DOI: 10.3897/jbcr.e183988

Authors: Guilherme Linha Secco, Lucas Ribas Lachman, Leticia Alves de Oliveira, Maisa Baldinu Caramujo, Lunna Giovanna Gonçalves Campos, Alana Barroso de Carvalho, Giovanna Moreira Nascimento de Castro, Fábio Henrique Malinoski, Caroline de Oliveira Christoff, Mateus Cordeiro Merlim da Silva

Abstract: Background: Alzheimer’s disease (AD) is the leading cause of dementia worldwide, with prominent hippocampal and medial temporal lobe atrophy. Limbic-predominant (LP) AD has been proposed as a distinct subtype, but distinctions from typical AD remain unclear. This systematic review evaluates clinical, radiological, and immunohistological differences between LP and typical AD. Methods: Following PRISMA guidelines, PubMed, Embase, and Web of Science were searched. Data on baseline characteristics, clinical, radiological, and immunohistological features were extracted. Screening was performed with Rayyan.ai, and study quality was assessed using the Newcastle–Ottawa Scale. Results: From 211 articles, 21 studies were included, totaling 11,315 patients: 1,178 (15.7%) LP, 4,159 (36.7%) typical AD, and 5,378 (47.6%) other presentations. Weighted averages: education 24.31 years (LP) vs. 17.15 years (AD); age at onset 77.36 years (LP) vs. 72.33 years (AD); disease duration 8.43 years (LP) vs. 8.95 years (AD). Clinical presentations were similar, with cognitive impairment and memory deficits predominant. MRI and FDG-PET revealed lower hippocampal volume and higher metabolism in LP. Tau-PET showed lower R2 relaxation in parietal, cingulate, and cuneus regions and elevated hippocampal neurofibrillary tangles. Immunohistology revealed higher hippocampal tau burden and more TDP-43 inclusions in LP compared to typical AD. Conclusion: LP and typical AD exhibit notable radiological and immunohistological differences, though clinical presentations overlap. Current evidence cannot definitively classify LP as a distinct subtype or separate disease. Further studies are required to clarify these distinctions.

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DOI: 10.3897/jbcr.e132202

Authors: Georgi Dimitrov, Maya Danovska, Eleonora Mineva-Dimitrova

Abstract: The objective of our study was to compare the age-related differences in the prevalence of modifiable risk factors (RF), stroke subtype and functional outcome at hospital discharge in young and middle-aged patients with first-ever ischemic stroke (IS). The study included 120 patients with acute first-ever IS, aged 18–59 years, admitted to the Neurology Clinic of Dr. Georgi Stranski University Hospital, Pleven. Of these, 41 (34.2%) were in the young-age group and 79 (65.8%) were middle-aged. The middle-aged patients had higher rates of arterial hypertension (81.0%), diabetes mellitus (45.6%), dyslipidemia (83.5%), low levels of HDL cholesterol (68.4%), high levels of LDL cholesterol (72.2%) and arterial fibrillation (7.6%). The most common subtype of IS in middle-aged patients was large artery atherosclerosis (40.5%), small vessel occlusion (29.1%) and cardioembolism (6.3%). In comparison, we found a higher incidence of IS in the young patients with other determined (34.1%) and undetermined aetiology (34.1%). Our data on functional outcomes at hospital discharge confirm age-related differences in the prevalence of modifiable RFs and stroke subtype in young and middle-aged patients with first-ever IS. These findings highlight the need to develop specific therapeutic approaches for early identification and effective control of health- and lifestyle-related RFs to reduce the incidence of the most common subtypes of IS.

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