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Wyman-Chick KA, Chaudhury P, Bayram E, Abdelnour C, Matar E, Chiu SY, Ferreira D, Hamilton CA, Donaghy PC, Rodriguez-Porcel F, Toledo JB, Habich A, Barrett MJ, Patel B, Jaramillo-Jimenez A, Scott GD, Kane JPM. Differentiating Prodromal Dementia with Lewy Bodies from Prodromal Alzheimer's Disease: A Pragmatic Review for Clinicians. Neurol Ther 2024; 13:885-906. [PMID: 38720013 PMCID: PMC11136939 DOI: 10.1007/s40120-024-00620-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
This pragmatic review synthesises the current understanding of prodromal dementia with Lewy bodies (pDLB) and prodromal Alzheimer's disease (pAD), including clinical presentations, neuropsychological profiles, neuropsychiatric symptoms, biomarkers, and indications for disease management. The core clinical features of dementia with Lewy bodies (DLB)-parkinsonism, complex visual hallucinations, cognitive fluctuations, and REM sleep behaviour disorder are common prodromal symptoms. Supportive clinical features of pDLB include severe neuroleptic sensitivity, as well as autonomic and neuropsychiatric symptoms. The neuropsychological profile in mild cognitive impairment attributable to Lewy body pathology (MCI-LB) tends to include impairment in visuospatial skills and executive functioning, distinguishing it from MCI due to AD, which typically presents with impairment in memory. pDLB may present with cognitive impairment, psychiatric symptoms, and/or recurrent episodes of delirium, indicating that it is not necessarily synonymous with MCI-LB. Imaging, fluid and other biomarkers may play a crucial role in differentiating pDLB from pAD. The current MCI-LB criteria recognise low dopamine transporter uptake using positron emission tomography or single photon emission computed tomography (SPECT), loss of REM atonia on polysomnography, and sympathetic cardiac denervation using meta-iodobenzylguanidine SPECT as indicative biomarkers with slowing of dominant frequency on EEG among others as supportive biomarkers. This review also highlights the emergence of fluid and skin-based biomarkers. There is little research evidence for the treatment of pDLB, but pharmacological and non-pharmacological treatments for DLB may be discussed with patients. Non-pharmacological interventions such as diet, exercise, and cognitive stimulation may provide benefit, while evaluation and management of contributing factors like medications and sleep disturbances are vital. There is a need to expand research across diverse patient populations to address existing disparities in clinical trial participation. In conclusion, an early and accurate diagnosis of pDLB or pAD presents an opportunity for tailored interventions, improved healthcare outcomes, and enhanced quality of life for patients and care partners.
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Affiliation(s)
- Kathryn A Wyman-Chick
- Struthers Parkinson's Center and Center for Memory and Aging, Department of Neurology, HealthPartners/Park Nicollet, Bloomington, USA.
| | - Parichita Chaudhury
- Cleo Roberts Memory and Movement Center, Banner Sun Health Research Institute, Sun City, USA
| | - Ece Bayram
- Parkinson and Other Movement Disorders Center, University of California San Diego, San Diego, USA
| | - Carla Abdelnour
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, USA
| | - Elie Matar
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Shannon Y Chiu
- Department of Neurology, Mayo Clinic Arizona, Phoenix, USA
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Solna, Sweden
- Department of Radiology, Mayo Clinic Rochester, Rochester, USA
- Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, Las Palmas, Spain
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Jon B Toledo
- Nantz National Alzheimer Center, Stanley Appel Department of Neurology, Houston Methodist Hospital, Houston, USA
| | - Annegret Habich
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institute, Solna, Sweden
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Matthew J Barrett
- Department of Neurology, Parkinson's and Movement Disorders Center, Virginia Commonwealth University, Richmond, USA
| | - Bhavana Patel
- Department of Neurology, College of Medicine, University of Florida, Gainesville, USA
- Norman Fixel Institute for Neurologic Diseases, University of Florida, Gainesville, USA
| | - Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- School of Medicine, Grupo de Neurociencias de Antioquia, Universidad de Antioquia, Medellín, Colombia
| | - Gregory D Scott
