Prediction of collateral circulation grading and functional outcomes in acute ischemic stroke using FLAIR vascular hyperintensity combined with multimodal CT parameters

Predictions DO NOTHING FOR STROKE RECOVERY, and with NO protocols written, COMPLETELY FUCKING USELESS! You're fired! All the mentors and senior researchers need to be fired for not having an objective of writing EXACT rehab protocols from research!

 Prediction of collateral circulation grading and functional outcomes in acute ischemic stroke using FLAIR vascular hyperintensity combined with multimodal CT parameters

Qiushi Yang^1,2Yanxin Ma^2*Xin Qu^1,2Yu Chen^1,2Hui Sun^1,2Gang Yao²

• ¹Mudanjiang Medical University, Mudanjiang, Heilongjiang, China
• ²Department of Radiology, Daqing Oilfield General Hospital, Daqing, Heilongjiang, China

Background/objectives: The variability in acute ischemic stroke (AIS) outcomes is closely associated with collateral circulation status. While fluid-attenuated inversion recovery vascular hyperintensity (FVH) and multimodal CT parameters (e.g., rLMC score, rCBV) were associated with 90-day functional outcomes in AIS patients, their combined predictive value and clinical utility warrant further investigation. This study investigates the combined predictive value of FVH and multimodal CT parameters for collateral assessment and prognosis in AIS.

Methods: We retrospectively and consecutively enrolled AIS patients with internal carotid artery or middle cerebral artery stenosis/occlusion who did not receive intravenous thrombolysis or mechanical thrombectomy. All patients underwent one-stop CT angiography–CT perfusion and multimodal MRI within 72 h of symptom onset. Evaluations included FVH scores (based on modified ASPECTS regions), rLMC scores, Maas scores, and ASITN/SIR collateral grading. Spearman analysis assessed correlations between FVH and CTA collateral scores. Univariate and multivariate logistic regression indicated the independent predictors of a 90-day functional outcome [favorable (mRS 0–2) vs. poor (mRS 3–6)], with receiver operating characteristic (ROC) curves evaluating predictive performance.

Results: The cohort comprised 112 patients (70 favorable outcomes, 42 poor outcomes). FVH scores showed a negative correlation with ASITN/SIR collateral grades (r = −0.432, p < 0.001). Compared to the favorable outcome group, the poor outcome group exhibited higher baseline National Institute of Health Stroke Scale (NIHSS) scores, elevated FVH scores, reduced rLMC scores, and lower rCBV values (all p < 0.05). Multivariate analysis indicated that NIHSS score, FVH score, rLMC score, and rCBV were independent predictors of poor outcomes. ROC analysis demonstrated strong predictive performance for rLMC score (AUC = 0.848, 95%CI 0.778–0.919), FVH score (AUC = 0.662, 95%CI 0.550–0.774), and rCBV (AUC = 0.727, 95%CI 0.631–0.822).

Conclusion: Multimodal CT combined with MRI facilitates early AIS diagnosis and collateral assessment. The integration of FVH with CT parameters (rLMC score and rCBV) was associated with the prediction of functional outcomes in AIS patients.

More at link.

Association between endothelial function and early neurological improvement in atrial fibrillation-related ischemic stroke

'Associations' DO NOTHING FOR SURVIVOR RECOVERY! Are you that blitheringly stupid you don't know that survivors would like recovery rather than a completely fucking useless 'association'?  By not writing a protocol on this, you were actually WORSE THAN USELESS! You're all fired!

 Association between endothelial function and early neurological improvement in atrial fibrillation-related ischemic stroke

So Young Yang^1,2Sung Hee Ahn³Jeonggeun Moon²Yeong-Bae Lee⁴Dae-il Chang⁴Sang Hee Ha^4*

• ¹Department of Cardiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
• ²Department of Cardiology, Gil Medical Center, Gacheon University, Incheon, Republic of Korea
• ³Department of Big Data Management and Engineering, Namseoul University, Chungcheongnam-do, Republic of Korea
• ⁴Department of Neurology, Gil Medical Center, Gacheon University, Incheon, Republic of Korea

Background: Understanding the factors related to early neurological improvement (ENI) is crucial in managing atrial fibrillation-related ischemic stroke (AF-stroke), as ENI indicates better long-term outcomes. We investigated the association between endothelial function, measured via flow-mediated dilation (FMD), and the occurrence of ENI in patients with AF-stroke.

