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Gururangan K, Peschansky VJ, Van Hyfte G, Agarwal P, Blank LJ, Mathew B, Goldstein J, Kwon CS, McCarthy L, Cohen A, Chan AHW, Deng P, Dhamoon M, Gutzwiller E, Hao Q, He C, Klenofsky B, Lemus HN, Marcuse L, Navis A, Heredia Nunez WD, Luckey MN, Schorr EM, Singh A, Tantillo GB, Ufongene C, Young JJ, Balchandani P, Festa JR, Naasan G, Charney AW, Nadkarni GN, Jetté N. Neuropsychiatric complications of coronavirus disease 2019: Mount Sinai Health System cohort study. J Neurol 2024:10.1007/s00415-024-12370-9. [PMID: 38656620 DOI: 10.1007/s00415-024-12370-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To describe the frequency of neuropsychiatric complications among hospitalized patients with coronavirus disease 2019 (COVID-19) and their association with pre-existing comorbidities and clinical outcomes. METHODS We retrospectively identified all patients hospitalized with COVID-19 within a large multicenter New York City health system between March 15, 2020 and May 17, 2021 and randomly selected a representative cohort for detailed chart review. Clinical data, including the occurrence of neuropsychiatric complications (categorized as either altered mental status [AMS] or other neuropsychiatric complications) and in-hospital mortality, were extracted using an electronic medical record database and individual chart review. Associations between neuropsychiatric complications, comorbidities, laboratory findings, and in-hospital mortality were assessed using multivariate logistic regression. RESULTS Our study cohort consisted of 974 patients, the majority were admitted during the first wave of the pandemic. Patients were treated with anticoagulation (88.4%), glucocorticoids (24.8%), and remdesivir (10.5%); 18.6% experienced severe COVID-19 pneumonia (evidenced by ventilator requirement). Neuropsychiatric complications occurred in 58.8% of patients; 39.8% experienced AMS; and 19.0% experienced at least one other complication (seizures in 1.4%, ischemic stroke in 1.6%, hemorrhagic stroke in 1.0%) or symptom (headache in 11.4%, anxiety in 6.8%, ataxia in 6.3%). Higher odds of mortality, which occurred in 22.0%, were associated with AMS, ventilator support, increasing age, and higher serum inflammatory marker levels. Anticoagulant therapy was associated with lower odds of mortality and AMS. CONCLUSION Neuropsychiatric complications of COVID-19, especially AMS, were common, varied, and associated with in-hospital mortality in a diverse multicenter cohort at an epicenter of the COVID-19 pandemic.
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Affiliation(s)
- Kapil Gururangan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Veronica J Peschansky
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Grace Van Hyfte
- Department of Population Health Science and Policy, Institute of Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parul Agarwal
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Institute of Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leah J Blank
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Institute of Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian Mathew
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan Goldstein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Churl-Su Kwon
- Departments of Neurosurgery, Neurology, Epidemiology, and the Gertrude H. Sergievsky Center, Columbia University, New York, NY, USA
| | - Louise McCarthy
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ariella Cohen
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andy Ho Wing Chan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Pojen Deng
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mandip Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eveline Gutzwiller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Qing Hao
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Celestine He
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Britany Klenofsky
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hernan Nicolas Lemus
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lara Marcuse
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allison Navis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Mallory N Luckey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily M Schorr
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anuradha Singh
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gabriela B Tantillo
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Claire Ufongene
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James J Young
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Priti Balchandani
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joanne R Festa
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Georges Naasan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander W Charney
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics & Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Girish N Nadkarni
- Division of Data Driven and Digital Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Population Health Science and Policy, Institute of Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada.
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Ufongene C, Van Hyfte G, Agarwal P, Goldstein J, Mathew B, Navis A, McCarthy L, Kwon CS, Gururangan K, Balchandani P, Marcuse L, Naasan G, Singh A, Young J, Charney A, Nadkarni G, Jette N, Blank LJ. Older adults with epilepsy and COVID-19: Outcomes in a multi-hospital health system. Seizure 2024; 114:33-39. [PMID: 38039805 PMCID: PMC10841585 DOI: 10.1016/j.seizure.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is associated with high rates of mortality and morbidity in older adults, especially those with pre-existing conditions. There is little work investigating how neurological conditions affect older adults with COVID-19. We aimed to compare in-hospital outcomes, including mortality, in older adults with and without epilepsy. METHODS This retrospective study in a large multicenter New York health system included consecutive older patients (age ≥65 years) either with or without epilepsy who were admitted with COVID-19 between 3/2020-5/2021. Epilepsy was identified using a validated International Classification of Disease (ICD) and antiseizure medicationbased case definition. Univariate comparisons were calculated using Chi-square, Fisher's exact, Mann-Whitney U, or Student's t-tests. Multivariable logistic regression models were generated to examine factors associated with mortality, discharge disposition and length of stay (LOS). RESULTS We identified 5384 older adults admitted with COVID-19 of whom 173 (3.21 %) had epilepsy. Mean age was significantly lower in those with (75.44, standard deviation (SD): 7.23) compared to those without epilepsy (77.98, SD: 8.68, p = 0.007). Older adults with epilepsy were more likely to be ventilated (35.84 % vs. 16.18 %, p < 0.001), less likely to be discharged home (21.39 % vs. 43.12 %, p < 0.001), had longer median LOS (13 days vs. 8 days, p < 0.001), and had higher in-hospital death (35.84 % vs. 28.29 %, p = 0.030) compared to those without epilepsy. Epilepsy in older adults was associated with increased odds of in-hospital death (adjusted odds ratio (aOR), 1.55; 95 % CI 1.12-2.14, p = 0.032), non-routine discharge disposition (aOR, 3.34; 95 % CI 2.21-5.03, p < 0.001), and longer LOS (46.46 % 95 % CI 34 %-59 %, p < 0.001). CONCLUSIONS In models that adjusted for multiple confounders including comorbidity and age, our study found that epilepsy was still associated with higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19 higher in-hospital mortality, longer LOS and worse discharge dispositions in older adults with COVID-19. This work reinforces that epilepsy is a risk factor for worse outcomes in older adults admitted with COVID-19. Timely identification and treatment of COVID-19 in epilepsy may improve outcomes in older people with epilepsy.
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Affiliation(s)
- Claire Ufongene
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY, United States
| | - Grace Van Hyfte
- Department of Neurology, ISMMS, New York, NY, United States; Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, NY, United States
| | - Parul Agarwal
- Department of Neurology, ISMMS, New York, NY, United States; Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, NY, United States
| | - Jonathan Goldstein
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, NY, United States
| | - Brian Mathew
- Department of Neurology, ISMMS, New York, NY, United States
| | - Allison Navis
- Department of Neurology, ISMMS, New York, NY, United States
| | | | - Churl-Su Kwon
- Department of Neurology, Epidemiology, Neurosurgery and the Gertrude H. Sergievsky Center, Columbia University, New York, NY, United States
| | | | - Priti Balchandani
- BioMedical Engineering and Imaging Institute, ISMMS, New York, NY, United States
| | - Lara Marcuse
- Department of Neurology, ISMMS, New York, NY, United States
| | - Georges Naasan
- Department of Neurology, ISMMS, New York, NY, United States
| | - Anuradha Singh
- Department of Neurology, ISMMS, New York, NY, United States
| | - James Young
- Department of Neurology, ISMMS, New York, NY, United States
| | | | | | - Nathalie Jette
- Department of Neurology, ISMMS, New York, NY, United States; Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, NY, United States; Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Leah J Blank
- Department of Neurology, ISMMS, New York, NY, United States; Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, NY, United States.