- Department of Pathology and Laboratory Services, VA Portland Medical Center, Portland, USA
| | - Joseph P M Kane
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Weber MA, Kerr G, Thangavel R, Conlon MM, Gumusoglu SB, Gupta K, Abdelmotilib HA, Halhouli O, Zhang Q, Geerling JC, Narayanan NS, Aldridge GM. Alpha-Synuclein Pre-Formed Fibrils Injected into Prefrontal Cortex Primarily Spread to Cortical and Subcortical Structures. JOURNAL OF PARKINSON'S DISEASE 2024; 14:81-94. [PMID: 38189765 PMCID: PMC10836574 DOI: 10.3233/jpd-230129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) are characterized by diffuse spread of alpha-synuclein (α-syn) throughout the brain. Patients with PDD and DLB have a neuropsychological pattern of deficits that include executive dysfunction, such as abnormalities in planning, timing, working memory, and behavioral flexibility. The prefrontal cortex (PFC) plays a major role in normal executive function and often develops α-syn aggregates in DLB and PDD. OBJECTIVE To investigate the long-term behavioral and cognitive consequences of α-syn pathology in the cortex and characterize pathological spread of α-syn. METHODS We injected human α-syn pre-formed fibrils into the PFC of wild-type male mice. We then assessed the behavioral and cognitive effects between 12- and 21-months post-injection and characterized the spread of pathological α-syn in cortical, subcortical, and brainstem regions. RESULTS We report that PFC PFFs: 1) induced α-syn aggregation in multiple cortical and subcortical regions with sparse aggregation in midbrain and brainstem nuclei; 2) did not affect interval timing or spatial learning acquisition but did mildly alter behavioral flexibility as measured by intraday reversal learning; and 3) increased open field exploration. CONCLUSIONS This model of cortical-dominant pathology aids in our understanding of how local α-syn aggregation might impact some symptoms in PDD and DLB.
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Affiliation(s)
- Matthew A. Weber
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Gemma Kerr
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Ramasamy Thangavel
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Mackenzie M. Conlon
- Medical Scientist Training Program, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Serena B. Gumusoglu
- Department of Obstetrics and Gynecology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Kalpana Gupta
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Hisham A. Abdelmotilib
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Oday Halhouli
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Qiang Zhang
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Joel C. Geerling
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Nandakumar S. Narayanan
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Georgina M. Aldridge
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
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3
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Weber MA, Kerr G, Thangavel R, Conlon MM, Abdelmotilib HA, Halhouli O, Zhang Q, Geerling JC, Narayanan NS, Aldridge GM. Alpha-synuclein pre-formed fibrils injected into prefrontal cortex primarily spread to cortical and subcortical structures and lead to isolated behavioral symptoms. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.31.526365. [PMID: 36778400 PMCID: PMC9915664 DOI: 10.1101/2023.01.31.526365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) are characterized by diffuse spread of alpha-synuclein (α-syn) throughout the brain. Patients with PDD and DLB have a neuropsychological pattern of deficits that include executive dysfunction, such as abnormalities in planning, timing, working memory, and behavioral flexibility. The prefrontal cortex (PFC) plays a major role in normal executive function and often develops α-syn aggregates in DLB and PDD. To investigate the consequences of α-syn pathology in the cortex, we injected human α-syn pre-formed fibrils into the PFC of wildtype mice. We report that PFC PFFs: 1) induced α-syn aggregation in multiple cortical and subcortical regions with sparse aggregation in midbrain and brainstem nuclei; 2) did not affect interval timing or spatial learning acquisition but did mildly alter behavioral flexibility as measured by intraday reversal learning; 3) increased open field exploration; and 4) did not affect susceptibility to an inflammatory challenge. This model of cortical-dominant pathology aids in our understanding of how local α-syn aggregation might impact some symptoms in PDD and DLB.
