The Neurologist’s Imperative in Brain Death

脑死亡中神经科医生的职责

This Viewpoint discusses the importance of the diagnosis of brain death/death by neurologic criteria and provides context and history of the diagnosis.

这篇观点文章探讨了依据神经学标准诊断脑死亡/死亡的重要性，并介绍了该诊断的背景和历史。

REF: Greer DM, Lewis A, Kirschen MP. The Neurologist's Imperative in Brain Death. JAMA Neurol. Published online March 24, 2025. doi:10.1001/jamaneurol.2025.0191 PMID: 40126488

The Regulatory Landscape for Clinical Metagenomic Testing

临床宏基因组学检测的监管格局

This Viewpoint discusses regulatory shifts and their effects on access to innovative diagnostic tests and provides ways to address regulatory barriers for clinical metagenomic testing.

这篇观点文章探讨了监管政策的转变及其对获取创新诊断检测方法的影响，并提出了解决临床宏基因组检测监管障碍的方法。

REF: Chiu CY, López-Labrador FX, Wilson MR, de Vries JJC. The Regulatory Landscape for Clinical Metagenomic Testing. JAMA Neurol. Published online April 7, 2025. doi:10.1001/jamaneurol.2025.0461 PMID: 40193099

Somebody to Love

有个人来爱 注：“Somebody to Love”是一个常见短语表述，若它是歌曲名，通常翻译为《有人来爱》 。

This essay describes a physician’s inspiration for a renewed sense of love in caring for patients.

这篇文章讲述了一位医生在照顾患者过程中重获关爱情怀的灵感来源。

REF: Johnson V. Somebody to Love. JAMA Neurol. Published online May 27, 2025. doi:10.1001/jamaneurol.2025.1382 PMID: 40423993

Global, Regional, and National Burden of Nontraumatic Subarachnoid Hemorrhage: The Global Burden of Disease Study 2021

非创伤性蛛网膜下腔出血的全球、区域和国家负担：2021 年全球疾病负担研究

This cross-sectional study investigates the global burden of nontraumatic subarachnoid hemorrhage in 2021. Although the global age-standardized burden rates of SAH more than halved over the last 3 decades, SAH remained one of the most common cardiovascular and neurological causes of death and disabilities in the world, with increasing absolute case numbers. These findings suggest evidence for the potential health benefits of proactive public health planning and resource allocation toward the prevention of SAH.

这项横断面研究调查了2021年非创伤性蛛网膜下腔出血（SAH）的全球负担情况。尽管在过去30年里，全球SAH的年龄标准化负担率降低了一半以上，但SAH仍然是全球导致死亡和残疾的最常见心血管和神经系统病因之一，且绝对病例数在增加。这些研究结果为积极开展公共卫生规划和资源分配以预防SAH的潜在健康益处提供了证据。

REF: GBD 2021 Global Subarachnoid Hemorrhage Risk Factors Collaborators, Rautalin I, Volovici V, et al. Global, Regional, and National Burden of Nontraumatic Subarachnoid Hemorrhage: The Global Burden of Disease Study 2021. JAMA Neurol. Published online May 23, 2025. doi:10.1001/jamaneurol.2025.1522 PMID: 40406922

Clinical and Neuropathological Evaluations of the New Brunswick Neurological Syndrome of Unknown Cause

新不伦瑞克原因不明神经系统综合征的临床和神经病理学评估

This cross-sectional study examines findings from second, independent clinical evaluations of patients initially diagnosed with an alleged “mystery” neurological illness in New Brunswick, Canada, to determine whether there is evidence of such a disease. There was no evidence supporting a diagnosis of NSUC in this cohort. The data inclusive of independent examinations and neuropathology strongly supported the presence of several neurodegenerative and non-neurodegenerative conditions. Unfounded concerns that a potentially fatal mystery disease, possibly induced by an environmental toxin, is causing the patients' neurological symptoms has been amplified in traditional and social media. Second, independent clinical evaluations are needed for any patient given a diagnosis of NSUC.

这项横断面研究对加拿大新不伦瑞克省最初被诊断为所谓“神秘”神经系统疾病的患者进行了第二次独立临床评估，以确定是否有证据表明存在这种疾病。在该队列中，没有证据支持无法归类的神经系统疾病（NSUC）的诊断。包括独立检查和神经病理学检查在内的数据有力地表明存在几种神经退行性和非神经退行性疾病。传统媒体和社交媒体放大了毫无根据的担忧，即一种可能由环境毒素引发的潜在致命神秘疾病正在导致患者出现神经系统症状。其次，任何被诊断为NSUC的患者都需要进行第二次独立临床评估。

REF: Bendahan N, Gautreau S, Medina Escobar A, et al. Clinical and Neuropathological Evaluations of the New Brunswick Neurological Syndrome of Unknown Cause. JAMA Neurol. Published online May 7, 2025. doi:10.1001/jamaneurol.2025.1718 PMID: 40332886 PMCID: PMC12060016

Ambroxol as a Treatment for Parkinson Disease DementiaA Randomized Clinical Trial

氨溴索治疗帕金森病痴呆的随机临床试验

This randomized clinical trial investigates the safety and tolerability of ambroxol for Parkinson disease dementia (PDD) and its role as a potential disease-modifying treatment for PDD. Results of this randomized clinical trial reveal that ambroxol was safe, well-tolerated, and demonstrated target engagement. However, the effect of ambroxol on cognition was not confirmed.

