Our study aimed to determine the prevalence and clinical phenotypes of JAK2 pathogenic mutation carriers in the CNSR-III ischemic stroke (IS) cohort, and to develop a pre-test genetic screening model for identifying high-risk individuals. We performed retrospective characterization of JAK2 pathogenic variants using targeted sequencing data in the CNSR-III cohort. Clinical and laboratory characteristics of JAK2 V617F mutation carriers and non-carriers were tested in a logistic regression model to identify key features. V617F screening score was developed to predict positive JAK2 V617F test results. 46 cases (0.4

Introduction: Post-stroke aphasia (PSA) affects 20–40% of stroke survivors and is characterized by heterogeneous impairments across phonological, lexical, semantic, and syntactic domains. Traditional scales largely collapse these dimensions, limiting mechanistic insights into their neural bases. Here, we combined a theory-driven language battery with multimodal rs-fMRI to delineate dissociable neural signatures of compensation and inhibition. Methods: 48 patients with acute PSA (<2 weeks post-onset) and 45 matched healthy controls underwent standardized testing and rs-fMRI. The Chinese Aphasia Language Battery (CALB) was subjected to principal component analysis, yielding latent dimensions of language capacity. Imaging indices included amplitude of low-frequency fluctuations (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), and network connectivity via independent component analysis. Group differences and brain–behavior associations were assessed with FWE/FDR-corrected statistics. Results: Behavioral analysis revealed two principal dimensions: lexical–semantic processing and phonological–auditory conversion. PSA patients showed widespread hypoactivity in left perisylvian and frontal regions, coupled with hyperactivity in the cerebellum and right posterior cingulate. Lexical–semantic ability positively correlated with ALFF in the left superior temporal gyrus, underscoring its pivotal role in semantic integration. Conversely, phonological–auditory ability negatively correlated with ReHo in the right middle temporal gyrus, directly supporting the interhemispheric inhibition hypothesis. Network-based statistics further identified large-scale disintegration of interhemispheric connectivity centered on the left middle temporal gyrus, disrupting links to bilateral temporal, parietal, and occipital regions. Conclusion: Our findings provide convergent evidence that acute PSA reflects both compensatory and inhibitory processes. Preservation of left superior temporal activity appears critical for semantic function, whereas maladaptive right-hemisphere overactivation may hinder phonological recovery. Widespread interhemispheric disconnection highlights network-level integration failure and suggests candidate biomarkers for prognosis. By integrating multidimensional behavioral phenotyping with rs-fMRI, this study advances mechanistic models of PSA and offers novel targets for stratified neurorehabilitation and neuromodulation.

Abstract Background and aims Although studies have found that transcranial magnetic stimulation (TMS) targeting the right Broca mirror area can promote the recovery of language function in post-stroke aphasia (PSA) patients, this target has certain limitations, so the specific target has not been determined. Previous studies have found that non-invasive electrical stimulation of the contralateral cerebellum can improve the language function of PSA patients. Therefore, this study aimed to compare repetitive TMS (rTMS) effects between contralateral cerebellum and right Broca mirror area on language function in PSA patients. Methods PSA patients caused by left hemisphere stroke were included and randomly divided into three groups: one targeting the Broca mirror area, another targeting the cerebellum, and a control group. All three groups received standard speech-language therapy for two weeks, intervention groups additively received 1Hz rTMS at selective targets. The language function was assessed by Western Aphasia Battery (WAB). Results The study finally included 77 PSA patients, 25 were assigned to the Broca mirror area group, 26 to the cerebellum group, and 26 to the control group. Compared with the control group, the Broca mirror area group and the cerebellum group showed more significant improvement in language function. Compared with the Broca mirror area group, there was no statistical difference in the improvement of language function in the cerebellum group (as showed in the Figure 1 Results of WAB). Conclusions Both Broca mirror area and cerebellum rTMS can enhance PSA language function with similar efficacy. Conflict of interest Yang LIU, Yumei ZHANG: nothing to disclose. Figure 1 - belongs to Results