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Becker JH, Lin JJ, Twumasi A, Goswami R, Carnavali F, Stone K, Rivera-Mindt M, Kale MS, Naasan G, Festa JR, Wisnivesky JP. Greater executive dysfunction in patients post-COVID-19 compared to those not infected. Brain Behav Immun 2023; 114:111-117. [PMID: 37586567 DOI: 10.1016/j.bbi.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND A number of patients post-coronavirus disease-19 (COVID-19) report cognitive impairment (CI), even months after acute infection. We aimed to assess if COVID-19 is associated with increased incidence of CI in comparison to controls. METHODS We analyzed data from the Mount Sinai Health System Post-COVID-19 Registry in New York City, a prospective cohort of patients post-COVID-19 ≥18 years of age and non-infected controls. CI was defined by scores ≥ 1.0 standard deviation below population norms, and was assessed using well-validated measures of attention, working memory, processing speed, executive functioning/cognitive flexibility, language, learning, and memory. Logistic regression models assessed odds for CI in each domain in patients post-COVID-19 vs. controls after adjusting for potential confounders. In exploratory analyses, we assessed odds for CI by site of acute COVID-19 care as a proxy for disease severity. FINDINGS 417 patients post-COVID-19 and 151 controls (mean age 49 years, 63% female, 21% Black, 17% Latinx) were included. In adjusted analyses, patients were significantly more likely than controls to have CI in executive functioning (odds ratio [OR]: 2.19; 95% confidence interval [CI]: 1.03 to 4.67), particularly those treated in outpatient (OR: 2.22; 95% CI: 1.02 to 4.82) and inpatient hospital (OR: 3.59; 95% CI: 1.27 to 10.16) settings. There were no significant associations between CI in other domains and history of COVID-19 or site of acute care. INTERPRETATION Patients post-COVID-19 have greater odds of executive dysfunction, suggesting that focused cognitive screening may be prudent, even in those with mild to moderate disease. Studies should explore the pathophysiology and potential treatments for CI in this population. FUNDING This work was funded by the Icahn School of Medicine at Mount Sinai.
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Affiliation(s)
- Jacqueline H Becker
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Akosua Twumasi
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Ruchir Goswami
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Fernando Carnavali
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Kimberly Stone
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Monica Rivera-Mindt
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Minal S Kale
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Georges Naasan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Joanne R Festa
- Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Juan P Wisnivesky
- Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
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4
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Downes MH, Morgenstern R, Naasan G, Patterson S, Pace A, Agarwal P, Shin S, Abrams R, Mueller B, Young J, Tamler R, Vickrey BG, Kummer BR. Healthcare utilization impacts of an eConsult program for headache at an academic medical center. J Telemed Telecare 2023:1357633X231207908. [PMID: 37901905 DOI: 10.1177/1357633x231207908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Interprofessional consultations ("eConsults") can reduce healthcare utilization. However, the impact of eConsults on healthcare utilization remains poorly characterized among patients with headache. METHODS We performed a retrospective, 1:1 matched cohort study comparing patients evaluated for headache via eConsult request or in-person referral at the Mount Sinai Health System in New York. Groups were matched on clinical and demographic characteristics. Our primary outcome was one or more outpatient headache-related encounters in 6 months following referral date. Secondary outcomes included one or more all-cause outpatient neurology and headache-related emergency department (ED) encounters during the same period. We used univariable and multivariable logistic regression to model associations between independent variables and outcomes. RESULTS We identified 74 patients with headache eConsults who were matched to 74 patients with in-person referrals. Patients in the eConsult group were less likely to achieve the primary outcome (29.7% vs 62.2%, P < 0.0001) or have an all-cause outpatient neurology encounter (33.8% vs 79.7%, P < 0.0001) than patients in the comparison group. Both groups did not significantly differ by headache-related ED encounters. In multivariable analyses, patients in the eConsult group had significantly lower odds of having one or more headache-related or all-cause neurology encounters than patients in the comparison group (odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1-0.6; OR 0.1, 95% CI 0.1-0.3, respectively). DISCUSSION In comparison to in-person referrals, eConsult requests for headache were associated with reduced likelihood of outpatient neurology encounters in the short-term but not with differential use of headache-related ED encounters. Larger-scale, prospective studies should validate our findings and assess patient outcomes.
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Affiliation(s)
| | - Rachelle Morgenstern
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Georges Naasan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shanna Patterson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anna Pace
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parul Agarwal
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Susan Shin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rory Abrams
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bridget Mueller
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James Young
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ronald Tamler
- Division of Endocrinology, Diabetes, and Bone Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Clinical Informatics, Mount Sinai Health System, New York, NY, USA
| | - Barbara G Vickrey
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin R Kummer
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Clinical Informatics, Mount Sinai Health System, New York, NY, USA
- Windreich Department of Artificial Intelligence and Human Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Ufongene C, Van Hyfte G, Agarwal P, Blank LJ, Goldstein J, Mathew B, Lin JY, Navis A, McCarthy L, Gururangan K, Peschansky V, Kwon CS, Cohen A, Chan AHW, Dhamoon M, Deng P, Gutzwiller EM, Hao Q, He C, Heredia Nunez WD, Klenofsky B, Lemus HN, Marcuse L, Roberts M, Schorr EM, Singh A, Tantillo G, Young J, Balchandani P, Festa J, Naasan G, Charney A, Nadkarni G, Jetté N. In-hospital outcomes in patients with and without epilepsy diagnosed with COVID-19-A cohort study. Epilepsia 2023; 64:2725-2737. [PMID: 37452760 DOI: 10.1111/epi.17715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Coronavirus disease 2019 (COVID-19) is associated with mortality in persons with comorbidities. The aim of this study was to evaluate in-hospital outcomes in patients with COVID-19 with and without epilepsy. METHODS We conducted a retrospective study of patients with COVID-19 admitted to a multicenter health system between March 15, 2020, and May 17, 2021. Patients with epilepsy were identified using a validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)/ICD-10-CM case definition. Logistic regression models and Kaplan-Meier analyses were conducted for mortality and non-routine discharges (i.e., not discharged home). An ordinary least-squares regression model was fitted for length of stay (LOS). RESULTS We identified 9833 people with COVID-19 including 334 with epilepsy. On univariate analysis, people with epilepsy had significantly higher ventilator use (37.70% vs 14.30%, p < .001), intensive care unit (ICU) admissions (39.20% vs 17.70%, p < .001) mortality rate (29.60% vs 19.90%, p < .001), and longer LOS (12 days vs 7 days, p < .001). and fewer were discharged home (29.64% vs 57.37%, p < .001). On multivariate analysis, only non-routine discharge (adjusted odds ratio [aOR] 2.70, 95% confidence interval [CI] 2.00-3.70; p < .001) and LOS (32.50% longer, 95% CI 22.20%-43.60%; p < .001) were significantly different. Factors associated with higher odds of mortality in epilepsy were older age (aOR 1.05, 95% CI 1.03-1.08; p < .001), ventilator support (aOR 7.18, 95% CI 3.12-16.48; p < .001), and higher Charlson comorbidity index (CCI) (aOR 1.18, 95% CI 1.04-1.34; p = .010). In epilepsy, admissions between August and December 2020 or January and May 2021 were associated with a lower odds of non-routine discharge and decreased LOS compared to admissions between March and July 2020, but this difference was not statistically significant. SIGNIFICANCE People with COVID-19 who had epilepsy had a higher odds of non-routine discharge and longer LOS but not higher mortality. Older age (≥65), ventilator use, and higher CCI were associated with COVID-19 mortality in epilepsy. This suggests that older adults with epilepsy and multimorbidity are more vulnerable than those without and should be monitored closely in the setting of COVID-19.
