SATURN MRI: study protocol for the statin use in intracerebral hemorrhage patients MRI ancillary study.

Background: The benefit-risk of statins in patients with lobar intracerebral hemorrhage (ICH) is under investigation in the StATins Use in intRacerebral hemorrhage patieNts (SATURN) trial. The relationship between statin use in ICH survivors, MRI markers of cerebral small vessel disease (CSVD), and outcomes such as recurrent ICH or major adverse cardiovascular or cerebrovascular events (MACCE) is unclear. The ancillary study, SATURN-MRI, intends to evaluate the interrelationship between statin use, the progression of MRI markers of CSVD, and cognitive and functional outcomes.

Atrial fibrillation and atherosclerosis cause different vascular brain lesions on magnetic resonance imaging.

Background And Aims: Atrial fibrillation (AF) and atherosclerosis pre-dispose to the occurrence of vascular brain lesions compared with the general population, yet direct comparisons of brain lesion patterns between these two cardiovascular patient groups are lacking. This study sought to compare the prevalence and distribution of vascular brain lesions on cerebral magnetic resonance imaging (MRI) between patients with AF and those with atherosclerosis.

Methods: Baseline clinical data and standardized brain MRI scans from the Swiss Atrial Fibrillation cohort study (Swiss-AF; representing patients with AF) and the COMPASS MRI sub-study (COMPASS MIND; representing patients with atherosclerosis without AF) were used to compare the prevalence of lacunar and non-lacunar infarcts, periventricular and deep white matter hyperintensities (WMH), and cerebral micro-bleeds (CMB) between groups.

Respiratory Event-related Physiological Biomarkers and Cognitive Performance in Obstructive Sleep Apnea.

Rationale: Individuals with obstructive sleep apnea (OSA) are at increased risk of cognitive impairment. However, the physiologic mechanisms that link OSA to this impairment are unclear. We assessed the association between novel physiologic biomarkers (, respiratory event-related electroencephalographic (EEG) activity and autonomic responses) and the risk of cognitive impairment.

National Versus State-Level Racial Disparities in Acute Stroke Interventions Using Get With The Guidelines-Stroke Data.

Background: Racial disparities have been reported in stroke care, but understanding if there is regional variability is critical to focusing policies and resources. Here, we sought to study racial and ethnic inequity in the administration of thrombolysis and thrombectomy at the national and state levels.

Methods: We conducted a retrospective cohort study using Get With The Guidelines-Stroke Program registry data from 2003 to 2022 to evaluate racial disparities in the administration of acute stroke treatments in US patients.

Vascular Contributions to Cognitive Impairment and Dementia in the United States: Prevalence and Incidence: A Scientific Statement From the American Heart Association.

Vascular contributions to cognitive impairment and dementia (VCID) are common and may be the most preventable cause of clinically significant cognitive decline. However, an estimate of the prevalence and incidence of VCID in the United States is lacking. In this scientific statement, we reviewed studies on the incidence and prevalence of VCID, defined as patients diagnosed with vascular dementia, evidence of vascular dementia in epidemiological studies, neuropathological evidence of cerebrovascular contributions to dementia, and neuroimaging evidence of covert (clinically silent) cerebrovascular disease.

Enhancing Alzheimer Disease Detection Using Neuropsychiatric Symptoms: The Role of Mild Behavioural Impairment in the Revised NIA-AA Research Framework.

BackgroundAs the prevalence of Alzheimer disease (AD) rises, early identification of at-risk individuals is essential for effective intervention. Mild behavioral impairment (MBI), which captures emergent and persistent neuropsychiatric symptoms (NPS) in later life, may enhance early detection of AD; however, its associations with 2024 NIA-AA Core 1 biomarkers remain unexplored. We investigated associations between MBI and cerebrospinal fluid (CSF) amyloid β-42 (Aβ42) and phosphorylated tau-181 (p-tau181).

Creating a Clinical Care Pathway for Depressive Symptoms and Disorders in Long-Term Care: A Modified Delphi Process.

Objectives: To create an evidence- and expert-informed clinical care pathway focused on identifying and treating depressive symptoms and disorders in long-term care (LTC) residents.

Design: Modified Delphi survey.

Setting And Participants: Delphi participants were LTC health care providers, LTC administrators, friend/family caregivers of residents living in LTC, and residents of LTC.

Toward compassionate communication: a rapid review on facilitating the dementia disclosure process.

