BACKGROUND AND PURPOSE:Sex disparities in post-stroke prognosis have been reported, with women showing worse functional outcomes and higher mortality. However, whether these differences reflect a genuine biological disadvantage or are attributable to inadequate adjustment for comorbidities remains debated. We aimed to assess sex differences in one-year functional outcome and mortality after ischemic stroke by taking into consideration a broad set of comorbidities. METHODS:All cases of acute ischemic stroke were prospectively recorded using the population-based Dijon Stroke Registry, France (2017-2022). Demographics, vascular risk factors, stroke characteristics, and comorbidities across multiple domains were collected. Patients were follow-up at one-year. Sequential Cox and logistic regression models were constructed (unadjusted, age-adjusted, and fully adjusted) to assess the association between female sex and, respectively, all-cause mortality and poor functional outcome defined as a modified Rankin Scale (mRS) score of 3-6, or failure to return to the prestroke mRS score in patients with prestroke mRS >2. RESULTS:1,361 patients were included of whom 718 were women (52.8%). Women were older (median age 83.4 vs. 75.0 years; p<0.001) and globally carried a lower burden of vascular risk factors and diseases, but a greater burden of other comorbidities. Stroke severity was also higher in women (median NIHSS score 5 vs. 3; p<0.001), whilst rates of acute revascularization therapy did not differ between sexes. In crude analyses, women had higher one-year mortality (32.3% vs. 27.2%; unadjusted HR=1.24, 95% CI 1.02-1.52; p=0.032) and worse functional outcome (59.8% vs. 48.3%; unadjusted OR=1.59; 95% CI 1.28-1.99, p<0.001). Adjustment for age alone abolished both associations (age-adjusted HR=0.90; 95% CI 0.73-1.10, p=0.29; age-adjusted OR=1.18, 95% CI 0.93-1.50, p=0.17). In fully adjusted models, no significant sex difference was observed for mortality (HR=0.78, 95% CI 0.60-1.03, p=0.08) or functional outcome (OR=1.15; 95% CI 0.93-1.59, p=0.38). CONCLUSIONS:Sex differences in post-stroke outcomes were largely explained by confounding, with age as the primary driver. These findings suggest that female sex may not independently predict one-year mortality or functional outcome after ischemic stroke, and underline the need for identification and optimized management of age-related comorbidities in women as the key strategy to reduce disparities in post-stroke outcomes.
INTRODUCTION:Cognitive stability, defined as the maintenance of cognitive performance within expected variability, may represent an early marker of resilience during aging. However, its determinants remain poorly understood, particularly in low resource settings. This 10 year population based study examined predictors of cognitive stability and long term cognitive trajectories in a homogeneous rural cohort. METHODS:Residents of rural Ecuador (median age: 60 years) completed the Montreal Cognitive Assessments (MoCA) at baseline, short‑term, and long‑term follow‑ups. Cognitive stability was defined as ≤2 points decline between the first and second MoCA (short‑term) and ≤3 points between the first and third MoCA (long‑term), thresholds aligned with test-retest variability. Baseline determinants included demographics, cardiovascular health metrics, sleep quality, oily fish intake, depressive symptoms, and social risk. Mixed effects models evaluated continuous cognitive trajectories and categorical stability. RESULTS:Of 830 participants with baseline MoCA, 637 completed the second assessment and 523 the third. Short‑term cognitive stability was common (74%), but long‑term stability persisted in only 40%. No participant classified as unstable at the short‑term regained stability at long‑term follow‑up, indicating that early instability marked the onset of irreversible decline. In multivariable models, younger age, higher educational attainment, and low social risk were independently associated with higher cognitive performance or greater odds of stability. CONCLUSION:Cognitive stability is frequent over short intervals but declines sharply across a decade. Early instability appears prognostic of persistent decline. Social context emerged as a robust determinant of resilience, underscoring the need to integrate social and biological factors when addressing cognitive aging in underserved rural populations.
