Global, regional, and national burden of neurological disorders in 204 countries and territories worldwide

Melissa officinalis extract nanoemulsion, Caffeic acid and Quercetin as a novel inducer for investigating neural differentiation of human Wharton's jelly mesenchymal stem cells

BACKGROUND

Cell therapy utilizing mesenchymal stem cells, which have the ability to differentiate into different lineages, has garnered significant attention in recent years. Melissa officinalis is rich in biologically active compounds and exhibits antioxidant activity, antimicrobial properties, and sedative effects. Nanoemulsions can facilitate the effective transfer of substances and also protect drugs and biological materials from environmental factors. The aim of the present study is to investigate the role of Melissa officinalis extract nanoemulsion and the active ingredients of caffeic acid and quercetin as inducers in increasing the efficiency of differentiation of mesenchymal stem cells into neural cells in a laboratory environment.

MATERIALS AND METHODS

Human WJMSCs were cultured in the basic culture medium consisting of: Hight glucose DMEM, 10 % FBS and 1 % penicillin/streptomycin. The alcoholic extract of Melissa officinalis was extracted and its nanoemulsion was prepared along with two other effective substances. Next, zeta potential and size of nanoparticles were measured by Dynamic light scattering (DLS) technique. The optimal dose of all three material was calculated by MTT (3-4,5-dimethylthiazol-2-yl-2, 5-diphenyl tetrazolium bromide) assay and Acridine orange-ethidium bromide (AO/EB) staining. In the following, neural differentiation was investigated using Real-time Reverse Transcription Polymerase Chain Reaction (RT-PCR) and immunocytochemistry (ICC) techniques on days 7 and 14.

RESULTS

The results obtained from MTT and AO/EB assays showed that the optimal dose of nanoemulsion M. officinalis, caffeic acid and quercetin is 150 μg/ml, 75 μg/ml and 25 μg/ml, respectively. The ideal particle size for nanoemulsion is below 100 nm. The zeta potential of the M. officinalis extract nanoemulsion was reported to be -9.45 and the average particle size was 17.76 nm. The results of this study indicated that the expression of neural marker genes (MAP-2, β-tubulin III and NSE) and proteins (MAP-2, β-tubulin III and Gamma-enolase) increased in differentiated cells treated with the synthesized nanoemulsion compared to the control group on days 7 and 14 (P ≤ 0.05).

CONCLUSION

In general, our results showed that M. officinalis extract nanoemulsion, caffeic acid and quercetin caused induction of neural differentiation mechanism in human WJ-MSCs.

Global trends and burden of age-related hearing loss: 32-year study

BACKGROUND

Age-related hearing loss (ARHL) is a major cause of disability and diminished quality of life in older adults. This study uses data from the 2021 Global Burden of Disease (GBD) study to assess global ARHL.

METHODS

We evaluated ARHL prevalence, DALYs (Disability-Adjusted Life Years), ASPR (Age-Standardized Prevalence Rate), and ASDR (Age-Standardized DALYs Rate). Trend analysis was conducted using Estimated Annual Percentage Change (EAPC), with projections to 2050.

RESULT

From 1990 and 2021, global ARHL prevalence cases and DALYs increased by 109 %, reaching 1.55 billion and 44.45 million, respectively. The ASPR increased from 17,106.88 to 18,070.26, while the crude prevalence rate significantly from 13,890.66 to 19,587.14. Both ASPR and ASDR demonstrated significant age-related increases, particularly for moderate and moderately severe ARHL, with EAPC values of 1.39 and 1.49 for ASDR, respectively. Among individuals aged over 85 years, the ASPR of ARHL is expected to reach 80 %. Prevalence cases peaked in the 55-69 age group, with the highest number of cases (179.43 million) observed in the 55-59 subgroup. High-middle SDI regions and East Asia exhibited the most rapid growth. By 2050, ARHL cases are projected to reach 2.31 billion, with ASPR and ASDR expected to continue rising.

CONCLUSION

ARHL has increased globally over the past three decades, largely due to population aging. The burden is most severe in middle SDI regions, East Asia, and the 55-69 age group, primarily due to their substantial population bases. Addressing this escalating challenge requires enhanced public awareness, early screening initiatives, and targeted interventions.

Facial expression deep learning algorithms in the detection of neurological disorders: a systematic review and meta-analysis

BACKGROUND

Neurological disorders, ranging from common conditions like Alzheimer's disease that is a progressive neurodegenerative disorder and remains the most common cause of dementia worldwide to rare disorders such as Angelman syndrome, impose a significant global health burden. Altered facial expressions are a common symptom across these disorders, potentially serving as a diagnostic indicator. Deep learning algorithms, especially convolutional neural networks (CNNs), have shown promise in detecting these facial expression changes, aiding in diagnosing and monitoring neurological conditions.

OBJECTIVES

This systematic review and meta-analysis aimed to evaluate the performance of deep learning algorithms in detecting facial expression changes for diagnosing neurological disorders.

METHODS

Following PRISMA2020 guidelines, we systematically searched PubMed, Scopus, and Web of Science for studies published up to August 2024. Data from 28 studies were extracted, and the quality was assessed using the JBI checklist. A meta-analysis was performed to calculate pooled accuracy estimates. Subgroup analyses were conducted based on neurological disorders, and heterogeneity was evaluated using the I2 statistic.

RESULTS

The meta-analysis included 24 studies from 2019 to 2024, with neurological conditions such as dementia, Bell's palsy, ALS, and Parkinson's disease assessed. The overall pooled accuracy was 89.25% (95% CI 88.75-89.73%). High accuracy was found for dementia (99%) and Bell's palsy (93.7%), while conditions such as ALS and stroke had lower accuracy (73.2%).

CONCLUSIONS

Deep learning models, particularly CNNs, show strong potential in detecting facial expression changes for neurological disorders. However, further work is needed to standardize data sets and improve model robustness for motor-related conditions.

CuII-bis(thioureido) Complex: A Potential Radiotracer for Detecting Oxidative Stress and Neuroinflammation in Neurodegenerative Diseases

Neurodegenerative diseases, characterized by progressive neuronal degeneration and associated with neuroinflammation and oxidative stress, present significant challenges in diagnosis and treatment. This review explores the potential of copper(II)-bis(thiosemicarbazone) complexes, particularly Cu-ATSM, as a dual-purpose radiopharmaceutical for imaging and therapeutic interventions. Cu-ATSM exhibits unique redox-dependent retention in pathological microenvironments, driven by mitochondrial dysfunction and hyper-reductive states, which enables the noninvasive detection of oxidative stress via positron emission tomography (PET). Preclinical studies demonstrate its efficacy in mitigating neuroinflammation by suppressing glial activation, reducing the secretion of pro-inflammatory cytokines (e.g., TNF-α, MCP-1), and increasing the expression of neuroprotective metallothionein-1 (MT1). Some Clinical research reveals elevated ⁶⁴Cu-ATSM uptake in Parkinson's disease (PD), Alzheimer's disease (AD), and amyotrophic lateral sclerosis (ALS) patients, correlating with disease severity and regional oxidative stress markers. Furthermore, Cu-ATSM derivatives show promise in modulating blood-brain barrier (BBB) permeability, enhancing amyloid-β clearance, and restoring copper homeostasis in ALS models. Despite these advances, limitations such as small cohort sizes and heterogeneity in clinical studies underscore the need for larger-scale validation. Multimodal imaging integrating PET and MRI, alongside novel structural analogs targeting Aβ plaques and redox imbalances, emerges as a strategic direction for future research. Collectively, Cu-ATSM represents a transformative tool for elucidating neuropathological mechanisms and advancing therapeutic strategies in neurodegenerative disorders.

Molecular mechanisms of neuroprotection: The interplay of Klotho, SIRT-1, Nrf2, and HO-1 in neurological health

Neurological disorders significantly impair neuronal function and lead to cognitive and motor deficits. This review manuscript explores the therapeutic potential of key proteins-Klotho, SIRT-1, Nrf2, and HO-1-in combating these disorders. Neurological conditions encompass neurotraumatic, neurodegenerative, and neuropsychiatric diseases, all characterized by neuronal loss and dysfunction. The complex functions of Klotho, an anti-aging protein, and SIRT-1, a histone deacetylase, highlight their roles in neuronal survival and neuroprotection through the enhancement of antioxidant defences and the modulation of stress responses. Nrf2 functions as the principal regulator of the antioxidant response, whereas HO-1 facilitates the control of oxidative stress and the resolution of inflammation. Evidence suggests that the interplay between these proteins facilitates neuroprotection by decreasing oxidative damage and promoting cognitive function. The study emphasises the significance of signalling pathways, particularly the Nrf2/HO-1 axis, which are essential in mitigating oxidative stress and inflammation linked to neurodegenerative disorders. Future therapeutic strategies must consider personalized approaches, innovative drug delivery systems, and early intervention to optimize outcomes. This review provides a comprehensive framework for understanding how targeting these pathways can mitigate the burden of neurological disorders, advancing the development of effective interventions for enhancing brain health.