Objective: Recent evidence shows transcranial magnetic stimulation (TMS) enhances language recovery in post-stroke aphasia (PSA), but optimal targets remain unclear. Studies show extensive neural connections between the cerebellum and frontal cortex. For PSA patients, non-invasive electrical stimulation of the contralateral cerebellum significantly improves language function. This study compares repetitive TMS (rTMS) effects between contralateral cerebellum and right Broca mirror area stimulation on language function, non-verbal cognition, and daily living skills in PSA patients to optimize rehabilitation strategies. Methods: Patients with PSA due to left hemisphere strokes were randomly assigned to three groups: one targeting the right hemisphere’s Broca mirror area, another targeting the contralateral cerebellum, and a control group. All received standard speech-language therapy; intervention groups additionally received 1Hz rTMS at respective targets pre-therapy. Assessments included: 1. Language: Western Aphasia Battery, Boston Naming Test, Word Fluency Test. 2. Cognition: Loewenstein Occupational Therapy Cognitive Assessment. 3. Daily living: Activity of Daily Living Scale. Results: Of the 77 PSA patients, 25 were assigned to the Broca mirror area group, 26 to the contralateral cerebellum group, and 26 to the control group. 1. Language function: Contralateral cerebellum group showed significant improvement vs baseline (P<0.05) and outperformed controls (P<0.05). 2. Non-verbal cognition: This group improved significantly in orientation, visual perception, visual motor organization, and thinking operations (P<0.05), exceeding both control and Broca mirror area groups (P<0.05). 3. Daily living ability: Contralateral cerebellum group demonstrated significant improvement (P<0.05), surpassing control and Broca mirror area groups (P<0.05). Conclusions: 1. Both right Broca mirror area and contralateral cerebellum rTMS enhance PSA language function with similar efficacy. 2. Contralateral cerebellum stimulation improves non-verbal cognition more effectively than Broca mirror area stimulation. 3. Cerebellar targeting yields greater daily living ability improvements compared to Broca mirror area stimulation.

OBJECTIVES:Non-invasive brain stimulation has emerged as a safe, pain-free, and cost-effective method for post-stroke aphasia (PSA) rehabilitation. However, the ideal site for stimulation is yet to be determined. The cerebellum has demonstrated its role in language function though the application of repetitive transcranial magnetic stimulation (rTMS) targeting the cerebellum for PSA has not been well-documented. This study aims to assess the short- and long-term efficacy of rTMS on the right cerebellum in enhancing language recovery in patients with PSA in the subacute phase, and to explore its neuropsychological and neural network mechanisms as well. METHODS:Our study will recruit sixty-six PSA patients, who will be randomly divided into either a real or a sham rTMS group with equal distribution. The real rTMS group (n  =  33) will receive rTMS treatment over the right cerebellar hemisphere along with speech-language therapy (SLT), while the sham group (n  =  33) will receive sham stimulation and SLT. We will assess the outcomes at five intervals: before rTMS treatment, 2, 12, and 24 weeks, and 1-year post-treatment. The primary outcome in this research is the change in performance of the West Aphasia Battery from baseline to the final follow-up. Secondary outcomes include alterations in the structure, function, and perfusion neuroimaging data, as well as changes in non-verbal cognitive functions, measured using the Loewenstein Occupational Therapy Cognitive Assessment over time and between the groups. Any adverse event related to rTMS therapy will also be recorded. The results of this trial will provide insights into whether cerebellar rTMS stimulation (1) improves language function recovery in subacute phase PSA patients; (2) strengthens the functional connection of the cerebro-cerebellar network, and (3) enhances aphasia treatment outcomes by improving non-linguistic cognitive functions. We commenced patient recruitment for this trial in June 2026, and it is currently in progress. Registration This project was prospectively registered at the Chinese Clinical Trial Registry (ChiCTR2600125453).

White matter lesions (WMLs) are a common cause of vascular cognitive impairment, yet the nature of whole-brain structural connectivity alterations in WML-related mild cognitive impairment (MCI) remains incompletely understood. In this study, an integrated approach combining whole-brain probabilistic fiber tracking with graph theory analysis was employed to investigate structural network changes in 33 patients with WML-related MCI and 37 healthy controls. The results revealed that, at the MCI stage, the brain's structural network exhibited not only reduced connectivity in specific neural circuits-primarily fronto-basal ganglia pathways-but also widespread increased connectivity, particularly between the frontal lobe and other cortical regions. Group comparisons identified 50 significantly altered connections (42 increased, 8 decreased), predominantly involving cortico-cortical, cortico-deep gray matter, and deep gray matter-deep gray matter pathways. Despite these connection-level abnormalities, no significant differences were observed in global or nodal graph-theoretical metrics. Notably, eight of the altered connections showed significant correlations with Montreal Cognitive Assessment (MoCA) scores. These structural alterations were closely associated with cognitive and behavioral deficits, indicating that they might serve as exploratory imaging indicators for WML-induced cognitive impairment.

