BACKGROUND:This study conducted a cross-sectional analysis to assess the prevalence of mild cognitive impairment (MCI) among older adults in China and to identify its associated risk factors, with the aim of informing the development of early intervention strategies. METHODS:This cross-sectional study used data collected in 2018 (Wave 4). The initial survey sample comprised 19,744 individuals, of whom 4773 formed the valid sample for analysis. After screening, the study ultimately selected 694 individuals who met all the inclusion criteria. MCI was defined according to the criteria for ageassociated cognitive decline (AACD). Sociodemographic information, past comorbidities, and lifestyle were assessed. RESULTS:The prevalence of MCI was 14.54%, with 694 individuals diagnosed with MCI. An elevated Center for Epidemiologic Studies Depression (CESD) score was identified as a significant risk factor for MCI (OR = 1.6, 95% CI: 1.3-1.9; p < 0.001). Living in rural areas (odds ratios (OR) = 2.0, 95% confidence interval (CI): 1.6-2.6; p < 0.001) and napping (OR = 1.3, 95% CI: 1.1-1.6; p = 0.002) were also significant risk factors for MCI. Additionally, gender, memory level, and nighttime sleep were each associated with a 1.2-fold increase in MCI risk (OR = 1.2 for all; p range: 0.001-0.047). Correlation analysis indicated that both age and the current CESD score were significantly negatively correlated with the total cognitive score (p < 0.001). CONCLUSIONS:Among Chinese older adults living in the community, CESD score, napping, nighttime sleep, being female, and memory level were identified as independent risk factorsfor MCI. These findings underscore the importance of implementing screening and preventive strategies to mitigate MCI risk in this demographic.

AIMS:The optimal antiplatelet regimen for branch atheromatous disease (BAD)-related stroke remains uncertain. This study aimed to compare the clinical outcomes of dual antiplatelet therapy (DAPT) vs. single antiplatelet therapy (SAPT) in these patients. METHODS:From the multicenter prospective BAD-study, we collected consecutive patients with BAD who received DAPT and SAPT. Propensity score matching (PSM) was used to balance baseline characteristics. The primary efficacy endpoint was an excellent outcome, defined as a modified Rankin Scale score of 0 to 1 at 90 days. The safety endpoint was bleeding events within 7 or 90 days. RESULTS:A total of 449 patients were enrolled in the analysis, with a median age of 60 years and a median National Institutes of Health Stroke Scale score of 3 at admission. After PSM, there were 112 patients in the SAPT group and 171 patients in the DAPT group, with well-balanced baseline characteristics. Excellent outcome occurred in 69.6% of the SAPT group and 79.5% of the DAPT group (odds ratio, 0.590; 95% confidence interval, 0.341 to 1.022; p = 0.059). No significant differences were observed in other efficacy outcomes between the two groups. In exploratory subgroup analysis, no significant treatment-by-subgroup interactions were observed, and after correction for multiple comparisons, no within-subgroup differences remained statistically significant. No increased bleeding risk was observed in DAPT. CONCLUSION:In acute BAD-related stroke, DAPT was safe but not statistically superior to SAPT for excellent functional outcome; however, its numerical trend toward benefit warrants further investigation.

BackgroundBrain iron deposition is associated with cognitive impairment in cerebral amyloid angiopathy (CAA) and Alzheimer's disease, but the exact mechanisms remain unclear.ObjectiveTo investigate whether cortical atrophy mediates iron-related cognitive impairment in CAA.MethodsWe prospectively enrolled CAA patients to collect clinical characteristics, conduct global cognitive assessment and magnetic resonance imaging. Iron levels of each brain region were quantified by susceptibility values from quantitative susceptibility mapping. Three-dimensional T1-weighted imaging was collected to calculate cortex volume. For statistical analyses, first, we conducted univariable linear regressions to identify regions with potential associations to cognitive impairment, with p < 0.1 as threshold. Second, we used elastic net analysis to identify regions where iron depositions strongly correlated with cognitive deficits. Finally, we conducted mediation analysis, using these selected regions to test whether iron-related cognitive dysfunction occurs through cortical atrophy.ResultsForty-four patients were included. The median age was 71.5 years old (IQR 62.3, 75.0), and twenty-two were male. Two-thirds of patients presented with mild cognitive impairment or dementia. Elastic net analysis revealed that iron accumulations in the right Rolandic area, left inferior occipital gyrus, left posterior cingulate gyrus and cerebellum were associated with worse cognitive performance. Mediation analysis showed significant total effect of iron in left posterior cingulate gyrus on Mini-Mental State Examination (β = -0.156, p = 0.002), but the average causal mediation effect was insignificant (p = 0.77).ConclusionsWhile regional iron deposition was associated with cognitive impairment in CAA, cortical atrophy did not significantly mediate this relationship in this exploratory study.