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Affiliation(s)
- Matthew A. Weber
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City
| | - Gemma Kerr
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City
| | - Ramasamy Thangavel
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City
| | - Mackenzie M. Conlon
- Medical Scientist Training Program, Carver College of Medicine, University of Iowa, Iowa City
| | | | - Oday Halhouli
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City
| | - Qiang Zhang
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City
| | - Joel C. Geerling
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City
| | | | - Georgina M. Aldridge
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City
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Characterising the prodromal phase in dementia with Lewy bodies. Parkinsonism Relat Disord 2023; 107:105279. [PMID: 36630737 DOI: 10.1016/j.parkreldis.2023.105279] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Three presentations of prodromal dementia with Lewy bodies (DLB) have recently been proposed. This study investigates the frequency of symptoms in the prodromal phase of DLB. METHOD Patients diagnosed with DLB between the 1st of February 2017 and 1st of February 2021 were retrospectively identified and matched to a group of patients diagnosed with Alzheimer's disease (AD). Patient case files were reviewed identifying the first symptoms and symptoms in the prodromal phase (cognitive impairment, psychiatric symptoms, delirium/acute confusional episodes, RBD, motor symptoms indicative of Parkinson's disease, anosmia, and autonomic dysfunction). RESULTS A total of 166 DLB patient and 168 AD patients were included. Of the proposed presentations in patients diagnosed with DLB, 30% presented with cognitive impairment at onset in isolation, 6% with psychiatric symptoms, and 2% with delirium/acute confusional episodes. Prodromal DLB was more likely to present with no cognitive symptoms at initial presentation (38% vs 10%) and was more likely to involve other symptoms (69% vs 26%). Of other possible presentations, Rapid eye-movement sleep Behaviour Disorder (RBD) was found at onset in 22% with a mean prodromal length of 8.4 years (all symptoms: mean 4.3 years, SD 5.8). CONCLUSION We found some supportive evidence of the proposed cognitive and psychiatric presentations of prodromal DLB. Our findings build on previous findings that an RBD presentation exist, and further research is needed to characterise this presentation.
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Richardson S, Lawson RA, Price A, Taylor JP. Challenges in diagnosis and management of delirium in Lewy body disease. Acta Psychiatr Scand 2022; 147:475-480. [PMID: 36281704 DOI: 10.1111/acps.13514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Delirium is an acute onset and fluctuating impairment of cognition, attention and arousal, often precipitated by acute illness. Lewy body disease (LBD) is an umbrella term for a range of clinical conditions, including Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB). People living with LBD seem to be more susceptible to delirium than those with other subtypes of dementia. AIM To describe the challenges in clinical diagnosis and management of LBD. METHODS A systematic review of published literature on diagnosis and management of delirium in LBD. RESULTS Delirium is particularly challenging to diagnose in LBD as many of the clinical characteristics which define delirium such as inattention, fluctuating arousal, complex visual hallucinations and delusions, are also common to LBD. Distinguishing delirium from LBD can be very difficult clinically especially in the prodromal stages. Both under and over diagnosis of delirium, and under and over treatment of the symptoms have the potential to compromise the care and safety of people with a diagnosed or undiagnosed LBD. Clinicians are currently working with an extremely limited set of evidence-based management options for those with delirium in the context of a LBD diagnosis. For patients with LBD and their families this is an area of clinical practice that needs focused research.