Methods: We reviewed patients with acute AF-stroke within 7 days of FMD between April 2019 and April 2025. ENI was defined as a ≥2-point decrease in National Institutes of Health Stroke Scale (NIHSS) or ≥1-point reduction in motor NIHSS items within 24 h in non-thrombolysis patients. For thrombolysis patients, ENI was a ≥8-point reduction or NIHSS 0–1 at 24 h. FMD was measured during hospitalization and expressed as %FMD = (peak diameter − baseline diameter) / Baseline diameter × 100. Multivariable analysis identified the factors associated with ENI and explored their relationship with FMD.

Results: Among the 169 patients diagnosed with AF-stroke, 77 (44.4%) experienced ENI. Those with ENI had higher NIHSS (7 [4–13] vs. 2 [1–5], p < 0.001), more confluent (38.7% vs. 25.5%) and scattered with confluent pattern (29.3% vs. 18.1%, p = 0.007), and higher %FMD (6.5% ± 2.5% vs. 5.3 ± 2.2%, p = 0.001). Multivariable analysis revealed a higher initial NIHSS score (adjusted odds ratio [aOR]: 1.329, p < 0.001) and a history of smoking (aOR: 4.532, p = 0.004), and higher %FMD score (aOR: 1.179; p = 0.043) were independently associated with ENI. Subgroup analysis demonstrated a stronger association between high %FMD and ENI in patients with concomitant vascular risk factors, such as hypertension and dyslipidemia.

Conclusion: Endothelial function was associated with ENI in patients with AF-stroke.

1 Introduction

More than 20% of stroke cases are caused by cardiac embolism attributable to atrial fibrillation (AF) (1). Compared to strokes of other etiologies, AF-related ischemic stroke (AF-stroke) is associated with greater severity and a higher risk of disability and mortality (2). This may be due to large infarct volumes resulting from the abrupt occlusion of blood flow by a clot originating in the heart, often without sufficient time for collateral circulation to compensate (3). Numerous studies have shown that AF-stroke is associated with a lower likelihood of early neurological improvement (ENI) (2, 4, 5). Nevertheless, ENI can still occur in a subset of patients with AF-stroke and is associated with favorable functional outcomes (6).

Several factors have been linked to ENI, including successful recanalization, collateral status, and smaller infarct core size (6–8). Additionally, the endothelium plays multiple roles in stroke pathophysiology and recovery by regulating vascular tone, maintaining blood–brain barrier (BBB) integrity, modulating inflammatory responses, and influencing thrombotic and fibrinolytic balance (9–11). Patients who have experienced acute ischemic stroke (AIS) with impaired FMD are associated with early neurological deterioration and poor long-term outcome (12). Furthermore, endothelial function is associated with the development of AF and AF-stroke by promoting atrial remodeling, thrombogenesis, and hemodynamic alterations (13, 14). However, whether endothelial function influences the capacity for early neurological recovery in patients with AF-stroke remains unclear.

Brachial artery flow-mediated dilation (FMD), assessed using high-resolution ultrasonography, is a widely used tool to evaluate endothelial function (15). In this study, we aimed to identify the factors associated with ENI in patients with AF-stroke, with a particular focus on the role of endothelial function as measured by FMD.

More at link.

Association between early depressive symptoms after stroke and trajectories of functional recovery among patients with acute ischemic stroke: a longitudinal study

'Associations' DO NOTHING FOR SURVIVOR RECOVERY! Are you that blitheringly stupid you don't know that survivors would like recovery rather than a completely fucking useless 'association'? 

