Genetic Risk for Alzheimer Disease and Plasma Tau Are Associated With Accelerated Parietal Cortex Thickness Change in Middle-Aged Adults
Plasma tau, particularly when combined with genetic stratification for AD risk, can be a useful indicator of brain change in midlife.
KEY FINDINGS: Plasma tau, particularly when combined with genetic stratification for AD risk, can be a useful indicator of brain change in midlife. Accelerated inferior parietal cortex changes in midlife may be an important factor to consider as a marker of AD-related brain alterations.
BACKGROUND: Neuroimaging and biomarker studies in Alzheimer disease (AD) have shown well-characterized patterns of cortical thinning and altered biomarker concentrations of tau and ß-amyloid (A ß). However, earlier identification of AD has great potential to advance clinical care and determine candidates for drug trials. The extent to which AD risk markers relate to cortical thinning patterns in midlife is unknown. The first objective of this study was to examine cortical thickness change associated with genetic risk for AD among middle-aged military veterans. The second objective was to determine the relationship between plasma tau and A ß and change in brain cortical thickness among veterans stratified by genetic risk for AD.
DETAILS: Participants consisted of post-9/11 veterans (N = 155) who were consecutively enrolled in the Translational Research Center for TBI and Stress Disorders prospective longitudinal cohort and were assessed for mild traumatic brain injury (TBI) and posttraumatic disorder (PTSD). Genome-wide polygenic risk scores (PRSs) for AD were calculated using summary results from the International Genomics of Alzheimer's Disease Project. T-tau and A ß40 and A ß42 plasma assays were run using Simoa technology. Whole-brain MRI cortical thickness change estimates were obtained using the longitudinal stream of FreeSurfer. Follow-up moderation analyses examined the AD PRS × plasma interaction on change in cortical thickness in AD-vulnerable regions. Higher AD PRS, signifying greater genetic risk for AD, was associated with accelerated cortical thickness change in a right hemisphere inferior parietal cortex cluster that included the supramarginal gyrus, angular gyrus, and intraparietal sulcus. Higher tau, but not A ß42/40 ratio, was associated with greater cortical thickness change among those with higher AD PRS. Mild TBI and PTSD were not associated with cortical thickness change.
Our Most Popular Resources
Copyright © American Academy of Neurology. All Rights Reserved.
Source: Hayes, J. P., Pierce, M. E., Brown, E., et al. (2023). Genetic Risk for Alzheimer Disease and Plasma Tau Are Associated With Accelerated Parietal Cortex Thickness Change in Middle-Aged Adults. Neuro Genetics. 2023; 9(1): e200053. Published: February, 2023. DOI: 10.1212/NXG.0000000000200053.
Depressive Symptoms Associated With Cognitive Impairment in Cerebral Amyloid Angiopathy
A study of 168 adults found that patients with cerebral amyloid angiopathy had substantially more depressive symptoms and poorer cognitive performance than cognitively normal controls. Possible depression was associated with impairment in episodic memory, executive function, and processing speed, and partially mediated the relationship between CAA and cognition. Greater depressive symptoms were also associated with MRI markers of cortical and small-vessel brain injury.
KEY FINDINGS: People with CAA in this study had substantially more depressive symptoms and poorer cognitive performance than cognitively normal controls. Depressive symptoms explained a small but significant portion of the association between CAA and impairment in episodic memory and executive function, suggesting that mood symptoms may contribute to cognitive difficulties in CAA. Greater depressive symptom severity was also associated with MRI markers of cortical and small-vessel brain injury. Because the study was cross-sectional, the findings do not establish whether CAA-related brain injury causes depression or whether depressive symptoms contribute to subsequent cognitive decline.
BACKGROUND: Cerebral amyloid angiopathy (CAA), a small-vessel disease characterized by β-amyloid deposition in cerebral vessel walls, is associated with cognitive impairment and dementia. Depression can independently affect memory and executive function, but the relationship between depressive symptoms, CAA-related brain injury, and cognition has been less clearly defined. This study examined whether depressive symptoms were associated with cognitive performance in people with CAA and whether depression helped explain the relationship between CAA and cognitive impairment.