BackgroundJuxtacortical perivascular spaces (jPVS) were observed in cerebral amyloid angiopathy (CAA), yet the diagnostic relevance between jPVS and CAA remains unclear.ObjectiveTo explore the association between in-vivo jPVS burden and clinical diagnosis of CAA, as well as established CAA imaging markers.MethodsWe retrospectively enrolled patients with probable CAA or arteriolosclerosis who underwent ultrahigh-field 5.0 T MRI. A visual rating scale was used to quantify jPVS burden. Established CAA markers were evaluated, including centrum semiovale perivascular spaces (CSO-PVS), lobar intracerebral hemorrhage (ICH), lobar cerebral microbleeds (CMBs), and cortical superficial siderosis (cSS). Multivariable logistic regression, receiver operating characteristic analyses, and generalized linear models were applied.ResultsAmong 117 participants (48 probable CAA and 69 arteriolosclerosis, mean age 65.6 ± 9.8 years, 63.2% males), jPVS burden was significantly higher in CAA (p < 0.001). The jPVS burden was independently associated with clinically diagnosed CAA (odds ratio for the highest tertile of total jPVS: 14.93; 95% confidence interval: 4.59-48.53; p < 0.001, compared with the lowest tertile), after adjusting for age, sex, hypertension, diabetes, and hyperlipidemia. Total jPVS count demonstrated good discrimination for CAA (area under the curve 0.799, 95% confidence interval: 0.717-0.882, p < 0.001) and was independently correlated with CSO-PVS, lobar ICH, lobar CMBs, and cSS (all p < 0.05).ConclusionsThe jPVS burden is independently associated with the clinical diagnosis of CAA and established CAA imaging markers. These findings may contribute to advancing the current understanding of CAA imaging and support jPVS as a complementary marker with potential clinical utility.

OBJECTIVE: To investigate the clinical characteristics, management and outcomes of cerebral venous thrombosis (CVT) patients with antiphospholipid syndrome (APS) in a Chinese cohort. METHODS: A retrospective cohort study was conducted on 121 consecutive CVT patients admitted to Peking Union Medical College Hospital from 2015 to 2023. Data on demographics, clinical manifestations, imaging findings, laboratory tests, treatment, and outcomes at discharge were analyzed. RESULTS: APS was identified in 16.5% (20/121) of CVT patients. The median age at onset was 34.5 years, with 60% (12/20) being female. 75% of patients had not experienced other thrombotic and obstetric events before CVT. In APS-CVT cases, chronic onset was observed in 50% (10/20), with a median diagnostic delay of 20 days. Headache was the most common symptom. Additional risk factors were present in 85% of APS-CVT patients. All patients received anticoagulation therapy, and 80% achieved favorable outcomes (modified Rankin Scale: < 2) at discharge. While most clinical and imaging features showed no significant differences, APS-CVT patients exhibited less frequent transverse/sigmoid sinus involvement (55% [APS-CVT] vs. 72.3% [non-APS-CVT], P = 0.045) and multisinus thrombosis (15% [APS-CVT] vs. 40.6% [non-APS-CVT], P = 0.020). Laboratory findings revealed lower hemoglobin levels (118 g/L [APS-CVT] vs. 130 g/L [non-APS-CVT], P < 0.05) and a higher prevalence of concomitant extracranial venous thrombosis (45% [APS-CVT] vs. 11.9% [non-APS-CVT], P < 0.001) in the APS-CVT group. CONCLUSION: APS represents a significant risk factor for CVT. CVT associated with APS primarily affects young individuals and women, often presents insidiously, and is frequently accompanied extracranial venous thrombosis. Given the challenges in diagnosing APS-CVT, screening for APS should be strongly considered in CVT patients with these clinical contexts. The characteristic pattern of venous sinus involvement in APS-CVT may provide insights into its unique pathogenesis. Most patients were treated with warfarin, which may be associated with a favorable outcome.

