Global Cortical Atrophy Research Articles (Page 1)

Neurodegenerative diseases have traditionally been defined in vivo based on clinical symptoms. However, the development of biomarkers has enabled a shift toward in vivo biological definitions. There is now a need to characterize memory clinic populations using multi-dimensional biomarker information. Here, we employed a data-driven approach to develop a biological framework for categorizing individuals in a heterogenous memory clinic cohort based on the presence, extent, and sequence of several common pathologies. We studied 1,677 individuals, including subjective cognitive decline (SCD, n=255), mild cognitive impairment (MCI, n=400), all cause dementia (n=393), and cognitively normal controls (n=625) from the BioFINDER-2 cohort (median age [IQR]=72.0 [16.2] years; 50.3% female). The Subtype and Stage Inference (SuStaIn) model was applied to biomarkers of amyloid-β (Aβ) (cerebrospinal fluid [CSF] Aβ42/Aβ40), tau (temporal meta-ROI positron emission tomography [PET]), neuronal α-synuclein (CSF seed amplification assay [SAA]), vascular pathology (MRI-based white matter hyperintensities [WMHs]), and regional atrophy (MRI-based cortical thickness) to identify biomarker-based clusters across the entire dataset. We then applied this framework to cognitively symptomatic individuals (n=788) to compare clinical symptoms, disease progression rate, and brain changes (atrophy and functional connectivity) across profiles. We identified five biomarker clusters reflecting established clinico-pathological entities, closely corresponding to (i) Alzheimer's disease (AD, n=317 [40.2%]); (ii) α-Synuclein disease (αSyn, n=123 [15.6%]), (iii) Vascular disease (n=67 [8.5%]); (iv) Mixed AD and Vascular diseases (Mixed, n=207 [26.3%]); and (v) a heterogenous group of individuals characterized by atrophy without any of the major brain pathologies, here termed Non-Vascular-Alzheimer-Synuclein (NOVAS, n=74 [9.4%]). The AD profile was characterized by global cognitive impairment and cortical atrophy in AD-associated regions. The αSyn profile was associated with visuospatial and executive dysfunction, motor impairment, hallucinations, and functional connectivity disruptions throughout the brain, despite less overall atrophy compared to all others. The Vascular profile showed language and motor impairments and both the Vascular and Mixed profiles demonstrated atrophy in cingulate and subcortical regions, alongside reduced periventricular white matter integrity. The NOVAS profile was older, demonstrated pronounced hippocampal and amygdala atrophy, and baseline memory deficits, possibly reflecting neurodegenerative diseases for which currently no robust biomarkers are available, such as primary tauopathies and TDP-43 proteinopathies (e.g. LATE). In longitudinal analyses, the AD profile showed the fastest global cognitive decline, while αSyn demonstrated an accelerated decline in language, executive, and visuospatial functioning. To conclude, classifying individuals using a multimodal biomarker approach can provide valuable diagnostic and prognostic insights, with potential implications for clinical trials.

To identify clinical and radiological features of cerebral amyloid angiopathy-related inflammation (CAA-ri), and compare these features with those of sporadic CAA, to improve the understanding, diagnosis, and clinical care of CAA-ri. We retrospectively reviewed routine clinical data from 37 patients with CAA-ri and 158 patients with sporadic CAA, including conventional vascular risk factors and comorbidities. We assessed brain magnetic resonance imaging for: radiological markers of CAA; features of amyloid-related imaging abnormalities with edema/effusion (ARIA-E) including parenchymal white matter hyperintensities, sulcal hyperintensities, and gyral swelling; and evidence of neurodegeneration (medial temporal atrophy and global cortical atrophy). Compared with patients with sporadic CAA, patients with CAA-ri had more numerous lobar cerebral microbleeds (median 207[IQR 33-811] vs 19[IQR 7-58], p < 0.001), and higher rates of medial temporal and global cortical atrophy. In comparison with sporadic CAA, all ARIA-E features were much more common in patients with CAA-ri (parenchymal hyperintensities 89% vs 3%, sulcal hyperintensities 78% vs 9%, and gyral swelling 86% vs 0.6%), as were conventional vascular risk factors (hypertension, dyslipidemia) and long-term comorbidities (inflammatory and infectious disorders, autoimmune or connective tissue disorders, or malignancies). Features of ARIA-E (parenchymal white matter hyperintensities, sulcal hyperintensities, and gyral swelling) are more common in CAA-ri in comparison with "non-inflammatory" sporadic CAA, suggesting shared mechanisms with Alzheimer's disease immunotherapy and a potential role in improving diagnostic accuracy for CAA-ri. The high prevalence of atrophy and lobar cerebral microbleeds suggests a potential mechanistic role for capillary CAA, Alzheimer's disease, or both, in CAA-ri. Cardiovascular risk factors and other long-term comorbidities may also be relevant to the underlying mechanisms of CAA-ri. ANN NEUROL 2025 ANN NEUROL 2025.

Cognitive function, psychobehavioral symptoms, and MRI features in patients with non-demented Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies.

The diagnosis of Dementia with Lewy Bodies (DLB) is primarily based on clinical features. The main driver of DLB is alpha-synuclein-related pathology, but cerebrovascular disease (CVD) and Alzheimer's Disease (AD) co-pathologies are often found in patients with DLB. Fluid biomarkers and magnetic resonance imaging (MRI) can provide mechanistic and diagnostic information beyond clinical features. Therefore, the aim of this study was to investigate the association of plasma biomarkers (GFAP, NfL, Aβ42/40, pTau231, pTau181) with MRI markers of neurodegeneration and CVD in DLB and in patients with AD as a control group. We also evaluated the ability of biomarkers and clinical features to discriminate between DLB and AD. We included 134 patients from the European DLB consortium (DLB (n = 92) and AD (n = 43)) with plasma biomarkers determined with Simoa and MRI assessed with radiological scales for medial temporal lobe atrophy (MTA), global cortical atrophy scale - frontal subscale (GCA-F), posterior atrophy (PA), and cerebrovascular disease (Fazekas scale). Associations between plasma and MRI biomarkers were assessed with the Mann-Whitney U test, and group differences and the discrimination between DLB and AD were assessed with ANCOVA, Random Forest, and ROC analyses. In DLB, plasma concentrations of GFAP and NfL were associated with MTA, GCA-F, and Fazekas scale; and the Aβ42/40 ratio was associated with PA and Fazekas. Most of these associations were not statistically significant in AD. Individually, plasma and MRI biomarkers had a limited ability to discriminate DLB from AD. Plasma biomarkers helped increase the low specificity of core clinical features from 68% up to 79%, keeping the high sensitivity of 90%. Plasma biomarkers of AD co-pathology, glial processes and unspecific neurodegeneration are associated with MRI biomarkers of atrophy and cerebrovascular disease in DLB patients. Plasma biomarkers increase the ability of core clinical features to discriminate between DLB and AD.

BackgroundPatients with Alzheimer's disease (AD) displayed abnormal retinal morphology; however, its potential associations with clinical symptoms, damage of the blood-brain barrier (BBB), and brain structure are unclear.ObjectiveTo investigate the correlations of retinal morphology with clinical symptoms, BBB damage, and brain structure in AD patients.MethodsIn 97 patients with mild cognitive impairment due to AD (AD-MCI) and dementia due to AD (AD-D), retinal morphology, clinical symptoms, BBB variables in cerebrospinal fluid, and brain structure variables, including medial temporal atrophy (MTA), global cortical atrophy (GCA), and white matter hyperintensities scores were evaluated.ResultsIn AD patients, peripapillary superotemporal retinal nerve fiber layer thickness (NFLT) was positively correlated with memory score; the NFLTs of average, inferior, and inferotemporal quadrants were negatively correlated with the level of matrix metalloproteinase 3 level in cerebrospinal fluid; the NFLTs of average, superior, and inferior quadrants were negatively correlated with MTA and GCA scores; superotemporal NFLT was negatively correlated with GCA score. In AD-MCI group, superotemporal NFLT maintained a positive correlation with memory score; the NFLTs in superior and nasoupper quadrants were negatively associated with GCA score. In AD-D group, superonasal NFLT was negatively correlated with matrix metalloproteinase 9 level in cerebrospinal fluid.ConclusionsIn AD patients, thinner peripapillary NFLT mirrors worse memory, significant BBB damage, the atrophy of medial temporal lobe and cortex. In AD-MCI patients, thinner NFLT mirrors worse memory and cortical atrophy. In AD-D patients, thinner NFLT mirrors significant BBB damage.

Background and PurposeCompare clinical and lab characteristics of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis cases with and without brain atrophy.MethodsAssess cerebral atrophy using median temporal lobe atrophy (MTA) and global cortical atrophy (GCA) scores in 82 anti-NMDAR encephalitis cases.ResultsGCA (+) cases had higher proportions of status epilepticus (p<0.001), memory problems (p=0.031), sepsis (p<0.001), and mechanical ventilation need (p=0.001) than GCA (−) cases. MTA (+) cases had higher memory problems (p<0.001) and sepsis (p=0.002) than MTA (−) cases. GCA (+) and MTA (+) groups had higher max modified Rankin Scale (mRS) (p<0.001, p=0.002) and 1-year mRS (p<0.001, p=0.004) scores than GCA (−) and MTA (−) groups. GCA (+) group had a longer hospital stay and a larger proportion of cases with limited treatment response (both p<0.001) than the GCA (−) group. GCA (p=0.005) was found to be a significant predictive factor for the mRS score 1 year after onset in multiple linear regression analysis.ConclusionsMTA and GCA may be associated with severity and prognosis in anti-NMDAR encephalitis.

Effects of Electroconvulsive Therapy on Brain Structure: A Neuroradiological Investigation Into White Matter Hyperintensities, Atrophy, and Microbleeds.

Early onset parkinsonism caused by F-box only protein7 (FBXO7) pathogenic variants is a rare autosomal recessive disorder presenting with a combination of parkinsonism, pyramidal signs, dystonia, cognitive impairment, and psychiatric features. Although previous case reports have mentioned neuroimaging findings, there is no comprehensive study characterizing the radiological spectrum of FBXO7 pathogenic variants. Ten patients from seven families followed at two tertiary centers in Turkey were included. The cohort included six males and four females with a mean onset age of 21.1 years. Frontal atrophy was the most common MRI finding, followed by global cortical and cerebellar atrophy. One patient showed iron accumulation in the pallidum, and two exhibited severe dopaminergic deficit on DaTSCAN. Pathogenic variants in the FBXO7 gene have been identified in diverse populations over the past 15 years, contributing to a broader understanding of clinical and radiological spectrum. Global cortical atrophy has emerged as the most frequently reported neuroimaging finding in FBXO7-related parkinsonism. FBXO7 pathogenic variants are associated with heterogeneous neuroimaging findings. Frontal and global cortical atrophy are common, while iron deposition and DaTSCAN abnormalities offer additional diagnostic clues. Larger, longitudinal studies are necessary to establish specific imaging biomarkers for FBXO7-related neurodegeneration.

Background: Delirium is a common, underdiagnosed neuropsychiatric syndrome in older adults, associated with high mortality and functional decline. Given its multifactorial nature and overlap with frailty, radiological markers may improve risk stratification in the emergency department (ED). Methods: We conducted a retrospective study on a small sample of 30 patients diagnosed with delirium in the emergency department who had recently undergone brain, thoracic, or abdominal CT scans for unrelated clinical indications. Using post-processing software, we analyzed radiological markers, including coronary artery calcifications (to estimate vascular age), cerebral atrophy (via the Global Cortical Atrophy scale), and cachexia (based on abdominal fat and psoas muscle volumetry). Results: Five domains were identified as significant predictors of 12-month mortality in univariate Cox regression: vascular age, delirium etiology, cerebral atrophy, delirium subtype (hyperactive vs. hypoactive), and cachexia. Based on these domains, we developed an exploratory 10-point delirium score. This score demonstrated acceptable diagnostic accuracy for mortality prediction (sensitivity 0.93, specificity 0.73, positive predictive value 0.77, negative predictive value 0.91) in this limited cohort. Conclusions: While preliminary and based on a small, retrospective sample of 30 patients, this multidimensional approach integrating clinical and radiological data may help improve risk stratification in elderly patients with delirium. Radiological phenotyping, particularly in terms of vascular aging and sarcopenia/cachexia, offers objective insights into patient frailty and could inform more personalized treatment pathways from the ED to safe discharge home, pending further validation.