DETAILS: Researchers analyzed baseline data from a prospective longitudinal cohort recruited through memory and stroke-prevention clinics at two Canadian centers. The analysis included adults aged ≥55 years with probable CAA and cognitively normal controls. Cognitive performance was evaluated across episodic memory, executive function, and processing speed, while depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). A score ≥5 was classified as "possible depression." The primary analysis included 168 participants: 85 with CAA and 83 cognitively normal controls. The mean age was 73.5 years among participants with CAA and 68.8 years among controls. Additional analyses exam-ined relationships between depressive symptoms and CAA-related MRI markers in 81 participants with CAA.
Our Most Popular Resources
Participants with CAA had substantially higher odds of possible depression than controls, with an odds ratio of 15.71 (95% CI, 4.26-80.05; P<0.001). Their GDS-15 scores were also 2.71 times higher than those of controls (95% CI, 2.10-3.51; P<0.001). Possible depression was associated with poorer performance across all three cognitive domains. After adjustment for age, sex, and education, associations were observed for episodic memory (β=-1.03; 95% CI, -1.53 to -0.53; P<0.001), executive function (β=-1.11; 95% CI, -1.65 to -0.58; P<0.001), and processing speed (β=-0.73; 95% CI, -1.24 to -0.21; P=0.006). Mediation analysis suggested that depressive symptoms accounted for 11% of the association between CAA and episodic memory and 9% of the association between CAA and executive function. No significant mediation was observed for processing speed, where depression accounted for approximately 2% of the association.
Among participants with CAA, greater depressive symptom severity was also associated with lower mean cortical thickness, cortical superficial siderosis, and a higher CAA-related small-vessel disease burden. Specifically, the count ratio was 1.33 (95% CI, 1.09-1.62; P=0.005) per SD decrease in cortical thickness, 2.04 (95% CI, 1.35-3.09; P<0.001) for cortical superficial siderosis, and 1.16 (95% CI, 1.00-1.35; P=0.047) for higher CAA small-vessel disease score.
Copyright © Skyscape. All rights reserved.
Source: Nukala, N., Muir, R. T., Beaudin, A. E., et al. Associations Between Cerebral Amyloid Angiopathy, Cognitive Impairment, and Depressive Symptoms. Neurology. 2026; 107(5): e218354. Published: September, 2026. DOI: 10.1212/WNL.0000000000218354.
Neovascular Glaucoma Associated With Increased Long-Term Mortality and Systemic Morbidity
A large TriNetX cohort study found that neovascular glaucoma was associated with increased long-term risks of mortality and systemic complications beyond underlying retinal vascular disease. At 10 years, NVG in patients with proliferative diabetic retinopathy was associated with higher mortality and end-stage renal disease, while NVG in patients with central retinal vein occlusion was associated with higher mortality and stroke risk. The findings highlight the potential value of coordinated ophthalmic and systemic care when NVG develops.
KEY FINDINGS: The development of NVG was associated with additional long-term systemic morbidity and mortality beyond the underlying PDR or CRVO in this large retrospective cohort. The strongest associations included mortality and ESRD among patients with PDR and mortality and stroke among those with CRVO. The findings suggest that development of NVG may identify patients with substantial systemic vascular risk and support closer coordination between ophthalmic and other medical specialties. Because the study was retrospective and based on electronic health records, the observed associations should not be interpreted as evidence that NVG itself directly causes these systemic outcomes.
BACKGROUND: Neovascular glaucoma (NVG) is a serious ocular complication of retinal vascular disease, including proliferative diabetic retinopathy (PDR) and central retinal vein occlusion (CRVO). Although NVG is primarily recognized for its effects on vision and intraocular pressure, less is known about whether its development is associated with additional long-term systemic health risks. This multicenter retrospective cohort study evaluated mortality and major systemic outcomes among adults with PDR or CRVO who did or did not subsequently develop NVG.
DETAILS: The investigators used the TriNetX Research Network, a deidentified electronic health record database containing information from more than 177 million patients across more than 150 healthcare organizations worldwide. Adults older than 40 years with PDR or CRVO were identified and compared according to whether NVG subsequently developed. Patients were propensity-score matched 1:1 based on demographic characteristics and comorbidities. Outcomes were assessed at 1, 5, and 10 years and included all-cause mortality, stroke, myocardial infarction (MI), end-stage renal disease (ESRD), and deep-vein thrombosis (DVT). A total of 1,278 patients with PDR and NVG were matched with 1,278 patients with PDR without NVG. The study also evaluated patients with CRVO and NVG compared with matched CRVO patients without NVG, as well as an NVG cohort compared with a cataract control cohort.