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Affiliation(s)
- Claire Ufongene
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, New York, USA
| | - Grace Van Hyfte
- Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, New York, USA
| | - Parul Agarwal
- Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, New York, USA
- Department of Neurology, ISMMS, New York, New York, USA
| | - Leah J Blank
- Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, New York, USA
- Department of Neurology, ISMMS, New York, New York, USA
| | - Jonathan Goldstein
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, New York, USA
| | - Brian Mathew
- Department of Neurology, ISMMS, New York, New York, USA
| | - Jung-Yi Lin
- Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, New York, USA
| | - Allison Navis
- Department of Neurology, ISMMS, New York, New York, USA
| | | | | | - Veronica Peschansky
- Department of Neurology, ISMMS, New York, New York, USA
- Department of Neurology, Columbia University, New York, New York, USA
| | - Churl-Su Kwon
- Department of Neurology, Columbia University, New York, New York, USA
- Department of Neurosurgery, Epidemiology, and the Gertrude H. Sergievsky Center, Columbia University, New York, New York, USA
| | - Ariella Cohen
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, New York, USA
| | | | | | - Pojen Deng
- Department of Neurology, ISMMS, New York, New York, USA
| | | | - Qing Hao
- Department of Neurology, ISMMS, New York, New York, USA
| | - Celestine He
- Icahn School of Medicine at Mount Sinai (ISMMS), New York, New York, USA
| | | | | | | | - Lara Marcuse
- Department of Neurology, ISMMS, New York, New York, USA
| | | | - Emily M Schorr
- Division of Neuroimmunology and Neuroinfectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Gabriela Tantillo
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - James Young
- Department of Neurology, ISMMS, New York, New York, USA
| | - Priti Balchandani
- BioMedical Engineering and Imaging Institute, ISMMS, New York, New York, USA
| | - Joanne Festa
- Department of Neurology, ISMMS, New York, New York, USA
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Mount Sinai, New York, New York, USA
| | - Georges Naasan
- Department of Neurology, ISMMS, New York, New York, USA
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Mount Sinai, New York, New York, USA
| | - Alexander Charney
- Department of Psychiatry, ISMMS, New York, New York, USA
- Department of Genetics and Genomic Sciences, ISMMS, New York, New York, USA
| | | | - Nathalie Jetté
- Institute for HealthCare Delivery Science, Department of Population Health Science and Policy, ISMMS, New York, New York, USA
- Department of Neurology, ISMMS, New York, New York, USA
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Harrison KL, Garrett SB, Halim M, Sideman AB, Allison TA, Dohan D, Naasan G, Miller BL, Smith AK, Ritchie CS. “I Didn’t Sign Up for This”: Perspectives from Persons Living with Dementia and Care Partners on Challenges, Supports, and Opportunities to Add Geriatric Neuropalliative Care to Dementia Specialty Care. J Alzheimers Dis 2022; 90:1301-1320. [DOI: 10.3233/jad-220536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In the United States, dementia specialty centers affiliated with centers of excellence for research hold promise as locations to develop innovative, holistic care in care systems otherwise siloed by discipline or payer. Objective: We conducted foundational research to inform development of patient-and family-centered palliative care interventions for dementia specialty centers. Methods: We interviewed persons living with dementia (PLWD), current, and former care partners (CP) recruited from a specialty dementia clinic and purposively selected for variation across disease syndrome and stage. A framework method of thematic analysis included coding, analytic matrices, and pattern mapping. Results: 40 participants included 9 PLWD, 16 current CPs, and 15 former CPs of decedents; 48% impacted by Alzheimer’s disease dementia. While help from family, support groups and adult day centers, paid caregiving, and sensitive clinical care were invaluable to PLWD, CPs, or both, these supports were insufficient to navigate the extensive challenges. Disease-oriented sources of distress included symptoms, functional impairment and falls, uncertainty and loss, and inaccessible care. Social and relational challenges included constrained personal and professional opportunities. The obligation and toll of giving or receiving caregiving were challenging. Clinical care challenges for PLWD and/or CPs included care fragmentation, insufficient guidance to inform planning and need for expert interdisciplinary clinical care at home. Conclusion: Findings highlight the breadth and gravity of gaps, which surpass the disciplinary focus of either behavioral neurology or palliative care alone. Results can inform the development of novel interventions to add principles of geriatrics and neuropalliative care to dementia care.