Association between early depressive symptoms after stroke and trajectories of functional recovery among patients with acute ischemic stroke: a longitudinal study

Fanfan Li^1†Xingjin Song^1,2†Cuicui Zhang^1,3†Chi Peng⁴Ting Hu¹Xiue Wei^1*Liangqun Rong^1*Haiyan Liu^1*

• ¹Department of Neurology, Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
• ²Graduate School of Xuzhou Medical University, Xuzhou, China
• ³Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
• ⁴Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China

Background: Depressive symptoms are very common in the acute phase of stroke; however, its impact on distinct functional recovery trajectories in acute ischemic stroke (AIS) patients remains unclear. Our study aimed to depict the functional recovery trajectories within 6 months after stroke and explore the association of early depressive symptoms with these recovery patterns among AIS patients.

Methods: A total of 219 eligible patients were enrolled at the stroke centers of two tertiary hospitals in Xuzhou, China from April 2023 to June 2024. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depressive symptoms during the acute hospitalization. The Group-based trajectory model was conducted to identify distinct trajectories of functional recovery, as measured by modified Rankin Scale (mRS) and Barthel Index (BI) at baseline, 3 months, and 6 months. A series of multinomial logistic regression models were performed to examine the relationship between early depressive symptoms and dynamic recovery patterns.

Results: We identified 3 mRS trajectories (mild, moderate, and severe) and 5 BI trajectories (low-rapid rise, moderate low-stable, moderate-progressive rise, moderate high-rapid decline, and high-stable), respectively. After full adjustments, patients with early depressive symptoms were at increased likelihood of being in the moderate (OR 8.22, 95% CI 2.77–24.39) and severe (OR 24.41, 95% CI 5.33–111.90) trajectory group for mRS trajectories, and of the moderate high-rapid decline (OR 12.93, 95% CI 1.49–112.42) trajectory group for BI trajectories ( p < 0.05).

Conclusion: Early depressive symptoms were associated with unfavorable functional recovery trajectories within 6 months following acute stroke in AIS patients.

More at link.

The protective effect of neurointerventional recanalization on the neurovascular unit in acute ischemic stroke and its correlation with serum GFAP and NfL levels

Predictions DO NOTHING FOR STROKE RECOVERY, and with NO protocols written, COMPLETELY FUCKING USELESS! You're fired!

 The protective effect of neurointerventional recanalization on the neurovascular unit in acute ischemic stroke and its correlation with serum GFAP and NfL levels

Ju Luo^†Yang Yang^*†Jingmin Zhou

• Department of Neurology, Huai’an Hospital Affiliated to Yangzhou University (The Fifth People’s Hospital of Huai’an), Huai’an, Jiangsu, China

Aim: This study aimed to investigate the neuroprotective mechanisms of mechanical thrombectomy (MT) by evaluating its effects on the neurovascular unit (NVU) and correlating these effects with dynamic changes in serum biomarkers in patients with acute ischemic stroke (AIS).

Methods: A prospective cohort of 128 AIS patients with anterior circulation large vessel occlusion was enrolled. Participants were divided into MT (n = 68) and intravenous thrombolysis (IVT) (n = 60) groups. Serum levels of neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) were measured at baseline (T0), 24 h (T1), and 72 h (T2) post-treatment. Clinical outcomes included recanalization rate (mTICI grade), NIHSS improvement, and 90-day modified Rankin Scale (mRS) score.

Results: The MT group showed significantly higher recanalization rates (94.1% vs. 36.7%, p < 0.001) and greater neurological improvement (median NIHSS improvement: 8 vs. 4, p < 0.001) compared to the IVT group. Serum NfL, GFAP, IL-1β, and TNF-α levels were markedly lower in the MT group at T1 and T2 (all p < 0.01). Strong correlations were identified between T2 NfL/GFAP levels and clinical outcomes (NIHSS improvement: r = −0.728/−0.663; 90-day mRS: r = 0.705/0.641; all p < 0.001).

Conclusion: Successful recanalization with MT is associated with mitigated axonal injury, astrocyte activation, and neuroinflammation, findings consistent with better preservation of NVU integrity. Serum NfL and GFAP represent promising biomarkers for predicting stroke prognosis and tailoring therapeutic strategies.

More at link.

Study on 250,000 People Links Omega-3s to Better Mood by SupervAge

 Don't let your incompetent? doctor use this to better your mood/treat depression, rather than: EXACT 100% RECOVERY PROTOCOLS! Your incompetent? doctor has known of the shitshow of stroke rehab since medical school and LEADERS WOULD BE SOLVING THAT PROBLEM!  Your doctor is obviously NO leader!