Our Most Popular Resources
Among patients with PDR, development of NVG was associated with higher 10-year mortality (HR, 1.34; 95% CI, 1.14-1.57) and ESRD (HR, 1.43; 95% CI, 1.23-1.67) compared with PDR without NVG. Ten-year survival was 60.4% in the PDR + NVG group compared with 68.4% in the PDR without NVG group. Among patients with CRVO, those who developed NVG had higher 10-year mortality (HR, 1.61; 95% CI, 1.17-2.20) and stroke risk (HR, 1.86; 95% CI, 1.19-2.90). Differences in MI and ESRD were not statistically significant in this comparison, and DVT risk was also not significantly different. When PDR + NVG was compared directly with CRVO + NVG, the PDR + NVG group had higher 10-year risks of mortality (HR, 1.56; 95% CI, 1.17-2.07), MI (HR, 1.94; 95% CI, 1.13-3.32), and ESRD (HR, 4.04; 95% CI, 2.43-6.73). Compared with the cataract control cohort, NVG was associated at 10 years with higher risks of mortality (HR, 2.66; 95% CI, 2.40-2.94), stroke (HR, 2.17; 95% CI, 1.85-2.54), MI (HR, 1.89; 95% CI, 1.60-2.23), and ESRD (HR, 3.34; 95% CI, 2.89-3.88).
Copyright © Skyscape. All rights reserved.
Source: Margolis, R., Vasu, P., and Dorairaj, S. K. Long-Term Risk of Mortality and Systemic Morbidity in Neovascular Glaucoma: A Multicenter Retrospective Cohort Study. Ophthalmology Glaucoma. 2026; 9(5): 517-526. Published: September-October, 2026. DOI: 10.1016/j.ogla.2026.01.017.
TMS Sites Associated With Nicotine Addiction Improvement Converge on a Common Brain Circuit
A study indicates that that TMS sites more strongly connected to a brain circuit linked to nicotine-addiction remission were associated with greater improvement in withdrawal symptoms. Data showed convergence between TMS and lesion-based brain circuits. The findings identify potential targets in the frontopolar, posterior parietal, lateral temporal, and superior frontal regions for future TMS research in nicotine addiction.
KEY FINDINGS: The findings indicate that brain regions associated with improvement in nicotine addiction through TMS and lesions converge on a common functional brain circuit. Rather than relying solely on stimulation of an individual anatomical region, connectivity with this circuit may help guide selection of TMS targets for nicotine addiction. The identified circuit provides a testable framework for future neuromodulation studies. However, the study demonstrates an association between TMS-site connectivity and withdrawal improvement and does not establish that targeting these regions will improve long-term smoking cessation outcomes.
BACKGROUND: Transcranial magnetic stimulation (TMS) is an established neuromodulation approach for smoking cessation, but the optimal brain region to target for nicotine addiction remains uncertain. Previous lesion-mapping research identified a brain circuit associated with remission of nicotine addiction. This study investigated whether TMS sites connected to that lesion-derived circuit were also associated with greater improvement in nicotine withdrawal symptoms.
DETAILS: The study included 72 participants with tobacco use disorder who abstained from smoking for at least 12 hours before TMS assessment. TMS was delivered to four left-hemisphere regions-the dorsolateral prefrontal cortex, superior frontal gyrus, posterior parietal cortex, and visual cortex-across separate sessions, producing a total of 243 stimulation sites.
Our Most Popular Resources
Nicotine withdrawal was assessed before and after each TMS session using the Shiffman-Jarvik Withdrawal Scale. The investigators used a normative functional-connectivity dataset derived from 1,000 healthy individuals to determine how strongly each stimulation site was connected with the previously identified lesion-based nicotine-addiction remission circuit. They then examined whether this connectivity predicted improvement in withdrawal symptoms.
Greater connectivity between the TMS stimulation site and the lesion-derived addiction-remission circuit was significantly associated with greater improvement in nicotine withdrawal symptoms. The association remained significant after adjustment for sex, baseline nicotine dependence, or both factors simultaneously.