Individuals with dementia and their care partners often report dissatisfaction with the disclosure process due to insufficient information and support. Healthcare providers face challenges in effective communication and connecting patients to post-diagnostic resources. To address these issues and emphasize person-centered communication, especially in diverse communities, we conducted a rapid systematic review consolidating preferences for dementia diagnosis disclosure from patients, care partners, and healthcare providers.

MRI findings intracranial hemorrhages in ARCADIA-MRI: an ancillary study to the ARCADIA trial.

Background And Purpose: The ARCADIA-MRI study, an ancillary study to the randomized Atrial Cardiopathy and Antithrombotic Drugs in Prevention After Cryptogenic Stroke (ARCADIA) trial, reported that the risk of incident non-lacunar covert infarcts was lower in the apixaban group than the aspirin group. This paper presents the additional, prespecified, exploratory outcomes beyond the primary paper, specifically examining the effect of apixaban on hemorrhagic lesions on MRI.

Materials And Methods: The ARCADIA-MRI study was conducted in conjunction with ARCADIA trial visits, with follow-up durations ranging from 4 months to 5.

Diagnosis and management of cerebral amyloid angiopathy: a scientific statement from the International CAA Association and the World Stroke Organization.

Cerebral amyloid angiopathy (CAA) is a well-recognized and challenging disease for neurologists and other clinicians caring for the rapidly aging worldwide population. CAA is a major cause of spontaneous lobar intracerebral hemorrhage (ICH), and can also cause transient focal neurological episodes, and convexity subarachnoid hemorrhage, CAA-associated ICH has a high mortality, morbidity, and recurrence rate. CAA can affect a wide range of clinical decisions including use of antithrombotic medications, safety for anti-β-amyloid peptide (Aβ) immunotherapy, and need for anti-inflammatory or immunosuppressive treatment.

Advancing clinical trial readiness in white matter disease and related dementias: key steps for future research progress.

White matter disease, a broad-spectrum term that covers various types of white matter lesions and degeneration, is strongly related to age-related neurodegenerative disorders including Alzheimer's disease (AD), and vascular contributions to cognitive impairment and dementia (VCID) and Alzheimer's related dementias (ADRD). There is no specific treatment for white matter disease. Therefore, basic research and clinical studies are essential for future outcomes.

Management of Patients With Mild Cognitive Impairment in the Era of Anti-Amyloid Therapy: A Worldwide Neurology Survey.

Background And Objectives: The aim of this study was to explore practice patterns in managing mild cognitive impairment (MCI). The investigation and management of MCI is considered important because it offers the opportunity to potentially stave off conversion to dementia. However, there are few data on current practices/approaches in this area, especially worldwide; such data can help identify potential disparities and anticipate adoption of new therapies.

Location, size, and risk factors of incident covert brain infarcts in patients with acute non-cardioembolic ischemic stroke: PACIFIC-STROKE trial.

Introduction: Covert brain infarcts (CBIs) identified by imaging are more frequent than symptomatic ischemic strokes and are usually small and/or involve non-eloquent brain areas. The spectrum of incident CBIs in patients following acute ischemic stroke has not been well characterized.

Patients And Methods: Exploratory observational cohort study of the size, location, multiplicity and risk factors of incident CBIs identified using serial MRIs in patients with acute non-cardioembolic ischemic stroke participating in the PACIFIC-STROKE trial.

Mild behavioural impairment-apathy and core Alzheimer's disease cerebrospinal fluid biomarkers.

Apathy is a common neuropsychiatric symptom (NPS) in Alzheimer's disease (AD) but can emerge earlier in prodromal and even preclinical stages as part of mild behavioural impairment (MBI-apathy), a syndrome defined by emergent and persistent NPS. In dementia, apathy is associated with higher morbidity, mortality, and caregiver distress. However, the significance of MBI-apathy in dementia-free persons, including its associations with AD biomarkers, remains unclear.

Correlation of Depression and Anxiety Responses on the Mild Behavioral Impairment Checklist With the Cornell Scale for Depression in Dementia and Abbreviated Version of the Penn State Worry Questionnaire.

Introduction: Cognitive disorders are often accompanied by depression and anxiety. The Mild Behavioral Impairment Checklist (MBI-C) was developed to capture neuropsychiatric symptoms that predict risk for dementia and includes questions on mood, but has not been validated for identifying significant depression or anxiety symptoms. Our objective was to determine whether MBI-C mood domain scores predict responses on 2 previously validated scales: the Cornell Scale for Depression in Dementia (CSDD) and the Penn State Worry Questionnaire-Abbreviated version (PSWQ-A) scales.

Exploring the association between mild behavioral impairment and plasma p-tau217: Implications for early detection of Alzheimer's disease.

