an observational cohort study investigating empathy, mental health and academic performance in medical students. Neurophobia was assessed using the NeuroQ scale. Stress, anxiety, depression and burnout were measured with validated instruments. Univariable and multivariable linear regression models, adjusted for age and gender, were used to identify correlates of neurophobia. RESULTS: Among 1066 students, 264 (24.8%) met the neurophobia threshold (NeuroQ ≥16/25). Neurophobia was more prevalent among female students and was associated with higher anxiety, depression and burnout in the univariable analysis. Only academic efficacy and emotional exhaustion, two dimensions of burnout, as well as gender remained significant in multivariable analysis. Students considering neurology as a specialty did not display higher burnout rates than their counterparts. DISCUSSION: This study demonstrates that neurophobia is associated with mental health variables and that specific burnout dimensions, low academic efficacy and emotional exhaustion, appear to be more proximal correlates than anxiety or depressive symptoms. Addressing student well-being and fostering a sense of academic competence may therefore warrant consideration as targets for intervention aimed at mitigating neurophobia and potentially enhancing engagement in neurology.
Karadeniz M, Wesselingh R, Jayakrishnan PC
… +18 more, Sequeira RP, Estupin M, Chao FY, Zhong M, Yeh W, Kalincik T, Van Der Walt A, Seery N, Rath L, Tan T, Skibina O, Bridge F, Taylor L, Nesbitt C, Fazzolari K, Sanfilippo P, Butzkueven H, Monif M
Multiple sclerosis (MS) relapse diagnosis is impeded by 'pseudo-relapses' whilst relapse treatment lacks specificity. Before we can improve clinical care, we must first improve our understanding of relapse pathogenesis....Multiple sclerosis (MS) relapse diagnosis is impeded by 'pseudo-relapses' whilst relapse treatment lacks specificity. Before we can improve clinical care, we must first improve our understanding of relapse pathogenesis. Currently, the circulatory immune mechanisms underpinning relapse are poorly understood. We aimed to determine changes in circulatory cell counts from people with MS during relapse versus remission and their association with clinical outcomes. Data was collected retrospectively by screening 2316 patient files through which we identified 78 episodes of MS relapse and remission. From these participants full blood examination data, we calculated immune cell counts and ratios. In participants with contrast enhancing lesions on magnetic resonance imaging (MRI, n = 38), total neutrophil count (p = 0.04) and neutrophils/total white cell count (N%) was higher (p = 0.04) in relapse versus remission. Similarly, in participants with a new lesion on MRI (n = 51), total neutrophil count (p = 0.01) was significantly higher during relapse versus remission. Univariable regression analyses demonstrated that lymphocytes, the neutrophil to lymphocyte ratio, monocytes/total white cell count (M%) and N% were all associated with changes in disability scores whilst multivariable regression analyses demonstrated that M% was associated with the presence of contrast enhancing lesions. This study determined that neutrophils are elevated in the circulation of people with MS during relapse compared to remission. Additionally, neutrophils, monocytes and lymphocytes were found to be associated with clinical outcomes of relapse. These findings support the notion that alterations in circulating immune cells may play a role in MS relapse pathogenesis and may inform future biomarker studies.
BACKGROUND: The mechanisms driving the broad spectrum of Long COVID symptoms-such as fatigue, brain fog, pain, and dysautonomia-remain uncertain. This study investigated central sensitization (CS) as a potential contribu...BACKGROUND: The mechanisms driving the broad spectrum of Long COVID symptoms-such as fatigue, brain fog, pain, and dysautonomia-remain uncertain. This study investigated central sensitization (CS) as a potential contributor to symptom burden in patients with Long COVID. We aimed to examine its association with symptom severity, as well as objective cerebrovascular, autonomic, and inflammatory markers. METHODS: A total of 169 consecutive patients with Long COVID referred for evaluation of orthostatic intolerance underwent assessment using the Central Sensitization Inventory, symptom burden surveys (autonomic: COMPASS-31; sensory: NTSS-6; global health: PROMIS), autonomic function testing (deep breathing, the Valsalva maneuver and head-up tilt test with transcranial Doppler and capnography monitoring), and skin biopsies for small-fiber assessment. RESULTS: CS was present in 81% of participants. Patients with CS were more often female (79.6% vs. 53.1%, p = 0.004) and had higher rates of anxiety, depression, fibromyalgia and headaches, as well as a significantly greater autonomic, sensory and global health symptom burden (all p < 0.001). Compared with patients without CS, they also exhibited a greater decline in orthostatic cerebral blood flow velocity (-25.53% ± 11.19 vs. -22.09% ± 10.53, p = 0.038) and higher interleukin-6 levels (p = 0.041). Autonomic failure, most commonly of mild grade, occurred at similar frequency in both groups (84.7% vs. 84.4%, p = 0.999). Skin biopsies demonstrated a comparable prevalence of abnormal findings in both groups (50.8% vs. 52.0%, p = 0.999). CONCLUSION: Central sensitization appears highly prevalent among patients with Long COVID and may contribute to their multisystem symptomatology. Cerebral hypoperfusion, and neuroinflammation may constitute pathophysiological mechanisms underlying central sensitization in this population.