News & Views in 2023

Using integrative multiomics, a new study has shed light on the aetiology of ischaemic stroke. By probing the mechanisms underlying stroke, such approaches could aid the development of therapies and improve risk prediction and stratification, with the ultimate aim of developing personalized preventive and therapeutic strategies.

A new study indicates that African American people with multiple sclerosis have higher markers of humoral disease pathology than white people with multiple sclerosis. However, apparent differences in pathophysiology between ethnic groups cannot be fully interpreted without more comprehensive studies that examine the effects of social inequality on disease.

New guidelines for designing controlled clinical trials for idiopathic intracranial hypertension (IIH) have been published. The design of such trials remains a challenge, as the heterogeneity of IIH necessitates different outcome measures for specific clinical presentations.

The underlying cause of sporadic Alzheimer disease (AD) remains enigmatic, but an increased risk among spouses of people with AD has led to speculation of transmissibility. A mouse study now suggests that the transfer of microbiota could underlie this potential transmissibility, but the findings leave many questions unanswered.

A new study indicates that although men and women are equally likely to experience cognitive impairment after acute ischaemic stroke, there are sex differences in particular cognitive domains. Whether these differences are directly linked to biological sex is uncertain, as many factors, including age and pre-stroke factors, could contribute to cognitive outcomes.

The TRACK-TBI LONG study has shown that outcomes are highly variable in the 7 years after traumatic brain injury (TBI). Although many patients remain stable, almost one-third experience declines in cognitive, psychiatric and functional state. These findings suggest that TBI is a chronic disease and that its management should change accordingly.

Two recent studies leverage the same French population-based disease registry to describe real-world medication prescription patterns, patient characteristics and treatment effectiveness in people with schizophrenia. These studies also identify disparities in the health care and outcomes of these individuals compared with those of the general population.

Results from the phase III trials of the amyloid-targeting antibodies donanemab and solanezumab add further evidence that amyloid pathology is a key driver of cognitive decline in Alzheimer disease. The mixed results highlight important considerations for future trials and clinical practice.

Two studies have confirmed previous observations that an inverse relationship exists between chronological age and focal white-matter inflammatory activity in individuals with multiple sclerosis, which could underlie the relative ineffectiveness of traditional disease-modifying therapies in older individuals.

The European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) and European Academy of Neurology (EAN) joint consensus statement on vaccination in people with multiple sclerosis provides highly relevant clinical guidance on immunization strategies in today’s era of effective immunotherapies. Nevertheless, several open questions remain to be addressed.

New biologics are rapidly opening up target-specific therapeutic opportunities for myasthenia gravis (MG) — an autoimmune disease caused by antibodies against neuromuscular junction proteins. Two recent trials have now demonstrated the efficacy and tolerability of the complement C5 inhibitor zilucoplan and the FcRn inhibitor rozanolixizumab in patients with generalized MG.

A new study using the UK Biobank database has shown that people with epilepsy are at an increased risk of developing dementia. The results demonstrate that this risk is multiplied in individuals who also have high cardiovascular risk, highlighting the importance of addressing modifiable cardiovascular risk factors.

A new study examining trends in postmortem neuropathology results over the past 25 years provides important insights into secular trends in dementia risk. The results suggest that improvements in both cardiovascular health and cognitive reserve underlie the reduced risk.

A study of more than 350,000 individuals has shown that multisite chronic pain is strongly correlated with elevated risk of dementia, decreased cognitive function and reduced hippocampal volume. Further study of these relationships and their potential underlying mechanisms is required and could inform the development of interventions to prevent or slow dementia.

Results from a phase III trial have set zavegepant as the first intranasal gepant to be approved by the FDA for the acute treatment of migraine. The therapeutic benefits were modest, however, and more work is needed to address unmet treatment needs.

An artificial intelligence-based tool can turn low-resolution clinical MRI scans into high-resolution 3D objects suitable for research studies. The new approach opens up the possibility of secondary analysis of large clinical MRI datasets to answer disease-relevant questions, although further work to automate scan annotation will be required.

A new study, drawing on data from national biobanks, adds to the growing evidence that exposure to common viral pathogens increases the risk of Alzheimer disease and other neurodegenerative diseases. These findings might provide insights into the initiating factors that lead to neurodegeneration.

Findings from a worldwide cohort of cognitively unimpaired individuals demonstrate that the presence of two canonical Alzheimer disease biomarkers — amyloid and tau — can reliably predict progression to mild cognitive impairment in the short-term. The results support the use of these biomarkers to diagnose preclinical Alzheimer disease in a clinical setting.

The phase III Clarity AD clinical trial of lecanemab, an amyloid-targeting antibody, showed a small clinical benefit in people with Alzheimer disease. However, several questions remain regarding the true clinical relevance, safety and accessibility of lecanemab in this patient population.

The results of the first randomized, placebo-controlled trial of dimethyl fumarate in a cohort of participants with radiologically isolated syndrome showed efficacy against the risk of a first clinical demyelinating event. The findings pave the way for preventive medicine in multiple sclerosis and highlight the need for more precise prognostication of risk.