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Affiliation(s)
- Sarah Richardson
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Annabel Price
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK.,Department of Psychological Medicine, Cambridgeshire and Peterborough Foundation NHS Trust, Cambridge, UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
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Inskip MJ, Mavros Y, Sachdev PS, Hausdorff JM, Hillel I, Singh MAF. Promoting independence in Lewy body dementia through exercise: the PRIDE study. BMC Geriatr 2022; 22:650. [PMID: 35945508 PMCID: PMC9361699 DOI: 10.1186/s12877-022-03347-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Lewy body dementia (LBD) is an aggressive type of dementia of rapid, fluctuating disease trajectory, higher incidence of adverse events, and poorer functional independence than observed in Alzheimer’s disease dementia. Non-pharmacological treatments such as progressive, high-intensity exercise are effective in other neurological cohorts but have been scarcely evaluated in LBD. Methods The Promoting Independence in Lewy Body Dementia through Exercise (PRIDE) trial was a non-randomised, non-blinded, crossover pilot trial involving older adults with LBD consisting of a baseline assessment, an 8-week wait-list, and an 8-week exercise intervention. The aims of this study were to evaluate the determinants of the primary outcome functional independence, as measured by the Movement Disorder Society Unified Parkinson’s Disease Rating Scale, and the feasibility and preliminary efficacy of an exercise intervention on this outcome. Additionally, important clinical characteristics were evaluated to explore associations and treatment targets. The exercise intervention was supervised, clinic-based, high-intensity progressive resistance training (PRT), challenging balance, and functional exercises, 3 days/week. Results Nine participants completed the baseline cross-sectional study, of which five had a diagnosis of Parkinson’s disease dementia (PDD), and four dementia with Lewy Bodies (DLB). Six completed the exercise intervention (three PDD, three DLB). The cohort was diverse, ranging from mild to severe dementia and living in various residential settings. Greater functional independence at baseline was significantly associated with better physical function, balance, cognition, quality of life, muscle mass ratio, walking endurance, faster walking speed and cadence, and lower dementia severity (p < 0.05). Participants declined by clinically meaningful amounts in functional independence, cognition, physical function, muscle mass, and weight over the wait-list period (p < 0.05). Following exercise, participants improved by clinically meaningful amounts in functional independence, cognition, physical function, and strength (p < 0.05). Progressive, high intensity exercise was well-tolerated (> 80% adherence), and only one minor exercise-related adverse event occurred. Conclusions PRIDE is the first exercise trial conducted specifically within individuals diagnosed with LBD, and provides important insight for the design of larger, randomized trials for further evaluation of progressive, high-intensity exercise as a valuable treatment in LBD. Trial registration The PRIDE trial protocol has previously been prospectively registered (08/04/2016, ANZCTR: ACTRN12616000466448). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03347-2.
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Affiliation(s)
- Michael J Inskip
- Sport and Exercise Science, College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia. .,Exercise and Sport Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia.
| | - Yorgi Mavros
- Exercise and Sport Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, NSW, Australia
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Inbar Hillel
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Maria A Fiatarone Singh
- Exercise and Sport Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia.,Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia.,Hebrew SeniorLife, Boston, MA, USA
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Halhouli O, Zhang Q, Aldridge GM. Caring for patients with cognitive dysfunction, fluctuations and dementia caused by Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2022; 269:407-434. [PMID: 35248204 DOI: 10.1016/bs.pbr.2022.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cognitive dysfunction is one of the most prevalent non-motor symptoms in patients with Parkinson's disease (PD). While it tends to worsen in the later stages of disease, it can occur at any time, with 15-20% of patients exhibiting cognitive deficits at diagnosis (Aarsland et al., 2010; Goldman and Sieg, 2020). The characteristic features of cognitive dysfunction include impairment in executive function, visuospatial abilities, and attention, which vary in severity from subtle impairment to overt dementia (Martinez-Horta and Kulisevsky, 2019). To complicate matters, cognitive dysfunction is prone to fluctuate in PD patients, impacting diagnosis and the ability to assess progression and decision-making capacity. The diagnosis of cognitive impairment or dementia has a huge impact on patient independence, quality of life, life expectancy and caregiver burden (Corallo et al., 2017; Lawson et al., 2016; Leroi et al., 2012). It is therefore essential that physicians caring for patients with PD provide education, screening and treatment for this aspect of the disease. In this chapter, we provide a practical guide for the assessment and management of various degrees of cognitive dysfunction in patients with PD by approaching the disease at different stages. We address risk factors for cognitive dysfunction, prevention strategies prior to making the diagnosis, available tools for screening. Lastly, we review aspects of care, management and considerations, including decision-making capacity, that occur after the patient has been diagnosed with cognitive dysfunction or dementia.