A data-driven TMS circuit associated with withdrawal improvement showed substantial correspondence with the lesion-based remission circuit, with a Pearson correlation of r=-0.74. Combining the lesion and TMS findings identified potential therapeutic targets involving the frontopolar cortex, posterior parietal cortex, lateral temporal lobe, and superior frontal gyrus.
Copyright © Skyscape. All rights reserved.
Source: Khosravani, S., Drew, W., Apostol, M. R., et al. Convergence of TMS Sites and Lesion Locations Associated With Nicotine Addiction Improvement on a Common Brain Circuit.. American Journal of Psychiatry. 2026; 183(9): 646-656. Published: September, 2026. DOI: 10.1176/appi.ajp.20250855.
Ophthalmic Artery Doppler May Serve as a Noninvasive Marker of Angiogenic Imbalance in Near-Term Pregnancy
The findings demonstrate a significant relationship between the sFlt-1/PlGF ratio and ophthalmic artery Doppler measurements in near-term pregnancy. In particular, the OA peak systolic velocity ratio appears to reflect underlying angiogenic imbalance. Because OA Doppler is noninvasive, relatively accessible, and inexpensive, it may represent a useful surrogate approach for excluding angiogenic imbalance.
KEY FINDINGS: In 203 nulliparous women assessed at 35+0 to 36+6 weeks, higher sFlt-1/PlGF ratios were associated with higher OA-PSV ratios, lower OA-PI, and higher MAP. An OA-PSV ratio 0.61 identified women with an sFlt-1/PlGF ratio <38 with 90.5% accuracy at a 15% false-positive rate. The findings suggest that OA Doppler, particularly the PSV ratio, may provide a noninvasive and accessible surrogate for angiogenic imbalance near term. Further validation is needed before OA Doppler can replace biochemical assessment in clinical practice.
BACKGROUND: Angiogenic imbalance, reflected by an elevated soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt-1/PlGF) ratio, is associated with the pathophysiology of pre-eclampsia. Although the sFlt-1/PlGF ratio can help identify angiogenic imbalance, its use may be limited by cost and availability. This study evaluated whether ophthalmic artery (OA) Doppler parameters are associated with the sFlt-1/PlGF ratio and whether OA Doppler could help identify or exclude angiogenic imbalance in near-term pregnancy.
DETAILS: This cross-sectional cohort study was nested within the PE37 randomized controlled trial and included nulliparous women recruited between January 2023 and January 2025. Women underwent sFlt-1/PlGF measurement between 35+0 and 36+6 weeks' gestation. A subsample underwent OA Doppler assessment, including the OA peak systolic velocity (PSV) ratio and pulsatility index (PI), together with measurement of mean arterial pressure (MAP) and mean uterine artery PI. The Doppler operator was blinded to the sFlt-1/PlGF results. The analysis included 203 women, distributed across the lowest, middle, and highest sFlt-1/PlGF ratio tertiles as 62, 71, and 70 women, respectively.
Our Most Popular Resources
Increasing sFlt-1/PlGF ratio was associated with progressive changes in OA Doppler measurements. The median OA-PSV ratio increased from 0.45 (IQR, 0.39–0.53) in the lowest tertile to 0.48 (IQR, 0.41–0.58) in the middle tertile and 0.59 (IQR, 0.50–0.66) in the highest tertile (adjusted P<0.001). Conversely, median OA-PI decreased from 2.20 (IQR, 1.92–2.61) to 2.13 (IQR, 1.86–2.37) and 1.86 (IQR, 1.60–2.26), respectively (adjusted P=0.031).
MAP also increased across the sFlt-1/PlGF tertiles, from 87.0 (IQR, 82.7–92.0) mmHg to 88.7 (IQR, 83.7–93.7) mmHg and 94.7 (IQR, 89.3–100.0) mmHg (adjusted P<0.001). In contrast, mean uterine artery PI did not demonstrate a significant trend across the sFlt-1/PlGF tertiles.
For identifying an sFlt-1/PlGF ratio <38, an OA-PSV ratio <0.61 correctly identified 90.5% of women at a 15% false-positive rate. The authors therefore identified OA Doppler, particularly the PSV ratio, as a potentially useful surrogate measure for angiogenic imbalance and a promising approach for ruling out abnormal angiogenic status.
Copyright © Skyscape. All rights reserved.