INTRODUCTION:This observational study evaluated demographic and regional disparities in mortality due to dementia with comorbid sepsis among older adults (≥65 years) in the United States from 1999 to 2020. METHODS:We analyzed death certificate data from the CDC WONDER Multiple Cause of Death database (1999-2020). Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and standardized to the 2000 U.S. POPULATION:Temporal trends were assessed using Joinpoint regression to estimate annual percentage change (APC) and average annual percent change (AAPC). Analyses were stratified by age, sex, race/ethnicity, geographic region, and urban-rural classification. RESULTS:Between 1999 and 2020, dementia with comorbid sepsis accounted for 284,645 deaths, yielding an overall AAMR of 30.8 (95% confidence interval: 30.7-30.9). Overall mortality remained stable (AAPC: 0.20%; 95% CI: -0.19 to 0.60). Males had higher mortality than females (AAMR: 31.8 vs. 30.0). Non-Hispanic Black individuals experienced the greatest burden (AAMR: 51.8), whereas Hispanic and non-Hispanic Asian/Pacific Islander populations demonstrated the steepest mortality increases. Crude mortality was highest among adults aged ≥85 years (136.1 per 100,000), while the largest relative increase occurred in those aged 75-84 years. The South exhibited the highest regional mortality (AAMR: 35.8), and rural areas showed elevated rates (AAMR: 31.7). CONCLUSION:Although mortality remained stable, disparities persist across demographic and geographic subgroups. Targeted interventions are needed to reduce inequities and mitigate mortality associated with dementia and sepsis in older adults.
BACKGROUND:Central nervous system (CNS) cancers, including brain cancer, are rare but highly lethal, and risk factors remain poorly understood. Radon, a known lung carcinogen, may affect non-pulmonary sites, including the CNS. METHODS:We estimated the radon-related hazard of incident malignant CNS cancer in a large United States (U.S.) cohort of postmenopausal women from the Women's Health Initiative. Incident CNS cancers were identified through physician adjudication or death certificates. Radon concentration estimates at residential addresses included U.S. Geological Survey (USGS) Radon Index and Zones, U.S. Environmental Protection Agency (EPA) Radon Zones, and models from the Lawrence Berkeley National Laboratory (LBL) and Li et al. (2025). Cox proportional hazards models were used to estimate hazard ratios, including study design, sociodemographic, behavioral, and environmental covariates. Corresponding population attributable fractions were calculated. RESULTS:Over follow-up (mean=17.7 years), 451 incident malignant CNS cancers were identified among 159,391 participants. Absolute risks of malignant CNS cancer increased with increasing radon concentration across all metrics. Non-linear spline models for USGS Radon Index, LBL estimates, and Li et al. estimates showed increasing CNS hazard even at low radon concentrations (global test of spline terms p=0.022 for Li et al.). In categorical analyses, the hazard ratio comparing the highest vs lowest Li et al. tertile was 1.49 (95% CI: 1.12-1.99), and the population attributable fraction was 20.1% (4.8%-33.9%). CONCLUSION:Higher radon concentrations were consistently associated with elevated malignant CNS cancer hazard, with the clearest concentration-response observed in continuous models. Residential radon exposure may contribute meaningfully to the overall burden of CNS cancers in this largest cohort study of the radon-CNS cancer association to date.
