Perivascular spaces (PVS) support metabolic clearance in the brain and are increasingly recognized as key contributors to dementia pathogenesis. Plasma-based biomarkers, such as glial fibrillary acidic protein (GFAP) and the amyloid β42/40 (Aβ42/40) ratio, show promise in dementia diagnosis but remain understudied in vascular cognitive impairment (VCI). VCI, a major global cause of cognitive decline, may be more prevalent in Southeast Asia. Despite its impact, it is underdiagnosed compared to Alzheimer’s, highlighting the need for early, reliable markers. This study aims to examine how these biomarkers relate to PVS burden and domain-specific cognitive outcomes in VCI. VCI was defined as global cognition as assessed by a Montreal Cognitive Assessment Score 2 or periventricular hyperintensities >3), and >1 lacuna. A total of 108 participants (mean age of 67.3 years, 51.9% female) were included. Multivariate ordinal regression assessed biomarker associations with PVS grade, adjusting for age and diastolic blood pressure. A Aβ42/40 ratio 54.1 pg/mL were used as biomarker thresholds to subgroup the participants, and the relationship between these thresholds and cognitive performance was analyzed. Elevated GFAP (p = 0.0438) and a reduced Aβ42/40 ratio (p < 0.01) were correlated with a higher PVS grade. In the subgroup with a low Aβ42/40 ratio, a greater PVS burden was associated with poorer executive function (p = 0.045, β = 0.612), while in those with high GFAP levels, it was linked to more pronounced impairments in learning and memory (p = 0.006, β = 0.375). A lower Aβ42/40 ratio and higher GFAP levels track greater PVS burden in VCI. PVS severity may be associated with domain-specific cognitive decline, highlighting the potential utility of these biomarkers in refining clinical assessments and monitoring disease progression.

Obstructive sleep apnea (OSA) and Parkinson’s disease (PD) are highly prevalent conditions with significant global health impacts. OSA affects 17–34% of middle-aged adults, while more than 10 million worldwide have PD. Clinical studies demonstrate a bidirectional relationship, with the OSA prevalence being higher among PD patients suggesting that hypoxia and sleep fragmentation contribute to worsening motor and cognitive symptoms. Conversely, PD-associated neurodegeneration impairs respiratory control, exacerbating OSA. Diagnostic differentiation is particularly challenging due to overlapping symptoms, such as sleep disturbances, cognitive decline, and autonomic dysfunction. Emerging neuromodulation therapies, including deep brain stimulation and hypoglossal nerve stimulation, show dual therapeutic potential. The interplay between OSA and PD draws attention to the need for integrated diagnostic and therapeutic approaches. Additional longitudinal studies to evaluate their cause–effect relationship and identify neuroimaging and biochemical biomarkers to elucidate novel pathophysiologic clues can potentially identify novel therapeutic targets.

There is considerable evidence linking alterations in gut microbiome composition with Parkinson’s disease, leading to several recent randomized controlled faecal microbiota transplantation (FMT) trials in patients with Parkinson’s disease targeting gut dysbiosis with the aim to modulate the gut–brain axis. Some FMT trials have observed motor and non-motor symptoms improvements in patients with Parkinson’s disease, possibly through microbiota linked enhanced short-chain fatty acid or other metabolite effects and reduced systemic inflammation. While the findings are exciting and can potentially open a new treatment paradigm, crital questions on donor selection, the optimal screening and selection of the donor microbiome, delivery routes and the timing and frequency of transplantation need to be addressed. We suggest that future FMT trials should incorporate blood, metabolites, urine and functional neuroimaging biological markers and to control for dietary, lifestyle comorbidities, medication intake and/or other potential variables to ensure optimal evaluation of interactions between the gut microbes and brain outcomes prospectively over a longer time frame.

Introduction: Parkinson's disease (PD) is a common neurodegenerative disorder affecting more than 10 million people worldwide. The actual prevalence and relative risk of venous thromboembolism (VTE) in PD have not been systematically examined, especially in various study designs and surgical settings. To address this gap in knowledge, we conducted a meta‐analysis on the risk of VTE and in PD.Methods: We searched PubMed, Embase, and Cochrane from inception to 22 June 2024 to identify cross‐sectional, cohort, and case–control studies comparing the frequency of VTE, deep vein thrombosis (DVT) and pulmonary embolism (PE) events in PD and non‐PD patients. We computed risk ratios (RR) with 95% confidence intervals (CIs) for each study and pooled results using a random‐effects meta‐analysis. Quality assessment was performed using Joanna Briggs Institute Critical Appraisal Tools.Results: Out of 758 studies screened initially, 13 studies involving 775,144 patients were included. VTE risk was elevated (RR 1.73, 95% CI 1.47–2.04) when comparing PD patients to non‐PD patients. In subgroup analysis comparing neurological and non‐neurological surgeries, there was no significant (p = 0.11) difference in VTE risk. Cross‐sectional studies had a higher elevated VTE risk (RR 5.43, 95% CI 3.40–8.67) when compared to case–control (RR 1.58, 95% CI 1.14–2.20) and cohort (RR 1.50, 95% CI 1.22–1.84) studies (p < 0.01).Conclusion: Our meta‐analysis showed an elevated risk of VTE events in PD patients. There was no significant difference between neurological and non‐neurological surgeries in the incidence of VTE. Greater vigilance should be exercised to detect VTE events early in PD patients due to impaired mobility.