Study on 250,000 People Links Omega-3s to Better Mood

More vigorous exercise means more healthy years by Super Age

I will never be doing any form of HIT(High intensity training). 

Two reasons:

1. My joints aren't aligned properly due to spasticity. Spasticity needs to be cured first.
2. Andrew Marr blames high-intensity training for his stroke. Can too much exercise cause a stroke?

 More vigorous exercise means more healthy years

Study Finds Surprising Link Between Aspirin in Seniors and Cancer Mortality

 Have your competent? doctor explain how this affects you.

I've been taking a 325 apirin for almost 19 years now to reduce clotting ability not to thin the blood. Not going to change.

Study Finds Surprising Link Be tween Aspirin in Seniors and Cancer Mortality

Longer follow-up of the ASPREE cohort is warranted, says researcher

by Charles Bankhead, Senior Editor, MedPage Today

 Key Takeaways 

• Among more than 19,000 older adults, cancer incidence during 10 years of follow-up was almost identical in patients who used aspirin and those who did not. 
• Use of aspirin was associated with increased cancer-related mortality.
• Aspirin was linked to a reduced risk of melanoma and an increased risk of brain cancer, though this was based on small numbers of events. 

Low-dose aspirin was not associated with a reduced incidence of cancer in older adults, but was associated with an increased risk of dying of cancer, according to a cohort study of participants from the randomized ASPREE trial. Among more than 19,000 adults with a mean age of 75, cancer incidence during 10 years of follow-up was almost identical in patients who used aspirin and those who did not (HR 0.98, 95% CI 0.92-1.05). The risk of dying of cancer was 15% higher in patients who took low-dose aspirin. An analysis of 14,907 surviving participants who continued follow-up in the extension phase of the randomized ASPREE trial showed no difference in cancer incidence or cancer mortality, reported Suzanne G. Orchard, PhD, of Monash University in Melbourne, Australia, and colleagues in JAMA Oncology.

Despite the size of the study and the extended duration of follow-up, the results do not rule out the possibility of a benefit from low-dose aspirin, said Orchard.

"It is hard to say anything definitive, especially since there are not that many studies conducted in older persons," she told MedPage Today. "The earlier studies have found that cancer incidence benefits can take up to 10 to 15 years to manifest, and so longer follow-up of the current ASPREE cohort is warranted, to see if the associations between aspirin and cancer incidence and mortality change over time."

"We would like to see whether aspirin can impact specific subgroups differently, and earlier work in our group has indicated this may be the case," she noted. "Studies exploring the mechanism of action in older people would also be valuable -- for example, those with certain gene variants. There have been some reports of individuals with PI3K gene variations responding differently to aspirin. So, genetic profiling of the cancers from those in the aspirin arm versus the placebo arm may shed some light on the mechanism."

The data did show a reduced incidence of melanoma in the aspirin arm, and an increased incidence of brain cancer, two findings that require further investigation, Orchard said.

Early randomized clinical trials of aspirin and cancer, mostly involving middle-age adults, showed a reduced risk of cancer and lower cancer-related mortality, particularly for colorectal cancer (CRC). The Women's Health Study provided additional evidence of a favorable effect of aspirin on CRC.

More recent studies showed that starting aspirin at an older age had no effect on cancer outcomes or increased rates of malignancy. However, follow-up in these studies was too brief for a preventive effect on cancer to emerge, the authors noted in their introduction.

The ASPREE trial comprised a randomized phase with a median follow-up of 4.7 years and a 5-year extension phase (ASPREE-XT) to examine long-term impact of prior randomization to aspirin or placebo. Conducted in Australia and the U.S., the trial enrolled patients ages 70 and older (65 or older for Black and Latino patients in the U.S.), who were randomized to low-dose aspirin (100 mg/day) or placebo. Eligible patients were free of cardiovascular disease, dementia, and independence-limiting physical disability.

The randomized phase enrolled patients from 2010-2014 with follow-up to 2017. ASPREE-XT followed study participants from 2018-2024.