BACKGROUND:Economic and social disparities in health care contribute to differential outcomes among patients with acute stroke. A patient's insurance status reflects access to care and serves as a surrogate of social determinants of health, which can be targeted for intervention. We examined the relationship between insurance status and risk of recurrent stroke, major bleeding or death following an embolic stroke of undetermined source (ESUS). METHODS:This is a secondary analysis of a United States multicenter (n=27) retrospective observational cohort of patients with ESUS, which examined the association between insurance status and the primary composite outcome of recurrent stroke, major bleeding, or death. Insurance providers were categorized by Private/Veterans Affairs (VA), Medicare, Other, and Medicaid/pending/none, as surrogate exposures for economic and social determinants of health. Unadjusted and adjusted Cox proportional hazards models were built to estimate the association between insurance carrier and the primary and secondary outcomes, adjusting for age, stroke severity, pre-stroke disability, atherosclerotic risk factors, and potential embolic sources. RESULTS:Of the 2130 patients included, 882 were Medicare beneficiaries (41.4%), 744 had private/VA insurance (34.9%), 368 had Medicaid/pending/none (17.3%) and 136 patients had other insurance (6.4%). Compared to Private/VA beneficiaries, patients with Medicaid/pending/no insurance were younger, more frequently Black, with more severe baseline stroke severity and higher prevalence of atherosclerotic risk factors. Patients with Medicaid/pending/no insurance had a higher probability of the primary outcome in unadjusted and adjusted regression (adjusted hazard ratio [aHR] 1.37, 95% confidence interval [CI] 1.08-1.74, adjusted α=0.03) when compared to Private/VA beneficiaries. Although not statistically significant (adjusted α=0.08), the risk of recurrent stroke trended toward being greater among patients with Medicaid/pending/no insurance (aHR 1.40, 95% CI, 1.04-1.87). Among subgroups, patients with Medicaid/pending/no insurance had a higher risk of recurrent stroke among patients with mild stroke, patients younger than 50 years of age, and male sex (pinteraction <0.01 for all). CONCLUSIONS:Patients with Medicaid/pending/no insurance remain at a significantly higher risk of the composite endpoint in this diverse cohort of patients with ESUS independent of vascular risk factor presence. Optimizing access to care and follow-up may attenuate the ongoing, significant disparities in ESUS patients.
INTRODUCTION:Previous studies have considered level of urbanization when evaluating the role of place of residence in ALS. However, these studies have been subject to recall bias regarding previous exposures to urban characteristics owing to a lack of historical geospatial measures on urban form indicators. METHODS:Thus, we created a robust database from multiple sources and conducted a matched case-control study in New Brunswick, Canada to investigate the association between long-term exposure to various local climate zones, as well as greenness, at place of residence and the development of ALS. RESULTS:Odds of ALS were not significantly associated with the dense urban (1.1, 0.6 - 2.0 [95% CI]), open urban (0.5, 0.2 - 1.3 [95% CI]), residential (1.0, 0.9 - 1.1 [95% CI]), industrial (0.8, 0.6 - 1.2 [95% CI]), natural (1.0, 0.9 - 1.1 [95% CI]), or water (1.0, 0.9 - 1.1 [95% CI]) local climate zone classification categories per ten percentage increase in influence in the adjusted regression models. Exposure to greenness (1.7, 0.5 - 6.2 [95% CI]) was also not significantly associated to ALS in the adjusted regression models. CONCLUSION:While not significantly associated to ALS, urban influence and greenness need to be further explored. Future studies should consider traffic-related pollutants as it pertains to urban density, while considering vegetation type and industry practices, such as farming and spraying, alongside greenness exposure measures.
INTRODUCTION:The incidence of multiple sclerosis (MS) has shown varying temporal trends across European countries in recent decades, particularly in high-incidence areas. We aimed to describe the incidence risks and temporal trends of MS in the city of Catania over the last 5 decades (1970-2019). METHODS:Incident cases of MS in residents in the city of Catania at disease onset were identified using the registries of the main MS centers. The annualized incidence risk was based on the year of clinical onset. RESULTS:From 1970 to 2019, a total of 754 incident cases were identified. The annualized incidence risk increased sharply from 0.7/100,000 in 1970-1974 to 9.2/100,000 in 2015-2019. The female-to-male ratio increased from 0.83 (95% CI: 0.26-2.62) in 1970-1974 to 2.14 (95% CI: 1.47-3.17) in 2015-2019. The mean age at onset was 29.1 ± 8.2 years in 1970-1974, reaching a mean of 37.1 ± 11.3 years in 2015-2019. CONCLUSION:Incidence of MS has been steadily increasing in the city of Catania, reaching a peak in 2015-2019 confirming Catania as one of the highest incidence areas in Italy. Additionally, we observed an increasing age at onset for both sexes, which may be attributable to improved diagnosis of late-onset MS cases.