Research Progress on Phytochemicals from Mulberry with Neuroprotective Effects: A Review

With the intensification of the population aging worldwide, neurological disorders (NDs) are seriously threatening human society. Mulberry, a traditional economic crop, is a significant medicinal plant. Increasing evidence suggests that phytochemicals from mulberry play critical roles in the prevention and treatment of NDs. This paper reviews the recently reported phytochemicals from mulberry with neuroprotective effects and systematically summarizes neuroprotective mechanisms and their classifications. Based on their origins from different parts of mulberry, the extracts with neuroprotective effects are classified into mulberry fruit extract and mulberry leaf extract. According to the compound structures, the compounds are divided into flavonoids, Diels-Alder-type adducts (DAAs), benzofurans, quinones, stilbenes, and alkaloids. This aims to provide a future reference for their pharmaceutical development and utilization.

The World Federation of Neurology: Brain health for all ages 2025

The World Federation of Neurology (WFN) has used the term brain health for many years and implemented the Brain Health campaign in 2020. This year's World Brain Day continues the WFN's engagement on brain health, emphasizing its relevance "for all ages." This continues on prior themes, such as Brain Health for All (2022), Brain Health and Disability (2023), and Brain Health and Prevention (2024). The burden of neurological disease is not evenly distributed worldwide, and significant differences exist across age groups and regions. The disparities reflect broader inequalities in healthcare infrastructure, workforce capacity, public health investment, and social determinants of health. The WFN World Brain Day raises awareness of all these issues as they pertain to brain health with the goal of improving equitable access to neurological care.

Relationship between stigma and negative emotions among patients with Parkinson's disease: The mediating role of health literacy and family function

BACKGROUND

Parkinson's disease is a neurodegenerative disorder causing physical and psychological challenges. Stigma exacerbates negative emotions, resulting in anxiety and depression, as well as undermining self-perception and social participation. Health literacy aids in disease management, and family function plays a crucial supportive role. However, the interplay between these variables remains underexplored.

OBJECTIVE

To examine the chain mediating effects of health literacy and family function between stigma and negative emotions in patients with Parkinson's disease.

METHODS

This study adopted a cross-sectional design, recruiting eligible patients from a tertiary hospital in Guangzhou, China. A total of 245 participants completed questionnaires on stigma, health literacy, family function and negative emotions. Statistical analyses were performed using Spearman's correlation and mediation effect analysis.

RESULTS

Negative emotions were positively correlated with stigma (β = 0.584) and inversely associated with health literacy (β = -0.258) and family function (β = -0.144). Mediation effect analysis showed that the mediating effects of health literacy, family function, and their combined effects on the relationship between stigma and negative emotions were 0.033, 0.020, and 0.008, respectively, accounting for 8.89%, 5.39%, and 2.16% of the total effect.

CONCLUSIONS

Stigma in patients with Parkinson's disease not only directly affects negative emotions but also indirectly influences them through health literacy and family function.

Biomarker-guided decision making in clinical drug development for neurodegenerative disorders

Neurodegenerative disorders are characterized by complex neurobiological changes that are reflected in biomarker alterations detectable in blood, cerebrospinal fluid (CSF) and with brain imaging. As accessible proxies for processes that are difficult to measure, biomarkers are tools that hold increasingly important roles in drug development and clinical trial decision making. In the past few years, biomarkers have been the basis for accelerated approval of new therapies for Alzheimer disease and amyotrophic lateral sclerosis as surrogate end points reasonably likely to predict clinical benefit.Blood-based biomarkers are emerging for Alzheimer disease and other neurodegenerative disorders (for example, Parkinson disease, frontotemporal dementia), and some biomarkers may be informative across multiple disease states. Collection of CSF provides access to biomarkers not available in plasma, including markers of synaptic dysfunction and neuroinflammation. Molecular imaging is identifying an increasing array of targets, including amyloid plaques, neurofibrillary tangles, inflammation, mitochondrial dysfunction and synaptic density. In this Review, we consider how biomarkers can be implemented in clinical trials depending on their context of use, including providing information on disease risk and/or susceptibility, diagnosis, prognosis, pharmacodynamic outcomes, monitoring, prediction of response to therapy and safety. Informed choice of increasingly available biomarkers and rational deployment in clinical trials support drug development decision making and de-risk the drug development process for neurodegenerative disorders.

Manual handling and back pain among health care professionals in neurological inpatient and outpatient settings: a mixed methods study

BACKGROUND

The number of patients with neurological disorders and severe disability is increasing globally. These patients often need help with positioning and the amount of support varies with their level of impairment. High rates of work-related musculoskeletal disorders are observed among healthcare professionals (HCP) with patient contact due to injuries during manual handling. There is insufficient research on manual handling by nurses and other HCP.

OBJECTIVES

The primary aim of this study was to explore manual handling strategies by HCP in neurological inpatient and outpatient settings. A secondary aim was to explore pain during and post manual handling activities.

DESIGN

A convergent parallel mixed methods design.

METHODS

A quantitative survey was combined with qualitative semi-structured telephone interviews of HCP. The inclusion criteria were licensed allied HCP with at least seven years of experience with neurological patients in inpatient and/or outpatient settings and expertise in manual handling. Exclusion criteria included insufficient proficiency in German and pre-existing illness prior to start of professional education. The survey data were analysed using descriptive statistics and interviews were evaluated through inductive-reflexive thematic analysis.

RESULTS

Ten nurses, 10 occupational, 12 physiotherapists participated. Survey findings showed moderate time pressure, body strain, and low back and neck pain during patient transfers. HCPs spent an average of 7.3 (± 5.5) hours per week on personal endurance and strength training. They considered transfer aids moderately important and accessible, predominantly using the transfer board. Interdisciplinary collaboration in patient transfers was reported as crucial and usually available. We identified three themes from interviews: (1) individualised manual handling; (2) facilitating active patient participation during transfers; (3) maintaining personal physical fitness.

CONCLUSIONS

Neurological symptoms, patient fears, and goal setting necessitated personalised transfer strategies. Patient characteristics, lack of space and time complicated transfers, prompting HCPs to use perception-oriented techniques, leverage, gravity, and momentum.

The Effect of Prebiotics and Probiotics on Levels of Depression, Anxiety, and Cognitive Function: A Meta-Analysis of Randomized Clinical Trials

INTRODUCTION

Recent studies have emphasized the relationship between mental health and the human intestine microbiota. In this study, we evaluate the effect of consuming Biotics, on levels of depression, anxiety, and cognitive function.

METHODS

This meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. We searched MEDLINE (PubMed), Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov. All full-text articles and major reviews were manually searched for additional studies.

RESULTS

The initial analysis was based on the concept that consuming Biotics causes changes in anxiety, measured using various instruments. This analysis showed that consuming Biotics significantly reduced anxiety in our study participants (SMD = 0.2894, Z = 2.46, P = 0.0139, I^2 = 92.4%). The meta-analysis included 4295 samples (2194 in the experimental group and 2101 in the control group). In terms of depression, the analysis showed that consuming Biotics significantly reduced depression in our study participants (SMD = 0.2942, Z = 2.13, P = 0.0335, I^2 = 91.7%). The meta-analysis included 3179 samples (1603 in the experimental group and 1576 in the control group). Regarding cognitive function, the analysis showed that consuming Biotics significantly improved cognitive function in our study participants (SMD = 0.4819, Z = 3.00, P = 0.0027, I^2 = 77.9%). The meta-analysis included 915 samples (470 in the experimental group and 445 in the control group).

CONCLUSIONS

Our results indicate that most recent studies support the effectiveness of probiotics in reducing symptoms of anxiety, depression, and cognitive issues despite some discrepancies in the findings. People with mild symptoms may experience greater benefits from taking probiotics.

TRIAL REGISTRATION

PROSPERO registration ID: CRD42024589507.

The Current Situation of Neurological Health in Bangladesh: A Perspective

BACKGROUND AND AIMS

In Bangladesh, neurological disorders are becoming a bigger public health concern because they significantly increase disability, mortality, and medical costs. This review explores the current neurological health landscape in Bangladesh, with a focus on prevalent disorders such as stroke, epilepsy, Parkinson's disease, and meningitis.

METHODS

To complete this review, we retrieved pertinent information from published articles that we located in Google Scholar, PubMed, and Scopus. We looked up terms like meningitis, stroke, Parkinson's disease, epilepsy, and neurological disease.

RESULTS

Due to common risk factors like diabetes, high blood pressure, and lifestyle choices, the prevalence of these conditions is increasing. Inadequate healthcare infrastructure, especially in rural areas, and a lack of specialized medical care make diagnosis and treatment extremely difficult. Effective disease management is made more difficult by systemic flaws in the public health system and socioeconomic disparities.

CONCLUSION

Public education campaigns, preventive measures, better access to necessary medications, and improvements to the healthcare infrastructure are all vital to lessen this burden. To improve neurological health outcomes in Bangladesh, this review emphasizes the urgent need for focused interventions and strong policies. It also emphasizes the significance of ongoing research and medical advancements in managing and lowering the prevalence of major neurological disorders in Bangladesh.