For the overall population, 3,448 cancers and 1,173 cancer-related deaths occurred during 10 years of follow-up (median 8.6 years). New cancers were almost evenly distributed between the two arms, 1,701 in the aspirin group and 1,747 in the placebo group. Incidence of localized, metastatic, and hematologic malignancies was also similar between the two groups. The aspirin arm had 623 deaths versus 550 in the placebo arm, resulting in a hazard ratio of 1.15 (95% CI 1.03-1.29).

During ASPREE-XT, 689 cancers occurred in the patients originally randomized to aspirin versus 762 in the placebo group, a nonsignificant 9% difference (95% CI 0.82-1.01). Each group had 188 cancer-related deaths (HR 1.02, 95% CI 0.83-1.25).

The incidence and mortality for colorectal cancer, a topic of multiple studies of cancer prevention with aspirin, were almost identical in the overall and ASPREE-XT analyses.

Over the entire duration of follow-up, fewer cases of melanoma occurred in the aspirin arm (159 vs 209, HR 0.77, 95% CI 0.62-0.94). The difference persisted in the analysis limited to ASPREE-XT participants (71 vs 101, HR 0.71, 95% CI 0.53-0.96).

During the randomized phase of the investigation, significantly more patients in the aspirin group developed brain cancer, though absolute numbers were small (HR 1.96, 95% CI 1.05-3.65). Additionally, the aspirin group had a higher mortality for combined rare cancers (HR 2.09, 95% CI 1.21-3.61).

"The results are difficult to be certain of due to low sample sizes," said Orchard.

Finger-Prick Blood Test Shows Promise for Early AD Detection

 Does your competent? doctor even know of the need for this test? 

So, EXACT DEMENTIA PREVENTION PROTOCOLS CAN BE INITIATED! NO? So, you DO have an incompetent? doctor? 

You need this prevention!

Parkinson’s Disease May Have Link to Stroke March 2017 

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018  

The latest here:

Finger-Prick Blood Test Shows Promise for Early AD Detection

New research provides more evidence that dried blood samples collected from a simple finger prick can be used to measure key biomarkers of Alzheimer’s disease (AD).

In a multicenter study of more than 300 participants, levels of p-tau217 in finger-prick samples closely matched results from standard blood tests, and they could identify AD-related changes in spinal fluid with an accuracy of 86%.

“These findings underscore the potential of dried blood collection and capillary blood as a minimally invasive, scalable approach for AD biomarker testing in research settings. Yet, further refinement of collection and analytical protocols is needed to fully translate this approach to be viable and useful as a clinical tool,” the investigators cautioned. 

For now, “what we have shown is that it’s an extremely useful research tool, and we already have large scale research studies going on, but we don’t envision this anytime soon to be a clinical test,” Nicholas Ashton, PhD, senior director of the Banner Fluid Biomarker Program, Banner Sun Health Research Institute in Sun City, Arizona, told Medscape Medical News.

The study was published online on January 5 in Nature Medicine. A Close Match

Blood biomarkers, p-tau217 in particular, have emerged as accurate tools for detecting AD pathology, offering a minimally invasive alternative to PET or lumbar puncture. Yet, standard blood testing still depends on venipuncture, controlled processing, and trained personnel, limiting scalability.

The DROP-AD project is evaluating whether AD biomarkers can be reliably measured from dried blood spot or dried plasma spot, derived from capillary blood obtained via finger prick, for detecting AD biomarkers, including p-tau217, glial fibrillary acidic protein (GFAP), and neurofilament light (NfL).

The current study included 337 participants recruited across seven European centers, spanning cognitively normal individuals, patients with mild cognitive impairment, AD dementia, non-AD dementias, and individuals with Down syndrome. A total of 304 participants provided paired capillary dried plasma or blood spot samples, as well as venous plasma samples.

Levels of p-tau217 in the finger-prick samples closely matched results from standard venous blood samples (Spearman’s rank correlation coefficient = 0.74; P < .001).

Dried plasma spot p-tau217 levels increased progressively across clinical disease stages and showed “good accuracy” in predicting CSF biomarker positivity, with an area under the curve of 0.864.