BACKGROUND AND OBJECTIVES:Neurologic disorders represent a growing global health burden. According to the Global Burden of Disease Study 2023, they remain a major cause of morbidity and mortality worldwide. However, a comprehensive assessment specifically focused on East Asia has been lacking. This study investigates data from the Global Burden of Disease 1990-2023 study to provide detailed and updated insights into the burden of neurologic disorders in East Asia. METHODS:We analyzed the 1990-2023 burden of 13 neurologic disorders in East Asia (e.g., stroke, dementia, epilepsy, migraine) using incidence, prevalence, deaths, and disability-adjusted life years (DALYs), stratified by sex, age, year, and location. Joinpoint regression assessed temporal trends and annual changes in age-standardized rates. RESULTS:In 2023, the neurologic disorders with the highest absolute DALYs in East Asia were stroke (44.42 million, 95% uncertainty interval [UI] 39.17-49.56), Alzheimer's disease and other dementias (12.02 million, 95% UI: 5.87-23.28), and migraine (6.80 million, 95% UI 4.56-9.33). Stroke was the leading cause of neurologic deaths (2.13 million, 95% UI 1.81-2.42), followed by Alzheimer's disease and other dementias (0.61 million, 95% UI 0.15-1.44) and Parkinson's disease (0.03 million, 95% UI 0.03-0.04). From 1990 to 2023, the overall age-standardized DALY rates (ASDR) for neurological disorders showed a slight decline (EAPC = -0.05; 95% confidence interval: -0.1 to -0.01). However, both the absolute number of DALYs and the prevalence of neurological disorders demonstrated a steady increase, driven primarily by population growth and aging. This divergence between declining age-standardized risk and rising absolute burden poses a mounting challenge for healthcare systems in the region. Substantial regional variation was observed in age-standardized rates across East Asia. Joinpoint regression analysis further revealed declining trends in the ASDR, age-standardized incidence rate (ASIR), and age-standardized prevalence rate (ASPR) for stroke, whereas Alzheimer's disease and other dementias showed significant increases across all three metrics. Migraine exhibited increases in ASDR, ASIR, and ASPR. DISCUSSION:This study provides the first comprehensive analysis of the burden of neurological disorders in East Asia from 1990 to 2023, revealing an urgent need for targeted public health strategies to address the growing challenge of neurological disorders.
BACKGROUND:The younger onset of ischemic stroke creates a significant premature disease burden for adults aged 50-69 years. China, India, and the USA represent different stages of global epidemiological transition. We evaluate the spatiotemporal evolution of ischemic stroke burden, shifts in disease composition (fatal versus disabling), and dynamic trajectories of core risk factors in this demographic across the three countries from 1990 to 2023, with exploratory long-term scenario projections to 2053. METHODS:Based on the GBD 2023 database, we extracted disability-adjusted life years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), and population attributable fractions for adults aged 50-69 years in the three nations. Autoregressive Integrated Moving Average (ARIMA) models were used to forecast the disease burden through 2053, with prediction intervals reported across multiple horizons to convey the widening uncertainty of long-range forecasts. RESULTS:Stroke burden trajectories among the three countries diverged significantly from 1990 to 2023. ARIMA scenario projections indicate that China's DALY rate will continue to decline, India's rate will remain approximately flat at its current high level, and the US rate will remain on a high plateau. India is projected to retain the highest DALY rate of the three countries throughout the 10-year horizon, though widening intervals indicate that long-range estimates should be interpreted as scenario-based projections rather than precise forecasts. Compositional analysis reveals that the USA has shifted toward a high-disability pattern, characterized by an expanding proportion of YLDs. India remains dominated by a YLL-driven burden indicating high acute mortality. China exhibits a prominent sex disparity with a male-to-female burden ratio of nearly 2:1. High smoking rates among Chinese men have stalled the overall decline in disease burden. Meanwhile, India faces dual pressures from persistent particulate matter pollution (PM2.5) and escalating metabolic risks. The attributable risk of high body mass index in the USA rose consistently over the past 3 decades, affecting both sexes equally. CONCLUSION:Stroke prevention for middle-aged and older adults requires tailored, region-specific strategies. China needs to enforce stricter tobacco control specifically targeting the male population. India faces systemic challenges ranging from upgrading primary energy structures to establishing robust cardiovascular screening networks. The USA must strengthen national metabolic disease management.
