Grief and Economic Stressors by Sex, Gender, and Education: Associations With Alzheimer Disease–Related Outcomes

性别，性别和教育程度的悲伤和经济压力: 与阿尔茨海默病相关结果的关联

The prevalence and impact of stressful life events (SLEs) on age-related and Alzheimer disease (AD)-related pathways may depend on social determinants including gender and education. We investigated whether specific SLEs are associated with AD pathology and neurodegeneration and how these associations differ by gender and education. Older adults at risk of cognitive decline with less education and women may be more susceptible to experience more SLEs. Men who have experienced widowhood and unemployment and women who have experienced financial difficulties may benefit from interventions.

压力性生活事件 (SLEs) 对年龄相关和阿尔茨海默病 (AD) 相关途径的患病率和影响可能取决于包括性别和教育在内的社会决定因素。我们调查了特定的SLEs是否与AD病理和神经变性相关，以及这些关联如何因性别和教育而异。受教育程度较低的老年人有认知能力下降的风险，女性可能更容易经历更多的SLEs。经历过丧偶和失业的男子和经历过经济困难的妇女可以从干预中受益。

REF: Palpatzis E, Akinci M, Garcia-Prat M, et al. Grief and Economic Stressors by Sex, Gender, and Education: Associations With Alzheimer Disease-Related Outcomes. Neurology. 2025;104(8):e213377. doi:10.1212/WNL.0000000000213377 PMID: 40163795 PMCID: PMC11961074

Demographic and Geographic Trends in Myasthenia Gravis–Related Mortality in the United States, 1999–2022

1999-2022美国重症肌无力相关死亡率的人口统计学和地理趋势

The prevalence and incidence of myasthenia gravis (MG) have been increasing, globally and in the United States. The literature lacks data on MG-related mortality (MGRM) and its trends in the United States. We aimed to examine nationwide demographic and geographic trends of MGRM from 1999 to 2022. The rising MGRM over the 23-year period is concerning and warrants investigation into the underlying causes for this trend. This increase was most prominent in older and male individuals. The growing burden of MG in the United States and globally might pose a serious challenge to health care in the future. Limitations of this study include reliance on ICD codes. Future work needs to take these trends and disparities into consideration and focus on improving MGRM.

在全球和美国，重症肌无力 (MG) 的患病率和发病率一直在增加。文献缺乏关于美国MG相关死亡率 (MGRM) 及其趋势的数据。我们的目的是研究从1999年到2022年MGRM的全国人口和地理趋势。23年来MGRM的上升令人担忧，有必要对这一趋势的根本原因进行调查。这种增加在老年人和男性个体中最为突出。在美国和全球范围内，日益增长的MG负担可能会对未来的医疗保健构成严峻挑战。本研究的局限性包括对ICD代码的依赖。未来的工作需要考虑到这些趋势和差距，并侧重于改进MGRM。

REF: Al-Salahat A, Abdul Jabbar AB, Sharma R, Chen YT, Bernitsas E. Demographic and Geographic Trends in Myasthenia Gravis-Related Mortality in the United States, 1999-2022. Neurology. 2025;104(8):e213505. doi:10.1212/WNL.0000000000213505 PMID: 40153683

Risk Factors of Aneurysmal Subarachnoid Hemorrhage Including Analysis by Sex: A Systematic Review and Meta-Analysis

动脉瘤性蛛网膜下腔出血危险因素的性别系统综述和Meta分析

A 2005 review identified smoking, hypertension, and excessive alcohol intake as the most important risk factors of aneurysmal subarachnoid hemorrhage (aSAH), but data on other factors remained inconclusive. While aSAH is more prevalent in female participants, evidence on sex differences and female-specific factors remains limited. Comprehensive identification of all risk factors, including potential sex differences and female-specific factors, is essential for improving prevention and accurately assessing aSAH risk. We aimed to determine whether there is now greater certainty around previously inconclusive risk factors, identify any new emerging factors, and explore sex differences in both established and emerging risk factors. Current smoking, but not hypertension or excessive alcohol, has a stronger association with aSAH in female patients than in male patients. Regular exercise and diabetes are associated with a reduced risk, with no sex-specific associations. Data on female-specific factors remain inconsistent. Targeted smoking prevention may particularly benefit female patients. Large-scale studies are needed to clarify the role of female-specific factors in explaining the higher incidence of aSAH in female patients.