Aurora (https://aurora-report.com/) is an open-source web application that introduces structured, standardized reporting for neuroimaging, currently focused on dementia and movement disorders. Developed by and for neuroradiologists and radiologists, Aurora provides a stepwise workflow to support evaluation and reporting. It includes validated atrophy scales such as medial temporal lobe atrophy, global cortical atrophy, entorhinal cortex atrophy, and Koedam posterior atrophy, as well as a systematic approach to describing small vessel disease based on STRIVE-2 criteria. Each section offers literature-based guidance and annotated examples for scoring. It generates a structured Aurora Report in English (US) or Portuguese (PT). The platform also features built-in calculators for atrophy and movement disorder metrics, including midbrain and pons measurements, midbrain-to-pons ratio, MR Parkinsonism Index (MRPI), and MRPI 2.0. To our knowledge, it is the first freely available platform to unify standardized reporting and calculation for dementia and movement disorders.ABBREVIATIONS: ARIA = Amyloid-Related Imaging Abnormalities; ERICA = Entorhinal Cortex Atrophy; GCA = Global Cortical Atrophy; MARS = Microbleed Anatomical Rating Scale; MRPI = Magnetic Resonance Parkinsonism Index; MRPI 2.0 = Magnetic Resonance Parkinsonism Index version 2.0; MTA = Medial Temporal Lobe Atrophy; PT = Portuguese (Portugal); STRIVE-2 = Standards for Reporting Vascular Changes on Neuroimaging, version 2; US = English (United States).

Introduction: The usefulness of neuroimaging in patients with first-episode psychosis (FEP) remains controversial. The aim of this study was to assess the prevalence and types of structural abnormalities on neuroimaging in patients with FEP and identify the most frequently used imaging modalities in a real-world setting. Methodology: A retrospective observational study based on a consecutive series of patients admitted to our institution with FEP was conducted. We analyzed the imaging tests performed, the presence of specific lesions, the degree of cortical atrophy (Global Cortical Atrophy, GCA scale), medial temporal atrophy (Medial Temporal lobe Atrophy, MTA scale) and non-specific white matter lesions (Fazekas scale). Descriptive and bivariate analyses were performed according to previously established age cut-offs. Results: A total of 105 patients were included (median age: 36 years; 52.4% men). The most frequently used neuroimaging test was computed tomography (CT) (92.4%). GCA scores that were out of the age range were found in 32.4% of patients, being more frequent in those older than 65 years (p < 0.001). Out-of-range MTA scores were found in 36.2% of patients, especially in patients older than 75 years (p < 0.001). Out-of-range Fazekas scores were found in 4.3% of patients, especially in patients older than 70 years (p = 0.157). Finally, only one specific structural lesion (right frontal cavernoma) was identified in one patient (1%). Overall, at least one non-age-matched abnormality was found in 46.7% of patients. Conclusions: Although non-specific alterations not in accordance with age exist in a significant percentage of patients with FEP, the prevalence of specific lesions is very low. This suggests that neuroimaging tests could be restricted in patients with FEP, especially CT, due to the risks associated with ionizing radiation. However, further prospective and controlled studies are needed to validate our results.

Periodontitis is a chronic inflammatory condition caused by the bacterial infection of the gums that leads to tissue destruction, bone loss and tooth loss. Various risk factors, including smoking, age, diabetes, and obesity, contribute to its development and progression. Recent studies have revealed systemic effects of periodontitis, linking it to diabetes, atherosclerosis, stroke, and dementia. The study aimed to assess the relationship between periodontitis and cerebral atrophy, an indirect marker of brain health. A cross-sectional study was conducted to examine the association between cerebral atrophy and periodontitis. A total of 166 participants were included in the study. All individuals underwent computed tomography (CT) of the head and a full-mouth periodontal assessment to verify if they met the diagnostic criteria for periodontitis. They also underwent a complete neurological examination to rule out dementia. Sixty-four patients (38.6%) had periodontitis, 85 individuals (51.2%) had cerebral atrophy, and 43 patients presented with both conditions. The study sample included 89 females (53.6%), and the median age of the participants was 67 ±10 years. Patients diagnosed with periodontitis showed a higher grade of cerebral atrophy, as measured using the global cortical atrophy (GCA) scale. An independent association was identified between periodontitis and cerebral atrophy (odds ratio (OR): 2.56; 95% confidence interval (CI): 1.29-5.07). Cerebral atrophy, even in the absence of cognitive decline, is significantly associated with periodontitis.