BACKGROUND:Neuromyelitis optica spectrum disorder (NMOSD) is a rare demyelinating autoimmune disease, and data on the prevalence of NMOSD in mainland China are lacking. The goal of this study was to estimate the prevalence of NMOSD in Fujian, China, and to investigate demographic and clinical characteristics. METHODS:We conducted a retrospective study using data from the social health insurance database of Fujian Province, which covers nearly all medical institutions in Fujian and 38.33 million insured residents. NMOSD Cases from January 1, 2021 to December 31, 2023 were identified to calculate period prevalence. The crude prevalence was calculated overall and stratified by age group and sex, and was then age- and sex-standardized to the Chinese population. RESULTS:A total of 515 patients with NMOSD, identified using ICD-10 code G36.0, were found among the insured individuals. The overall crude prevalence was 1.34 per 100,000. The age- and sex-standardized prevalence for the Chinese population was 1.35 per 100,000. The female-to-male prevalence ratio was 4.76:1. Fifty-four (10.5%) patients had concomitant autoimmune diseases. Sixty-seven patients were further investigated, with a median age at onset of 40 (range 10.5-67.5) years. The anti-aquaporin-4 antibody positivity was 74.6%. Fifty-four (80.6%) patients had a relapsing disease course. CONCLUSIONS:This study provides population-based prevalence data for NMOSD in Fujian, China, during the period from 2021 to 2023, representing one of the most up-to-date estimates of NMOSD prevalence in southeastern China. The extrapolated national prevalence may provide valuable insights into the national disease burden of NMOSD in China.
INTRODUCTION:Our objective was to calculate age-adjusted motor-neuron disease (MND) mortality rates in the United States, 2010-2023, by year, age, sex, race, origin, period, and state. Amyotrophic lateral sclerosis makes up almost 80% of all MNDs. METHODS:Multiple cause mortality data was obtained from the National Center for Health Statistics (NCHS) for years 2010-2023. Cases were included if code G12.2, the code for MND listed in the International Classification of Disease, 10th Revision (ICD-10), was listed as a cause of death. Using the direct method, cases were age-adjusted to the 2000 U.S. Standard population and mortality rates were calculated. RESULTS:The overall national MND associated mortality rate was 2.07 per 100,000 population (95% CI 2.06, 2.09). Rates were highest in those aged 80+ years (13.69, 95% CI 13.49, 13.89) at death, non-Hispanic (2.17, 95% CI 2.15, 2.18), and male (2.50, 95% CI 2.48, 2.52). Northern states had higher rates (2.26, 95% CI 2.23, 2.29) with a rate ratio of (1.05, (95% CI 1.04, 1.07) when compared to the middle state tier (2.14, 95% CI 2.12, 2.17, p<0.01). State rates ranged from 3.07 (95% CI 2.75, 3.42) in Vermont to 1.41 (95% CI 1.27, 1.57) in Hawaii. The average annual percentage change was -1.62, corresponding to a statistically significant negative trend. CONCLUSION:MND associated mortality rates were higher among northern states, decedents who were male, White, or non-Hispanic, which is consistent with previous studies of U.S. MND mortality. Decreasing mortality rates may indicate longer patient life spans due to increased treatment options and care access, but further research is needed.
INTRODUCTION:This study conducts a comprehensive bibliometric analysis of global stroke mortality research, by assessing publication trends, top authors, institutions, countries, and thematic analysis of keywords. METHODS:We performed a bibliometric analysis using Web of Science data retrieved on December 21, 2024, based on title searches for "Stroke mortality," "CVA mortality," "Cerebral infarction mortality," and "Cerebrovascular accident mortality." We generated descriptive statistics, investigated publication and citation trends, and performed advanced mappings for keyword frequency and thematic evolution. RESULTS:Of 2,261 stroke mortality documents from 636 journals (1961-2024), the annual growth was 1.73%. Each document averaged 37.7 citations, with 46,494 total references. This study included 14,456 authors (48 single-authored) and averaged 8.89 coauthors per document; 21.32% involved international collaboration. Publication output increased markedly post-2000, peaking with 1,171 studies in 2017-2024. Stroke (246 articles) was the most productive journal followed by Journal of Stroke & Cerebrovascular Diseases (137); the USA (2,975 articles) and China (2,536) dominated global output. Wang Y led as the most prolific author (77 articles), and Capital Medical University in China produced the highest number of publications (143). Collaboration networks featured strong multinational clusters led by the USA, China, and key European nations. CONCLUSION:This bibliometric analysis showed a steady but modest research growth, with the USA and China leading in output and citation. Thematic shifts revealed movement from clinical risk factors to public health and biological predictors. While strong international collaborations exist, regional partnerships remain limited in areas like Africa and Latin America.