Multi-targeted benzylpiperidine-isatin hybrids: Design, synthesis, biological and in silico evaluation as monoamine oxidases and acetylcholinesterase inhibitors for neurodegenerative disease therapies

Neurodegenerative diseases (NDDs) like Alzheimer's and Parkinson's, characterized by gradual loss of neuronal structure and function, results in cognitive and motor impairments. These complex disorders involve multiple pathogenic mechanisms, including neurotransmitter imbalances, oxidative stress, and protein misfolding, necessitating multifunctional therapeutic approaches. Piperidine and isatin are valuable scaffolds in drug design due to their favorable pharmacokinetic profiles, ability to cross blood-brain barrier, and ease of modification. This study focuses on design, synthesis, and evaluation of benzylpiperidine-isatin hybrids as dual inhibitors targeting key enzymes implicated in NDDs: monoamine oxidases (MAO-A/B) and acetylcholinesterase (AChE). Strategic hybridization of piperidine and isatin produced novel benzylpiperidine-isatin hybrids, combining pharmacological benefits of both scaffolds. Synthesized hybrids were tested for MAO-A/B and AChE inhibitory effects. 15 emerged as a lead inhibitor for both MAO-A (IC50 = 0.108 ± 0.004 μM, competitive and reversible) and AChE (IC50 = 0.034 ± 0.002 μM, mixed and reversible), outperforming donepezil in AChE inhibition. 4 showed significant MAO-B inhibition (IC50 = 0.057 ± 0.001 μM, competitive and reversible). SAR studies identified crucial structural elements for potency and selectivity, while molecular docking revealed key interactions stabilizing the enzyme-inhibitor complexes. MD simulations of lead molecules demonstrate the ligand's suitability for strong and consistent binding to the respective proteins. Lead compounds were non-neurotoxic, exhibited good antioxidant properties, and had favorable in silico ADMET predictions. These findings suggest that benzylpiperidine-isatin hybrids hold promise as multifunctional agents against NDDs, warranting further refinement to enhance their efficacy and safety.

Vitamin K Properties in Stroke and Alzheimer's Disease: A Janus Bifrons in Protection and Prevention

Vitamin K is essential for many physiological processes, including coagulation, bone metabolism, tissue calcification, and antioxidant activity. Vitamin K vitamers are represented by lipophilic compounds with similar chemical structure (i.e., phylloquinone (vitamin K1) and menaquinone (vitamin K2)). Vitamin K deficiency can affect coagulation and vascular calcification, increasing the risk of hemorrhages, atherosclerosis, cerebrovascular diseases, and neurodegeneration. Recently, several studies have hypothesized a possible dual role of vitamin K vitamers in benefiting both vascular and cerebral health, e.g., by sphingolipids biosynthesis or ferroptosis inhibition. The aim of this narrative review is to deepen the understanding of biological activities of vitamin K and its possible dual protective/preventive actions in neurovascular and degenerative conditions, e.g., stroke and dementia. Given the difficulties related to hemorrhagic risk entailed in the prevention of strokes, the function of vitamin K antagonists is also investigated. Finally, we track the development of a clinical concept for a future preventive strategy and innovative use of vitamin K as a supplement to counteract neurovascular and pathological processes, focusing in particular on stroke and dementia.

Nanotechnology to Overcome Blood-Brain Barrier Permeability and Damage in Neurodegenerative Diseases

The blood-brain barrier (BBB) is a critical structure that maintains brain homeostasis by selectively regulating nutrient influx and waste efflux. Not surprisingly, it is often compromised in neurodegenerative diseases. In addition to its involvement in these pathologies, the BBB also represents a significant challenge for drug delivery into the central nervous system. Nanoparticles (NPs) have been widely explored as drug carriers capable of overcoming this barrier and effectively transporting therapies to the brain. However, their potential to directly address and ameliorate BBB dysfunction has received limited attention. In this review, we examine how NPs enhance drug delivery across the BBB to treat neurodegenerative diseases and explore emerging strategies to restore the integrity of this vital structure.

Global trends and burden of idiopathic epilepsy: regional and gender differences from 1990 to 2021 and future outlook

BACKGROUND

Idiopathic epilepsy (IE) remains a significant neurological disorder, contributing to substantial global morbidity and mortality. This study aims to comprehensively evaluate the global burden of IE from 1990 to 2021, focusing on trends in incidence, mortality, and disability-adjusted life years (DALYs) across different geographic regions. Additionally, the study projects IE burden trends through 2036, providing insights for future public health interventions.

METHODS

Data were extracted from the Global Burden of Disease Study 2021 (GBD 2021). IE incidence, mortality, and DALYs were analyzed by age, sex, year, and geographic location. Age-standardized rates were computed to facilitate comparisons across countries and regions. Temporal trends in IE burden were evaluated using Joinpoint regression, while future trends were projected using the Bayesian age-period-cohort (BAPC) model.

RESULTS

In 2021, there were approximately 3.27 million new cases of IE globally (95% uncertainty interval [UI]: 2.4 to 4.13 million) and 140,000 deaths (95% UI: 120,000 to 150,000). Total DALYs reached 13.88 million (95% UI: 10.73 to 17.62 million). The global age-standardized incidence rate increased from 38.12 per 100,000 in 1990 to 42.82 per 100,000 in 2021. The Andean and Central Latin American regions exhibited the highest incidence rates, while East Asia and Oceania reported the lowest. Despite a decrease in the global age-standardized mortality rate from 2.07 per 100,000 in 1990 to 1.74 per 100,000 in 2021, mortality rates remained elevated in low- and middle-income countries, particularly in sub-Saharan Africa. Male patients showed consistently higher incidence, mortality, and DALY rates compared to females, with the highest burden observed in children under 5 years and adults over 60 years.

CONCLUSION

Over the past three decades, global IE incidence has steadily increased, while mortality and DALY rates have declined, especially in high-income countries. However, low- and middle-income regions continue to face significant challenges due to limited access to healthcare. Public health efforts must prioritize enhancing early diagnosis and treatment capabilities in these resource-limited areas.

Post-irradiation vertebral and carotid stenosis heightens stroke risk in head and neck cancer

BACKGROUND

The relative risk of ischemic stroke (IS) in head and neck cancer (HNC) patients developing carotid artery stenosis (CAS) or vertebral artery stenosis (VAS) after radiation therapy (RT) remains uncertain due to limited studies, complicating vascular follow-ups and preventive strategies.

METHODS

We included HNC patients who received RT between 2010 and 2023. The patients were divided into nasopharyngeal carcinoma (NPC) and non-NPC groups. The primary outcome was the occurrence of IS after RT, and the secondary outcomes included the development of > 50% CAS or > 50% VAS after RT.

RESULTS

Of the 1,423 HNC patients, there were 19% of patients developed > 50% CAS, 6.8% of patients developed > 50% VAS, and 2.3% of patients developed IS. In patients with HNC, > 50% CAS (adjusted hazard ratio [HR] = 3.21, 95% confidence interval [CI] = 1.53-6.71), and > 50% VAS (adjusted HR = 2.89, 95% CI = 1.28-6.53) were both the independent predictors of IS. In the patients with NPC, > 50% CAS was an independent predictor of anterior circulation IS (adjusted HR = 4.39, 95% CI = 1.17-16.47). By contrast, > 50% VAS emerged as a predictor of posterior circulation IS in both the NPC (adjusted HR = 15.02, 95% CI = 3.76-60.06) and non-NPC groups (adjusted HR = 13.59, 95% CI = 2.21-83.46).

CONCLUSION

HNC patients with > 50% CAS or > 50% VAS after RT had an increased risk of IS within their corresponding vascular territory. CAS could be an important predictor of IS in NPC patients, whereas VAS might also be a significant predictor of IS in both NPC and non-NPC patients. Evaluation both the carotid and vertebral arteries after RT might be necessary.

TRIAL REGISTRATION

ClinicalTrials.gov identifier No.: NCT06111430.

Role of exercise on ncRNAs and exosomal ncRNAs in preventing neurodegenerative diseases: a narrative review

Engaging in activity has proven to have beneficial effects on different facets of well-being, such as conditions related to the deterioration of the nervous system. Non-coding RNAs (ncRNAs) and exosomal ncRNAs associated with vesicles have been recognized as influencers of gene expression and cell signaling, potentially contributing to the positive impact of physical activity on neurodegenerative conditions. It is hypothesized that exercise-induced changes in ncRNA expression may regulate key processes involved in neuroprotection, including neuroinflammation, oxidative stress, protein aggregation, and synaptic function. Exercise has shown promise in preventing neurodegenerative diseases (NDs), and ncRNAs and exosomal ncRNAs are emerging as potential mediators of these benefits. In review, we explored how ncRNAs and exosomal ncRNAs play a role in enhancing the impacts of activity on neurodegenerative disorders for future treatments. Research studies, both preclinical and clinical, that have documented the use of various exercises and their effects on ncRNAs and exosomal ncRNAs for the treatment of NDs have been compiled and enlisted from the PubMed database, spanning the time period from the year 2000 up to the current time. Studies show that manipulating specific ncRNAs or harnessing exercise-induced changes in ncRNA expression and exosomal cargo could potentially be utilized as therapeutic strategies for preventing or treating NDs. In conclusion, studies suggest that various exercise modalities, including aerobic, resistance, and high-intensity interval training, can modulate the expression of ncRNAs and exosomal ncRNAs in the context of NDs. The altered ncRNA profiles may contribute to the neuroprotective and therapeutic effects observed with exercise interventions. However, more research is needed to fully understand the underlying mechanisms and to further explore the potential of exercise-induced ncRNA signatures as biomarkers and therapeutic targets for neurodegenerative disorders.