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Affiliation(s)
- Oday Halhouli
- University of Iowa, Department of Neurology, Iowa City, IA, United States
| | - Qiang Zhang
- University of Iowa, Department of Neurology, Iowa City, IA, United States
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8
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Hansen N, Timäus C, Bouter C, Lange C, Packroß K. Delirium-Onset of Prodromal Dementia With Lewy Bodies—Putative Brainstem-Related Pathomechanism and Clinical Relevance. Front Aging Neurosci 2022; 14:829098. [PMID: 35283755 PMCID: PMC8914055 DOI: 10.3389/fnagi.2022.829098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Niels Hansen
- Department of Psychiatry and Psychotherapy, University of Goettingen, Göttingen, Germany
- *Correspondence: Niels Hansen
| | - Charles Timäus
- Department of Psychiatry and Psychotherapy, University of Goettingen, Göttingen, Germany
| | - Caroline Bouter
- Department of Nuclear Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Claudia Lange
- Department of Psychiatry and Psychotherapy, University of Goettingen, Göttingen, Germany
| | - Katharina Packroß
- Department of Psychiatry and Psychotherapy, University of Goettingen, Göttingen, Germany
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9
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Payne S, Shofer JB, Shutes-David A, Li G, Jankowski A, Dean P, Tsuang D. Correlates of Conversion from Mild Cognitive Impairment to Dementia with Lewy Bodies: Data from the National Alzheimer's Coordinating Center. J Alzheimers Dis 2022; 86:1643-1654. [PMID: 35213374 PMCID: PMC9536845 DOI: 10.3233/jad-215428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many patients with dementia with Lewy bodies (DLB) miss out on the best standards of care and psychosocial support due to diagnostic delays or inaccuracies following symptom onset. OBJECTIVE This study seeks to identify baseline characteristics in individuals with mild cognitive impairment (MCI) that correlate with eventual conversion to DLB or Alzheimer's disease (AD). METHODS Baseline neuropsychological and neuropsychiatric data were analyzed in National Alzheimer's Coordinating Center participants who completed the Uniform Data Set between 2006 and 2020 and subsequently converted from MCI to DLB or AD (n = 1632). RESULTS Only 6% of participants with MCI converted to DLB. Among those who converted to DLB, multidomain amnestic MCI (aMCI) was the most common subtype at study entry. As part of logistic regression analyses, odds ratios (ORs) were estimated for conversion to DLB versus AD based on study-entry characteristics, adjusting for age, sex, education, and years to diagnosis. The strongest predictors of conversion to DLB (p≤0.0001) were nonamnestic MCI versus aMCI (OR 8.2, CI [5.0, 14]), multidomain MCI versus single-domain MCI (OR 2.7, CI [1.7. 4.2]), male sex (OR 4.2, CI [2.5, 7.1]), and presence of nighttime behaviors (OR 4.4 CI [2.8, 6.9]). CONCLUSION A diagnosis of prodromal DLB should be considered in individuals with MCI who present with prominent executive/visuospatial deficits, neuropsychiatric symptoms, and less memory impairment. Early diagnosis of DLB may guide treatment planning, including the avoidance of antipsychotic medications in patients who develop psychotic symptoms, caregiver support, and initiation of early treatment(s) once medications become available.
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Affiliation(s)
- Sarah Payne
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, USA
| | - Jane B. Shofer
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Andrew Shutes-David
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, USA
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA, USA
| | - Ge Li
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, USA
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Adrienne Jankowski
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, USA
| | - Pamela Dean
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Mental Health Service, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Debby Tsuang
- Geriatric Research, Education, and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Correspondence to: Debby Tsuang, MD, MS, VA Puget Sound, Health Care System, 1660 S Columbian Way, MS-182, Seattle WA, 98108, USA. Tel.: +1 206 277 1333;
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10
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FitzGerald JM, Price A. Delirium in the acute hospital setting: the role of psychiatry. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2020.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
SUMMARYIn this overview we discuss the role of psychiatry in managing delirium in acute hospital admissions. We briefly discuss the role psychiatry can offer in four main domains: (a) assessment; (b) management; (c) recovery; and (d) paradigm, education and research. In the assessment section we discuss accurately detecting delirium in the context of comorbid mixed neuropsychiatric syndromes, including depression and dementia, and the clinical importance of delirium subtyping. The management section briefly outlines pharmacological and non-pharmacological approaches to delirium and their evidence-based rationale. The recovery section focuses on the effect delirium can have on cognitive decline, mental health and long-term health, including functional outcome and need for institutional care after hospital discharge. Finally, we outline the role of psychiatry in delirium research and education. We hope that this article will encourage clinicians to reflect on their current practice and consider holistic and evidence-based care for this vulnerable population in the acute hospital setting.