BACKGROUND:This systematic review aimed to summarize the epidemiology, etiology, diagnostic challenges, antimicrobial resistance, and clinical outcomes of community-acquired central nervous system (CNS) infections in Western Asian countries. METHODS:A systematic search of PubMed was conducted for studies published from January 2010 to July 2025. Eligible studies included original research and case reports on CNS infections, while unrelated studies or studies outside the region were excluded. Data were extracted and synthesized narratively by pathogen group. Risk of bias was assessed based on study design, sample size, and methodological quality. RESULTS:Of 1,790 retrieved articles, 450 studies met the inclusion criteria, including case reports and observational studies across neonates, children, and adults. Streptococcus pneumoniae and Neisseria meningitidis were the most common bacterial pathogens; Listeria monocytogenes and multidrug-resistant Gram-negative organisms were notable. Among viral pathogens, Enteroviruses, herpes simplex virus type 1, and West Nile virus predominated, with increasing reports of post-COVID-19 autoimmune encephalitis. Tuberculous meningitis and neurobrucellosis remained significant causes of chronic CNS infections in endemic areas. Pneumococcal penicillin resistance exceeded 40% in some countries. Molecular diagnostic capacity and surveillance were limited. LIMITATIONS:Evidence was limited by heterogeneity in study design, regional data gaps, and variable reporting of antimicrobial resistance, which may affect the comprehensiveness of the review. CONCLUSIONS:Community-acquired CNS infections continue to impose a substantial health burden in Western Asia. Expanded vaccination, improved molecular diagnostics, strengthened surveillance, and regional antimicrobial resistance monitoring are essential to reduce preventable mortality and long-term neurological sequelae.
INTRODUCTION:Migraine is a common neurological disorder with attacks lasting 4-72 h. Although duration is a key diagnostic criterion, the clinical and demographic factors associated with its variability are not well defined. Identifying temporal phenotypes may improve diagnostic accuracy and inform individualized management. METHODS:In this cross-sectional observational study, we evaluated 694 patients fulfilling ICHD-3 migraine criteria. Patients were categorized by attack duration into short (4-12 h), medium (13-24 h), and long (>24 h) groups. Sociodemographic features, migraine characteristics, associated symptoms, and disability measures were compared across groups. Multinomial logistic regression was performed using the short-duration group as the reference category to identify variables independently associated with medium- and long-duration attacks. RESULTS:Of 694 participants (84% female; mean age 36.66 ± 12.20 years), 33.3% (n = 231) experienced short, 28.2% (n = 196) medium, and 38.5% (n = 267) long attacks. Long-duration attacks were associated with older age (39.98 ± 11.36 vs. 34.09 ± 12.62 years, p < 0.001), higher female ratio (89.1% vs. 78.8%, p = 0.007), and lower educational level (p = 0.008). Patients with prolonged attacks had higher allodynia scores (median ASC 6 vs. 4, p < 0.001), greater pain intensity (VAS 9 vs. 8, p < 0.001), and more frequent nausea and vomiting (p = 0.002). Illness duration was the longest in the long-attack group (median 120 vs. 60 months, p < 0.001). Other clinical characteristics, including aura, localization, and chronic migraine rates, showed no significant differences. In multivariable analysis, older age and higher pain intensity remained independently associated with long-duration attacks, while lower educational level and higher pain intensity were independently associated with medium-duration attacks. CONCLUSION:Migraine attack duration is associated with distinct demographic and clinical characteristics independent of attack frequency. In multivariable analysis, older age and higher pain intensity remained independently associated with long-duration attacks, while lower educational level and higher pain intensity were independently associated with medium-duration attacks. These findings suggest that attack duration could represent a meaningful clinical phenotype; therefore, frequency-based classification approaches might overlook patients with infrequent but prolonged and disabling attacks.