To search for an effective method for early diagnosis of Alzheimer's disease (AD) and mild cognitive impairment (MCI) of amnestic type using scanning laser ophthalmoscopy as a safe and widely available examination method. The study included 45 patients: 20 with AD, 10 with MCI, and 15 healthy control subjects. The patients were examined to visualize amyloid deposition in the retina using a solid lipid food curcumin ligand and a modified scanning laser ophthalmoscope, with a total of 63 observations since not all subjects were eligible for assessment of the retinas of both eyes. All patients underwent a neurological and ophthalmological examination, neuropsychological testing (MMSE, FCSRT, Clock Drawing test), brain MRI for visual assessment of atrophic changes (using global cortical atrophy scales, GCA and the medial temporal lobe atrophy, MTA), as well as confocal scanning laser ophthalmoscopy at two timepoints before and during curcumin administration. A semi-automated calculation of the area increase multiplicity (S) and the number (N) of particles with peak brightness (PPB) was performed. In patients with AD, the following findings were obtained after taking curcumin: NPPB 167% [129; 258] (p=0.1) and SPPB 198% [148; 230] (p=0.007); MCI: NPPB 123% [114; 157] (p=0.15) and SPPB 129% [110; 140] (p=0.08). The results indicate an increased deposition of beta-amyloid protein in the retina in patients with AD and expand the possibilities of its early diagnosis.

BackgroundCerebral small vessel disease (CSVD) is one of the most important causes of cognitive decline. Only a few previous studies have evaluated lung function measures in relation to brain neuropathological changes, and even less studies on specific lesions and areas that could shed light on mechanisms of CSVD.ObjectiveThe aim was to study the association between lung function and CSVD in the general elder population.Methods379 participants, aged 72-87 years from the general population study 'Good Aging in Skåne study (GÅS)'were investigated with a 3 T MRI brain examination and spirometry. Z-scores of FEV1 and FVC were calculated using the GLI 2012 equations. Age-adjusted associations between white matter hyperintensities (WMH), medial temporal lobe atrophy (MTA), lacunar infarction, cerebral atrophies and cerebral microbleeds and lung function were calculated and stratified for sex.ResultsDecreased FEV1 and FVC z-scores below ≤ -1.0 were both associated with increased risk of WMI and global cortical atrophy. Decreased FVC z-scores were also associated with MTA and lacunar infarction in women and precuneus atrophy in men. The associations for WMH, MTA and lacunar infarctions and higher STRIVE score were noted among women, but not among men. FEV1 z scores were not related to diabetes, coronary artery disease or stroke.ConclusionsLower lung function was associated to MRI markers of CSVD in this general healthy population, particularly with WMH, especially for women. Although possible shared risk factors exist between lung and heart disease, lung function should be recognized in future studies on CSVD.