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11
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Espinosa R, Davis M, Johnson S, Cline S, Weintraub D. Direct Medical Costs of Dementia With Lewy Bodies by Disease Complexity. J Am Med Dir Assoc 2020; 21:1696-1704.e5. [PMID: 32773201 DOI: 10.1016/j.jamda.2020.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 05/13/2020] [Accepted: 06/01/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There is currently no accurate profile of the economic burden of dementia with Lewy bodies (DLB), particularly any examination of the direct medical costs of DLB by the number of affected clinical domains. Understanding how trends in the use of healthcare resources evolve as DLB progresses presents opportunities for the development of earlier and more appropriate interventions. DESIGN Retrospective study using claims data extracted from the IBM MarketScan Commercial and Medicare Supplemental database. SETTING AND PARTICIPANTS In total, 536 patients with DLB from the Commercial database and 5485 patients with DLB from the Medicare Supplemental database. METHODS Patients were grouped into disease complexity categories based on core clinical features (ie, fluctuating cognition, motor symptoms, visual hallucinations, and rapid eye movement sleep behavior disorder in addition to dementia) observed during the study period: dementia with no core features observed, dementia plus 1, 2, or ≥3 core features, respectively. Outcome measures included healthcare resource utilization and healthcare costs. RESULTS In both databases, total healthcare resource utilization and costs increased with number of core features. Compared with patients with no core features observed, patients in all other complexity categories had significantly higher mean medical visits and costs in both adjusted and unadjusted analyses. Fluctuating cognition was associated with the highest total costs, suggesting that this clinical feature in particular is associated with a considerable economic burden. CONCLUSIONS AND IMPLICATIONS Analyzing direct medical costs of DLB by disease complexity using claims data showed that a higher cost impact was associated with increasing number of clinical domains affected and with specific clinical domains, suggesting the need for both targeted and comprehensive interventions to improve the overall economic burden of DLB.
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Affiliation(s)
| | | | | | | | - Daniel Weintraub
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Parkinson's Disease Research, Education and Clinical Center (PADRECC), Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
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12
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Möllers T, Perna L, Stocker H, Ihle P, Schubert I, Schöttker B, Frölich L, Brenner H. New use of psychotropic medication after hospitalization among people with dementia. Int J Geriatr Psychiatry 2020; 35:640-649. [PMID: 32100308 DOI: 10.1002/gps.5282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/14/2020] [Accepted: 02/13/2020] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Psychotropic medication is commonly used among people with dementia (PWD), but it shows modest efficacy and it has been associated with severe adverse events. Hospitalizations are an opportunity for medication management as well as treatment recommendations for outpatient physicians. The aim of this study was to asses factors associated with new use of psychotropic medication after hospitalization among PWD. METHODS We conducted a retrospective dynamic cohort study from 2004 to 2015 using claims data from a German health insurance company. PWD were identified by an algorithm that included ICD-10 diagnosis and diagnostic measures. The medication classes included were antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication. The assessment period was up to 30 days after discharge from the hospital across four hospitalizations. RESULTS The main predictors for new use of psychotropic medication were similar across medication classes. Neuropsychiatric symptoms (NPS) and the need of care were associated with higher odds of new use of antidepressants, antipsychotics, and anxiolytics or hypnotics/sedatives. A hospital stay due to dementia was an independent predictor for new use across medication classes as well. Delirium increased the odds for new use of antipsychotics and anxiolytics or hypnotics/sedatives. CONCLUSIONS Factors associated with new use of psychotropic medication included delirium, NPS, and the need of care in PWD. The findings highlight the need for preventive interventions and non-medical treatment options in regards to delirium and NPS as well as for a more intensive use of screening tools for inappropriate medication use among PWD. Key points The percentage of new users was 1.8%, 7.1%, 2.1%, and 2.5% across hospitalizations for antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication, respectively. 83.0%, 61.9%, 56.9%, and 88.1% of new users received antidepressants, antipsychotics, anxiolytics or hypnotics/sedatives, and Alzheimer's medication for more than 6 weeks. Delirium and neuropsychiatric symptoms were associated with significantly increased odds of new psychotropic medication use. Hospital stays due to dementia and the need of care were predictors for new use of psychotropic medication.