BACKGROUND:National data on dementia incidence are scarce in low- and middle-income countries, limiting public health surveillance and planning. In Argentina, no nationwide estimates of dementia incidence exist despite rapid population aging. Administrative disability registries do not capture clinical disease onset; rather, they record certification events and therefore provide a registry-based proxy for population-level dementia surveillance in settings without prospective incidence cohorts. METHODS:We conducted a population-based registry study using data from Argentina's National Registry of Persons with Disabilities between 2016 and 2022, excluding pandemic-disrupted years (2020-2021). Incident registry entries with dementia recorded as the primary cause of disability were identified using ICD-10 codes for Alzheimer's disease and related disorders (ADRDs), vascular dementia, and other etiologies. Crude and age-standardized incidence (ASI) rates of dementia certification per 100,000 inhabitants were estimated by sex, age group, dementia subtype, and early-onset (<65 years) versus late-onset (≥65 years) dementia. Prespecified sensitivity analyses quantified capture fraction against regional cohorts and adjusted temporal trends for an exogenous proxy of registry maturation. RESULTS:In 2022, the registry-based crude dementia incidence was 47.7 per 100,000 inhabitants (95% CI: 46.6-48.7). Crude incidence was higher in women than men, whereas ASI was comparable between sexes (48.1 vs. 45.5 per 100,000). Incidence increased steeply with age, from 0.9 per 100,000 at ages 40-45 years to nearly 480 per 100,000 among individuals aged ≥95 years. ADRDs predominated from approximately 55-60 years onward, while other etiologies were relatively more frequent at younger ages. Late-onset dementia incidence (≥65 years) was substantially higher than early-onset dementia (<65 years) (130.9 vs. 6.3 per 100,000). Provincial age-standardized rates varied from 4.7 to 137.7 per 100,000, and were strongly associated with care access metrics. Between 2016 and 2022, ASI increased significantly (p < 0.001); however, capture fractions were 6-12% relative to regional cohorts, and there was a 45% attenuation of the temporal coefficient after adjustment for registry maturation. CONCLUSIONS:This study provides the first nationwide characterization of registry-based dementia certification incidence in Argentina. Distinct age-, sex-, and etiology-specific patterns highlight different epidemiological scenarios for early- and late-onset dementia. Because these estimates reflect administrative certification rather than clinical disease onset and are subject to differential ascertainment, they should be interpreted as a lower bound of true incidence; nonetheless, they constitute a feasible and informative surveillance approach for countries lacking national clinical registries and can support health system planning and prevention strategies.
INTRODUCTION:Childhood arterial stroke is a rare but serious condition, and data on long-term trends in incidence are limited. This population-based study aimed to assess incidence rates, characterize secular trends, and provide nationwide estimations of childhood arterial stroke beyond the neonatal period. METHODS:All cases of first-ever arterial stroke (ischemic stroke, spontaneous intracerebral hemorrhage, and subarachnoid hemorrhage) among children aged >28 days and <18 years were prospectively identified using the population-based Dijon Stroke Registry, France, between 1985 and 2025. Incidence rates were calculated and expressed according to five time periods. The annual number of children with first-ever stroke in France was estimated by standardization to sex-specific rates of the last study period (2017-2025), and 2022 French population as the denominator. RESULTS:Among 1,037,746 person-years <18 years old, 26 children experienced a first-ever arterial stroke (15 girls and 11 boys, median age: 8.5 [IQR: 4-14] years). Among them, 17 (65.4%) had ischemic stroke, 8 (30.8%) had spontaneous intracerebral hemorrhage, and 1 (3.8%) had subarachnoid hemorrhage. The overall incidence was 2.5 per 100,000 children per year (95% confidence intervals [CI]: 1.64-3.67), with similar rates between girls (rate: 2.97; 95% CI: 1.66-4.88) and boys (rate: 2.07; 95% CI: 1.03-3.71) (sex incidence rate ratio boys/girls: 0.70; 95% CI: 0.29-1.63, p = 0.19). Although the lowest incidence was observed during the first study period (1985-1992, rate: 0.99; 95% CI: 0.12-3.57), and fluctuations were observed across study periods, incidence remained stable over time. Based on national extrapolation, we estimated that 373 cases occurred annually in France in the most recent period. CONCLUSION:First-ever arterial stroke in children remains rare, with no significant apparent temporal change over the past 40 years.