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Affiliation(s)
- Krista L. Harrison
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
| | - Sarah B. Garrett
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
| | - Madina Halim
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Theresa A. Allison
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA
- Department of Humanities and Social Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Georges Naasan
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Mount Sinai Hospitals, Icahn School of Medicine, New York, NY, USA
| | - Bruce L. Miller
- Global Brain Health Institute, University of California, San Francisco, CA, USA
- Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Alexander K. Smith
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Christine S. Ritchie
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
- The Mongan Institute and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
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7
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Li L, Zhan S, Naasan G, Ornstein KA, Taioli E, Mazumdar M, Jebakumar J, McCardle K, Liu B. Time trends in cancer and dementia related hospital admissions among Medicare fee-for-service population, 2013-2018. J Geriatr Oncol 2022; 13:1058-1061. [PMID: 35514016 DOI: 10.1016/j.jgo.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/31/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Lihua Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Serena Zhan
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Georges Naasan
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Emanuela Taioli
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Madhu Mazumdar
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jebakaran Jebakumar
- Clinical Operations, Mount Sinai Hospital, New York, NY, United States of America
| | - Ken McCardle
- Clinical Operations, Mount Sinai Hospital, New York, NY, United States of America
| | - Bian Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
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8
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Kummer BR, Agarwal P, Sweetnam C, Robinson-Papp J, Blank LJ, Katz Sand I, Naasan G, Palmese CA, Jimenez-Shahed J, Grant J, Patterson S, Navis A, Stein LK, Jetté N. Trends in the Utilization of Teleneurology and Other Healthcare Resources Prior to and During the COVID-19 Pandemic in an Urban, Tertiary Health System. Front Neurol 2022; 13:834708. [PMID: 35222258 PMCID: PMC8873082 DOI: 10.3389/fneur.2022.834708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patient groups traditionally affected by health disparities were less likely to use video teleneurology (TN) care during the initial COVID-19 pandemic surge in the United States. Whether this asymmetry persisted later in the pandemic or was accompanied with a loss of access to care remains unknown. METHODS We conducted a retrospective cohort study using patient data from a multicenter healthcare system in New York City. We identified all established pediatric or adult neurology patients with at least two prior outpatient visits between June 16th, 2019 and March 15th, 2020 using our electronic medical record. For this established pre-COVID cohort, we identified telephone, in-person, video TN or emergency department visits and hospital admissions for any cause between March 16th and December 15th, 2020 ("COVID period"). We determined clinical, sociodemographic, income, and visit characteristics. Our primary outcome was video TN utilization, and our main secondary outcome was loss to follow-up during the COVID period. We used multivariable logistic regression to model the relationship between patient-level characteristics and both outcomes. RESULTS We identified 23,714 unique visits during the COVID period, which corresponded to 14,170 established patients from our institutional Neurology clinics during the pre-COVID period. In our cohort, 4,944 (34.9%) utilized TN and 4,997 (35.3%) were entirely lost to follow-up during the COVID period. In the adjusted regression analysis, Black or African-American race [adjusted odds ratio (aOR) 0.60, 97.5%CI 0.52-0.70], non-English preferred language (aOR 0.49, 97.5%CI 0.39-0.61), Medicaid insurance (aOR 0.50, 97.5%CI 0.44-0.57), and Medicare insurance (aOR 0.73, 97.5%CI 0.65-0.83) had decreased odds of TN utilization. Older age (aOR 0.98, 97.5%CI 0.98-0.99), female sex (aOR 0.90 97.5%CI 0.83-0.99), and Medicaid insurance (aOR 0.78, 0.68-0.90) were associated with decreased odds of loss to follow-up. CONCLUSION In the first 9 months of the COVID-19 pandemic, we found sociodemographic patterns in TN utilization that were similar to those found very early in the pandemic. However, these sociodemographic characteristics were not associated with loss to follow-up, suggesting that lack of TN utilization may not have coincided with loss of access to care.
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Affiliation(s)
- Benjamin R. Kummer
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Clinical Informatics, Mount Sinai Health System, New York, NY, United States
| | - Parul Agarwal
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Chloe Sweetnam
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jessica Robinson-Papp
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Leah J. Blank
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Clinical Informatics, Mount Sinai Health System, New York, NY, United States
| | - Ilana Katz Sand
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Georges Naasan
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Christina A. Palmese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joohi Jimenez-Shahed
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jihan Grant
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Shanna Patterson
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alison Navis
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Laura K. Stein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nathalie Jetté
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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9
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Shafir A, Ritchie CS, Garrett SB, Bernstein Sideman A, Naasan G, Merrilees J, Widera E, Flint L, Harrison KL. "Captive by the Uncertainty"-Experiences with Anticipatory Guidance for People Living with Dementia and Their Caregivers at a Specialty Dementia Clinic. J Alzheimers Dis 2022; 86:787-800. [PMID: 35124641 DOI: 10.3233/jad-215203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND After a diagnosis of Alzheimer's disease and related disorders, people living with dementia (PWD) and caregivers wonder what disease trajectory to expect and how to plan for functional and cognitive decline. This qualitative study aimed to identify patient and caregiver experiences receiving anticipatory guidance about dementia from a specialty dementia clinic. OBJECTIVE To examine PWD and caregiver perspectives on receiving anticipatory guidance from a specialty dementia clinic. METHODS We conducted semi-structured interviews with PWD, and active and bereaved family caregivers, recruited from a specialty dementia clinic. Interviews were recorded, transcribed, and systematically summarized. Thematic analysis identified anticipatory guidance received from clinical or non-clinical sources and areas where respondents wanted additional guidance. RESULTS Of 40 participants, 9 were PWD, 16 were active caregivers, and 15 were bereaved caregivers. PWD had a mean age of 75 and were primarily male (n = 6/9); caregivers had a mean age of 67 and were primarily female (n = 21/31). Participants felt they received incomplete or "hesitant" guidance on prognosis and expected disease course via their clinicians and filled the gap with information they found via the internet, books, and support groups. They appreciated guidance on behavioral, safety, and communication issues from clinicians, but found more timely and advance guidance from other non-clinical sources. Guidance on legal and financial planning was primarily identified through non-clinical sources. CONCLUSION PWD and caregivers want more information about expected disease course, prognosis, and help planning after diagnosis. Clinicians have an opportunity to improve anticipatory guidance communication and subsequent care provision.
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Affiliation(s)
- Adi Shafir
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Veterans Affairs Medical Center, San Francisco, CA, USA.,Division of General Internal Medicine and Geriatrics, Oregon Health and Sciences University, Portland, OR, USA
| | - Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Division of Palliative Care and Geriatric Medicine and the Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah B Garrett
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,UCSF Department of Humanities & Social Sciences, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Georges Naasan
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Mount Sinai, Icahn School of Medicine, New York, NY, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Merrilees
- UCSF Memory and Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Eric Widera
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Lynn Flint
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Department of Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Krista L Harrison
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
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10
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Naasan G, Boyd ND, Harrison KL, Garrett SB, D'Aguiar Rosa T, Pérez-Cerpa B, McFarlane S, Miller BL, Ritchie CS. Advance Directive and POLST Documentation in Decedents With Dementia at a Memory Care Center: The Importance of Early Advance Care Planning. Neurol Clin Pract 2022; 12:14-21. [PMID: 36157620 PMCID: PMC9491507 DOI: 10.1212/cpj.0000000000001123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/06/2021] [Indexed: 02/03/2023]
Abstract
Background and Objectives To determine the frequency of and challenges to documentation of advance care planning (ACP) in people with dementia, we conducted a chart review of 746 deceased patients seen at a tertiary memory care center between 2012 and 2017. Methods The rates of documented advance directives (ADs), Physician Order for Life-Sustaining Treatment (POLST), and Do Not Resuscitate (DNR) status were calculated from review of institutional electronic health records. Regression analysis was used to determine associations between ACP documentation and patient characteristics. Results At the time of death, approximately half of the patients had a documented AD and/or DNR status and 37% had a documented POLST; 30% of patients did not have any ACP documentation. Whereas most of the ADs were documented more than 5 years before time of death, POLST and DNR status were documented more frequently within 2 years of time of death. People who presented to clinic at a younger age and who primarily spoke English were more likely to have documented ADs. People living in zip codes with lower household incomes were 2-4.5 times less likely to have a POLST or DNR documentation. Discussion ACP is underutilized in people with dementia, even among those seen in a specialty memory care center. ACP should be introduced early on for people with dementia to ensure patients have a voice in their care.
