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Neurological manifestations are known in hereditary ATTR but remain comparatively understudied in ATTRwt.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with ATTRwt cardiomyopathy were prospectively evaluated at baseline and after 1\u00a0year, alongside healthy controls. Neurological assessment included Neuropathy Impairment Score Lower Limb (NIS-LL), nerve conduction studies, quantitative sensory testing (QST), serum neurofilament light chain (sNfL), and intra-epidermal nerve fiber density (IENFD) from skin biopsies. Symptoms and fatigue were assessed using Norfolk-QoL-DN and Chalder Fatigue scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-three patients were included and compared to controls. Pathological IENFD occurred in 47.8% of patients vs. 4.3% of controls (\n                      <jats:italic>p<\/jats:italic>\n                      =0.002). In ATTRwt, except cold detection, all QST parameters were abnormal. Sensory\u2013predominant axonal polyneuropathy was present in 82.6%, with higher NIS-LL and symptom burden (\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001). sNfL levels were similar between groups. Carpal tunnel syndrome was frequent (82.7%). Polyneuropathy with CTS was more common in ATTRwt (\n                      <jats:italic>p<\/jats:italic>\n                      =0.025). At follow-up, we observed no clinical or electrophysiological progression, and no newly diagnosed cases of polyneuropathy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ATTRwt is associated with mixed fiber neuropathy and frequent entrapment neuropathies which should raise suspicion for ATTRwt. We found subtle clinical progression over 13\u00a0months.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-14066-8","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T17:53:36Z","timestamp":1787680416000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal multimodal assessment of peripheral nerve involvement in wild-type transthyretin amyloidosis"],"prefix":"10.1007","volume":"273","author":[{"given":"Vera E. 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