INTRODUCTION:The study aimed to evaluate long-term medication persistence and adherence to secondary prevention therapies in young ischemic stroke survivors (aged 18-49 years) and identify factors influencing these outcomes. METHODS:The single-center prospective cohort study enrolled young ischemic stroke patients (aged 18-49 years) from March 2017 to March 2023. Medication persistence (continuation of all prescribed secondary prevention drugs) and adherence (assessed by the Morisky Medication Adherence Scale-8 (MMAS-8)) were evaluated, with reasons for discontinuation and influencing factors analyzed. RESULTS:Among 226 patients (median age 35 years, 34.5% female), 80.1% remained persistent with their medication regimen over a median follow-up of 3.9 years. Patients with persistence had higher rates of large artery atherosclerosis (42% vs. 22.2%, p = 0.015) and comorbid diabetes (13.3% vs. 2.2%, p = 0.015). The median MMAS-8 score was 7 (6-7.38), with 24.2% showing high adherence, 63% moderate adherence, and 12.8% poor adherence. Poor adherence was associated with younger age (<35 years, p = 0.018), the absence of large artery atherosclerosis (p = 0.017), and a lower quality of life (p = 0.004). Multivariate analysis revealed that older age (p = 0.043) and large artery atherosclerosis (p = 0.047) were independent predictors of better adherence. CONCLUSION:Young ischemic stroke patients demonstrated high medication persistence and moderate adherence, which were influenced by age, stroke etiology, and quality of life. These findings highlight the need for tailored secondary prevention strategies to improve outcomes in this population.

Standardized patients (SPs) are widely used in clinical skills education, primarily to support communication training and clinical performance assessment. However, structured training that enables SPs to recognize technical errors and provide precise, technique-oriented feedback during neurological examinations remains limited. Twelve experienced SPs completed a 16-hour structured training program, starting with knowledge comprehension and terminology standardization, followed by video‑based study of normal examination signs, and culminating in practical sessions focused on error recognition and technique‑oriented feedback. Formative assessments evaluated SPs’ ability to detect predefined examination errors (pass threshold ≥ 85

Our aim is to examine the interplay between cerebral small vessel disease (CSVD) pathology, Alzheimer's disease (AD) related amyloid-β (Aβ) clearance, and cognition in general population. Cross-sectional structural equation modeling (SEM) was conducted to evaluate CSVD burden, cognition, and plasma Aβ42/40 ratios in 1026 participants without dementia from a prospective community-based cohort. CSVD burden was quantified using five established MRI markers, while cognition was assessed with the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), verbal fluency test, and reverse digit span. Models were adjusted for age, sex, education, body mass index, vascular risk factors (hypertension, diabetes mellitus, hyperlipidemia, and smoking), antihypertensive medication use, and APOE4 carrier status. Greater CSVD burden was significantly associated with poorer cognition (B = -2.607 ± 1.016, β = -0.167, p = 0.010), with white matter hyperintensity volume (∆R2 = 0.3%, p = 0.016) and brain parenchymal fraction (∆R2 = 0.4%, p = 0.019) contributing most strongly. CSVD burden was also negatively correlated with plasma Aβ42/40 ratios (B = -0.280 ± 0.074, β = -0.140, p < 0.001), which partially mediated the CSVD-cognition association (B = -0.241 ± 0.087, β = -0.015, p = 0.006). These findings underscore potential CSVD involvement in AD-related pathology across aging.

Cerebral amyloid angiopathy (CAA) has long been regarded as a hemorrhagic age-related small vessel disease (SVD). However, cerebral ischemia, indicated by symptomatic and incidental diffusion-weighted imaging (sDWI and iDWI) hyperintensities, remains controversial regarding its clinical relevance and pathological mechanisms. This study aimed to investigate the prevalence, distributing characteristics, and risk factors of sDWI and iDWI lesions in patients with CAA. Participants meeting the criteria for probable CAA (Boston criteria version 1.5) were recruited from a prospective cohort of cerebral small vessel disease at Peking Union Medical College Hospital between March 2017 and February 2026. Baseline clinical data and neuroimaging markers of SVD were collected. sDWI lesions and iDWI lesions were recorded at any MRI time point, with topography showing via lesion probability maps. Cumulative incidence was estimated using Kaplan–Meier method. The characteristics were compared between patients with sDWI lesions or iDWI lesions and those without any DWI lesion at baseline. The prospective Cox regression analyses were performed to identify risk factors for sDWI lesions and iDWI lesions, respectively. We enrolled 185 patients with probable CAA, of whom 99 underwent follow-up MRI with a total of 163 scans. sDWI lesions were detected in 29 patients and iDWI lesions in 49 patients. sDWI lesions predominantly involved deep regions (72.7