Home-Based Sampling?

The investigators also successfully detected GFAP and NfL from dried blood and plasma spot analysis.

“Both GFAP and NfL showed high concordance between capillary and venous samples, and were similarly associated with cognitive performance and age, reinforcing the validity of these remote sampling methods,” the authors reported.

Notably, the study also demonstrated feasibility in individuals with Down syndrome, a population at high genetic risk for AD for whom venipuncture can be particularly challenging. 

In the subgroup with Down syndrome, capillary biomarker concentrations were higher in those with dementia than in asymptomatic individuals and showed strong agreement with venous plasma levels.

The study also found “high concordance” between supervised and unsupervised blood collections, suggesting that remote or home-based sampling may be feasible.

Not Ready for Clinical Use

The findings build on earlier data from the DROP-AD project, as reported by Medscape Medical News.

“Despite the promise shown, we do not currently recommend the use of dried blood analysis for clinical use, decision-making, or patient management because of observed differences in analytical performance and diagnostic accuracy between capillary-derived and venous blood samples,” the authors cautioned.

Further methodological refinement, standardization, and validation in larger cohorts are required before this approach can be translated into routine clinical practice, they concluded.

Once that happens, Ashton said he could envision a “scenario in the future” where elderly asymptomatic individuals could be sent a dried blood spot card as a “first step in triage.”

“Especially if we get a readout next year, or even this year, that antiamyloid drugs are beneficial to people without symptoms because these individuals are not going to be walking into our clinics in primary care or specialty services because they don’t have objective memory concerns,” Ashton said.

Having an at-home test could help engage asymptomatic people with positive biomarkers in early treatment, he added.

Worth Further Study

Reached for comment, Maria C. Carrillo, PhD, Alzheimer’s Association chief science officer and medical affairs lead, said blood-based biomarkers are “reshaping how we identify, diagnose, and understand Alzheimer’s disease, especially in research settings.”

“Currently, the evidence supports the use of blood biomarkers as one tool of many in a multi-phase diagnostic process in people experiencing changes in memory and thinking abilities. The science is not yet strong enough to recommend blood tests as a standalone diagnostic, nor for their use in people without symptoms,” Carrillo told Medscape Medical News.

The association’s clinical practice guideline provides clear, evidence-based recommendations for when and how blood-based biomarker tests can be responsibly integrated into diagnostic workflows in specialty care, she noted.

Carrillo said the Alzheimer’s Association “agrees with the authors that more research is needed before this [finger-prick] technique can become a suitable tool for clinicians.”

However, the finding that the biomarker results were very similar between the supervised and self-collected blood samples “shows that the idea has merit and is worth further investigation — in a variety of locations and situations, and with much larger and more representative populations — to help ensure that the test results are credible and consistent wherever they are done.”

Summing up, Carrillo said, “The approach described in this new paper points to a future where Alzheimer’s biomarker testing is simple, minimally invasive, widely available, and potentially even self-administered.”

The study had no commercial funding. Ashton reported receiving consultancy and/or speaker fees from Alamar Biosciences, BioArctic, Biogen, Eli Lilly, Neurogen Biomarking, Roche, Spear Bio, Quanterix, and Vigil Neuroscience. A complete list of author disclosures is provided with the original article. Carrillo had no relevant disclosures.

Frequent Diet Soda Intake Linked to Fourfold Increased Dementia Risk

 Has your competent? doctor and hospital managed to remove ALL soda from the  hospital? Not just diet soda?

soda (11 posts to September 2011)

Frequent Diet Soda Intake Linked to Fourfold Increased Dementia Risk

Frequent consumption of diet soda has been tied to an increased risk for dementia, although the association may be mediated by certain physical conditions.

New findings from the Northern Manhattan Study (NOMAS) showed a fourfold increased dementia risk among dementia-free individuals who consumed more than one diet soda per day. In addition, the increased risk was found in individuals who were White or Black but not Hispanic. 

However, after excluding participants with either diabetes or obesity, this association was no longer significant. 

“I think the takeaway message for clinicians is that we need more research to better understand the association of soda consumption with neurological health,” corresponding author Hannah Gardener, ScD, Department of Neurology, University of Miami Miller School of Medicine, Miami, told Medscape Medical News.