一项2005审查确定吸烟，高血压和过量饮酒是动脉瘤性蛛网膜下腔出血 (aSAH) 的最重要危险因素，但其他因素的数据尚无定论。虽然aSAH在女性参与者中更为普遍，但关于性别差异和女性特定因素的证据仍然有限。全面识别所有风险因素，包括潜在的性别差异和女性特定因素，对于改善预防和准确评估aSAH风险至关重要。我们的目的是确定现在是否有更大的确定性围绕以前不确定的风险因素，确定任何新出现的因素，并探讨在既定和新兴风险因素的性别差异。与男性患者相比，女性患者目前吸烟而不是高血压或过量饮酒与aSAH的相关性更强。经常运动和糖尿病与风险降低有关，没有性别特异性关联。关于女性特定因素的数据仍然不一致。有针对性的吸烟预防可能特别有益于女性患者。需要进行大规模研究，以阐明女性特异性因素在解释女性患者中较高的aSAH发病率中的作用。

REF: Ali M, van Eldik MJA, Rietkerken S, et al. Risk Factors of Aneurysmal Subarachnoid Hemorrhage Including Analysis by Sex: A Systematic Review and Meta-Analysis. Neurology. 2025;104(8):e213511. doi:10.1212/WNL.0000000000213511 PMID: 40153684 PMCID: PMC11952700

Statin Use and Risk of Intracerebral Hemorrhage in Chinese Population: A Target Trial Emulation Study

中国人群中他汀类药物的使用和脑出血的风险: 一项目标试验模拟研究

Statins have been shown to prevent major vascular events in a wide range of individuals. However, their potential mechanisms-such as impairing fibrinogen cleavage and reducing thrombin generation-raise concerns on increased risk of intracerebral hemorrhage (ICH). Given the inconsistent findings of previous trials and observational studies, this study aims to assess the effect of statins on ICH risk in Chinese population. Statin use may increase the risk of ICH in Chinese patients without history of ICH. However, the findings of this study may be limited by residual confounding, particularly the lack of cholesterol-related measurements.

他汀类药物已被证明可以预防多种个体的主要血管事件。然而，它们的潜在机制-例如削弱纤维蛋白原裂解和减少凝血酶生成-引起了人们对脑出血 (ICH) 风险增加的担忧。鉴于以前的试验和观察性研究的结果不一致，本研究旨在评估他汀类药物对中国人群ICH风险的影响。他汀类药物的使用可能会增加无ICH病史的中国患者的ICH风险。然而，这项研究的结果可能受到残余混杂因素的限制，特别是缺乏胆固醇相关的测量。

REF: Ji D, Dong S, Wang T, et al. Statin Use and Risk of Intracerebral Hemorrhage in Chinese Population: A Target Trial Emulation Study. Neurology. 2025;104(8):e213489. doi:10.1212/WNL.0000000000213489 PMID: 40146950

Neurotoxicity in Patients With CNS Lymphomas Treated With CAR T-Cell Therapy: A Study From the French Oculo-Cerebral Lymphoma Network

CAR T细胞疗法治疗的中枢神经系统淋巴瘤患者的神经毒性: 来自法国Oculo-脑淋巴瘤网络的一项研究

Several recent studies have shown the promising efficacy of chimeric antigenic receptor (CAR) T cells in treating CNS lymphomas. However, data on neurotoxicity in this setting are limited. The objective of this study was to describe neurotoxicity in patients with CNS lymphoma treated with anti-CD19 CAR T cells and to identify risk factors. Although the rate of neurotoxicity seems acceptable in CNS lymphomas, the risk of unusual prolonged neurologic deterioration is high in patients with grade 3-4 neurotoxicity. Special attention should be given to older patients with cognitive impairment who seem at greater risk of severe forms of neurotoxicity. Larger series are warranted to confirm these results.

最近的几项研究显示了嵌合抗原受体 (CAR) T细胞在治疗CNS淋巴瘤中的有希望的功效。然而，在这种情况下，关于神经毒性的数据是有限的。这项研究的目的是描述anti-CD19 CAR T细胞治疗的中枢神经系统淋巴瘤患者的神经毒性并确定危险因素。尽管中枢神经系统淋巴瘤的神经毒性发生率似乎是可以接受的，但3-4级神经毒性患者发生异常长时间神经系统恶化的风险很高。应特别注意患有认知障碍的老年患者，这些患者似乎有更大的严重神经毒性风险。需要更大的系列来确认这些结果。

REF: Hernández-Tost H, Weiss N, Choquet S, et al. Neurotoxicity in Patients With CNS Lymphomas Treated With CAR T-Cell Therapy: A Study From the French Oculo-Cerebral Lymphoma Network. Neurology. 2025;104(8):e213501. doi:10.1212/WNL.0000000000213501 PMID: 40146949

Clinical and Imaging Markers of Cardiac Function and Brain Health: A Meta-Analysis of Community-Based Studies

心功能和脑健康的临床和影像学标志物: 基于社区研究的荟萃分析

Cardiac dysfunction and heart failure are linked to cognitive impairment, but the underlying brain pathology remains undetermined. We investigated associations between cardiac function (measured by echocardiography or cardiac MRI), clinical heart failure, and structural markers on brain MRI, including volumes of gray and white matter (WM), the hippocampus, and white matter hyperintensities (WMHs). In this large study among community-dwelling adults, subclinical cardiac dysfunction was associated with brain imaging markers of neurodegeneration. These findings encourage longitudinal investigations on the effect of maintaining cardiac function on brain health.