Introduction:Cerebral small vessel disease (CSVD) is a common cause of functional decline in the elderly, yet its diagnosis often relies on neuroimaging, which may be inaccessible in routine practice. Given that gait impairment is a core feature of CSVD, we aimed to develop and validate a clinically applicable diagnostic model by integrating quantitative spatiotemporal gait parameters with conventional clinical features. Methods:This case-control study included 417 healthy controls from a community-based cohort and 117 hospital-based CSVD patients. Conventional clinical characteristics and quantitative spatiotemporal gait parameters were collected from all participants. A two-stage modeling approach was used, in which least absolute shrinkage and selection operator (LASSO) regression was first applied for predictor screening, followed by multivariable logistic regression for constructing the final diagnostic model. Model performance was assessed by discrimination (area under the curve [AUC]), calibration, and clinical utility (decision curve analysis [DCA]). Results:Six key variables were included in the final diagnostic model: sex, hypertension, body mass index (BMI), stride length, step frequency, and step width. The model exhibited excellent discrimination, achieving an AUC of 0.914 (95% CI: 0.886-0.943), along with strong calibration. DCA further confirmed its clinical utility, showing a greater net benefit across a wide range of threshold probabilities compared to default screening strategies. Conclusion:The diagnostic model developed in this study effectively identifies individuals at high risk of CSVD by leveraging quantitative spatiotemporal gait parameters alongside conventional clinical features.

Branch atheromatous disease (BAD)-related stroke shows distinct prognostic features from other stroke subtypes, with modifiable prognostic factors remaining inconclusive. The present research investigated the association between systolic blood pressure variability (BPV) and 90-day functional outcomes of BAD-related stroke. We enrolled 423 patients (median age 60 years; 70.2% male) with radiologically confirmed BAD from a prospective multicenter study in China. BPV was assessed using standard deviation (SD), coefficient of variation (CV), and variation independent of the mean (VIM) of systolic blood pressure measurements during hospitalization. The primary outcome was a poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) score >2. The secondary outcome was early neurological deterioration (END) within 7 days. Multivariable logistic regression models were used to evaluate the association between BPV and outcomes. Subgroup and sensitivity analyses were conducted. Overall, 13.9% of patients experienced poor functional outcome. A higher BPV was associated with increased risk of END. Compared with the lowest tertile, patients in the highest tertile of systolic BPV had a significantly increased risk of poor functional outcome (OR: 3.10 for SD, 2.77 for CV, and 2.97 for VIM; all p < 0.05, p for trend <0.05 for all indices). Sensitivity analysis and subgroup analysis results were consistent with the primary findings. In conclusion, elevated systolic BPV during the acute phase is independently associated with END and poor 90-day functional outcome in BAD-related stroke, highlighting the importance of BPV monitoring and blood pressure stabilization in the management of BAD-related stroke.

OBJECTIVE:High-resolution MRI enables detailed assessment of intracranial vessel wall pathology in moyamoya vasculopathy. We aimed to classify adult moyamoya vasculopathy etiologies using high-resolution MRI and to examine subtype-specific associations between high-resolution MRI features and ischemic infarction. METHODS:We enrolled 398 adult patients with moyamoya vasculopathy. According to high-resolution MRI characteristics, 340 patients were classified as moyamoya disease (n = 279) or atherosclerosis-associated moyamoya vasculopathy (n = 61). Hemisphere-level analyses were performed using generalized estimating equations logistic models with patients as clusters to evaluate associations between high-resolution MRI measures and ischemic hemispheres. RESULTS:Compared with atherosclerosis-associated moyamoya vasculopathy, moyamoya disease patients were more often female and more likely to have a family history of early-onset stroke and posterior cerebral artery involvement. In the moyamoya disease group, greater middle cerebral artery stenosis, higher Suzuki stage, and more severe internal carotid artery, middle cerebral artery, and posterior cerebral artery involvement were independently associated with ischemic hemispheres, whereas a higher middle cerebral artery remodeling index was inversely associated with ischemia. In the atherosclerosis-associated moyamoya vasculopathy group, higher middle cerebral artery remodeling index and more severe anterior cerebral artery involvement were independently associated with ischemic hemispheres, while other high-resolution MRI metrics showed no significant associations. INTERPRETATION:High-resolution MRI-derived quantitative vascular metrics show distinct ischemia-related patterns in moyamoya disease and atherosclerosis-associated moyamoya vasculopathy. Global steno-occlusive burden with impaired middle cerebral artery remodeling characterizes ischemic hemispheres in moyamoya disease, whereas adverse middle cerebral artery remodeling and anterior cerebral artery involvement are key correlates of ischemia in atherosclerosis-associated moyamoya vasculopathy.