PurposeThe aim of this study was to assess retinal microvascular parameters (RMPs) in Fabry disease (FD) using deep learning, and analyze the correlation with brain lesions related to cerebral small vessel disease (CSVD).MethodsIn this retrospective case control study, fundus images from 27 FD patients and 27 age- and sex-matched healthy subjects were collected. RMPs, encompassing diameter, density, symmetry, bifurcation, and tortuosity, were quantified. Laboratory examination results, Mainz severity score index (MSSI) scores, and a brain magnetic resonance imaging scan for CSVD scores were extracted and their relationships with RMPs was analyzed.ResultsUtilizing artificial intelligence-assisted analysis, compared with controls, FD patients exhibited reduced diameter (p = 0.001 for central retinal artery equivalent, p = 0.049 for central retinal vein equivalent), density (p < 0.001 for vessel area density, p = 0.001 for length density), fractal dimension (p < 0.001), and heightened arteriolar and venular asymmetry ratios (p = 0.002 and p = 0.037, respectively), venular curvature tortuosity (p = 0.037), and simple tortuosity (p = 0.037) in retinal microvascular networks. Gender-based differences in RMPs were observed among FD patients. Furthermore, RMPs were significantly associated with disease markers such as plasma globotriaosylsphingosine and α-galactosidase A activity, as well as MSSI scores. Notably, there was a significant negative correlation between the arteriolar asymmetry ratio and CSVD-related scores (age-related white matter changes: r = − 0.683, p = 0.001; Fazekas: r = − 0.673, p = 0.001; Lacuna: r = − 0.453, p = 0.045; small vessel diseases: r = − 0.721, p = 0.012; global cortical atrophy: r = − 0.582, p = 0.009).ConclusionsFabry disease patients demonstrated increased vascular tortuosity and asymmetry, reduced density and diameter, and a simpler fractal dimension in retinal microvasculature. These microvascular characteristics may serve as preliminary indicators for assessing brain lesions and could represent potential novel biomarkers for CSVD, aiding in the monitoring of FD severity and progression.

Diabetic striatopathy is a rare complication of diabetes mellitus characterised by movement disorders secondary to hyperglycemia. While most commonly associated with chorea and ballism, it may also present with other hyperkinetic manifestations, including, albeit rarely, isolated dystonia and myoclonus. We report a case of a patient with poorly controlled diabetes mellitus who developed acute hand dystonia and action myoclonus, highlighting the broader spectrum of hyperglycemia-induced movement disorders.

PurposeTo determine neurocognitive function (NCF) profiles of patients with lower grade glioma (LGG) eligible to undergo proton radiotherapy (PRT), and how these relate to clinical and radiological characteristics. PRT is offered to those patients for whom sparing of NCF is considered important given their favorable prognosis. To date it is unknown to which extent their NCF profiles are favorable as well.MethodsA consecutive cohort of 151 LGG patients eligible for PRT according to prevailing Dutch criteria, referred between 2018 and 2023, were assessed with standardized neuropsychological tests prior to PRT. Scores were compared to norm-scores. Composite scores were calculated for the total NCF and 6 separate cognitive domains, and profiles were related to tumor location. Clinical and radiological factors characterizing overall NCF impaired patients were investigated, comparing 3 definitions for impairment.ResultsPatients had on average significantly lower NCF than their norm-group, but interindividual variability was large. For 100/151 patients (66.2%), all cognitive domains were intact, whereas 15/151 patients (9.9%) displayed multiple domain impairments. Poorer NCF was related to right-sided LGG laterality, larger PRT target volume, no Wait & Scan policy, worse neurological function and worse radiological indices (Fazekas and global cortical atrophy, respectively). LGG involvement of the left temporal and occipital lobes was associated with, respectively, lower verbal memory and processing speed.ConclusionPrior to PRT, the majority of selected LGG patients display favorable NCF profiles. However, a subgroup showed NCF impairments, with multiple relevant clinical and radiological covariates.

Post-stroke-delirium has been linked to worse outcome in patients with acute cerebrovascular disease; identification of individuals at risk may prevent delirium and thereby improve outcome. We investigate prognosis and factors associated with post-stroke-delirium in patients with large vessel occlusion (LVO) ischemic stroke treated by mechanical thrombectomy (MT). 747 patients (53.4% female) prospectively enrolled in the Gutenberg-Stroke-Study from May 2018-November 2022 were analyzed with regard to diagnosis of delirium. Group comparison of patient-, stroke- and treatment characteristics as well as computed tomography(CT)-imaging based parameters of cerebral atrophy (global cortical atrophy [GCA], posterior atrophy [Koedam], medial temporal lobe atrophy [MTA] scores) and white matter lesions (Fazekas score) was conducted. Independent predictors of delirium and the association of delirium with functional outcome at 90-day follow-up was investigated by multiple logistic regression analyses. We report 8.2% of patients (61/747) developing delirium following MT of LVO. Independent predictors were older age (aOR[95%CI] per year: 1.034[1.005-1.065], p = 0.023), male sex (aOR[95%CI]: 2.173[1.182-3.994], p = 0.012), general anesthesia during MT (aOR[95%CI]: 2.455[1.385-4.352], p = 0.002), infectious complications (aOR[95%CI]: 1.845[1.031-3.305], p = 0.039), "other determined" etiology of stroke (aOR[95%CI]: 2.424[1.100-5.345], p = 0.028), and a MTA score exceeding age-specific cut-offs (aOR[95%CI]: 2.126[1.065-4.244], p = 0.033). Delirium was independently associated with worse functional outcome (aOR[95%CI]: 2.902[1.005-8.383], p = 0.049) at 90-day follow-up. Delirium is independently associated with worse functional outcome after MT of LVO, stressing the importance of screening and preventive measures. Besides conventional risk factors, pathological MTA scores and use of general anesthesia during MT may be easy-to-apply criteria to identify individuals at risk of delirium and implement prevention strategies.