INTRODUCTION:The Brazilian Unified Health System (SUS) is one of the largest publicly funded health systems worldwide, yet persistent regional inequalities and structural constraints challenge equitable access to care. Understanding referral patterns for paediatric neurological conditions at tertiary centres may help inform evolving health system demands. METHODS:We conducted a retrospective longitudinal study of paediatric neurology outpatient visits from 2014 to 2024 at a single tertiary referral centre within the SUS, using first visits per patient within each specialised clinic. Primary diagnoses grouped by ICD-10 code and populational-level data were extracted from medical records. Temporal trends, diagnostic overlap, and sociodemographic associations were analysed. RESULTS:We analysed 9,000 outpatient visits. Epilepsy was the most frequent diagnosis (32.7%), followed by cerebral palsy (CP; 15.8%) and autism spectrum disorder (ASD; 11.0%). ASD increased from 3.9% in 2014 to 21.6% in 2024, whereas epilepsy declined from 39.3% to 25.2%. Over time, ASD showed the strongest increase in odds of diagnosis (OR 1.18 [1.16-1.21]; p < 0.001), along with genetic counselling, sleep disorders, and headaches, while epilepsy, CP, intellectual disability, neonatal seizures, and rare diseases showed lower odds. Male sex was associated with higher odds of ASD (1.59 [1.37-1.85]; p < 0.001) and attention-deficit hyperactivity disorder (2.13 [1.73-2.61]; p < 0.001). Diagnostic overlap was identified in 27.1% of patients. CONCLUSION:These findings suggest a change in the referral case-mix at a single tertiary paediatric neurology centre within the Brazilian SUS, characterised by a marked pre-pandemic rise in ASD referrals that stabilised at an elevated level, alongside shifts in the distribution of other neurological diagnoses.
Objectives: To investigate the causal effects of body mass index (BMI) at different life stages (childhood and adulthood) on migraine and its subtypes. Background: While previous studies suggest BMI is a risk factor for migraine, it is unclear whether BMI influences migraine differently throughout the life course. The causal effect of childhood BMI may have obscured the association between adult BMI and migraine, making it difficult to determine the independent role of adult adiposity. Methods: We conducted a life-course Mendelian randomization (MR) study. Two-sample and conventional multivariable MR analyses were performed initially. Subsequently, FLOW-MR—a newly-developed three-sample multivariable MR method—was applied to estimate the direct, indirect, and total effects of BMI at childhood or adulthood on migraine. All estimates were scaled per 1-SD increase in BMI (SDs: 1.35 kg/m² at age 1; 1.78 kg/m² at age 8; 4.76 kg/m² in adulthood). Results: The causal effect of BMI on migraine is strictly dependent on the timing of exposure. First, we found no evidence that adult BMI influences the risk of either migraine subtype. Second, higher BMI at age 8 exerted a direct protective effect against migraine with aura (OR = 0.522). Third, BMI at age 1 exhibited a dual role: its direct risk-increasing effect (OR = 1.983) was offset by an indirect protective effect mediated through 8-year-old BMI (OR = 0.511), resulting in a null total effect on migraine with aura. Migraine without aura was unaffected by BMI at any life stage. Conclusion: The causal effect of BMI on migraine is dependent on developmental timing, challenging the conventional view of BMI as a uniform risk factor. We emphasize that the observed protective role of childhood BMI is a model-estimated association from genetic data, which does not constitute a recommendation to increase body weight in children.