这项随机临床试验旨在研究氨溴索用于帕金森病痴呆（PDD）的安全性和耐受性，以及其作为PDD潜在疾病修饰疗法的作用。该随机临床试验的结果显示，氨溴索安全且耐受性良好，并显示出对靶点的作用。然而，氨溴索对认知功能的影响尚未得到证实。

REF: Silveira CRA, Coleman KKL, Borron K, et al. Ambroxol as a Treatment for Parkinson Disease Dementia: A Randomized Clinical Trial. JAMA Neurol. Published online June 30, 2025. doi:10.1001/jamaneurol.2025.1687 PMID: 40587145 PMCID: PMC12210149

APOE ε4 and Risk of Intracranial Hemorrhage in Patients With Atrial Fibrillation Taking Apixaban

服用阿哌沙班的心房颤动患者载脂蛋白E ε4与颅内出血风险

This cohort study uses genetic association data from All of Us participants with atrial fibrillation who are treated with apixaban to determine whether being a carrier of the APOE ε4 allele increases the risk of intracranial hemorrhage. Further research is needed to evaluate whether cerebral amyloid angiopathy mediates the observed association and whether APOE e4 information improves clinical decision-making about anticoagulation therapy in patients with atrial fibrillation. The latter is important now that APOE information is used in clinical settings to guide antiamyloid treatment for Alzheimer disease and has been returned to millions of persons by direct-to-consumer genotyping companies.

这项队列研究利用“全美医疗研究项目”（All of Us）中接受阿哌沙班治疗的房颤患者的基因关联数据，来确定载脂蛋白E（APOE）ε4等位基因携带者是否会增加颅内出血的风险。需要进一步研究来评估脑淀粉样血管病是否介导了所观察到的关联，以及APOE ε4信息是否能改善房颤患者抗凝治疗的临床决策。鉴于目前临床已使用APOE信息来指导阿尔茨海默病的抗淀粉样蛋白治疗，且直接面向消费者的基因分型公司已将相关信息反馈给数百万人，后一个问题尤为重要。

REF: Clocchiatti-Tuozzo S, Rivier CA, Renedo D, et al. APOE ε4 and Risk of Intracranial Hemorrhage in Patients With Atrial Fibrillation Taking Apixaban. JAMA Neurol. Published online June 23, 2025. doi:10.1001/jamaneurol.2025.0182 PMID: 40549373 PMCID: PMC12186128

Regional Differences in Dementia Incidence Among US Veterans

美国退伍军人痴呆发病率的地区差异

This observational study investigates geographic differences in dementia incidence across the US among older adults in the Veterans Health Administration (VHA) system. Among older adults in the VHA, dementia incidence varied significantly across US regions, independent of key covariates. These findings highlight the need for targeted health care planning, public health interventions, and policy development.

这项观察性研究调查了美国退伍军人健康管理局（VHA）系统中老年人群痴呆症发病率的地域差异。在VHA的老年人群中，美国不同地区的痴呆症发病率存在显著差异，且与关键协变量无关。这些研究结果凸显了开展有针对性的医疗保健规划、公共卫生干预和政策制定的必要性。

REF: Dintica CS, Bahorik AL, Xia F, Boscardin J, Yaffe K. Regional Differences in Dementia Incidence Among US Veterans. JAMA Neurol. Published online June 9, 2025. doi:10.1001/jamaneurol.2025.1536 PMID: 40489088 PMCID: PMC12150226

White Matter Abnormalities and Cognition in Aging and Alzheimer Disease

衰老与阿尔茨海默病中的白质异常与认知

This prognostic study investigates the associations between tract-specific white matter microstructure and cognitive performance and decline in aging- and Alzheimer disease–related cognitive impairment. White matter microstructural changes, particularly FW, play a critical role in cognitive decline in aging and AD-related cognitive impairment. These findings highlight the importance of FW correction in dMRI studies and highlight the limbic system, especially the cingulum and fornix, as key regions associated with cognitive decline; the interaction models highlight that integrating FW-corrected metrics with other AD biomarkers may further elucidate the biological mechanisms of neurodegeneration in aging.

这项预后研究探讨了特定脑白质束的微观结构与衰老及阿尔茨海默病相关认知障碍患者的认知表现和认知衰退之间的关联。白质微观结构变化，尤其是游离水（FW），在衰老和阿尔茨海默病相关认知障碍导致的认知衰退中起着关键作用。这些发现强调了在弥散磁共振成像（dMRI）研究中进行游离水校正的重要性，并指出边缘系统，尤其是扣带回和穹窿，是与认知衰退相关的关键脑区；交互模型表明，将经游离水校正的指标与其他阿尔茨海默病生物标志物相结合，可能进一步阐明衰老过程中神经退行性变的生物学机制。

REF: Peter C, Sathe A, Shashikumar N, et al. White Matter Abnormalities and Cognition in Aging and Alzheimer Disease. JAMA Neurol. 2025;82(8):825-836. doi:10.1001/jamaneurol.2025.1601 PMID: 40513084 PMCID: PMC12150229