The Global Burden of Migraine: A 30-Year Trend Review and Future Projections by Age, Sex, Country, and Region

INTRODUCTION

Migraine is a prevalent neurological disorder causing significant disability worldwide. Despite extensive research on specific populations, comprehensive analyses of global trends are remains limited.

METHODS

We extracted incidence, prevalence, and disability-adjusted life years (DALYs) data for migraine from the Global Burden of Disease 2021 database. Trends were analyzed across regions, age groups, sexes, and sociodemographic index (SDI) using estimated annual percentage changes (EAPC). Predictive models (ARIMA) were used to forecast trends to 2050.

RESULTS

From 1990 to 2021, the global burden of migraine significantly increased: prevalence increased by 58.15%, from 732.56 million to 1.16 billion cases, and incidence increased by 42.06%. The DALYs also increased by 58.27%. There were differences between the sexes: female individuals had higher absolute rates of migraine incidence and prevalence, but male individuals exhibited a four- to five-fold more rapid increase than female individuals in these parameters. Adolescents (< 20 years old) have the fastest growth in prevalence and DALYs. Regionally, high SDI regions having the highest age-standardized rate (ASR) and low SDI regions having the lowest ASR in DALYs. East Asia and Latin America exhibited the most significant increases in migraine burden, whereas Southeast Asia exhibited the most pronounced decrease. Predictive analysis suggests prevalence will continue to rise until 2050, particularly among male individuals and adolescents.

CONCLUSIONS

The global burden of migraine has significantly escalated from 1990 to 2021, with female individuals bearing a greater burden but male individuals showing a faster growth rate. Adolescents also face a rapidly rising prevalence. Disparities across SDI regions, countries, age groups, and sexes emphasize the need for targeted public health strategies. Focused interventions are required to mitigate the growing impact of migraines on global health, particularly among male individuals and adolescents.

From innovation to clinic: Emerging strategies harnessing electrically conductive polymers to enhance electrically stimulated peripheral nerve repair

Peripheral nerve repair (PNR) is a major healthcare challenge due to the limited regenerative capacity of the nervous system, often leading to severe functional impairments. While nerve autografts are the gold standard, their implications are constrained by issues such as donor site morbidity and limited availability, necessitating innovative alternatives like nerve guidance conduits (NGCs). However, the inherently slow nerve growth rate (∼1 mm/day) and prolonged neuroinflammation, delay recovery even with the use of passive (no-conductive) NGCs, resulting in muscle atrophy and loss of locomotor function. Electrical stimulation (ES) has the ability to enhance nerve regeneration rate by modulating the innate bioelectrical microenvironment of nerve tissue while simultaneously fostering a reparative environment through immunoregulation. In this context, electrically conductive polymer (ECP)-based biomaterials offer unique advantages for nerve repair combining their flexibility, akin to traditional plastics, and mixed ionic-electronic conductivity, similar to ionically conductive nerve tissue, as well as their biocompatibility and ease of fabrication. This review focuses on the progress, challenges, and emerging techniques for integrating ECP based NGCs with ES for functional nerve regeneration. It critically evaluates the various approaches using ECP based scaffolds, identifying gaps that have hindered clinical translation. Key challenges discussed include designing effective 3D NGCs with high electroactivity, optimizing ES modules, and better understanding of immunoregulation during nerve repair. The review also explores innovative strategies in material development and wireless, self-powered ES methods. Furthermore, it emphasizes the need for non-invasive ES delivery methods combined with hybrid ECP based neural scaffolds, highlighting future directions for advancing preclinical and clinical translation. Together, ECP based NGCs combined with ES represent a promising avenue for advancing PNR and improving patient outcomes.

Bioactive compounds from Chinese herbal plants for neurological health: mechanisms, pathways, and functional food applications

Neurological disorders pose significant global public health challenges, with a rising prevalence and complex pathophysiological mechanisms that impose substantial social and economic burdens. Traditional Chinese Medicine (TCM), with its holistic approach and multi-target effects, has gained increasing attention in the treatment of neurological diseases. This review explores bioactive compounds derived from Chinese herbal plants, focusing on their mechanisms of action, underlying pathways, and potential applications in functional food development. The review highlights the neuroprotective properties of flavonoids, alkaloids, polysaccharides, and polyphenols found in key TCM herbs such as Scutellaria baicalensis, Salvia miltiorrhiza, Ligusticum chuanxiong, and Gastrodia elata. These compounds have demonstrated significant anti-inflammatory, antioxidant, and neurogenic effects, making them promising candidates for the prevention and treatment of neurological conditions, including Alzheimer's disease (AD), Parkinson's disease (PD), and depression. Furthermore, the synergistic effects of TCM formulations targeting multiple signaling pathways offer advantages over single-target therapies, especially in combating neurodegenerative diseases. The review also discusses the challenges and future directions for integrating these bioactive compounds into functional foods and dietary supplements, aiming to improve neurological health and enhance clinical outcomes. Ultimately, this work aims to provide valuable insights into the potential of TCM-based interventions for promoting neurological well-being and addressing the global burden of neurological disorders.

Advances in chromosomal microarray analysis: Transforming neurology and neurosurgery

Over the past two decades, genomics has transformed our understanding of various clinical conditions, with Chromosomal Microarray Analysis (CMA) standing out as a key technique. Offering unparalleled sensitivity, CMA detects submicroscopic chromosomal imbalances, enabling the examination of DNA for copy number variations, deletions, duplications, and other structural differences. In neurology, CMA has revolutionised diagnoses, personalised treatment plans, and patient outcomes. By identifying genetic anomalies linked to neurological conditions, CMA allows clinicians to tailor treatments based on individual genetic profiles, enhancing precision medicine. CMA's clinical utility spans numerous neurological conditions, providing crucial insights into neurodevelopmental disorders, CNS tumours, neurodegenerative diseases, cerebrovascular diseases, and epilepsy. In neurodevelopmental disorders, CMA aids in diagnosing autism and intellectual disabilities, facilitating early interventions that improve long-term outcomes. In epilepsy, CMA helps identify genetic causes of drug-resistant seizures, enabling more targeted therapies and reducing adverse reactions. CMA also aids in stratifying risk for cerebrovascular diseases, enabling preventive interventions that improve patient prognosis. Despite its potential, challenges remain, such as interpreting variants of uncertain significance (VOUS), the lack of standardised testing guidelines, and issues of cost and accessibility. Addressing these challenges will optimise CMA's impact, advancing personalised medicine and reshaping neurology. This review discusses CMA's pivotal role in bridging the gap between genomics and clinical practice, underscoring its potential to transform neurogenetics and ultimately improve patient care.

Brain health: Pathway to primary prevention of neurodegenerative disorders of environmental origin

While rising global rates of neurodegenerative disease encourage early diagnosis and therapeutic intervention to block clinical expression (secondary prevention), a more powerful approach is to identify and remove environmental factors that trigger long-latencybrain disease (primary prevention) by acting on a susceptible genotype or acting alone. The latter is illustrated by the post-World War II decline and disappearance of Amyotrophic Lateral Sclerosis and Parkinsonism-Dementia Complex (ALS/PDC), a prototypical often-familial neurodegenerative disease formerly present in very high incidence on the island of Guam. Lessons learned from 75 years of investigation on the etiology of ALS/PDC include: the importance of focusing field research on the disease epicenter and patients with early-onset disease; soliciting exposure history from patients, family, and community to guide multidisciplinary biomedical investigation; recognition that disease phenotype may vary with exposure history, and that familial brain disease may have a primarily environmental origin. Furthermore, removal from exposure to the environmental trigger effects primary disease prevention.

Depression and anxiety in Chinese patients hospitalized with primary headache: A cross-sectional multicenter study

BACKGROUND

Primary headache and psychiatric diseases are bidirectional correlated. The real-world data of depression and anxiety in Chinese patients hospitalized for primary headache, considering all subtypes, remain unclear.

METHODS

This study enrolled patients attending eight Chinese headache centers from October 2022 to September 2023. A WeChat mini-program was designed to collect data. Headache was diagnosed and confirmed by two headache specialists. The Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 were used to assess depression and anxiety.

