Neurology

Deep-learning plasma proteomics model enables simultaneous probabilistic diagnosis of six dementia-related conditions

ProtAIDe-Dx uses plasma proteomics from 17,187 patients and controls to deliver probabilistic diagnoses for six dementia-associated conditions from one blood draw. Cross-validated balanced accuracy ranged from 70–95%, with AUC values above 78% across all conditions, suggesting clinically meaningful discrimination. Probabilistic outputs identified patient subgroups with co-pathologies and correlated with pathology-specific biomarkers even in cognitively unimpaired individuals. Interpretable protein networks revealed shared and disease-specific biology, and protein drivers of individual-level diagnostic decisions in a memory-clinic cohort. These data support plasma proteomics plus AI as a scalable adjunct to current dementia workups, pending external clinical validation and standardization. 1

Initial high-efficacy DMTs in relapsing MS lower relapse-associated worsening but not relapse-independent progression

This Swedish registry study followed 2,563 DMT-naïve relapsing-onset MS patients starting platform versus high-efficacy therapies from 2005–2019. High-efficacy DMTs reduced relapse-associated worsening compared with platform therapy (HR 0.60, 95% CI 0.38–0.92). There was no difference in progression independent of relapse activity (HR 1.05, 95% CI 0.79–1.39), implying limited impact on noninflammatory progression. Risks of reaching EDSS 3 and 4 were substantially lower with high-efficacy DMTs, and EDSS trajectories rose more steeply on platform agents. These findings support early high-efficacy treatment to limit relapse-driven disability, while highlighting unmet need for neuroprotective strategies. 2

Intensive blood pressure lowering improves outcomes after ICH, mainly in small-to-moderate hematoma volumes

This pooled analysis of INTERACT and ATACH-2 trials included 6,125 ICH patients with baseline hematoma volume data. Intensive blood pressure lowering improved functional recovery (OR for unfavorable mRS shift 0.90, 95% CI 0.82–0.99). Among 3,897 patients with hematoma expansion data, intensive treatment reduced both absolute and relative hematoma growth (OR 0.88 for each). Treatment benefit showed U-shaped modification by hematoma volume, with greatest benefit around 20 ml and volumes roughly 7–30 ml. These data support early intensive blood pressure lowering in ICH while emphasizing careful selection by initial hematoma size. 3

In large-core anterior circulation stroke, thrombectomy increases cerebral edema and midline shift

This prespecified SELECT2 secondary analysis examined cerebral edema among 342 large-core anterior circulation stroke patients randomized to EVT or medical therapy. Median maximum midline shift within 7 days was greater after EVT than medical management, and EVT independently increased shift after adjustment. Greater midline shift was associated with early neurological worsening and reduced odds of functional improvement at 90 days. Mediation analysis suggested cerebral edema attenuated EVT’s functional benefit by about 10.6%, despite net overall treatment advantage. Clinicians should anticipate more edema after EVT in large-core infarcts and intensify early imaging, monitoring, and individualized edema management. 4