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11
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Boyd ND, Naasan G, Harrison KL, Garrett SB, D’Aguiar Rosa T, Pérez-Cerpa B, McFarlane S, Miller BL, Ritchie CS. Characteristics of people with dementia lost to follow-up from a dementia care center. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5628. [PMID: 34590336 PMCID: PMC8740544 DOI: 10.1002/gps.5628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/06/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify the prevalence and characteristics of people living with dementia (PLWD) lost to follow-up (LTFU) from a specialized dementia care clinic and to understand factors influencing patient follow-up status. METHODS We conducted a retrospective chart review of PLWD seen at a dementia care clinic 2012-2017 who were deceased as of 2018 (n = 746). Participants were evaluated for follow-up status at the time of death. Generalized linear regression was used to analyze demographic and diagnostic characteristics by follow-up status. Text extracted from participant medical records was analyzed using qualitative content analysis to identify reasons patients became LTFU. RESULTS Among PLWD seen at a dementia care clinic, 42% became LTFU before death, 39% of whom had chart documentation describing reasons for loss to follow-up. Increased rates of LTFU were associated with female sex (risk ratio 1.27, [95% confidence interval 1.09-1.49]; p = 0.003), educational attainment of high school or less (1.34, [1.13-1.61]; p = 0.001), and death in a long-term care facility (1.46, [1.19-1.80]; p = 0.003). Commonly documented reasons for not returning for care at the clinic included switching care to another provider (42%), logistical difficulty accessing care (26%), patient-family decision to discontinue care (24%), and functional challenges in accessing care (23%). CONCLUSIONS PLWD are LTFU from specialized memory care at high rates. Attention to care coordination, patient-provider communication, and integrated use of alternative care models such as telehealth are potential strategies to improve care.
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Affiliation(s)
- Nicole D. Boyd
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Georges Naasan
- University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA,Department of Neurology, Department of Medicine, University of California San Francisco, San Francisco, California, USA,Department of Neurology, Mount Sinai Hospitals, Ichan School of Medicine, New York City, New York, USA
| | - Krista L. Harrison
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA,University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Sarah B. Garrett
- University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Talita D’Aguiar Rosa
- University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA,Department of Neurology, University of Louisville, Louisville, Kentucky, USA
| | - Brenda Pérez-Cerpa
- University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA,Hospital Civil de Guadalajara (Hospital Civil Fray Antonio Alcade), Guadalajara, Jalisco, Mexico
| | - Shamiel McFarlane
- University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA
| | - Bruce L. Miller
- University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA,Department of Neurology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Christine S. Ritchie
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA,University of California San Francisco / Global Brain Health Institute, San Francisco, California, USA,Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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12
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de Paula França Resende E, Ketelle R, Karydas A, Allen I, Grinberg LT, Spina S, Seeley WW, Perry DC, Miller B, Naasan G. Late-Onset Alcohol Abuse as a Presenting Symptom of Neurodegenerative Diseases. J Alzheimers Dis 2022; 86:1073-1080. [PMID: 35180118 PMCID: PMC9090138 DOI: 10.3233/jad-215369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The association between lifetime alcohol abuse and a higher risk to develop dementia is well known. However, it is unknown whether older adults who begin abusing alcohol late in life have an underlying neurodegenerative disease. OBJECTIVE Identify the frequency of lifelong alcohol abuse (L-AA), late-onset alcohol abuse (LO-AA), and alcohol abuse as a first symptom of dementia (AA-FS) in patients with neurodegenerative diseases. METHODS Cross-sectional retrospective study of patients evaluated at an academic referral center with a clinical diagnosis of behavioral variant frontotemporal dementia (bvFTD), Alzheimer-type dementia (AD), and semantic variant primary progressive aphasia (svPPA) (n = 1,518). The presence of alcohol abuse was screened with the National Alzheimer's Coordinating Center questionnaire. L-AA was defined as onset < 40 years, LO-AA as onset ≥40 years, and AA-FS was defined when the abuse started within the first three years from symptom onset. RESULTS The frequency of LO-AA was 2.2% (n = 33/1,518). LO-AA was significantly more frequent in patients with bvFTD than AD (7.5%, n = 13/173 versus 1.3%, n = 16/1,254, CI:1.0;11.4%), but not svPPA (4.4%, n = 4/91, CI: -4.4;10.7%). Similarly, AA-FS was more frequent in bvFTD patients than AD (5.7%, n = 10/173 versus 0.7%, n = 9/1,254, CI:0.5%;9.5%), but not svPPA (2.2%, n = 2/91, CI:-2.4;9.1%). CONCLUSION LO-AA can be a presenting symptom of dementia, especially bvFTD. Alcohol abuse onset later in life should prompt a clinical investigation into the possibility of an underlying neurodegenerative process because delay in diagnosis and treatment may increase patient and caregiver burden. The results need to be interpreted with caution due to the limitations of the study.
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Affiliation(s)
- Elisa de Paula França Resende
- Hospital das Clínicas da Universidade Federal de Minas Gerais – EBSERH, Belo Horizonte, Brazil
- Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
| | - Robin Ketelle
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Anna Karydas
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Isabel Allen
- Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Lea T. Grinberg
- Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Salvatore Spina
- Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - William W. Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - David C. Perry
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Bruce Miller
- Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Georges Naasan
- Global Brain Health Institute based at University of California, San Francisco and Trinity College, Dublin, Ireland
- The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Mount Sinai Hospitals, Icahn School of Medicine, New York, NY, USA
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13
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Naasan G, Shdo SM, Rodriguez EM, Spina S, Grinberg L, Lopez L, Karydas A, Seeley WW, Miller BL, Rankin KP. Psychosis in neurodegenerative disease: differential patterns of hallucination and delusion symptoms. Brain 2021; 144:999-1012. [PMID: 33501939 DOI: 10.1093/brain/awaa413] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023] Open
Abstract
Although psychosis is a defining feature of Lewy body disease, psychotic symptoms occur in a subset of patients with every major neurodegenerative disease. Few studies, however, have compared disease-related rates of psychosis prevalence in a large autopsy-based cohort, and it remains unclear how diseases differ with respect to the nature or content of the psychosis. We conducted a retrospective chart review of 372 patients with autopsy-confirmed neurodegenerative pathology: 111 with Alzheimer's disease, 59 with Lewy body disease and concomitant Alzheimer's disease, 133 with frontotemporal lobar degeneration (FTLD) with tau inclusions (including progressive supranuclear palsy, corticobasal degeneration or Pick's disease), and 69 with FTLD and TDP inclusions (FTLD-TDP, including types A-C). Psychosis content was classified by subtype, and the frequency of each subtype was compared among pathological diagnoses using logistic regression. A total of 111 of 372 patients had psychosis. Compared to other groups, patients with Lewy body disease/Alzheimer's disease pathology were significantly more likely to have hallucinations and were more likely to have more than one subtype of hallucination. Patients with Braak Parkinson stage 5-6 Lewy body disease were significantly more likely than those with no Lewy body disease to have visual hallucinations of misperception, peripheral hallucinations, hallucinations that moved, hallucinations of people/animals/objects, as well as delusions regarding a place and delusions of misidentification. The feeling of a presence occurred significantly more frequently in patients with Lewy body disease/Alzheimer's disease than all other pathologies. Patients with FTLD-TDP were significantly more likely to have delusions, and for the delusions to occur in the first 3 years of the disease, when compared to patients with Alzheimer's disease and FTLD-tau, though rates were not significantly greater than patients with Lewy body disease/Alzheimer's disease. Paranoia occurred more frequently in the FTLD-TDP and Lewy body disease/Alzheimer's disease categories compared to patients with Alzheimer's disease or FTLD-tau. Patients with FTLD-TDP pathology had delusions of misidentification as frequently as patients with Lewy body disease/Alzheimer's disease, and were significantly more likely to have self-elevating delusions such as grandiosity and erotomania compared to patients with other pathologies including FTLD-tau. These data show that the nature and content of psychosis can provide meaningful information about the underlying neurodegenerative pathology, emphasizing the importance of characterizing patients' psychoses for prediction of the neuropathological diagnosis, regardless of a patient's clinical syndrome.