Post-stroke aphasia (PSA) is a common and disabling consequence of stroke, characterized by substantial heterogeneity in language impairment and recovery trajectories. In recent years, functional magnetic resonance imaging (fMRI) has markedly advanced our understanding of the neural mechanisms underlying PSA recovery by revealing dynamic changes in regional activation, functional connectivity, and large-scale network coordination. This review provides a state-of-the-art synthesis of fMRI studies on functional reorganization in PSA across two intersecting dimensions: the temporal evolution of the disease course (acute, subacute, and chronic stages) and the major categories of rehabilitation intervention, including behavioral therapies, neuromodulation, and combined treatment approaches. Current evidence suggests that PSA recovery is a stage-dependent and network-based neuroplastic process. In the early phase after stroke, recovery is strongly influenced by the rapid recruitment of domain-general cognitive control systems, whereas later recovery is increasingly shaped by the reorganization of residual left-hemisphere language networks, with contralesional and cerebellar contributions becoming more prominent in patients with extensive left-hemisphere damage. However, important controversies remain regarding the functional role of right-hemisphere activation and the relative significance of perilesional restoration versus compensatory recruitment. Furthermore, the field is limited by substantial heterogeneity in patient characteristics, lesion profiles, study design, and imaging methodology, which constrains comparability across studies and hinders clinical translation. By integrating current evidence, unresolved debates, and emerging trends, this review highlights key research gaps and outlines future directions for biomarker-guided, stage-adapted, and individualized rehabilitation strategies in PSA.

Background:Post-stroke rehabilitation is often delivered in a fragmented manner across disciplines, with respiratory function routinely overlooked. This oversight represents a significant gap in comprehensive stroke management, potentially limiting functional recovery, and undermining efforts to deliver truly integrated, patient-centered rehabilitation. Objective:This study aims to provide empirical evidence supporting the integration of pulmonary assessment into multidisciplinary stroke rehabilitation by examining, in stroke survivors, the associations between standard pulmonary function parameters and key functional domains, including objective measures of balance, lower-limb motor function, and trunk stability. Methods:In this observational study, 46 patients with stroke underwent comprehensive assessments, which included pulmonary function [percent predicted vital capacity (VC%), inspiratory capacity (IC%), forced vital capacity (FVC%), forced expiratory volume in 1 s (FEV1%), ratio of FEV1 to FVC (FEV1/FVC), peak expiratory flow (PEF%), maximum voluntary ventilation (MVV%)], the Berg Balance Scale (BBS), the Fugl-Meyer Assessment for Lower Extremity (FMA-LE), the Trunk Impairment Scale (TIS), and plantar pressure analysis [center of pressure (COP) path length, COP velocity, and 95% confidence ellipse area]. Results:In this exploratory analysis, the BBS and FMA-LE scores showed positive correlations with VC%, FEV1%, and PEF% (r = 0.30-0.48, p < 0.05). TIS scores were positively associated with multiple pulmonary parameters (VC%, IC%, FVC%, FEV1%, FEV1/FVC, PEF%, MVV%; r = 0.31-0.54, p < 0.05), with the strongest exploratory correlation observed with PEF% (r = 0.54, p < 0.001). Furthermore, PEF% was negatively correlated with COP path length and velocity (r s = -0.30 to -0.33, p < 0.05). The 95% confidence ellipse area was negatively correlated with IC% (r s = -0.40, p < 0.01) and PEF% (r s = -0.34, p < 0.05). Conclusion:Our results support the integration of simple, low-cost pulmonary screening, particularly PEF measurement, into stroke rehabilitation workflows. Such integration can act as a practical trigger for timely multidisciplinary collaboration among general practitioners, respiratory therapists, and rehabilitation specialists, thereby fostering a more cohesive, proactive approach to improving long-term functional trajectories in stroke survivors.