RESULTS

Overall, 1963 patients with primary headache were analyzed; the prevalence of depression and anxiety was 20.1% (396/1963) and 14.8% (290/1963), respectively. Of the 1963 patients, 217 (11.1%) had history of anxiety or depression and 184 (9.4%) had undergone assessments. Patients with both primary headache and depression were more likely to be women (77.8% vs 71.9%), experience more severe headache (numerical rating scale; 6.2 ± 1.9 vs 5.7 ± 1.9) and greater impacts on quality of life (Headache Impact Test-6; 65.3± 8.5 vs 58.1 ± 11.5). Those with both primary headache and anxiety exhibited similar results and were less educated. Depression and anxiety were more prevalent in chronic migraineurs (CM) than in episodic migraineurs (36.8% vs 16.9% and 28.9% vs 12.3%, respectively) and in those with chronic (CTTH) than in those with episodic tension-type headache (30.6% vs 15.1% and 20.1% vs 12.8%, respectively).

CONCLUSION

Depression and anxiety are inadequately diagnosed and strongly associated with sex, severe headache, chronification and disability in patients with primary headache in China. To improve the health of patients with primary headaches, early screening for depression and anxiety is important.

Probiotics as Potential Treatments for Neurodegenerative Diseases: a Review of the Evidence from in vivo to Clinical Trial

Neurodegenerative diseases (NDDs), characterized by the progressive deterioration of the structure and function of the nervous system, represent a significant global health challenge. Emerging research suggests that the gut microbiota plays a critical role in regulating neurodegeneration via modulation of the gut-brain axis. Probiotics, defined as live microorganisms that confer health benefits to the host, have garnered significant attention owing to their therapeutic potential in NDDs. This review examines the current research trends related to the microbiome-gut-brain axis across various NDDs, highlighting key findings and their implications. Additionally, the effects of specific probiotic strains, including Lactobacillus plantarum, Bifidobacterium breve, and Lactobacillus rhamnosus, on neurodegenerative processes were assessed, focusing on their potential therapeutic benefits. Overall, this review emphasizes the potential of probiotics as promising therapeutic agents for NDDs, underscoring the importance of further investigation into this emerging field.

Myasthenia gravis: understanding treatment patterns and direct medical costs in the Czech Republic

BACKGROUND

Myasthenia gravis (MG) is a rare autoimmune disorder with significant clinical implications, including life-threatening myasthenic crises and exacerbations. Understanding real-world treatment patterns, especially associated direct medical costs, is essential for the effective management of healthcare delivery.

METHODS

We conducted a descriptive cohort study using health administrative claims data from the Czech Republic covering more than 1,500 prevalent MG patients. Data were analysed for healthcare resource utilization, medication costs, and hospitalization rates related to MG and its complications.

RESULTS

Acetylcholine inhibitors and corticosteroids were widely prescribed, with 91.1% and 75.2% of patients receiving them at least once, respectively. Immunosuppressive therapy was given to 45.2% of patients. Myasthenic crises occurred in 2% of patients, with a mean hospitalization cost of 21,020 EUR, while exacerbations occurred in 9.2% of patients, with lower costs (5,951 EUR per hospitalization). Outpatient intravenous immunoglobulin and plasma exchange therapies incurred additional costs of 20,700 EUR and 18,206 EUR per person-year, respectively. The mean total cost per patient-year was 1,271 EUR, with significant cost differences among patients with different treatment patterns.

CONCLUSION

This study offers real-world insights into the treatment patterns and associated direct medical costs of MG in the Czech Republic. Myasthenic crises and exacerbations pose considerable cost burdens, while outpatient therapies and common pharmacotherapies are less costly. These findings are vital for healthcare planning, economic evaluation, and resource allocation, potentially leading to enhanced patient care and outcomes.

Pleozymes: Pleiotropic Oxidized Carbon Nanozymes Enhance Cellular Metabolic Flexibility

Our group has synthesized a pleiotropic synthetic nanozyme redox mediator we term a "pleozyme" that displays multiple enzymatic characteristics, including acting as a superoxide dismutase mimetic, oxidizing NADH to NAD+, and oxidizing H2S to polysulfides and thiosulfate. Benefits have been seen in acute and chronic neurological disease models. The molecule is sourced from coconut-derived activated charcoal that has undergone harsh oxidization with fuming nitric acid, which alters the structure and chemical characteristics, yielding 3-8 nm discs with broad redox potential. Prior work showed pleozymes localize to mitochondria and increase oxidative phosphorylation and glycolysis. Here, we measured cellular NAD+ and NADH levels after pleozyme treatment and observed increased total cellular NADH levels but not total NAD+ levels. A 13C-glucose metabolic flux analysis suggested pleozymes stimulate the generation of pyruvate and lactate glycolytically and from the tricarboxylic acid (TCA) cycle, pointing to malate decarboxylation. Analysis of intracellular fatty acid abundances suggests pleozymes increased fatty acid β-oxidation, with a concomitant increase in succinyl- and acetyl-CoA. Pleozymes increased total ATP, potentially via flexible enhancement of NAD+-dependent catabolic pathways such as glycolysis, fatty acid β-oxidation, and metabolic flux through the TCA cycle. These effects may be favorable for pathologies that compromise metabolism such as brain injury.

The Search for a Universal Treatment for Defined and Mixed Pathology Neurodegenerative Diseases

The predominant neurodegenerative diseases, Alzheimer's disease, Parkinson's disease, dementia with Lewy Bodies, Huntington's disease, amyotrophic lateral sclerosis, and frontotemporal dementia, are rarely pure diseases but, instead, show a diversity of mixed pathologies. At some level, all of them share a combination of one or more different toxic biomarker proteins: amyloid beta (Aβ), phosphorylated Tau (pTau), alpha-synuclein (αSyn), mutant huntingtin (mHtt), fused in sarcoma, superoxide dismutase 1, and TAR DNA-binding protein 43. These toxic proteins share some common attributes, making them potentially universal and simultaneous targets for therapeutic intervention. First, they all form toxic aggregates prior to taking on their final forms as contributors to plaques, neurofibrillary tangles, Lewy bodies, and other protein deposits. Second, the primary enzyme that directs their aggregation is transglutaminase 2 (TGM2), a brain-localized enzyme involved in neurodegeneration. Third, TGM2 binds to calmodulin, a regulatory event that can increase the activity of this enzyme threefold. Fourth, the most common mixed pathology toxic biomarkers (Aβ, pTau, αSyn, nHtt) also bind calmodulin, which can affect their ability to aggregate. This review examines the potential therapeutic routes opened up by this knowledge. The end goal reveals multiple opportunities that are immediately available for universal therapeutic treatment of the most devastating neurodegenerative diseases facing humankind.

Neprilysin-Mediated Amyloid Beta Clearance and Its Therapeutic Implications in Neurodegenerative Disorders

Neprilysin (NEP) is a neutral endopeptidase, important for the degradation of amyloid beta (Aβ) peptides and other neuropeptides, including enkephalins, substance P, and bradykinin, in the brain, that influences various physiological processes such as blood pressure homeostasis, pain perception, and neuroinflammation. NEP breaks down Aβ peptides into smaller fragments, preventing the development of detrimental aggregates such as Aβ plaques. NEP clears Aβ plaques predominantly by enzymatic breakdown in the extracellular space. However, NEP activity may be regulated by a variety of factors, including its expression and activity levels as well as interactions with other proteins or substances present in the brain. The Aβ de novo synthesis results from the amyloidogenic and nonamyloidogenic processing of the amyloid precursor protein (APP). In addition to Aβ synthesis, enzymatic degradation and various clearance pathways also contribute to the degradation of the monomeric form of Aβ peptides in the brain. Higher production, dysfunction of degradation enzymes, defective clearance mechanisms, intracellular accumulation of phosphorylated tau proteins, and extracellular deposition of Aβ are hallmarks of neurodegenerative diseases. Strategies for promoting NEP levels or activity, such as pharmaceutical interventions or gene therapy procedures, are being studied as possible therapies for neurodegenerative diseases including Alzheimer's disease. Therefore, in this perspective, we discuss the recent developments in NEP-mediated amyloidogenic and plausible mechanisms of nonamyloidogenic clearance of Aβ. We further highlight the current therapeutic interventions such as pharmaceutical agents, gene therapy, monoclonal antibodies, and stem-cell-based therapies targeting NEP for the management of neurodegenerative disorders.

Burden of neurologic diseases in BRICS countries (1990 to 2021): an analysis of 2021 Global Burden of Disease Study

Background

Neurological disorders are a major global health concern, especially in BRICS nations (Brazil, Russia, India, China, South Africa), where demographic and socio-economic changes have amplified their impact. This study evaluates trends in incidence, prevalence, mortality, and Disability-Adjusted Life Years (DALYs) associated with neurological diseases in these countries from 1990 to 2021, focusing on sex disparities and key risk factors.

Methods

Data were obtained from the Global Burden of Disease (GBD) 2021 database. Join point regression and Estimated Annual Percentage Change (EAPC) analyses were used to assess trends in neurological disease burden. Age-standardized rates for incidence, prevalence, and mortality were calculated, along with DALYs, and key risk factors were analyzed.

Results

China showed the largest increase in incidence (7541.89 to 8031.37 per 100,000) and prevalence (26494.85 to 28534.79 per 100,000). Mortality increased in India (21.01 to 24.27 per 100,000) and South Africa (27.66 to 30.65 per 100,000), while China showed a decline (39.59 to 37.30 per 100,000). Brazil experienced a substantial rise in DALYs (1610.65 to 42024.59). Sex disparities showed higher DALY rates for females across all nations.

Conclusion

The research highlights the rising burden of neurological disorders in BRICS nations, especially in China and Brazil due to aging populations and metabolic risks. It emphasizes the need for targeted interventions in India and South Africa, where increasing mortality rates and DALYs are concerning. Effective health policies should focus on early detection, managing metabolic risks, and implementing sex-specific strategies to address these issues.

Temporal Trends in the Epidemiology of Lower Back Pain in the United States

STUDY DESIGN

This was an observational study.

OBJECTIVE

This study aims to explore sociodemographic and regional geographic variations in lower back pain (LBP) incidence, prevalence, and burden in the United States (US from 2000 to 2019).

SUMMARY OF BACKGROUND DATA

LBP is a major contributor to lost wages and disability in the United States. As LBP is associated with increasing age and sedentary lifestyle, the incidence of LBP is expected to rise. Due to LBP's multifactorial causes, US epidemiological trends lack sufficient data.

MATERIALS AND METHODS

Descriptive epidemiological data including disability-adjusted life years (DALYs), incidence, and prevalence per 100,000 population from 2000 to 2019 were collected from the Global Burden of Disease database. State-level data regarding poverty, insurance and employment status were obtained from the US Government Census Bureau and US Department of Labor. Statistical significance was indicated by P <0.05.

RESULTS

From 2000 to 2019, the US demonstrated reductions in LBP incidence, prevalence, and DALYs. Regional analysis demonstrated the Midwest to have the greatest mean incidence, prevalence, and DALYs; with Midwestern females significantly more affected than females in other regions. Those aged 25 to 49 in the Midwest were impacted significantly more across all measures compared with age-matched populations in other regions. Nationally, there were no significant associations between unemployment and LBP. Poverty was inversely correlated with LBP incidence. Uninsured status was positively correlated with prevalence and DALYs.

CONCLUSION

Although there has been progress in reducing the impact of LBP in the United States, the Midwest region has greater rates for all measures compared with other US regions. Further, females and those aged 25 to 49 in the Midwest were more likely to be affected by LBP compared with counterparts in other regions. Future studies should identify specific factors contributing to elevated LBP rates in the Midwest in order to guide targeted interventions to reduce the incidence and burden of LBP there.

Feasibility of Using Rebound Exercise in Community-Dwelling Adults With Neurological Disorders

Rebound exercise (RE) increases mobility in hospitalized adults with neurological disorders (AwND), but its feasibility in community settings remains largely unexplored. This study evaluates the practicality of implementing RE in the community, particularly for AwND. The feasibility study involved 53 community-dwelling AwND engaging in RE sessions for 30 min, once- or twice-weekly, over 12 weeks. Feasibility was assessed through recruitment rates, adherence, attrition, and participant feedback. The study measured blood pressure (BP), walking speed (WS), and physical activity level (PAL) at baseline, 6 weeks, and 12 weeks. Repeated measures ANOVA and the Friedman tests were used to test for significant differences across the time points. The study demonstrated high recruitment (70.59%) and retention (98.1%) rates, with most participants (76.9%) preferring once-weekly sessions due to time constraints. There were no reported injuries or adverse events. Most participants were older adults (50%), females (67.3%), and retired (55.8%). Significantly lower resting BP (p < 0.001), higher WS (p < 0.001), and PAL (p = 0.000) were observed after 12 weeks of RE. In conclusion, RE is a feasible, safe, and acceptable intervention for supervised community-dwelling AwND and could be a valuable tool for promoting PAL in this population.

Enriching the Mediterranean diet could nourish the brain more effectively

The increasing prevalence of neurodegenerative disorders represents a challenge to the global health of all nations and populations, particularly with increasing longevity. Urgent prevention strategies are therefore needed, and one opportunity may be to explore the relationship between dietary patterns and brain health which has emerged as a promising strategy. Numerous studies indicate that dietary choices have a significant impact on cognitive function, memory and the risks of neurological disorders, recognizing the dynamic role of diet in maintaining cognitive abilities. One of the most studied dietary styles, the Mediterranean diet, characterized by healthy, plant-based foods fats and moderate consumption of animal products, has demonstrated its neuroprotective potential. Rich in antioxidants, vitamins and polyphenols, this diet shows consistent associations with cardiovascular health and cognitive function. Some less talked about foods, such as seaweed, blackcurrants, Lion's Mane mushroom and chia seeds, are emerging as potential brain health boosters. These and other new foods could enrich the Western diet making it capable of effectively preventing neurological disorders. Despite promising scientific data, difficulties persist in understanding the complex relationship between nutrition and brain health. Individual variability, long-term dietary adherence, comorbidities, and the need for rigorous clinical evidence pose obstacles. In this review, we would like to focus our attention on the future of brain-diets, which should involve accessible, personalized and evidence-based interventions, providing hope against the challenges posed by neurodegenerative diseases. In fact, as research progresses, more and more attention are being placed to brain health, promising a harmonious and resilient cognitive landscape for individuals and society.

The New Era of Neural Modulation Led by Smart Nanomaterials

Understanding the physiology and pathology of neural circuits is crucial in neuroscience research. A variety of techniques have been utilized in medical research, with several established methods applied in clinical therapy to enhance patient' neurological functions. Traditional methods include generating electric fields near neural tissue using electrodes, or non-contact modulation using light, chemicals, magnetic fields, and ultrasound. The advent of nanotechnology represents a new advancement in neural modulation techniques, offering high precision and the ability to target specific cell types. Smart nanomaterials enable the conversion of remote signals (such as light, magnetic, or ultrasound) into local stimuli (eg, electric fields or heat) for neurons. Surface treatment technologies of nanomaterials have enhanced biocompatibility, making targeted delivery to specific cell types possible and paving the way for precise neural modulation. This perspective will explore neural modulation techniques supported by nanomedical materials, focusing on photoelectric, photothermal, magnetoelectric, magnetothermal, and acoustoelectric conversion mechanisms, and looking forward to their medical applications.

Role of glucagon-like peptide-1 receptor agonists in Alzheimer's disease and Parkinson's disease

Neurodegenerative diseases, including Alzheimer's Disease (AD) and Parkinson's Disease (PD) are common complications of diabetes, arising from insulin resistance, inflammation, and other pathological processes in the central nervous system. The potential of numerous antidiabetic agents to modify neurodegenerative disease progression, both preclinically and clinically, has been assessed. These agents may provide additional therapeutic benefits beyond glycemic control. Introduced in the twenty-first century, glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a class of antidiabetic drugs noted not only for their potent glucose-lowering effects but also for their cardiovascular and renal protective benefits. Various GLP-1RAs have been demonstrated to have significant benefits in in vitro and in vivo models of neurodegenerative diseases through modulating a variety of pathogenic mechanisms, including neuroinflammation, autophagy, mitochondrial dysfunction, and the abnormal phosphorylation of pathognomonic proteins. These agents also have substantial protective effects on cognitive and behavioral functions, such as motor function. However, clinical trials investigating GLP-1RAs in diseases such as AD, PD, mild cognitive impairment, psychiatric disorders, and diabetes have yielded mixed results for cognitive and motor function. This review examines the link between diabetes and neurodegenerative diseases, explores the effects of antidiabetic agents on neurodegeneration, provides a concise overview of the GLP-1 pathway, and discusses both preclinical and clinical trial outcomes of GLP-1RAs for neurodegenerative diseases, including their effects on cognition in AD and PD. This review also proposed new strategies for the design of future clinical trials on GLP-1 RAs for both AD and PD.

Harnessing Brainwave Entrainment: A Non-invasive Strategy To Alleviate Neurological Disorder Symptoms

From 1990-2019, the burden of neurological disorders varied considerably across countries and regions. Psychiatric disorders, often emerging in early to mid-adulthood, are linked to late-life neurodegenerative diseases like Alzheimer's disease and Parkinson's disease. Individuals with conditions such as Major Depressive Disorder, Anxiety Disorder, Schizophrenia, and Bipolar Disorder face up to four times higher risk of developing neurodegenerative disorders. Contrarily, 65 % of those with neurodegenerative conditions experience severe psychiatric symptoms during their illness. Further, the limitation of medical resources continues to make this burden a significant global and local challenge. Therefore, brainwave entrainment provides therapeutic avenues for improving the symptoms of diseases. Brainwaves are rhythmic oscillations produced either spontaneously or in response to stimuli. Key brainwave patterns include gamma, beta, alpha, theta, and delta waves, yet the underlying physiological mechanisms and the brain's ability to shift between these dynamic states remain areas for further exploration. In neurological disorders, brainwaves are often disrupted, a phenomenon termed "oscillopathy". However, distinguishing these impaired oscillations from the natural variability in brainwave activity across different regions and functional states poses significant challenges. Brainwave-mediated therapeutics represents a promising research field aimed at correcting dysfunctional oscillations. Herein, we discuss a range of non-invasive techniques such as non-invasive brain stimulation (NIBS), neurologic music therapy (NMT), gamma stimulation, and somatosensory interventions using light, sound, and visual stimuli. These approaches, with their minimal side effects and cost-effectiveness, offer potential therapeutic benefits. When integrated, they may not only help in delaying disease progression but also contribute to the development of innovative medical devices for neurological care.