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Affiliation(s)
- Georges Naasan
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA.,The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Suzanne M Shdo
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA.,Department of Psychology, University of California Berkeley, Berkeley, CA, USA
| | - Estrella Morenas Rodriguez
- Biomedizinisches Centrum (BMC), Biochemistry Chair, Ludwig-Maximilians-Universität and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Munich, Germany
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Lea Grinberg
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Lucia Lopez
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Anna Karydas
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
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Samboju V, Cobigo Y, Paul R, Naasan G, Hillis M, Tsuei T, Javandel S, Valcour V, Milanini B. Cerebrovascular Disease Correlates With Longitudinal Brain Atrophy in Virally Suppressed Older People Living With HIV. J Acquir Immune Defic Syndr 2021; 87:1079-1085. [PMID: 34153014 PMCID: PMC8547347 DOI: 10.1097/qai.0000000000002683] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mild cognitive difficulties and progressive brain atrophy are observed in older people living with HIV (PLWH) despite persistent viral suppression. Whether cerebrovascular disease (CVD) risk factors and white matter hyperintensity (WMH) volume correspond to the observed progressive brain atrophy is not well understood. METHODS Longitudinal structural brain atrophy rates and WMH volume were examined among 57 HIV-infected participants and 40 demographically similar HIV-uninfected controls over an average (SD) of 3.4 (1.7) years. We investigated associations between CVD burden (presence of diabetes, hypertension, hyperlipidemia, obesity, smoking history, and atrial fibrillation) and WMH with atrophy over time. RESULTS The mean (SD) age was 64.8 (4.3) years for PLWH and 66.4 (3.2) years for controls. Participants and controls were similar in age and sex (P > 0.05). PLWH were persistently suppressed (VL <375 copies/mL with 93% <75 copies/mL). The total number of CVD risk factors did not associate with atrophy rates in any regions of interests examined; however, body mass index independently associated with progressive atrophy in the right precentral gyrus (β = -0.30; P = 0.023), parietal lobe (β = -0.28; P = 0.030), and frontal lobe atrophy (β = -0.27; P = 0.026) of the HIV-infected group. No associations were found in the HIV-uninfected group. In both groups, baseline WMH was associated with progressive atrophy rates bilaterally in the parietal gray in the HIV-infected group (β = -0.30; P = 0.034) and the HIV-uninfected participants (β = -0.37; P = 0.033). CONCLUSIONS Body mass index and WMH are associated with atrophy in selective brain regions. However, CVD burden seems to partially contribute to progressive brain atrophy in older individuals regardless of HIV status, with similar effect sizes. Thus, CVD alone is unlikely to explain accelerated atrophy rates observed in virally suppressed PLWH. In older individuals, addressing modifiable CVD risk factors remains important to optimize brain health.
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Affiliation(s)
- Vishal Samboju
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
| | - Yann Cobigo
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
| | - Robert Paul
- Missouri Institute of Mental Health, University of
Missouri, St. Louis, MO, USA
| | - Georges Naasan
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
- Global Brain Health Institute, University of California,
San Francisco, CA, USA
- The Barbara and Maurice Deanne Center for Wellness and
Cognitive Health, Department of Neurology, Mount Sinai, Icahn School of Medicine,
NY, USA
| | - Madeline Hillis
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
| | - Torie Tsuei
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
| | - Shireen Javandel
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
- Global Brain Health Institute, University of California,
San Francisco, CA, USA
| | - Benedetta Milanini
- Memory and Aging Center, Department of Neurology,
University of California San Francisco, CA, USA
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15
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Bernstein Sideman A, Harrison KL, Garrett SB, Naasan G, Ritchie CS. Practices, challenges, and opportunities when addressing the palliative care needs of people living with dementia: Specialty memory care provider perspectives. Alzheimers Dement (N Y) 2021; 7:e12144. [PMID: 33969177 PMCID: PMC8087986 DOI: 10.1002/trc2.12144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/30/2020] [Accepted: 01/06/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Palliative care focuses on reducing suffering and improving quality of life for individuals with serious illness and their families. In an effort to develop palliative care interventions for specialty memory care clinics, this study characterizes memory care providers' perspectives on addressing palliative care needs of people living with dementia (PLWD). METHODS Qualitative interviews with specialty memory care providers were followed by thematic analysis by a multidisciplinary research team. RESULTS Provider approaches overlap with key domains of palliative care. Approaches unique to dementia include having a detailed understanding of dementia syndromes, behavioral symptoms, and caregiver burden. Challenges were identified related to disease progression, provider-level factors, and systems and cultural issues. Respondents identified training needed to strengthen a palliative care approach. DISCUSSION There are many strengths of using memory care teams to address palliative care needs of PLWD. However, they may require additional knowledge and training to strengthen their work.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy StudiesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Global Brain Health InstituteUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Department of Humanities and Social SciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Krista L. Harrison
- Global Brain Health InstituteUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Division of GeriatricsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Sarah B. Garrett
- Philip R. Lee Institute for Health Policy StudiesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Georges Naasan
- NeurologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Christine S. Ritchie
- Global Brain Health InstituteUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Division of Palliative Care and Geriatric MedicineHarvard Medical SchoolBostonMassachusettsUSA
- Mongan Institute Center for Aging and Serious IllnessMassachusetts General HospitalBostonMassachusettsUSA
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16
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Kummer BR, Sweetnam C, Vickrey BG, Naasan G, Harvey D, Gallagher K, Jetté N. Teleneurology Expansion in Response to the COVID-19 Outbreak at a Tertiary Health System in New York City. Neurol Clin Pract 2021; 11:e102-e111. [PMID: 33842078 DOI: 10.1212/cpj.0000000000001057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/19/2021] [Indexed: 01/24/2023]
Abstract
Objective To assess the implementation of teleneurology (TN), including patient and clinician experiences, during the coronavirus respiratory disease 2019 (COVID-19) pandemic. Methods We studied synchronous (video visit) and asynchronous (store-and-forward, patient-portal evaluation, remote monitoring) TN utilization in the Mount Sinai Health System Neurology Department in New York, 2 months before and after the start of our department's response to the pandemic in mid-March 2020. Weekly division meetings enabled ongoing assessments and analysis of barriers and facilitators according to the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change models. We used postvisit surveys of clinicians (from April 13 to May 15, 2020) and patients (from May 11 to 15, 2020) to determine technology platforms used, and TN experience and acceptability, using Likert scales (1 = very poor/unlikely to 5 = very good/likely). Results Over the 4-month period, 117 TN clinicians (n = 14 subspecialties) conducted 4,225 TN visits with 3,717 patients (52 pre- vs 4,173 post-COVID-19). No asynchronous TN services were delivered. Post-COVID-19, the number of TN clinicians, subspecialties performing TN, and visits increased by 963%, 133%, and 7,925%, respectively. Mean acceptability among patients and clinicians was 4.7 (SD 0.6) and 3.4 (SD 1.6), respectively. Most video visits were completed using Epic MyChart (78.5%) and Zoom (8.1%). TN implementation facilitators included Medicare geographic restriction waivers, development of clinician educational materials, and MyChart outreach programs for patients experiencing technical difficulties. Conclusions A significant expansion of TN utilization accompanied the COVID-19 response. Patients found TN more acceptable than did clinicians. Proactive application of an implementation framework facilitated rapid and effective TN expansion.