Still, she added that the study adds to previous research showing that drinking diet soda “is not very healthy, and consuming more of it is not an effective way to decrease cardiometabolic risk,” Gardener said.

The findings were published online on January 6 in the Journal of Alzheimer’s Disease.

The History of the Soda-Dementia Link

Soda consumption is linked to vascular risk, but little is known about its potential association with dementia. 

A prospective 2017 study published in Stroke showed an increased incidence of both stroke and dementia among participants who consumed artificially sweetened beverages, including diet soda — but not among those who consumed sugar-sweetened beverages.

On the other hand, a meta-analysis published in 2022 showed a link between cognitive disorders and sugar-sweetened beverages — but not with artificially sweetened beverages. 

The investigators wanted to assess these associations in a population-based cohort, deciding to analyze data from the longitudinal NOMAS project.

The analysis included 947 adults without dementia at baseline. Participants at the start of the study had a mean age of 64 years; 59% were women, 64% Hispanic, 18% Black, and 16% White. 

A variation of the Block-National Cancer Center Institute food-frequency questionnaire was used to determine consumption of both regular and diet soda. Among participants, 4.8% consumed regular soda more than once per day, and 2.3% consumed diet soda more than once per day.

Dementia was diagnosed using neuropsychological and functional testing, with 20% of participants developing the condition over the follow-up period.

Reverse Causation?

Diet soda consumption was linked to a significantly increased risk for dementia, with an adjusted incidence rate ratio (aIRR) of 1.39 per soda per day after accounting for demographic and vascular risk factors.

Those who consumed more than one diet soda per day had an even greater risk for dementia than those who drank one or fewer diet sodas per day (aIRR, 4.15; P = .001).

Diet soft drink consumption was also associated with a greater risk for dementia in non-Hispanic White and Black individuals but not in Hispanic individuals. 

Although the investigators had hypothesized that regular soda consumption would also be linked to increased risk for dementia, they found no significant association. Still, they did observe a “nonstatistically significant trend” (unadjusted P = .07).

Interestingly, sensitivity analyses showed that the link between higher consumption of diet soda and increased dementia risk “was not apparent after excluding those with obesity or diabetes, highlighting a potential for reverse causation,” the researchers reported.

“Further study is needed into the impacts of obesity and diabetes,” they added. 

Gardener noted that the study did not assess how long the participants had been drinking soft drinks, or whether or when they switched from regular sodas to diet versions.

“Were they increasing their consumption of diet sodas in an effort to control their metabolic risk factors — to consume fewer calories or to control their blood sugar? We really need more research to better understand if this association that we and other researchers have seen is causal,” she said.

No Definitive Answer

Commenting for Medscape Medical News, Matthew P. Pase, PhD, a professor of neurology in the School of Psychological Sciences at Monash University in Melbourne, Australia, said it was notable that the current findings closely resembled those from his 2017 Stroke paper, one of the first major studies to examine these associations, despite being conducted nearly nine years ago.

He also pointed out similar limitations in both papers, including the fact that consumption data were collected at the same timepoint and that it was difficult to tease out whether physical conditions, such as obesity and diabetes, may play a role in the diet soda-dementia association.

“It’s just a quick snapshot. We don’t know what these people were doing 5 or 10 or 30 years ago. It’s difficult to [assess] that, but I think that’s what’s needed in order to be able to really tease out the ‘chicken or the egg’ question,” he said. 

Pase added that it makes one wonder whether the association was only there because the individuals who drank diet drinks were already unhealthy

Overall, “I actually don’t think there’s a strong message yet for clinicians,” he said. 

If a patient raises the topic, “it might be best to say that the science is a bit mixed currently, and it makes it hard to make a conclusion one way or the other,” Pase said. 

Partial results were presented previously at the 2024 Alzheimer's Association International Conference in Philadelphia, Pennsylvania

NOMAS was funded by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging. One investigator reported receiving royalties from Wolters Kluwer, Inc. for a writing project on vascular dementia. Gardener, Pase, and the other investigators reported no relevant financial relationships.