Neurología

Relative impact of multidomain lifestyle interventions on deficit accumulation frailty over 24 months in the U.S. POINTER trial

2026-05-01T00:00:00Z

Relative impact of multidomain lifestyle interventions on deficit accumulation frailty over 24 months in the U.S. POINTER trial Espeland, Mark A.; Olson, Kay Loni; Tangney, Christy C.; Gitelman, Darren R.; Cleveland, Maryjo L.; Thro, Amber A.; Demesie, Yitbarek N.; Snyder, Heather M.; Whitmer, Rachel A.; Desai, Pankaja; Alam, Rifat; Crivelli, Lucía; Holland, Thomas M.; Preissle, Olivia; Raman, Rema; York, Michele K.; Baker, Laura; U.S. POINTER Study Group Background: Multidomain lifestyle interventions hold promise as approaches to slow aging. Deficit accumulation frailty indices (FIs) are increasingly used to capture aging processes. Frailty is highly associated with increased mortality and chronic disease risk, but the degree to which multidomain lifestyle changes impact frailty is not clear. Methods: The U.S. Study to Protect Brain Health through Lifestyle Intervention to Reduce Risk (U.S. POINTER) was a 2-year randomized clinical trial to compare two multidomain lifestyle interventions designed to increase exercise, improve diet, and promote social and cognitive stimulating activities and health monitoring. The Structured intervention incorporated greater structure, intensity, and accountability than the Self-Guided intervention. A modified FI (mFI) was developed from data collected at baseline, 12, and 24 months. Results: The trial enrolled 2111 adults (ages 60-79 years) who were at increased risk for accelerated cognitive decline. At 24 months, the mean (standard error) changes from baseline of a 31-component mFI were -0.009 (0.002) for Self-Guided and -0.024 (0.002) for Structured participants, a difference averaging -0.014 [-0.019, -0.008] (P < .0001). Group differences were similar across subgroups based on age, sex, body mass index, diabetes, and baseline mFI. Changes in mFI did not account for the relative cognitive benefits provided by the Structured intervention compared to the Self-Guided intervention. Conclusions: Multidomain lifestyle interventions may decrease frailty and slow aging processes with greater structure and intensity, resulting in greater benefits.

Delphi consensus guidelines for the use of striatal dopaminergic imaging and cardiac metaiodobenzylguanidine (MIBG) scintigraphy for the diagnosis of dementia and mild cognitive impairment with Lewy bodies

2026-03-04T00:00:00Z

Delphi consensus guidelines for the use of striatal dopaminergic imaging and cardiac metaiodobenzylguanidine (MIBG) scintigraphy for the diagnosis of dementia and mild cognitive impairment with Lewy bodies Donaghy, Paul C.; Greenfinch, Gemma; Petrides, George; Kane, Joseph; Verberne, Hein J.; Taylor, John-Paul; O'Brien, John T.; Thomas, Alan J.; DLB Indicative Imaging Biomarker Study Group Introduction: The aim of this Delphi process was to develop consensus guidelines to support the effective use of striatal dopaminergic imaging and cardiac metaiodobenzylguanidine (MIBG) scintigraphy in the diagnosis of dementia with Lewy bodies and mild cognitive impairment with Lewy bodies. Methods: A Delphi consensus panel of 37 international experts independently indicated their agreement or disagreement with statements on indications for the use of these biomarkers and clinical situations in which each biomarker should and should not be used. Statements were accepted if they reached > 80% agreement. Results: Overall, 36/70 statements (51%) were accepted in Round 1, and 19/37 (51%) were accepted in Round 2. Discussion: The Delphi consensus process has developed freely available guidelines outlining clinical situations in which striatal dopaminergic imaging and cardiac MIBG scintigraphy may be useful and considerations for their use, including the effect of specific comorbidities and medications on each of the biomarkers.

Chapter 21 - Role of cerebellum in Parkinson's disease symptoms

2025-12-11T00:00:00Z

Chapter 21 - Role of cerebellum in Parkinson's disease symptoms Varani, Andrés Pablo; Bagliani, María Camila; Rossi, Malco Damián Parkinson's disease is characterized by a variety of motor and non-motor symptoms that arise from different regions of the central nervous system. Growing evidence indicates that pathological alterations in Parkinson's disease extend beyond the basal ganglia to other areas of the brain, such as the cerebellum, even though the nigro-striatal system is primarily affected. It is now recognized that the cerebellum plays a significant role in cognition, sleep, and emotion in addition to its primary function in motor control. Clinical, pathological, neurophysiological, structural, and functional neuroimaging data have been gathered over the last 10 years, and these findings unequivocally demonstrate a connection between Parkinson's disease and the cerebellum. The involvement of the cerebellum in the pathophysiology and clinical features of Parkinson's disease is summarized and updated in this chapter.

Persistent post‑craniotomy headache: a narrative review

2025-12-31T00:00:00Z

Persistent post‑craniotomy headache: a narrative review Alarcon-Ruiz, Christoper A.; Goicochea, María Teresa Persistent post-craniotomy headache (PPCH) is a frequent yet underrecognized complication of cranial surgery, often leading to long-term disability and impaired quality of life. Defined as a headache developing within seven days of craniotomy and lasting more than three months, the true PPCH prevalence and incidence remains unclear and varied widely across studies and time windows. Despite its prevalence, the condition remains poorly understood, and standardized diagnostic and therapeutic protocols are lacking. Review PPCH arises from multifactorial mechanisms, including direct nerve injury, muscle adhesion to the dura mater, aseptic inflammation, and central sensitization. Five main phenotypes can be identified: scar-related neuropathic pain, occipital neuralgia–like headache, diffuse tension-type pattern, migraine-like phenotype, and mixed presentations. Risk factors include posterior fossa and suboccipital surgeries, pre-existing migraine, female sex, inadequate perioperative analgesia, and psychological comorbidities such as anxiety or depression. Evaluation must rule out secondary causes through clinical examination and selective imaging. Treatment should follow a multimodal, phenotype-driven approach combining pharmacologic agents with interventional procedures such as peripheral nerve blocks or scar-targeted botulinum toxin A injections. Surgery is reserved for refractory, well-defined cases involving neuromas or hardware irritation. Conclusions PPCH represents a complex chronic secondary headache condition that demands systematic identification and personalized, stepwise management. However, evidence remains limited, and prospective multicenter studies with standardized definitions and outcomes are urgently needed to improve prognosis and quality of life for affected patients.