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The selection of acute ischemic stroke (AIS) patients for mechanical thrombectomy (MT) is based on the clinical-radiological mismatch, where the NIHSS is higher than expected based on the ASPECT score. Our objective was to estimate the mismatch (NIHSS mismatch%) between the expected NIHSS (NIHSS expected ) and the actual NIHSS (NIHSS actual ) on admission, and to study its prognostic value for early neurological improvement (ENI, defined as a reduction of NIHSS of ≥ 8 points or reaching 0/1 at 24 h) in AIS patients with large vessel occlusion (LVO) of the anterior circulation treated with MT. A cross-sectional study was conducted on AIS related to anterior territory LVO (2017–2022) at a Stroke Center. Using multivariate linear regression models in the derivation cohort, a formula for calculating the NIHSS expected on admission was developed, and the NIHSS mismatch% between NIHSS actual and NIHSS expected was measured. Multivariate analyses were performed to identify if NIHSS mismatch% levels predicted ENI. In the derivation cohort ( n  = 123), the following formula was developed: NIHSS expected = 10.8 + 0.05 x Age + 2.5 x DM + 2.6 x Hemisphere – 1.5 x ASPECTS admission . In the validation cohort ( n  = 185), 64 (34.6%) patients experienced ENI. The ROC curve identified 75% of NIHSS mismatch% as the optimal cutoff for predicting ENI (80% sensitivity and 58% specificity). Multivariate analyses showed that both NIHSS mismatch% and NIHSS mismatch% >75 were predictors of ENI (OR 1.062; 95% CI 1.033–1.092 and OR 5.687; 95% CI 2.562–12.623, respectively), adjusted for potential confounders. NIHSS mismatch% could be a predictor of ENI in AIS patients treated with MT.

Cognitive reserve is an increasingly studied concept. According to this framework, individuals with higher reserve can better cope with pathology, delaying symptom onset. The Cognitive Reserve Questionnaire (CRQ) is a brief (<2 min) eight-item scale validated in the Spanish population. Recently, it has been used to create normative data for a screening cognitive test (TMA-93), showing greater variability in scores than the isolated education level. This study aimed to explore sex differences in cognitive reserve, as measured by the CRQ, in a biologically-confirmed Alzheimer's disease (AD) cohort enriched with illiterate individuals from southern Spain. Cross-sectional study, including patients from the Outpatient Memory Clinic at Torrecárdenas Hospital in Almería (2023-2024), diagnosed with AD based on CSF biomarkers (p-tau 181/Aβ42 < 0.023; Elecsys automated platform). Baseline sociodemographic data (age, sex, education, Fototest score) and biomarker levels (Aβ42, p-tau 181, t-tau) were collected, along with CRQ scores, reported by a reliable informant. We analyzed sex differences in total CRQ scores (Mann-Whitney U test) and examined the distribution of each CRQ item score across sexes. 53 AD patients (median age: 70 years, IQR: 66-75) were included (31 females, 22 males). No significant differences were found between sexes in age, education level, Fototest score, or biomarker levels (Table). Notably, only 37.7% of participants had education beyond primary school. Both sexes exhibited low cognitive reserve (median CRQ score: 7/25, IQR: 4-11), with significantly lower scores in females (Figure 1; W = 212; p = 0.01977). At the item level, males scored higher across all items (Figure 2A, 2B), with notable differences in occupation, reading, skills development courses, and languages spoken. Cognitive reserve, which moderates the relationship between brain pathology and cognitive outcomes, may be influenced by sex. Developing feasible cognitive reserve assessments applicable to illiterate individuals, which also account for sex differences, is essential. Women may have lower cognitive reserve, particularly in populations with a high prevalence of illiteracy. Future studies are needed to explore the sex-specific moderating effects of AD pathology on cognition and the potential generational changes in cognitive reserve across sexes.

Background Cognitive reserve is an increasingly studied concept. According to this framework, individuals with higher reserve can better cope with pathology, delaying symptom onset. The Cognitive Reserve Questionnaire (CRQ) is a brief (<2 min) eight‐item scale validated in the Spanish population. Recently, it has been used to create normative data for a screening cognitive test (TMA‐93), showing greater variability in scores than the isolated education level. This study aimed to explore sex differences in cognitive reserve, as measured by the CRQ, in a biologically‐confirmed Alzheimer's disease (AD) cohort enriched with illiterate individuals from southern Spain. Method Cross‐sectional study, including patients from the Outpatient Memory Clinic at Torrecárdenas Hospital in Almería (2023–2024), diagnosed with AD based on CSF biomarkers (p‐tau 181/Aβ42 < 0.023; Elecsys automated platform). Baseline sociodemographic data (age, sex, education, Fototest score) and biomarker levels (Aβ42, p‐tau 181, t‐tau) were collected, along with CRQ scores, reported by a reliable informant. We analyzed sex differences in total CRQ scores (Mann‐Whitney U test) and examined the distribution of each CRQ item score across sexes. Result 53 AD patients (median age: 70 years, IQR: 66–75) were included (31 females, 22 males). No significant differences were found between sexes in age, education level, Fototest score, or biomarker levels (Table). Notably, only 37.7% of participants had education beyond primary school. Both sexes exhibited low cognitive reserve (median CRQ score: 7/25, IQR: 4–11), with significantly lower scores in females (Figure 1; W = 212; p = 0.01977). At the item level, males scored higher across all items (Figure 2A, 2B), with notable differences in occupation, reading, skills development courses, and languages spoken. Conclusion Cognitive reserve, which moderates the relationship between brain pathology and cognitive outcomes, may be influenced by sex. Developing feasible cognitive reserve assessments applicable to illiterate individuals, which also account for sex differences, is essential. Women may have lower cognitive reserve, particularly in populations with a high prevalence of illiteracy. Future studies are needed to explore the sex‐specific moderating effects of AD pathology on cognition and the potential generational changes in cognitive reserve across sexes.

Introduction Myasthenia gravis (MG) is a chronic autoimmune disorder increasingly affecting older adults, with rising prevalence and comorbidity burden across Europe. Contemporary nationwide data describing MG-related hospital utilisation in European healthcare systems remain limited. We examined temporal trends and severity-related hospital outcomes in Spain between 2016 and 2022. Methods We conducted a retrospective, population-based analysis using the Spanish Minimum Basic Data Set, including all adult hospital episodes with a primary diagnosis of MG (ICD-10-ES G70.00, G70.01). Hospital admissions, day-hospital visits and emergency department (ED) encounters were evaluated. Variables included demographics, intensive care unit (ICU) admission, myasthenic crisis, in-hospital mortality and comorbidities. Temporal trends were analysed using segmented negative binomial regression models incorporating a breakpoint in 2018. Results A total of 20,251 MG-related episodes corresponding to 6,308 unique patients were identified. Following 2018, hospital admissions declined by 5.4% annually (95% CI − 8.4 to − 2.4), whereas day-hospital and ED utilisation increased markedly, particularly among older adults. In-hospital mortality remained low and stable (mean 2.6%). ICU admissions increased from 8.2% to 13.7% of hospitalised patients. Myasthenic crisis accounted for 4.5% of admissions and was strongly associated with ICU utilisation, representing 39% of all ICU stays. Conclusions MG care in Spain is undergoing a sustained transition toward ambulatory management without evidence of worsening short-term hospital outcomes. Despite an ageing patient population and rising ICU utilisation, in-hospital mortality remained stable, supporting the safety of outpatient-based MG care models. These findings highlight the need for integrated clinical data to inform future healthcare planning in MG.