Bacterial lipopolysaccharide model of neuroinflammation-associated neurodegeneration in Wistar rats: A comparison between different durations of lipopolysaccharide induction

Background and Aim

Bacterial lipopolysaccharide (LPS)-induced neuroinflammation can be the most dependable animal model for studying neurodegeneration mechanisms driven by systemic inflammation-induced neuroinflammation. Hence, this study aimed to standardize the LPS model of neuroinflammation by comparing the effect of relatively low-dose LPS administered for different durations on the induction of neurodegeneration in Wistar rats.

Materials and Methods

Six groups of six adult Wistar rats per group were used in the study. Group 1 was the control group, and the other five were administered single weekly dose of LPS (170 μg/kg) for increasing durations, ranging from 4 weeks to 8 weeks. The study endpoints included behavioral parameters, neuronal assay results, and the expression of microglia and astrocytes in the frontal cortex, dentate gyrus, and hippocampus.

Results

We observed a significant reduction in the number of neurons and an increase in glial cells at 5 weeks of exposure, along with a decline in memory. Thereafter, these changes were gradual until 7 weeks of exposure. However, at 8 weeks of exposure, there was no further statistically significant worsening compared with the group exposed for 7 weeks.

Conclusion

To effectively induce neuroinflammation and cause neuronal damage, a minimum of five weekly LPS administrations at a dose of 170 μg/kg is required. Moreover, our results recommend a maximum of 7 weeks of LPS exposure to create a chronic inflammatory model of neuroinflammation.

Technological Strategies Applied to Pharmaceutical Systems for Intranasal Administration of Drugs Intended for Neurological Treatments: A Review

The complexity of treating neurological diseases has meant that new strategies have had to be developed to deliver drugs to the brain more efficiently and safely. Intranasal drug delivery is characterized by its ease of administration, safety, and rapid delivery directly from the nose to the brain. Several strategies have been developed to improve the delivery of drugs to the brain via nasal administration. These include the use of mucoadhesive and thermoresponsive polymers and their combination into polymer blends, as well as the use of liposomes, niosomes, and nano- and microemulsions. Therefore, this review focuses on technologies for developing pharmaceutical systems aimed at delivery via the nose to the brain, contributing to new treatments for difficult neurological disorders. Some of the most common and difficult-to-treat neurological conditions, the intranasal route of administration, and the anatomy of the nasal cavity have been discussed, as well as factors that may influence the absorption of drugs administered into the nose. The types of intranasal formulations and the devices that can be used to administer these products are also discussed in this review. Strategies for improving the transport of bioactive agents and increasing bioavailability are highlighted. The technologies discussed in this review can facilitate the development of formulations with improved properties, such as drug release and mucoadhesiveness, which have several advantages for patients requiring complex neurological treatments.

ApoE: The Non-Protagonist Actor in Neurological Diseases

BACKGROUND

Apolipoprotein E (APOE = gene, ApoE = protein) is a glycoprotein involved in the biological process of lipid transportation and metabolism, contributing to lipid homeostasis. APOE has been extensively studied for its correlation with neurodegenerative diseases, in particular Alzheimer's disease (AD), where the possession of the epsilon 4 (E4) allele is established as a risk factor for developing AD in non-familiar sporadic forms. Recently, evidence suggests a broad involvement of E4 also in other neurological conditions, where it has been shown to be a predictive marker for worse clinical outcomes in Parkinson's disease (PD), brain trauma, and disturbances of consciousness. The mechanisms underlying these associations are complex and involve amyloid-β (Aβ) peptide accumulation and neuroinflammation, although many others have yet to be identified.

OBJECTIVES

The aim of this review is to overview the current knowledge on ApoE as a non-protagonist actor in processes underlying neurodegenerative diseases and its clinical significance in AD, PD, acquired brain trauma, and Disorders of Consciousness (DoC). Ethical implications of genetic testing for APOE variants and information disclosure will also be briefly discussed.

Predictive and Explainable Artificial Intelligence for Neuroimaging Applications

BACKGROUND

The aim of this review is to highlight the new advance of predictive and explainable artificial intelligence for neuroimaging applications.

METHODS

Data came from 30 original studies in PubMed with the following search terms: "neuroimaging" (title) together with "machine learning" (title) or "deep learning" (title). The 30 original studies were eligible according to the following criteria: the participants with the dependent variable of brain image or associated disease; the interventions/comparisons of artificial intelligence; the outcomes of accuracy, the area under the curve (AUC), and/or variable importance; the publication year of 2019 or later; and the publication language of English.

RESULTS

The performance outcomes reported were within 58-96 for accuracy (%), 66-97 for sensitivity (%), 76-98 for specificity (%), and 70-98 for the AUC (%). The support vector machine and the convolutional neural network registered the best performance (AUC 98%) for the classifications of low- vs. high-grade glioma and brain conditions, respectively. Likewise, the random forest delivered the best performance (root mean square error 1) for the regression of brain conditions. The following factors were discovered to be major predictors of brain image or associated disease: (demographic) age, education, sex; (health-related) alpha desynchronization, Alzheimer's disease stage, CD4, depression, distress, mild behavioral impairment, RNA sequencing; (neuroimaging) abnormal amyloid-β, amplitude of low-frequency fluctuation, cortical thickness, functional connectivity, fractal dimension measure, gray matter volume, left amygdala activity, left hippocampal volume, plasma neurofilament light, right cerebellum, regional homogeneity, right middle occipital gyrus, surface area, sub-cortical volume.

CONCLUSION

Predictive and explainable artificial intelligence provide an effective, non-invasive decision support system for neuroimaging applications.

Global, Regional, and National Burden of Brain and Central Nervous System Cancers for Males from 1990 to 2021 and Its Predicted Level in the Next 25 Years

BACKGROUND

A study of the global burden of cerebral and central nervous system (CNS) cancers from the Global Burden of Diseases (GBD) indicates that these cancers significantly contribute to morbidity and mortality internationally. To fully understand the global impact of CNS cancer, expanded research efforts are essential. We analyzed the temporal trend of the disease burden from 1990 to 2021 and made projections for the expected burden from 2020 through 2044.

METHODS

We tapped into GBD 2021 Study data to evaluate CNS cancer incidence and trends among males. Prevalence was assessed with DisMod-MR, trends via cluster analysis, and estimated annual percentage change (EAPC) calculated via linear regression. Forecasts for 2022-2044 used APC and BAPC models, with a p value <0.05 considered significant. Analyses relied on R software 4.0.2.

RESULTS

In 2021, males experienced between 148,118 and 232,469 new brain and CNS cancer cases, indicating increased global burden from 1990 to 2021. An observed link between the prevalence's EAPCs and Human Development Indices (HDIs) suggests higher incidence in more developed regions. Projections using the APC model suggest rising numbers of cases and losses in disability-adjusted life years (DALYs) from 2020 to 2044, while age-standardized rates are expected to decrease overall.

CONCLUSIONS

In summary, a higher Socio-Demographic Index (SDI) correlates with better outcomes for CNS cancer due to early medical interventions in regions with strong healthcare systems. This demonstrates the need for equitable healthcare policies that focus on improving diagnostic capabilities and professional training to enhance survival rates universally.

Advances in different adult stem cell-derived exosomal non-coding RNAs for the treatment of neurological disorders: a narrative review

Neurological disorders are being increasingly recognized as major causes of death and disability around the world. Neurological disorders refer to a broad range of medical conditions that affect the brain and spinal cord. These disorders can have various causes, including genetic factors, infections, trauma, autoimmune reactions, or neurodegenerative processes. Each disorder has its own unique symptoms, progression, and treatment options. Optimal communication between interneurons and neuron-glia cells within the homeostatic microenvironment is of paramount importance. Within this microenvironment, exosomes play a significant role in promoting intercellular communication by transferring a diverse cargo of contents, including proteins, lipids, and non-coding RNAs (ncRNAs). Partially, nervous system homeostasis is preserved by various stem cell-derived exosomal ncRNAs, which include circular RNAs (circRNAs), long noncoding RNAs (lncRNAs), microRNAs (miRNAs), and PIWI-interacting RNAs (piRNAs). The diversity of these exosomal ncRNAs suggests their potential to influence multiple pathways and cellular processes within the nervous system. Stem cell-derived exosomes and their ncRNA contents have been investigated for potential therapeutic uses in neurological disorders, owing to their demonstrated capabilities in neuroprotection, neuroregeneration, and modulation of disease-related pathways. The ability of stem cell-derived exosomes to cross the blood-brain barrier makes them a promising delivery vehicle for therapeutic ncRNAs. This review aims to summarize the current understanding of different stem cell-derived exosomal ncRNAs and their therapeutic potential and clinical applications.