Background: Vitamin D is vital for musculoskeletal health, with emerging evidence highlighting its role in muscle function. While its preoperative and postoperative benefits for bone health are well documented, the effect of vitamin D supplementation on post-surgical muscle recovery remains underexplored. This systematic review consolidates current evidence on the impact of vitamin D supplementation in enhancing muscle strength following surgery. Methods: This review adhered to PRISMA guidelines and was registered on PROSPERO. A systematic search of PubMed, EMBASE, and Cochrane databases was conducted, covering articles from inception to 15 January 2025. Studies evaluating the effect of vitamin D supplementation on muscle strength in surgical contexts were included. Data extraction focused on study design, population demographics, vitamin D dosage, timing, and measured outcomes. A narrative synthesis was performed due to heterogeneity in study designs and outcomes. Results: From 701 initial records, 10 studies met the inclusion criteria. The findings indicate that vitamin D supplementation, particularly high-dose regimens administered preoperatively or early postoperatively, significantly improves muscle strength and functional outcomes in orthopaedic surgeries, such as hip and knee replacements, and bariatric surgeries. The benefits varied by surgical type, baseline vitamin D levels, and supplementation strategy. However, inconsistent dosing regimens and limited long-term follow-up studies hinder conclusive evidence. Conclusions: Vitamin D supplementation demonstrates potential in enhancing post-surgical muscle recovery and functional outcomes. Tailored supplementation strategies, based on patient-specific needs and surgical context, are essential. Future research should address optimal dosing regimens and evaluate long-term impacts on recovery and quality of life.

Background: Perivascular spaces (PVS) are fluid‐filled spaces in the brain, hypothesized in promoting clearance of metabolites implicated in dementia through glymphatic system drainage. PVS are classified according to Grades (0‐4). Blood‐based biomarkers including Glial fibrillary acidic protein (GFAP), Amyloid β 42/40 (Aβ42/40) ratio have shown promise in diagnosing and prognosing dementia.However, the association between blood‐based biomarkers and PVS remains relatively unexplored in Vascular Cognitive Impairment (VCI) participants. Thus, this study aims to characterize association between blood‐based biomarkers and PVS in relation to cognitive domains in VCI participants.Method: Participants from the Biomarkers and Cognition Study, Singapore were included and VCI was defined in participants with confluent white matter hyperintensities (WMH), >1 lacunae and Montreal Cognitive Assessment (MoCA) score <26.108 participants (mean age 67.3, education years 13.3, 51.9% females) were included.Normality tests, multivariate ordinal correlation analysis was performed to understand association between blood‐based biomarkers and PVS grade, with correction for age, diastolic blood pressure and WMH.Aβ42/40 and GFAP ratio values of 0.05 and 54.1pg/ml were utilized to segregate VCI participants to different subgroups (high vs low levels) and their association with cognitive domain performance was assessed.Result: Higher GFAP (p=0.026) and lower Aβ42/40 ratio (p=0.049) was associated with higher PVS grade.In the low Aβ42/40 ratio subgroup, higher PVS grade was most significantly associated with executive function impairment (p = 0.045, β = 0.612). For the subgroups of high Aβ42/40 ratio (p=0.017, β = 0.325), low GFAP (p = 0.027, β = 0.610), high GFAP (p = 0.006, β = 0.375), higher PVS grade was most significantly associated with learning and memory impairment.Conclusion: These results demonstrate that low Aβ42/40 ratio, high GFAP levels were associated with higher PVS grade in VCI participants, suggesting their utility as markers for VCI.Furthermore, higher PVS Grade in VCI participants with low Aβ42/40 ratio were associated with executive function impairment compared to other subgroups which were associated with learning and memory impairment. This could be an important clinical marker when examining patients with high PVS Grade as it could be associated with a more sinister disease progression.