Introduction: Mild behavioral impairment (MBI), marked by late-onset persistent neuropsychiatric symptoms (NPS), may signal early dementia risk. While MBI is linked to previously established amyloid-beta (Aβ) and tau biomarkers, its association with plasma p-tau217, a promising blood-based biomarker for Alzheimer's disease (AD), remains unexplored. Here, we investigated the association between MBI and plasma p-tau217 in dementia-free individuals from the Alzheimer's Disease Neuroimaging Initiative.

Vascular risk factor associations with subjective cognitive decline and mild behavioural impairment.

Subjective cognitive decline and mild behavioural impairment identify older persons more likely to have early Alzheimer's disease. Vascular co-pathologies may also contribute to new onset and persistent cognitive and behavioural symptoms later in life. We investigated vascular risk factor associations with subjective cognitive decline and mild behavioural impairment.

Validation of the standard assessment of global everyday activities (SAGEA) scale for dementia diagnosis.

Background: Standardised questionnaires of cognitive symptoms and cognitive-related function can assist in diagnosing dementia. The Standardised Assessment of Global Everyday Activities (SAGEA) is a 15-item questionnaire, developed to measure functional status by capturing cognitive symptoms, basic and instrumental activities of daily living, participation in activites, and mobility.

Objective: The aim of this study was to validate the SAGEA as a tool for assessing cognitive dysfunction in dementia.

Neuropsychiatric symptoms and progression to pathologically confirmed Alzheimer's disease.

Whether or not neuropsychiatric symptoms (NPS) in advance of dementia are associated with Alzheimer disease (AD) and/or other neurodegenerative dementias remains to be determined. The mild behavioural impairment (MBI) construct selects persons with NPS that are later-life emergent and persistent to identify a high-risk group for cognitive decline and incident dementia. Here, in older adults without dementia at baseline, we examined whether postmortem AD and other neurodegenerative pathologies were associated with MBI in the five years before death.

Increased risk of recurrent stroke in patients with impaired kidney function: results of a pooled analysis of individual patient data from the MICON international collaboration.

Background: Patients with chronic kidney disease are at increased risk of stroke and frequently have cerebral microbleeds. Whether such patients also encounter an increased risk of recurrent stroke has not been firmly established. We aimed to determine whether impaired kidney function is associated with the risk of recurrent stroke, and microbleed presence, distribution and severity.

Cannabis Use Prevalence and Correlates in Patients Attending a Canadian Cognitive Clinic.

Background: Since cannabis was legalized in Canada in 2018, its use among older adults has increased. Although cannabis may exacerbate cognitive impairment, there are few studies on its use among older adults being evaluated for cognitive disorders.

Methods: We analyzed data from 238 patients who attended a cognitive clinic between 2019 and 2023 and provided data on cannabis use.

Hemorrhagic Infarction Does Not Worsen Functional Outcomes in Noncardioembolic Ischemic Stroke: Secondary Analysis From PACIFIC-STROKE.

Background: Hemorrhagic infarction (HI) of acute ischemic stroke is frequent. Whether radiologically detected HI affects stroke outcomes has been less explored.

Methods: This was a secondary analysis of the PACIFIC-STROKE trial (Proper Dosing and Safety of the Oral FXIa Inhibitor BAY 2433334 in Patients Following Acute Noncardioembolic Stroke), which enrolled patients with acute noncardioembolic ischemic stroke receiving either asundexian or placebo in addition to guideline-based antiplatelet therapy.

Outcomes Following Minimally Invasive Surgery for Intracerebral Hemorrhage in the AHA Get With The Guidelines-Stroke Registry.

Background: The efficacy of minimally invasive surgery (MIS) in improving outcomes after nontraumatic intracerebral hemorrhage (ICH) remains uncertain, with inconsistent findings from randomized clinical trials. Our objective was to evaluate the real-world impact of MIS on ICH outcomes using a nationally representative cohort.

Methods: We performed a retrospective cohort study of patients with a nontraumatic ICH enrolled in the American Heart Association Get With The Guidelines-Stroke Registry between January 1, 2011, and December 31, 2021.

Plasma biomarkers distinguish Boston Criteria 2.0 cerebral amyloid angiopathy from healthy controls.

Introduction: Cerebral amyloid angiopathy (CAA) is characterized by the deposition of beta-amyloid (Aβ) in small vessels leading to hemorrhagic stroke and dementia. This study examined whether plasma Aβ, phosphorylated-tau (p-tau), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP) differ in CAA and their potential to discriminate Boston Criteria 2.0 probable CAA from healthy controls.