Impacts on study design when implementing digital measures in Parkinson's disease-modifying therapy trials

Introduction

Parkinson's Disease affects over 8.5 million people and there are currently no medications approved to treat underlying disease. Clinical trials for disease modifying therapies (DMT) are hampered by a lack of sufficiently sensitive measures to detect treatment effect. Reliable digital assessments of motor function allow for frequent at-home measurements that may be able to sensitively detect disease progression.

Methods

Here, we estimate the test-retest reliability of a suite of at-home motor measures derived from raw triaxial accelerometry data collected from 44 participants (21 with confirmed PD) and use the estimates to simulate digital measures in DMT trials. We consider three schedules of assessments and fit linear mixed models to the simulated data to determine whether a treatment effect can be detected.

Results

We find at-home measures vary in reliability; many have ICCs as high as or higher than MDS-UPDRS part III total score. Compared with quarterly in-clinic assessments, frequent at-home measures reduce the sample size needed to detect a 30% reduction in disease progression from over 300 per study arm to 150 or less than 100 for bursts and evenly spaced at-home assessments, respectively. The results regarding superiority of at-home assessments for detecting change over time are robust to relaxing assumptions regarding the responsiveness to disease progression and variability in progression rates.

Discussion

Overall, at-home measures have a favorable reliability profile for sensitive detection of treatment effects in DMT trials. Future work is needed to better understand the causes of variability in PD progression and identify the most appropriate statistical methods for effect detection.

Targeting Neurological Disorders with Stilbenes: Bridging the Preclinical-Clinical Gap

Neurological disorders (NDs) encompass a range of debilitating conditions that affect the nervous system, including prevalent illnesses such as Alzheimer's disease, Parkinson's disease, and ischemic stroke. Despite significant ongoing studies, effective therapeutic strategies to halt or slow down the progression of these illnesses are still lacking. Stilbenes, a class of natural polyphenols, have shown potential as candidates for therapeutic strategies due to their capacity to protect the nervous system. Preclinical studies have provided strong evidence that stilbenes can regulate many cellular pathways implicated in neurodegeneration, with resveratrol being a well-studied compound that has shown the ability to reduce oxidative damage, promote neurogenesis, and enhance mitochondrial function - crucial for maintaining brain health. In preclinical animal models, initial research has also shown promise in additional substances such as piceatannol and pterostilbene. Furthermore, clinical studies have explored the therapeutic benefits of stilbenes in NDs. Despite promising results in preclinical research, the use of stilbenes in clinical trials is currently limited, with most studies focusing on resveratrol. Although several clinical studies have demonstrated the beneficial impact of resveratrol supplementation on brain health and degenerative consequences, other investigations have yielded ambiguous findings, underscoring the urgent need for more comprehensive and precisely planned clinical research. This study delves into the potential benefits of stilbenes as neuroprotective agents for NDs. It emphasizes the need for more clinical research to enhance our understanding of their therapeutic effectiveness in specific patient groups.

Cathepsins and neurological diseases: a Mendelian randomization study

Background

The causal relationship between cathepsins and neurological diseases remains uncertain. To address this, we utilized a two-sample Mendelian randomization (MR) approach to assess the potential causal effect of cathepsins on the development of neurological diseases.

Methods

This study conducted a two-sample two-way MR study using pooled data from published genome-wide association studies to evaluate the relationship between 10 cathepsins (B, D, E, F, G, H, L2, O, S, and Z) and 7 neurological diseases, which included ischemic stroke, cerebral hemorrhage, Alzheimer's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, and epilepsy. The analysis employed various methods such as inverse variance weighting (IVW), weighted median, MR Egger regression, MR pleiotropy residual sum and outlier, Cochran Q statistic, and leave-one-out analysis.

Results

We found a causal relationship between cathepsins and neurological diseases, including Cathepsin B and Parkinson's disease (IVW odds ratio (OR): 0.89, 95% confidence interval (CI): 0.83, 0.95, p = 0.001); Cathepsin D and Parkinson's disease (OR: 0.80, 95%CI: 0.68, 0.95, p = 0.012); Cathepsin E and ischemic stroke (OR: 1.05, 95%CI: 1.01, 1.09, p = 0.015); Cathepsin O and ischemic stroke (OR: 1.05, 95%CI: 1.01, 1.10, p = 0.021). Reverse MR analyses revealed that multiple sclerosis and Cathepsin E (OR: 1.05, 95%CI: 1.01, 1.10, p = 0.030). There is currently no significant relationship has been found between other cathepsins and neurological diseases.

Conclusion

Our study reveals a causal relationship between Cathepsins B, D, E, and O and neurological diseases, offering valuable insights for research aimed at improving the diagnosis and treatment of such conditions.

CNN-Based Neurodegenerative Disease Classification Using QR-Represented Gait Data

PURPOSE

The primary aim of this study is to develop an effective and reliable diagnostic system for neurodegenerative diseases by utilizing gait data transformed into QR codes and classified using convolutional neural networks (CNNs). The objective of this method is to enhance the precision of diagnosing neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS), Parkinson's disease (PD), and Huntington's disease (HD), through the introduction of a novel approach to analyze gait patterns.

METHODS

The research evaluates the CNN-based classification approach using QR-represented gait data to address the diagnostic challenges associated with neurodegenerative diseases. The gait data of subjects were converted into QR codes, which were then classified using a CNN deep learning model. The dataset includes recordings from patients with Parkinson's disease (n = 15), Huntington's disease (n = 20), and amyotrophic lateral sclerosis (n = 13), and from 16 healthy controls.

RESULTS

The accuracy rates obtained through 10-fold cross-validation were as follows: 94.86% for NDD versus control, 95.81% for PD versus control, 93.56% for HD versus control, 97.65% for ALS versus control, and 84.65% for PD versus HD versus ALS versus control. These results demonstrate the potential of the proposed system in distinguishing between different neurodegenerative diseases and control groups.

CONCLUSION

The results indicate that the designed system may serve as a complementary tool for the diagnosis of neurodegenerative diseases, particularly in individuals who already present with varying degrees of motor impairment. Further validation and research are needed to establish its wider applicability.

Functional activity, functional connectivity and complex network biomarkers of progressive hyposmia Parkinson's disease with no cognitive impairment: evidences from resting-state fMRI study

Background

Olfactory dysfunction stands as one of the most prevalent non-motor symptoms in the initial stage of Parkinson's disease (PD). Nevertheless, the intricate mechanisms underlying olfactory deficits in Parkinson's disease still remain elusive.

Methods

This study collected rs-fMRI data from 30 PD patients [15 with severe hyposmia (PD-SH) and 15 with no/mild hyposmia (PD-N/MH)] and 15 healthy controls (HC). To investigate functional segregation, the amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) were utilized. Functional connectivity (FC) analysis was performed to explore the functional integration across diverse brain regions. Additionally, the graph theory-based network analysis was employed to assess functional networks in PD patients. Furthermore, Pearson correlation analysis was conducted to delve deeper into the relationship between the severity of olfactory dysfunction and various functional metrics.

Results

We discovered pronounced variations in ALFF, ReHo, FC, and topological brain network attributes across the three groups, with several of these disparities exhibiting a correlation with olfactory scores.

Conclusion

Using fMRI, our study analyzed brain function in PD-SH, PD-N/MH, and HC groups, revealing impaired segregation and integration in PD-SH and PD-N/MH. We hypothesize that changes in temporal, frontal, occipital, and cerebellar activities, along with aberrant cerebellum-insula connectivity and node degree and betweenness disparities, may be linked to olfactory dysfunction in PD patients.

Pathological Involvement of Protein Phase Separation and Aggregation in Neurodegenerative Diseases

Neurodegenerative diseases are the leading cause of human disability and immensely reduce patients' life span and quality. The diseases are characterized by the functional loss of neuronal cells and share several common pathogenic mechanisms involving the malfunction, structural distortion, or aggregation of multiple key regulatory proteins. Cellular phase separation is the formation of biomolecular condensates that regulate numerous biological processes, including neuronal development and synaptic signaling transduction. Aberrant phase separation may cause protein aggregation that is a general phenomenon in the neuronal cells of patients suffering neurodegenerative diseases. In this review, we summarize the pathological causes of common neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease, and Huntington's disease, among others. We discuss the regulation of key amyloidogenic proteins with an emphasis of their aberrant phase separation and aggregation. We also introduce the approaches as potential therapeutic strategies to ameliorate neurodegenerative diseases through intervening protein aggregation. Overall, this review consolidates the research findings of phase separation and aggregation caused by misfolded proteins in a context of neurodegenerative diseases.