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Affiliation(s)
- Benjamin R Kummer
- Department of Neurology (BRK), Icahn School of Medicine at Mount Sinai and Clinical Informatics, Mount Sinai Health System; Department of Neurology (CS, BV, GN, DH, KG) and Departments of Neurology and Population Health Science and Policy (NJ), Icahn School of Medicine at Mount Sinai, New York
| | - Chloe Sweetnam
- Department of Neurology (BRK), Icahn School of Medicine at Mount Sinai and Clinical Informatics, Mount Sinai Health System; Department of Neurology (CS, BV, GN, DH, KG) and Departments of Neurology and Population Health Science and Policy (NJ), Icahn School of Medicine at Mount Sinai, New York
| | - Barbara G Vickrey
- Department of Neurology (BRK), Icahn School of Medicine at Mount Sinai and Clinical Informatics, Mount Sinai Health System; Department of Neurology (CS, BV, GN, DH, KG) and Departments of Neurology and Population Health Science and Policy (NJ), Icahn School of Medicine at Mount Sinai, New York
| | - Georges Naasan
- Department of Neurology (BRK), Icahn School of Medicine at Mount Sinai and Clinical Informatics, Mount Sinai Health System; Department of Neurology (CS, BV, GN, DH, KG) and Departments of Neurology and Population Health Science and Policy (NJ), Icahn School of Medicine at Mount Sinai, New York
| | - Dayneen Harvey
- Department of Neurology (BRK), Icahn School of Medicine at Mount Sinai and Clinical Informatics, Mount Sinai Health System; Department of Neurology (CS, BV, GN, DH, KG) and Departments of Neurology and Population Health Science and Policy (NJ), Icahn School of Medicine at Mount Sinai, New York
| | - Kimberly Gallagher
- Department of Neurology (BRK), Icahn School of Medicine at Mount Sinai and Clinical Informatics, Mount Sinai Health System; Department of Neurology (CS, BV, GN, DH, KG) and Departments of Neurology and Population Health Science and Policy (NJ), Icahn School of Medicine at Mount Sinai, New York
| | - Nathalie Jetté
- Department of Neurology (BRK), Icahn School of Medicine at Mount Sinai and Clinical Informatics, Mount Sinai Health System; Department of Neurology (CS, BV, GN, DH, KG) and Departments of Neurology and Population Health Science and Policy (NJ), Icahn School of Medicine at Mount Sinai, New York
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17
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Liu AJ, Chang JE, Naasan G, Boxer AL, Miller BL, Spina S. Progressive supranuclear palsy and primary lateral sclerosis secondary to globular glial tauopathy: a case report and a practical theoretical framework for the clinical prediction of this rare pathological entity. Neurocase 2020; 26:91-97. [PMID: 32090696 PMCID: PMC7197509 DOI: 10.1080/13554794.2020.1732427] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Globular glial tauopathy (GGT) is a rare 4-repeat tauopathy characterized by the accumulation of tau globular inclusions in astrocytes and oligodendrocytes. Several clinical phenotypes have been associated with GGT, making the prediction of this rare pathological entity difficult. We report the case of a patient with eye-movement abnormalities and gait instability, reminiscent of progressive supranuclear palsy-Richardson's syndrome (PSP-RS), who later developed upper motor neuron symptoms suggestive of primary lateral sclerosis (PLS). Neuropathological assessment revealed GGT type III pathology. A theoretical framework is proposed to help clinicians predict GGT in subjects with coexistent features of PSP-RS and PLS.
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Affiliation(s)
- Andy J Liu
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Jessica E Chang
- Department of Psychological Services, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Georges Naasan
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, USA
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18
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Possin KL, Merrilees JJ, Dulaney S, Bonasera SJ, Chiong W, Lee K, Hooper SM, Allen IE, Braley T, Bernstein A, Rosa TD, Harrison K, Begert-Hellings H, Kornak J, Kahn JG, Naasan G, Lanata S, Clark AM, Chodos A, Gearhart R, Ritchie C, Miller BL. Effect of Collaborative Dementia Care via Telephone and Internet on Quality of Life, Caregiver Well-being, and Health Care Use: The Care Ecosystem Randomized Clinical Trial. JAMA Intern Med 2019; 179:1658-1667. [PMID: 31566651 PMCID: PMC6777227 DOI: 10.1001/jamainternmed.2019.4101] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Few health systems have adopted effective dementia care management programs. The Care Ecosystem is a model for delivering care from centralized hubs across broad geographic areas to caregivers and persons with dementia (PWDs) independently of their health system affiliations. OBJECTIVE To determine whether the Care Ecosystem is effective in improving outcomes important to PWDs, their caregivers, and payers beyond those achieved with usual care. DESIGN, SETTING, AND PARTICIPANTS A single-blind, randomized clinical trial with a pragmatic design was conducted among PWDs and their caregivers. Each PWD-caregiver dyad was enrolled for 12 months between March 20, 2015, and February 28, 2017. Data were collected until March 5, 2018. Study interventions and assessments were administered over the telephone and internet by clinical and research teams in San Francisco, California, and Omaha, Nebraska. Of 2585 referred or volunteer PWD-caregiver dyads in California, Iowa, or Nebraska, 780 met eligibility criteria and were enrolled. A total of 512 PWD-caregiver dyads were randomized to receive care through the Care Ecosystem and 268 dyads to receive usual care. All eligible PWDs had a dementia diagnosis; were enrolled or eligible for enrollment in Medicare or Medicaid; and spoke English, Spanish, or Cantonese. Analyses were intention-to-treat. INTERVENTION Telephone-based collaborative dementia care was delivered by a trained care team navigator, who provided education, support and care coordination with a team of dementia specialists (advanced practice nurse, social worker, and pharmacist). MAIN OUTCOMES AND MEASURES Primary outcome measure: Quality of Life in Alzheimer's Disease based on caregiver's rating of 13 aspects of PWD's well-being (including physical health, energy level, mood, living situation, memory, relationships, and finances) on a 4-point scale (poor to excellent). Secondary outcomes: frequencies of PWDs' use of emergency department, hospitalization, and ambulance services; caregiver depression (score on 9-Item Patient Health Questionnaire; higher scores indicate more severe depression); and caregiver burden (score on 12-Item Zarit Burden Interview; higher scores indicate more severe caregiver burden). RESULTS The 780 PWDs (56.3% female; mean [SD] age, 78.1 [9.9] years) and 780 caregivers (70.9% female; mean [SD] age, 64.7 [12.0] years) lived in California (n = 452), Nebraska (n = 284), or Iowa (n = 44). Of 780 dyads, 655 were still active at 12 months, and 571 completed the 12-month survey. Compared with usual care, the Care Ecosystem improved PWD quality of life (B, 0.53; 95% CI, 0.25-1.30; P = .04), reduced emergency department visits (B, -0.14; 95% CI, -0.29 to -0.01; P = .04), and decreased caregiver depression (B, -1.14; 95% CI, -2.15 to -0.13; P = .03) and caregiver burden (B, -1.90; 95% CI, -3.89 to -0.08; P = .046). CONCLUSIONS AND RELEVANCE Effective care management for dementia can be delivered from centralized hubs to supplement usual care and mitigate the growing societal and economic burdens of dementia. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02213458.