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Affiliation(s)
- Tobias Möllers
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Laura Perna
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Department of Translational Research in Psychiatry, Max Planck Institute for Psychiatry, Munich, Germany
| | - Hannah Stocker
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Medical Faculty, Heidelberg University, Heidelberg, Germany
| | - Peter Ihle
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ingrid Schubert
- PMV Research Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ben Schöttker
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Lutz Frölich
- Department of Gerontopsychiatry, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Hermann Brenner
- Network Aging Research, Heidelberg University, Heidelberg, Germany.,Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
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13
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McKeith IG, Ferman TJ, Thomas AJ, Blanc F, Boeve BF, Fujishiro H, Kantarci K, Muscio C, O'Brien JT, Postuma RB, Aarsland D, Ballard C, Bonanni L, Donaghy P, Emre M, Galvin JE, Galasko D, Goldman JG, Gomperts SN, Honig LS, Ikeda M, Leverenz JB, Lewis SJG, Marder KS, Masellis M, Salmon DP, Taylor JP, Tsuang DW, Walker Z, Tiraboschi P. Research criteria for the diagnosis of prodromal dementia with Lewy bodies. Neurology 2020; 94:743-755. [PMID: 32241955 PMCID: PMC7274845 DOI: 10.1212/wnl.0000000000009323] [Citation(s) in RCA: 319] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/25/2020] [Indexed: 12/11/2022] Open
Abstract
The prodromal phase of dementia with Lewy bodies (DLB) includes (1) mild cognitive impairment (MCI), (2) delirium-onset, and (3) psychiatric-onset presentations. The purpose of our review is to determine whether there is sufficient information yet available to justify development of diagnostic criteria for each of these. Our goal is to achieve evidence-based recommendations for the recognition of DLB at a predementia, symptomatic stage. We propose operationalized diagnostic criteria for probable and possible mild cognitive impairment with Lewy bodies, which are intended for use in research settings pending validation for use in clinical practice. They are compatible with current criteria for other prodromal neurodegenerative disorders including Alzheimer and Parkinson disease. Although there is still insufficient evidence to propose formal criteria for delirium-onset and psychiatric-onset presentations of DLB, we feel that it is important to characterize them, raising the index of diagnostic suspicion and prioritizing them for further investigation.
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Affiliation(s)
- Ian G McKeith
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.).
| | - Tanis J Ferman
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Alan J Thomas
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Frédéric Blanc
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Bradley F Boeve
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Hiroshige Fujishiro
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Kejal Kantarci
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Cristina Muscio
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - John T O'Brien
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Ronald B Postuma
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Dag Aarsland
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Clive Ballard
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Laura Bonanni
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Paul Donaghy
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Murat Emre
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - James E Galvin
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Douglas Galasko
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Jennifer G Goldman
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Stephen N Gomperts
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Lawrence S Honig
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Manabu Ikeda
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - James B Leverenz
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Simon J G Lewis
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Karen S Marder
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Mario Masellis
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - David P Salmon
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - John Paul Taylor
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Debby W Tsuang
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Zuzana Walker
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
| | - Pietro Tiraboschi
- From the Newcastle University (I.G.M., A.J.T., P.D., J.P.T.); Mayo Clinic (T.J.F.), Jacksonville; University of Strasbourg (F.B.); Mayo Clinic (B.F.B., K.K.), Rochester; Nagoya University (H.F.), Kawasaki Memorial Hospital; Istituto Neurologico "Carlo Besta" (C.M., P.T.), Milan; Cambridge University (F.M.S.); McGill University (R.B.P.); King's College London and Stavanger University Hospital (D.A.); University of Exeter (C.B.); University of Chieti-Pescara (L.B.); Istanbul Faculty of Medicine (M.E.); University of Miami Miller School of Medicine (J.E.G.); University of California (D.G., D.P.S.), San Diego; Feinberg School of Medicine (J.G.G.); Massachusetts General Hospital (S.N.G.); Columbia University Irving Medical Center (L.S.H., K.S.M.); Osaka University (M.I.); Lou Ruvo Center of Brain Health (J.B.L.), Cleveland Clinic; University of Sydney (S.J.G.L.); Sunnybrook Health Sciences Centre (M.M.), University of Toronto; VA Puget Sound & University of Washington (D.W.T.); University College London (Z.W.)