Source: Tinajero, M. F., Faraci, C., Cuenca, M., et al. Ophthalmic artery Doppler as potential surrogate marker of angiogenic imbalance in near-term pregnancy. Ultrasound in Obstetrics & Gynecology. 2026; 68(2):211–219. Published: August, 2026. DOI: 10.1002/uog.70270.
Next-Generation Phenotyping May Strengthen Variant Interpretation in Mowat-Wilson Syndrome
In a proof-of-concept study, GestaltMatcher ranked Mowat-Wilson syndrome as the leading diagnosis in a 4-year-old child with a de novo ZEB2 variant. Three of 4 facial images met the PP4 moderate threshold and 1 met the supporting threshold. Integration of facial, HPO, and molecular data through PEDIA ranked ZEB2 as the most likely disease-causing gene. The findings suggest that AI-assisted phenotyping may provide quantitative support for variant interpretation while complementing expert clinical genetics assessment.
KEY FINDINGS: Computational facial phenotyping using GestaltMatcher identified MWS as the leading diagnosis in a child with a suspected de novo ZEB2 variant and provided quantitative evidence that supported variant interpretation. Three of 4 facial images reached the PP4 moderate threshold, while 1 reached the supporting threshold. Integration of facial phenotype, HPO information, and molecular data through PEDIA ranked ZEB2 first and contributed to classification of the variant as likely pathogenic. The findings provide a proof of concept for incorporating NGP into rare-disease diagnostic and variant-interpretation workflows, although larger, multicenter studies are needed to establish reproducibility and generalizability.
BACKGROUND: Mowat-Wilson syndrome (MWS) is a rare neurodevelopmental disorder caused by pathogenic variants in the ZEB2 gene and characterized by developmental impairment, epilepsy, congenital anomalies, and distinctive craniofacial features. Although next-generation phenotyping (NGP) tools such as GestaltMatcher can assist in recognizing rare genetic disorders, their use as quantitative evidence for variant interpretation within the American College of Medical Genetics and Genomics (ACMG) framework remains less established. This study evaluated whether computational facial phenotyping and multimodal clinical data could support variant prioritization and the ACMG PP4 phenotype-specificity criterion in MWS.
DETAILS: The investigators applied GestaltMatcher to a 4-year-old child with an undiagnosed neurodevelopmental disorder, suspected MWS, and a de novo ZEB2 variant. Facial photographs were analyzed alongside Human Phenotype Ontology (HPO) terms and simulated exome data using the PEDIA framework. Bayesian likelihood modeling was used to establish Gestalt score thresholds corresponding to supporting, moderate, strong, and very strong PP4 evidence. Brain MRI was also analyzed for structural abnormalities associated with MWS. The GestaltMatcher model had been trained using 9,671 images from 7,294 patients representing 275 disorders. For the MWS analysis, the dataset included 11 individuals with MWS and 14 age-matched controls.
Our Most Popular Resources
GestaltMatcher ranked MWS as the leading diagnosis, while integration through PEDIA also ranked ZEB2 as the most likely disease-causing gene. Across the 4 facial images from the proband, 3 achieved the PP4 moderate threshold and 1 achieved the PP4 supporting threshold. The established Gestalt score thresholds were 0.5111 for supporting, 0.5672 for moderate, 0.6609 for strong, and 0.7632 for very strong evidence.
Using the NGP-derived PP4 moderate evidence together with the original ACMG evidence, the ZEB2 variant was classified as likely pathogenic. Brain MRI demonstrated subtle thinning of the corpus callosum, a finding consistent with previously reported MWS-associated neuroimaging abnormalities. MRI-derived features also differentiated individuals with MWS from age-matched controls in exploratory analysis.
An additional exploratory case involving an infant with molecularly confirmed MWS showed that GestaltMatcher could prioritize MWS based solely on infant facial characteristics. The authors emphasize that NGP is intended to complement, rather than replace, expert clinical genetic assessment.
Copyright © Skyscape. All rights reserved.
Source: Hsieh, T. C., Todd, D., Warner, T., et al. Leveraging Next-Generation Phenotyping in Dysmorphology to Support Variant Interpretation in Mowat-Wilson Syndrome. Neurology Genetics. 2026; 12(4): e200384. Published: July 1, 2026. DOI: 10.1212/NXG.0000000000200384
Specialty: