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Mission Statement: The mission of JAMA Neurology is to publish and disseminate scientific information primarily important for physicians caring for people with neurologic disorders and for those interested in the structure and function of the normal and diseased human nervous system. The specific aims are to (1) publish timely original research, including clinical trials that will directly improve clinical neurologic care and that will inform efforts to improve neurological health and promote health care equity; (2) report translational research that is pertinent to the understanding of neurologic disease; (3) address topics of practice, ethics, education, and public health that are a key part of modern medicine; and (4) provide a forum for discussion and publication of important topics including bias, racism, and diversity. This information will be published only after extensive review by scientific peers and journal editors so that clarity, rigor, originality, and precision are ensured.
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This secondary analysis of the MR CLEAN-LATE randomized clinical trial studies the interaction between computed tomography perfusion imaging parameters and endovascular treatment with functional outcomes in patients in the late window after stroke selected based on collateral flow.
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This randomized clinical trial investigates if treatment with fremanezumab compared with placebo leads to improvements in migraine and depressive symptoms in patients with migraine and comorbid major depressive disorder.
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This cross-sectional study examines registry data for patients with dementia to gauge the prevalence of Alzheimer disease–related biomarkers and their contribution to progression in other dementias.
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The SECA randomized clinical trial assesses the risk of recurrence of chronic subdural hematoma (cSDH) and cardiovascular events in patients undergoing surgical treatment for cSDH with continuous vs discontinuous low-dose acetylsalicylic acid treatment.
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Nearly one-third of patients with intracerebral hemorrhage (ICH) have acute punctate infarcts on the diffusion-weighted imaging (DWI) sequence of magnetic resonance imaging (MRI) scans in the first week after symptom onset. These DWI lesions portend poor long-term prognoses and are independently associated with 2-fold higher odds of major disability or death. From a mechanistic standpoint, underlying cerebral small-vessel disease is purported to cause DWI lesions. Whether intensive blood pressure (BP) lowering contributes to these lesions is highly contested. Several prior studies have shown a significant relationship between the magnitude of BP reduction in the first 24 hours and the occurrence of DWI lesions. In contrast, a pooled, individual patient–level meta-analysis of 1750 patients showed that admission BP, and not change in BP, was independently associated with DWI lesions. More recently, intensive systolic BP (SBP) control did not result in DWI lesions compared with liberal SBP management in a post hoc analysis of the INTERACT2 trial (Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial). Additionally, in the ICHADAPT trial (Intracerebral Hemorrhage Acutely Decreasing Arterial Pressure Trial), intensive (SBP <150 mm Hg) vs liberal (SBP <180 mm Hg) BP control did not lead to significant reduction in blood flow in the perihematomal or watershed border zones in patients with an acute ICH, indicating that acute BP reduction does not result in ischemia in these patients. Given these conflicting findings, the role of BP management after acute ICH, particularly in the context of incident DWI lesions, remains poorly understood.
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To the Editor In a Special Communication, the International Working Group (IWG) advocated for Alzheimer disease (AD) diagnosis based on both positive biomarkers and objective cognitive impairment. This position stood in contrast to that of the Alzheimer Association (AA) workgroup, which proposed permitting AD diagnoses based solely on biological criteria. In response, Petersen and colleagues emphasized that both groups agree on the biological underpinnings of AD but disagree on the naming conventions for patients who are biomarker positive in the absence of clinical symptoms. Underlying this debate is an assumption that we can accurately differentiate between patients with and without cognitive impairment. Neither the AA nor the IWG criteria provided practical recommendations for conducting such clinical staging. As neuropsychologists, we aim to emphasize the critical need for appropriate use criteria, including updated guidance on neuropsychological methods for AD clinical staging, alongside biomarker staging recommendations.
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To the Editor In 2024, an Alzheimer Association (AA) workgroup published revised criteria for diagnosis and staging of Alzheimer disease (AD), which were recently critiqued by the International Working Group (IWG). An objective comparison of the AA and IWG criteria reveals far more similarities than differences.
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In Reply We agree with Jack et al in their assessment of common elements between the Alzheimer Association and International Working Group (IWG) criteria in Alzheimer disease (AD) diagnosis in symptomatic patients with clinical phenotypes and positive biomarkers of Alzheimer pathology (BAP). However, IWG diverges and does not recommend the diagnosis of AD in persons who are asymptomatic with positive BAP, given that the majority of such persons will not express clinical symptoms in their lifetime. The difference is essential since this scenario will become more important in the future as blood-based biomarkers arrive in clinical care. The IWG requirement of both clinical and biological evidence for diagnosis spares the significant potential for negative impact of diagnosis for people who may never experience disease symptoms and yet will face the attendant problems and stigma of diagnosis.
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This multicenter, randomized clinical trial examines whether systolic blood pressure reduction increases the incidence of lesions detected with diffusion-weighted imaging in adult patients with acute intracerebral hemorrhage.
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This essay describes a physician’s frustration with insurance company denial of patient medication and treatment.
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In the Research Letter titled “Status Epilepticus Identification and Treatment Among Emergency Medical Services Agencies,” which was published online on June 3, 2024, and in the July 2024 issue, there was an error in the first sentence of the Introduction. The first sentence should be “Seizures and status epilepticus (SE) constitute approximately 3% of emergency medical services (EMS) evaluations, carrying substantial morbidity and mortality.” This article has been corrected online.
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In the Original Investigation titled “Directly Isolated Allogeneic Virus–Specific T Cells in Progressive Multifocal Leukoencephalopathy,” published online October 7, 2024, and in the November 2024 issue, one of the affiliations for author Britta Eiz-Vesper, PhD, was incorrect. Affiliation 3 was changed to affiliation 4, Institute of Transfusion Medicine and Transplant Engineering, Hannover Medical School, Hannover, Germany. This article was corrected online.
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This case report discusses a man who tested positive for IgLON5-IgG antibody after intermittent episodes of paresthetic feeling involving the throat and jaw, associated with subtle dysarthria and dysphagia, and upper-extremity paresthesia with piloerection of the forearms.
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This cohort study investigates the risk of and risk factors for poststroke epilepsy at a young age and validates current risk scores for poststroke epilepsy among adults younger than 50 years.
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This cohort study compares definitions of progression independent of relapse activity by analyzing data from the MSBase registry to quantify its incidence and persistence and then proposes a standard definition for use in multiple sclerosis clinical trials, registries, and cohorts.
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This cohort study uses Ontario health administrative data to assess the association between cannabis-related acute care encounters and dementia diagnosis.
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This study attempts to investigate factors associated with late-onset epilepsy in people with cognitive decline.
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This case report describes a 61-year-old man with myasthenia gravis initially diagnosed with blepharospasm who was later found to have the nonparalytic disorder apraxia of eyelid opening.
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This Viewpoint discusses the potential benefits and drawbacks of a biological, rather than clinical, framework for the diagnosis of Alzheimer disease.
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This Viewpoint advocates for the expansion of clinical research in amyotrophic lateral sclerosis through the development of a well-organized network of centers and community-based clinics.