Postural instability and gait difficulty (PIGD) is a debilitating subtype in patients with Parkinson’s disease (PD). Gait performance under dual-task (DT) may reveal subtle impairments. This exploratory retrospective cross-sectional study aimed to investigate whether gait performance under DT differs between PD motor subtypes and to generate hypotheses for future confirmatory studies. This study enrolled 66 PD patients (mean age 64.64 ± 8.36 years). Motor subtypes [tremor-dominant (TD), PIGD and intermediate type (IT)] were classified by MDS-UPDRS-derived ratios. Gait parameters under single-task (ST) and DT were assessed by wearable G-Walk system. Binary logistic regression examined the association between gait parameters and PIGD subtype, adjusting for age, sex and H-Y staging and gait parameters (primary analysis). A sensitivity analysis excluded the IT subtype. Receiver operating characteristic (ROC) analysis evaluated the discriminatory ability of gait parameters. In the primary analysis, cadence under DT was associated with the PIGD subtype after adjusting for age, sex and H-Y staging (OR = 1.056, 95

BackgroundThe hemoglobin glycation index (HGI) effectively captures individual variations in glycation, its association with cognitive impairment remains unclear.ObjectiveThe purpose of this study was to investigate the relationship between HGI and cognitive impairment risk in the Chinese population.MethodsData from the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2015 were analyzed. Cognitive function was assessed using the American Health and Retirement Study's methodology, which included episodic memory and mental status. Multivariate Cox proportional hazards models and restricted cubic splines were used to examine the link between HGI and the likelihood of cognitive impairment, specific cognitive domains included. Moreover, the potential inflection points were investigated using saturation threshold effect analysis, with bootstrap resampling applied for internal validation.ResultsA U-shaped relationship was observed between HGI and the risk of cognitive impairment, as demonstrated by the restricted cubic spline analysis (p for non-linearity <0.001). The primary analysis identified an inflection point at approximately 0.085. Internal validation via bootstrapping yielded a 95% empirical confidence interval of 0.013 to 0.255 for this point. Conversely, HGI levels above 0.085 resulted in a 70.6% increase in the hazard ratio of cognitive impairment (all p < 0.05).ConclusionsIn the Chinese population, our results point to a U-shaped association between HGI and the risk of cognitive impairment, suggesting that both very low and very high HGI levels raise the risk of cognitive impairment, especially execution and memory.

Abstract Background Inflammation and malnutrition are well-recognized contributors to adverse outcomes in patients with acute ischemic stroke (AIS). The advanced lung cancer inflammation index (ALI), a composite biomarker of inflammation and nutritional status that incorporates body mass index (BMI), albumin (ALB), and neutrophil-to-lymphocyte ratio (NLR), has demonstrated prognostic value in various clinical settings, but evidence in AIS remains limited. We aimed to evaluate the association between ALI and multiple adverse outcomes in patients with AIS and to compare its predictive performance with that of its individual components. Methods A multicenter prospective cohort study was conducted including 12,911 individuals with AIS from the Third China National Stroke Registry. Multivariable logistic and Cox proportional hazards regression analyses were used to estimate the association between ALI and all-cause mortality, combined vascular events (CVE), stroke recurrence, and poor functional outcome [modified Rankin Scale (mRS) score 3–6] at 3-month and 1-year follow-up. Non-linear relationships were investigated using restricted cubic splines (RCS). Predictive performance was assessed using receiver operating characteristic curves with DeLong’s test, and model calibration was evaluated using calibration curves. Results After adjustment for confounders, each IQR increase in ALI was associated with reduced risks of all-cause mortality (HR 0.61, 95% CI 0.52–0.72), poor functional outcome (OR 0.73, 95% CI 0.69–0.77), stroke recurrence (HR 0.87, 95% CI 0.82–0.93), and CVE (HR 0.87, 95% CI 0.82–0.93) at 3 months. Quartile-based analysis further demonstrated a dose–response relationship, with patients in the highest quartile showing the lowest risks (all P for trend < 0.0001). RCS analysis revealed approximately L-shaped nonlinear relationships. Furthermore, ALI demonstrated superior predictive value for all-cause mortality (AUC = 0.736) and poor functional outcome (AUC = 0.666) compared to BMI, ALB, and NLR (all P < 0.005), with good calibration. Similar results were observed at 1 year. Conclusions Higher baseline ALI was independently associated with reduced risks of all-cause mortality, poor functional outcome, CVE, and recurrence in patients with AIS. ALI demonstrated moderate to good predictive value with good calibration for mortality and poor functional outcome, whereas its discriminative ability for stroke recurrence and CVE was limited. Further validation in diverse populations and evaluation of incremental predictive value are warranted. Clinical trial number Not applicable.