心功能障碍和心力衰竭与认知障碍有关，但潜在的大脑病理仍未确定。我们研究了心脏功能 (通过超声心动图或心脏MRI测量)，临床心力衰竭和脑MRI上的结构标志物之间的关系，包括灰质和白质 (WM) 的体积，海马和白质高信号 (WMHs)。在这项针对社区居住成年人的大型研究中，亚临床心功能障碍与神经变性的脑成像标志物有关。这些发现鼓励对维持心脏功能对大脑健康的影响进行纵向研究。

REF: Yaqub A, Bis JC, Frenzel S, et al. Clinical and Imaging Markers of Cardiac Function and Brain Health: A Meta-Analysis of Community-Based Studies. Neurology. 2025;104(8):e213421. doi:10.1212/WNL.0000000000213421 PMID: 40138616 PMCID: PMC11981472

The Social Vulnerability Index and Incidence of Alzheimer Disease in a Population-Based Sample of Older Adults

基于人群的老年人样本中的社会脆弱性指数和阿尔茨海默病的发病率

The primary study objective was to examine the association between Social Vulnerability index (SVI) and risk of incident Alzheimer disease (AD) and rate of cognitive decline. Most Black participants who lived in areas with higher SVI that had over twice the risk of incident AD than most White participants who lived in areas with lower SVI, showing a higher social burden in Black older adults. There was no statistically significant race difference in incident AD after adjusting for SVI. SVI should be accounted for when examining race differences in AD.

主要研究目的是检验社会脆弱性指数 (SVI) 与阿尔茨海默病 (AD) 发病风险和认知下降速度之间的关系。居住在SVI较高的地区的大多数黑人参与者发生AD事件的风险是居住在SVI较低地区的大多数白人参与者的两倍以上，这表明黑人老年人的社会负担更高。调整SVI后，事件AD的种族差异无统计学意义。在检查AD的种族差异时，应考虑SVI。

REF: Desai P, Bond J, Dhana A, et al. The Social Vulnerability Index and Incidence of Alzheimer Disease in a Population-Based Sample of Older Adults. Neurology. 2025;104(8):e213464. doi:10.1212/WNL.0000000000213464 PMID: 40138617 PMCID: PMC11962047

A Machine Learning Approach to Predict Cognitive Decline in Alzheimer Disease Clinical Trials

预测阿尔茨海默病临床试验中认知下降的机器学习方法

Among the participants of Alzheimer disease (AD) treatment trials, 40% do not show cognitive decline over 80 weeks of follow-up. Identifying and excluding these individuals can increase power to detect treatment effects. We aimed to develop machine learning-based predictive models to identify persons unlikely to show decline on placebo treatment over 80 weeks. Our results indicate that predictive models have the potential to improve the design of AD trials through selective inclusion and exclusion criteria based on expected cognitive decline. Such predictive models need further validation across data from different AD clinical trials.

在阿尔茨海默病 (AD) 治疗试验的参与者中，40% 人在80周的随访中没有出现认知能力下降。识别和排除这些个体可以增加检测治疗效果的能力。我们的目标是开发基于机器学习的预测模型，以识别在80周内不太可能出现安慰剂治疗下降的人。我们的结果表明，预测模型有可能通过基于预期认知能力下降的选择性纳入和排除标准来改善AD试验的设计。这种预测模型需要进一步验证来自不同AD临床试验的数据。

REF: Nallapu BT, Petersen KK, Qian T, et al. A Machine Learning Approach to Predict Cognitive Decline in Alzheimer Disease Clinical Trials. Neurology. 2025;104(8):e213490. doi:10.1212/WNL.0000000000213490 PMID: 40132145

Association of Cardiovascular Health With Brain Volume and White Matter Integrity: Results of the SOL-INCA MRI Study

心血管健康与脑容量和白质完整性的关系: sol-inca MRI研究的结果

Better cardiovascular health (CVH), measured using the Life's Simple 7 (LS7) score, is associated with improved cognitive function. However, its effect on brain imaging in Hispanics/Latinos has not been reported. We investigated the association of LS7 score with brain MRI outcomes in a diverse Hispanic/Latino population. We found that better CVH is associated with better brain-based volumes and microstructural integrity and that the effects of LS7 score on brain health are age dependent. Additional studies are needed to assess the longitudinal effect of CVH on MR-based brain health outcomes.

使用Life's Simple 7 (LS7) 评分测量的更好的心血管健康 (CVH) 与改善的认知功能相关。但是，尚未报道其对西班牙裔/拉丁美洲人的脑成像的影响。我们调查了不同西班牙裔/拉丁裔人群中LS7评分与脑MRI结果之间的关系。我们发现更好的CVH与更好的基于大脑的体积和微结构完整性相关，并且LS7评分对大脑健康的影响取决于年龄。需要进一步的研究来评估CVH对基于MR的大脑健康结果的纵向影响。

REF: Trifan G, Stickel AM, Cai J, et al. Association of Cardiovascular Health With Brain Volume and White Matter Integrity: Results of the SOL-INCA MRI Study. Neurology. 2025;104(8):e213404. doi:10.1212/WNL.0000000000213404 PMID: 40127389