Current guidelines have not recommended an upper age limit for endovascular thrombectomy (EVT) in patients with large vessel occlusion (LVO) stroke. However, elder age links to an increased risk of poor outcome. This study aimed to investigate the efficacy of EVT in elderly versus non-elderly patients and determine the respective factors of poor outcome. Three hundred and two consecutive patients with LVO-stroke who underwent EVT were included, and we used sensitivity analysis with restricted cubic spline to define 75 years as the inflexion point. Participants were thus dichotomized into elderly (≥75 years) and non-elderly (<75 years) groups. Brain frailty on neuroimaging was evaluated using the global cortical atrophy (GCA) scale and the Fazekas scale for white matter lesions (WML). The primary outcome was 3-month functional outcome, and the secondary outcomes were EVT efficacy and safety. Elderly patients had significantly higher incidences of hypertension, diabetes mellitus, atrial fibrillation, and more severe GCA and WML. The rate of good outcome in elderly patients was 32%, significantly lower than non-elderly patients (54%, p<0.001). There was no difference in terms of reperfusion (89% vs 93%, p=0.363) and intracranial hemorrhage (38% vs 41%, p=0.826) between two groups. In elderly patients, high degree of GCA (OR 1.15, 95% CI 1.02-1.30, p=0.012) and moderate/severe WML (OR 5.88, 95% CI 1.47-23.50, p=0.015) independently predicted 3-month poor outcomes. GCA and WML play pivotal roles for the functional outcomes in elderly patients undergoing EVT for LVO-stroke, providing valuable and practical information for early prediction of long-term prognosis.

ABSTRACT Background: One of the most common and significant issues associated with alcohol consumption is its consequences, and one of the organs most affected is the brain. Numerous chronic drinkers in their fifth and sixth decades have demonstrated cortical atrophy in radiological examinations; nevertheless, there is little study in the young age range. Aim: To assess the degree of cortical atrophy in young male adults with alcohol dependence compared to those who have no history of alcohol consumption and its correlation with the severity of alcohol dependence. Materials and Methods: This cross-sectional study included a purposive sampling of 30 patients aged 18–45 years, fulfilling the diagnostic criteria of alcohol-dependence syndrome, and having no prior history of brain damage-causing substances other than alcohol. An equal number of age- and sex-matched control subjects were taken who did not have any history of alcohol consumption. Computed tomography (CT) scans were done for both groups. Alcohol Use Disorders Identification Test C (AUDIT-C), Severity of Alcohol Dependence Questionnaire (SADQ), and Global Cortical Atrophy (GCA) scale were applied to measure alcohol dependence and its severity and the degree of cortical atrophy. Results: All 30 male patients who fulfilled the criteria of alcohol dependence showed significant cortical atrophy in CT scans as compared to control subjects. Out of the 30 alcohol-dependence patients, 4 had only frontal lobe atrophy, while 26 patients had diffuse cortical atrophy, among which 19 patients showed frontal lobe predominance. The degree of atrophy and the severity of alcohol dependency also showed a strong association. Conclusion: There is a persistent pattern of neuroradiological evidence of diffuse cortical atrophy with frontal predominance in young people having alcohol dependence with a mean total duration of alcohol consumption of around 21 ± 5.5 years as compared to those who have no history of alcohol consumption.