Abstract Background Storage symptoms after stroke—isolated urgency, urgency with frequency, and isolated frequency—are common but traditionally attributed to a single overactive bladder mechanism via suprapontine disinhibition. However, clinical heterogeneity in symptom presentation suggests distinct underlying mechanisms. We aimed to characterize the neural substrates of three storage symptom subtypes after stroke using comprehensive lesion-symptom mapping. Methods We prospectively evaluated 1,498 consecutive subacute stroke patients admitted for inpatient rehabilitation (1,105 men, 73.8%; median age 61 years). Storage symptoms were classified into three subtypes: isolated urgency (n=109), urgency with frequency (n=32), and isolated frequency (n=19). Multivariable logistic regression models with Bonferroni correction identified independent predictors across demographic, clinical, white matter hyperintensity (WMH), brain atrophy, and lesion location variables. Results The three subtypes demonstrated largely distinct sets of independent predictors. The left genu of the corpus callosum (aOR=20.06, 95% CI 7.78–51.74, P <0.001) and the inferior frontal gyrus (aOR=3.48, 95% CI 1.81–6.67, P <0.001) were independently associated with isolated urgency and survived Bonferroni correction, together with a right IFG–insula synergistic effect (OR=21.46, 95% CI 10.49–43.88, P <0.001). Urgency with frequency was associated with a broad fronto-cingulate network—the IFG (aOR=11.45, 95% CI 3.10–42.33, P <0.001, surviving Bonferroni correction) and the ACC (aOR=11.53, 95% CI 2.40–55.49, P =0.002)—with diffuse right-hemisphere dominance, older age and brain atrophy. Isolated frequency was associated with anterior corona radiata involvement (aOR=5.46, 95% CI 1.92–15.54, P =0.002) and male sex (aOR=10.62, 95% CI 1.36–82.98, P =0.024), though none reached the strict Bonferroni threshold. Conclusions These findings identify three mechanistically distinct post-stroke storage symptom subtypes with separable neural substrates, lateralization profiles, and clinical determinants. The triple dissociation across subtypes supports a discrete pathway model over the traditional unitary OAB framework, providing a neuroanatomically grounded basis for subtype-stratified treatment.

Objective:To analyze the clinical characteristics of stroke patients with lower extremity deep venous thrombosis (DVT), and to provide a reference for the prevention and treatment of DVT in stroke patients. Methods:A retrospective analysis was performed on the clinical records of 5,980 patients diagnosed with stroke and admitted to Beijing Tian'tan Hospital, Capital Medical University, between January and December 2023. Based on the presence or absence of DVT, patients were categorized into two groups: a control group (without DVT, n = 5,862) and a DVT group (with DVT, n = 118). Propensity score matching was conducted at a 1:1 ratio, yielding 118 matched cases in each group. Comparative analyses were conducted to evaluate the clinical characteristics of the matched cohorts. Multivariate logistic regression analysis was employed to identify independent risk factors associated with the development of lower extremity DVT in stroke patients. Additionally, the functional status, treatment strategies, and clinical outcomes of patients with stroke complicated by lower extremity DVT were systematically assessed. Results:The incidence of lower extremity DVT was significantly higher in stroke patients aged ≥65 years, those with bed rest duration ≥3 days, a history of smoking, absence of anticoagulant therapy, muscle strength < grade 3, and without rehabilitation therapy (p < 0.05). Additionally, comorbid conditions such as diabetes mellitus, hypertension, hyperhomocysteinemia (Hcy), elevated D-dimer, hypertriglyceridemia, and increased low-density lipoprotein (LDL) cholesterol were also significantly associated with a higher incidence of lower extremity DVT (p < 0.05). Multivariate logistic regression analysis identified all of these variables as independent risk factors for the development of lower extremity DVT in stroke patients (p < 0.05). Conclusion:Vigilance for DVT is warranted in this high-risk population. Implementation of early, systematic therapeutic interventions (rehabilitation and appropriate anticoagulation therapy) following stroke is recommended to mitigate the incidence of lower extremity DVT.