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Gao H, Ma HJ, Li YJ, Yin C, Li Z. Prevalence and risk factors of postoperative delirium after spinal surgery: a meta-analysis. J Orthop Surg Res 2020; 15:138. [PMID: 32272939 PMCID: PMC7146882 DOI: 10.1186/s13018-020-01651-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Postoperative delirium (POD) was common after spinal surgery, but the main findings in previous studies remained conflicting. This current meta-analysis was aimed at exploring the prevalence and risk factors of POD after spinal surgery. METHODS PubMed and Embase were searched from inception to June 2019. Studies which reported the prevalence and risk factors of POD after spinal surgery were included. STATA version 12.0 was employed to analyze the pooled data. Statistical heterogeneity across included studies was identified using the I2 statistics. RESULTS A total of 28 studies with 588,732 patients were included in the meta-analysis. The pooled prevalence of POD after spinal surgery was 0.85% (95%CI, 0.83-0.88%) with substantial heterogeneity (I2 = 97.3%). The central nervous system disorder (OR 4.73; 95%CI, 4.30-5.19) was a strong predictor for POD, whereas age (OR 1.16; 95%CI, 1.05-2.47; I2 = 99.2%) and blood loss (OR 1.10; 95%CI, 1.01-1.20; I2 = 93.3%) were weaker predictors. The funnel plot and statistical tests suggested that there existed potential publication bias, but the trim and fill method indicated that the pooled prevalence basically kept stable after adding two "missing" studies. CONCLUSIONS The pooled POD after spinal surgery ranges from 0.83 to 0.88%. The central nervous system disorder, age, and blood loss were potential risk factors for POD.
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Affiliation(s)
- Hua Gao
- Department of Outpatient, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, 730030, China.
| | - Hui-Juan Ma
- Operating Theater, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, 730030, China
| | - Ying-Jia Li
- Operating Theater, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, 730030, China
| | - Ci Yin
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, 730030, China
| | - Zheng Li
- Department of Thoracic Surgery, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, Lanzhou, 730030, China
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15
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Using clinical registries, administrative data and electronic medical records to improve medication safety and effectiveness in dementia. Curr Opin Psychiatry 2020; 33:163-169. [PMID: 31972590 DOI: 10.1097/yco.0000000000000579] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Clinical registries, routinely collected administrative data and electronic medical records (EMRs) provide new opportunities to investigate medication safety and effectiveness. This review outlines the strengths and limitations of these data, and highlights recent research related to safe and effective medication use in dementia. RECENT FINDINGS Clinical registries, administrative data and EMRs facilitate observational research among people often excluded from randomized controlled trials (RCTs). Larger sample sizes and longer follow-up times permit research into less common adverse events not apparent in RCTs. The validity of diagnoses recorded in administrative data and EMRs remains variable, although positive predictive values are typically high and sensitivity is low. Dispensing records are a rich source of data for estimating medication exposure. Recent research has investigated medications and prescribing patterns as risk factors for incident dementia, strategies to alleviate behavioural symptoms and the management of comorbidity. Common study protocols and common data models are examples of distributed network approaches increasingly used to conduct large and generalizable multi-database studies across different countries. SUMMARY Greater availability of electronic health data provides important opportunities to address evidence-practice gaps in relation to medication use and safety in people with dementia.
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16
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Vardy E. Dementia with Lewy bodies. Clin Med (Lond) 2019; 19:429-430. [PMID: 31530705 DOI: 10.7861/clinmedicine.19-5-429b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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