Background and aims Covert MRI markers of cerebral small vessel disease (CSVD) can coexist with large artery atherosclerosis. We aimed to explore whether the spatial distributions of these markers were diverse in people with or without intracranial artery stenosis (ICAS).Methods This cross-sectional analysis included 1206 stroke-free participants (aged 55.69±9.27, 62.94% female) with brain MRI and MR angiography from community-based Shunyi cohort. We analysed the relationships between ICAS and CSVD markers. We also compared the probability maps of lacunes, cerebral microbleeds (CMB), white matter hyperintensities (WMH) and cortex morphology at a voxel/vertex-wise level in groups with and without ICAS.Results ICAS increased the risk of lacunes by 2.99-fold (95% CI 1.99 to 4.50, p<0.001), lacunes ≥3 by 5.32 times (95% CI 2.76 to 10.28, p<0.001), correlated with WMH volume (β=0.332, SE=0.059, p<0.001), WMH Fazekas scores ≥5 (OR 4.50, 95% CI 2.44 to 8.29, p<0.001) and brain parenchymal fraction (β=−0.012, SE=0.002, p<0.001), but not with CMB. ICAS is associated with lacunes in the corresponding blood supply area. Lacunes that coexist with ICAS were prone in basal ganglia, while the lacunes without ICAS appeared in centrum semiovale more often. WMH with ICAS was prone to present in deep white matter involving the bilateral pyramidal tracts and superior thalamic radiation. People with ICAS were susceptible to worse cortical atrophy of right superior frontal and left rostral anterior cingulate. No obvious distributional differences were found for CMB between the two groups.Conclusions Since ICAS may be involved in the upstream pathogenesis of lacunes, white matter lesions and cortical atrophy, the impact of ICAS should not be ignored when evaluating MRI markers of CSVD.

BACKGROUND:The mechanisms underlying covert versus symptomatic acute infarcts in cerebral small vessel disease are unclear. METHODS:Based on the multicenter Cerebral Small Vessel Disease Disability and Outcome Cohort Study, we consecutively enrolled patients presenting with an acute lacunar stroke within 30 days or patients without acute stroke symptoms but with moderate to severe white matter hyperintensities. Between August 2016 and June 2019, 1710 patients (mean age 61.87±11.28 years, 37.25% female) were recruited across 30 hospitals in China. We compared the clinical and imaging characteristics between individuals with incidental diffusion-weighted imaging (DWI)-positive lesions and those with recent small subcortical infarcts (RSSI). RESULTS:The prevalence of incidental DWI-positive lesions and RSSI was 2.28% and 31.64%. Patients with incidental DWI-positive lesions were older, had lower blood pressure and lipid levels, and more prior lacunar stroke. Incidental DWI-positive lesions were typically smaller and round/ovoid, more often involved the subcortical white matter and cerebral cortex. RSSI more frequently affected perforating artery territories, 39.9% of RSSI cases were consistent with branch atheromatous disease. Incidental DWI-positive lesions patients had a higher risk of 90-day recurrent stroke (hazard ratio [HR], 8.28 [95% CI, 1.96-34.90], log-rank P<0.001). They also had lower Mini-Mental State Examination scores after adjustment for age and sex. CONCLUSIONS:Atherosclerosis and branch atheromatous disease appear to be predominant causes of RSSI among Chinese patients with cerebral small vessel disease. Incidental DWI-positive lesions likely reflecting intrinsic small vessel injury constitute a cerebral small vessel disease marker and carry prognostic value for stroke recurrence and cognitive decline.

Background Near-peer learning (NPL) may address challenges in neurology residency training, but its comparative efficacy across subspecialties with different cognitive demands remains unclear. Methods The authors conducted a six-year longitudinal study evaluating a structured NPL curriculum within a neurology residency program. The study included residents who participated in three modules: cerebrovascular disease (CVD), electromyography (EMG), and electroencephalography (EEG). Knowledge gains were assessed using pre- and post-course examinations. Linear mixed-effects models with Bonferroni correction were used for longitudinal comparisons across participation times. Participant feedback was collected via a structured questionnaire. Results Among 117 enrollments, first-time participants showed significant improvements in all modules (all p < 0.001), with the largest gain in EEG (mean improvement 22.79 points). After correcting for repeated measures, only the EEG module demonstrated a significant advantage of the first session over repeat sessions (adjusted p < 0.001). For CVD and EMG, no significant differences in gain magnitude were observed across participation times (all adjusted p > 0.05). Supplementary analysis of residents who completed three years confirmed no statistically significant decline in any module. Questionnaire responses (n = 46) indicated high satisfaction with the NPL curriculum. Conclusion This study supports that NPL can be a useful component of neurology residency training, particularly for initial knowledge acquisition in complex, low-exposure topics such as EEG. The added value of repeated NPL sessions is domain-dependent, and curriculum design may be tailored accordingly.