BackgroundCerebral small vessel disease (CSVD) may worsen motor and cognitive impairment in Parkinson’s disease (PD), yet whether peripheral metabolic inflammation mediates this link remains unclear. The triglyceride-glucose (TyG) index, a surrogate for insulin resistance, has been associated with CSVD and neurodegeneration. This study examined whether the TyG index statistically accounts for the association between CSVD burden and motor or cognitive deficits in PD.MethodsThis retrospective cross-sectional study enrolled 362 PD patients. The 4-point scale assessed CSVD burden. Movement Disorder Society Unified Parkinson’s Disease Rating Scale part III (MDS-UPDRS III) and Montreal Cognitive Assessment (MoCA) evaluated motor and cognitive function, separately. Spearman correlation and mediation analyses were performed, adjusting for age, sex, education, hypertension, diabetes, and daily dose equivalent of levodopa. Sensitivity analyses were conducted to assess the robustness and specificity of the findings.ResultsCSVD burden was positively associated with MDS-UPDRS III (total effect = 2.309, 95% CI [0.463, 4.155, p = 0.014]) and negatively associated with TyG index (a = −0.067, p = 0.025). TyG index was negatively associated with MDS-UPDRS III (b = −6.561, p < 0.001). The indirect effect was 0.441 (95% CI [0.048, 0.958]), accounting for 19.1% of the total effect. This mediation was specific to TyG, as four alternative inflammatory indices showed no significant effects. Additional analyses adjusting for disease duration and Hoehn-Yahr staging confirmed robustness [indirect effect = 0.288, 95% CI (0.019, 0.687)]. Neither fasting triglycerides nor glucose alone mediated the effect. No mediation was found for cognition.ConclusionThe TyG index statistically accounts for part of the association between CSVD and motor function in PD via a negative-to-negative pathway, suggesting a hypothesis-generating metabolic target that warrants prospective investigation.

Introduction: The combination of verbal and non-verbal cognitive dysfunction in post-stroke aphasia (PSA) patients may ultimately affect social interactions. However, the underlying neural mechanisms of both verbal and non-verbal cognitive impairment remain unclear. This study aimed to investigate the activity and functional abnormalities of local and remote brain regions and their relationship with cognitive behaviour, to provide more effective guidance in future clinical therapy. Methods: We recruited 46 PSA patients and 40 normal controls(NCs) matched for general characteristics in this study and evaluated their verbal and non-verbal cognitive functions. Functional magnetic resonance imaging(fMRI) was used to examine the fractional amplitude of low-frequency fluctuations(fALFF), regional homogeneity(ReHo), and functional connectivity(FC) in PSA patients. Independent two-sample t-tests were used to identify differences in these measures between two groups. Moreover, partial correlation analyses were performed to determine the correlation between FC from the affected brain regions and language and cognitive performance in PSA patients. Results: This study revealed that PSA patients presented significantly lower fALFF and ReHo values in right cerebellum superior (CRBL.Superior.R), left thalamus(THA.L), and left middle frontal gyrus(MFG.L). Moreover, the FC in the MFG.L-left inferior frontal gyrus, orbital part was significantly lower among PSA patients and was positively correlated with language and cognitive performance(p< 0.05). The CRBL. Superior. R-left caudate nucleus and right lenticular nucleus FC were also decreased and were associated with cognitive function(p< 0.05). In addition, PSA patients were further divided into fluent and nonfluent groups. The results revealed that nonfluent patients performed worse in verbal and non-verbal cognitive performance(p< 0.05) and had weaker performance in the THA.L and left supplementary motor area FC(p< 0.001). Conclusions: This study provides new evidence that abnormal neural activity and functional connectivity within specific brain regions may play crucial roles in language and cognitive processing. The underlying mechanisms of impaired linguistic function accompanied by decline in cognition may be a partial overlap between language and cognitive-related brain networks. In future, combining cognitive and linguistic functions and designing a comprehensive treatment plan will be the focus of rehabilitation.

Body mass index (BMI) affects cognitive health throughout life. BMI variability has emerged as a promising indicator for tracking longitudinal changes in BMI. The association of BMI variability with cognitive impairment remains unclear. This study investigated the relationship between BMI variability and cognitive outcomes across age groups defined by a 50-year threshold. The current study enrolled 1474 participants (> 18 years) from the China Suboptimal Health Cohort Study (COCAS). Various metrics, including the coefficient of variation (CV), standard deviation (SD), variability independent of the mean (VIM), and average real variability (ARV), were used to measure BMI variability. The main clinical outcome was the incidence of cognitive impairment, which was diagnosed via the Mini-Mental State Examination (MMSE). We stratified the subjects into two groups on the basis of age (> 50 years and ≤ 50 years), and multivariable logistic regression analysis was performed to evaluate the association between BMI variability and cognitive changes in these groups. We further used a latent growth curve model (LGCM) to explore the BMI trajectories of these two groups. Among those age > 50 years at baseline, stratified analysis revealed that the odds ratio (OR) comparing participants in the highest tertile with those in the lowest tertile of CV was 0.45 (95

Binocular fusion normally relies on a "cyclopean eye" that integrates image disparities between the two eyes into a single coherent percept. When fusion fails, how the brain chooses its spatial reference frame remains unclear. Here, we report a rare case of a 44-year-old man who developed multiple-directions diplopia following surgical resection of a cerebellar vermis hemangioblastoma. Clinical tests showed deficits in several extraocular muscles. Experimentally, in binocular and dichoptic viewing, perception was always anchored to the left eye with the right eye's image misaligned, whereas monocular viewing produced no diplopia. Crucially, the patient could voluntarily switch to the right eye as reference, which was independent of stimulus shape similarity, stimulus exposure order, or participant response demands. This case offers a unique window to understand the relationship between automatic sensory integration and top-down control in binocular vision: When cyclopean fusion breaks down, visual perception adapts to a single-eye reference frame that can be flexibly influenced by attention.

BackgroundSubcortical aphasia, caused by lesions in deep brain structures such as the basal ganglia, thalamus, and periventricular white matter, remains poorly understood due to its heterogeneous clinical presentations and disputed neural mechanisms. Unlike classical cortical aphasia syndromes, subcortical aphasia often involves subtle deficits in lexical, semantic, and phonological processing, which may be underestimated by standard assessments.ObjectiveThis study aimed to comprehensively characterize the language profiles of patients with subcortical aphasia using a multidimensional assessment approach, and to explore the underlying components of language impairment and their relationship to aphasia severity.MethodsThirty-four right-handed, native Chinese-speaking patients with first-ever, MRI-confirmed subcortical stroke and aphasia were enrolled within 4 weeks post-stroke. Standardized assessments included the Chinese version of the Western Aphasia Battery (WAB), the Aphasia Severity Rating Scale (ASRS), the Chinese Aphasia Fluency Characteristic Scale, and the naming battery of Chinese Aphasia Language Battery (CALB-nb). Principal component analysis (PCA) and correlation analyses were used to identify key dimensions of language impairment, with correlation coefficients calculated to quantify patient performance across linguistic domains. A one-year follow-up assessment was conducted using the ASRS to evaluate prognostic outcomes of the enrolled patients.ResultsMost patients exhibited mild to moderate aphasia, with anomic aphasia being the most prevalent subtype (47.1%). CALB naming battery results revealed high accuracy in tone decoding but lower performance in low-frequency word performance and semantic association. Strong correlations were found between phonological output and both auditory perception and phonemic decoding, as well as between auditory lexical comprehension and multiple semantic tasks. PCA identified two components—lexical-semantic and phonological-auditory, which together explained 77.3% of the variance. A composite PCA score significantly predicted aphasia severity (R2 = 0.31, p < 0.001). At one-year follow-up, 73.6% of patients achieved functional language recovery (ASRS 4–5), and five patients resumed their pre-stroke occupations.ConclusionMultidimensional assessments reveal distinct but interrelated components of lexical-semantic and phonological processing, which are closely linked to functional recovery. These findings underscore the necessity for sensitive and domain-specific language evaluations to inform prognosis and guide individualized rehabilitation strategies for subcortical aphasia.

Background and Objective: After a stroke, proprioceptive disorders can impair patients' ability to perceive the speed and direction of movement accurately and promptly, as well as the spatial position of their limbs. This impairment often leads to motor dysfunction, including balance and postural control deficits, which severely affect patients' activities of daily living (ADLs) and quality of life. Neural plasticity is a key factor influencing poststroke functional recovery. In recent years, neuromodulation techniques targeting the enhancement of neural plasticity have emerged as a major research focus. This study aims to conduct a meta-analysis of the efficacy of neuromodulation techniques in treating proprioceptive disorders in stroke patients. Methods: A systematic search was conducted in PubMed, Embase, the Cochrane Library, and Web of Science for studies investigating the effects of neuromodulation techniques on proprioceptive impairment in stroke patients. The search spanned from the inception of each database to December 2024. The primary outcome measure was the change in proprioception. Results: In this meta-analysis, a total of nine randomized controlled trials (RCTs) were included. One study compared two different neuromodulation techniques, resulting in the extraction of 10 distinct datasets. Overall, 360 patients were involved in these studies. Specifically, 182 patients in the treatment group received neuromodulation techniques combined with conventional rehabilitation, while 178 patients in the control group received conventional rehabilitation alone. The meta-analysis revealed no significant difference in the efficacy of neuromodulation techniques combined with conventional rehabilitation compared to conventional rehabilitation alone(standardized mean difference [SMD] = 0.221,95% CI = -0.194 to 0.636, p=0.296). The subgroup analysis based on the stage of the stroke course revealed no significant differences between the two groups(acute stage: SMD = 0.303, 95% CI = -1.300 to 1.905, p=0.711; subacute stage: SMD = 0.351, 95% CI = -0.200 to 0.903, p=0.212; chronic phase: SMD = -0.047, 95% CI = -0.634 to 0.539, p=0.874). Subgroup analysis based on the types of neuromodulation techniques revealed that three specific techniques, electroacupuncture, repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS), were effective in improving proprioceptive disorders after stroke electroacupuncture group: SMD = -0.504, 95% CI = -1.006 to -0.002, p=0.049; rTMS group: SMD = 1.207, 95% CI = 0.246-2.168, p=0.014; tDCS group: SMD = 0.894, 95% CI = 0.323-1.465, p=0.002). Conclusion: No statistically significant difference was found in the efficacy of neuromodulation techniques for treating proprioceptive disorders after stroke. Additionally, no significant differences were observed in the intervention across different stages of stroke. However, subgroup analysis indicated that electroacupuncture, rTMS, and tDCS may be effective in managing proprioceptive disorders poststroke. Therefore, it is recommended to prioritize these techniques in clinical practice.

Explore the correlation between basal ganglia nuclei and cortical gray matter volume changes in tremor-dominant and postural instability-gait difficulty (PIGD) Parkinson’s disease subtypes for Parkinson’s disease diagnosis and individualized treatment. High-resolution 3D-T1WI MRI data from 35 tremor-dominant and 30 PIGD patientsand 35 healthy controls were analyzed. Voxel-based morphometry identified gray matter volume differences. Automated basal ganglia segmentation quantified subcortical volumes, followed by multivariate analysis of covariance and Spearman correlation analyses. Compared with healthy control, patients with PIGD exhibited severe gray matter loss ( P < 0.0001), while tremor-dominant showed nonsignificant reductions. Subcortically, different basal ganglia volumes were atrophied in the tremor-dominant and PIGD groups compared with the healthy control ( P < 0.05). PIGD demonstrated greater left putamen atrophy than tremor-dominant ( P < 0.05). Spearman correlation analysis revealed that the volume of the right globus pallidus was positively correlated with that of the left medial and lateral cingulate gyrus in patients with tremor-dominant ( r = 0.35, P = 0.04); and between the left globus pallidus volume and the right superior temporal gyrus volume in patients with PIGD ( r = 0.47, P = 0.01). Compared with the tremor-dominant subtype, the PIGD subtype exhibits more severe GM atrophy, with different basal ganglia volume changes across subtypes. These altered anatomical features and the correlation between degeneration of the basal ganglia region and cortical gray matter changes may provide insights into the differential functional changes in patients with different motor subtypes and help to elucidate the underlying pathologic mechanisms.