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Affiliation(s)
- Katherine L Possin
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco.,Global Brain Health Institute, University of California, San Francisco
| | - Jennifer J Merrilees
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Sarah Dulaney
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Stephen J Bonasera
- Home Instead Center for Successful Aging, Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Winston Chiong
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Kirby Lee
- Department of Clinical Pharmacy, University of California, San Francisco
| | - Sarah M Hooper
- UCSF/UC Consortium on Law, Science & Health Policy, UC Hastings College of the Law, San Francisco
| | - Isabel Elaine Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Tamara Braley
- Home Instead Center for Successful Aging, Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
| | - Alissa Bernstein
- Global Brain Health Institute, University of California, San Francisco.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Talita D Rosa
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco.,Global Brain Health Institute, University of California, San Francisco
| | - Krista Harrison
- Global Brain Health Institute, University of California, San Francisco.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.,Division of Geriatrics, University of California, San Francisco
| | - Hailey Begert-Hellings
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - John Kornak
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - James G Kahn
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Georges Naasan
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Serggio Lanata
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Amy M Clark
- Home Instead Center for Successful Aging, Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha.,Department of Social Work, Nebraska Wesleyan University, Lincoln
| | - Anna Chodos
- Division of Geriatrics, University of California, San Francisco
| | - Rosalie Gearhart
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
| | - Christine Ritchie
- Division of Geriatrics, University of California, San Francisco.,Center for Research on Aging, San Francisco Campus for Jewish Living, San Francisco, California
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco
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Naasan G, Boyd N, Garrett S, D'Aguiar Rosa T, Pérez-Cerpa B, Harrison KL, Ritchie CS. F5‐02‐04: ADVANCED DIRECTIVE AND POLST UTILIZATION IN DECEDENTS WITH DEMENTIA PREVIOUSLY SEEN AT A MEMORY CENTER. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Georges Naasan
- University of California San Francisco/Global Brain Health Institute San Francisco CA USA
- University of California San Francisco San Francisco CA USA
| | - Nicole Boyd
- University of California San Francisco San Francisco CA USA
| | - Sarah Garrett
- University of California San Francisco San Francisco CA USA
| | - Talita D'Aguiar Rosa
- University of California San Francisco/Global Brain Health Institute San Francisco CA USA
- University of California San Francisco San Francisco CA USA
| | - Brenda Pérez-Cerpa
- University of California San Francisco/Global Brain Health Institute San Francisco CA USA
- University of California San Francisco San Francisco CA USA
| | - Krista L. Harrison
- University of California San Francisco/Global Brain Health Institute San Francisco CA USA
- University of California San Francisco San Francisco CA USA
| | - Christine S. Ritchie
- University of California San Francisco San Francisco CA USA
- Global Brain Health Institute/University of California San Francisco San Francisco CA USA
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20
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Boyd N, Naasan G, Garrett S, D'Aguiar Rosa T, Pérez-Cerpa B, Harrison KL, Ritchie CS. F5‐02‐03: FACTORS IMPACTING LOSS‐TO‐FOLLOW‐UP FROM A MEMORY CARE CENTER: A STUDY OF POTENTIAL PALLIATIVE CARE NEEDS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nicole Boyd
- University of California San Francisco San Francisco CA USA
| | - Georges Naasan
- University of California San Francisco San Francisco CA USA
- University of California San Francisco/Global Brain Health Institute San Francisco CA USA
| | - Sarah Garrett
- University of California San Francisco San Francisco CA USA
| | - Talita D'Aguiar Rosa
- University of California San Francisco San Francisco CA USA
- University of California San Francisco/Global Brain Health Institute San Francisco CA USA
| | - Brenda Pérez-Cerpa
- University of California San Francisco San Francisco CA USA
- University of California San Francisco/Global Brain Health Institute San Francisco CA USA
| | - Krista L. Harrison
- University of California San Francisco San Francisco CA USA
- University of California San Francisco/Global Brain Health Institute San Francisco CA USA
| | - Christine S. Ritchie
- University of California San Francisco San Francisco CA USA
- Global Brain Health Institute/University of California San Francisco San Francisco CA USA
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21
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Karageorgiou E, Naasan G, Pleasure SJ, Alexandrescu S, Gelfand JM, Tammewar G, Miller BL, Rabinovici GD, Grinberg LT. Focal cerebral β-amyloid angiopathy: A distinct clinicopathologic presentation. Neurol Clin Pract 2018; 7:444-448. [PMID: 29620074 DOI: 10.1212/cpj.0000000000000354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/03/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Elissaios Karageorgiou
- Memory and Aging Center (EK, GN, GT, BLM, GDR, LTG) and Multiple Sclerosis and Neuroinflammation Center (SJP, JMG), Department of Neurology, and Department of Pathology and Laboratory Medicine (SA), University of California San Francisco; Neurological Institute of Athens (EK), Greece; and Department of Pathology (LTG), University of São Paulo Medical School, Brazil. S.A. is currently affiliated with Boston Children's Hospital, MA
| | - Georges Naasan
- Memory and Aging Center (EK, GN, GT, BLM, GDR, LTG) and Multiple Sclerosis and Neuroinflammation Center (SJP, JMG), Department of Neurology, and Department of Pathology and Laboratory Medicine (SA), University of California San Francisco; Neurological Institute of Athens (EK), Greece; and Department of Pathology (LTG), University of São Paulo Medical School, Brazil. S.A. is currently affiliated with Boston Children's Hospital, MA
| | - Samuel J Pleasure
- Memory and Aging Center (EK, GN, GT, BLM, GDR, LTG) and Multiple Sclerosis and Neuroinflammation Center (SJP, JMG), Department of Neurology, and Department of Pathology and Laboratory Medicine (SA), University of California San Francisco; Neurological Institute of Athens (EK), Greece; and Department of Pathology (LTG), University of São Paulo Medical School, Brazil. S.A. is currently affiliated with Boston Children's Hospital, MA
| | - Sanda Alexandrescu
- Memory and Aging Center (EK, GN, GT, BLM, GDR, LTG) and Multiple Sclerosis and Neuroinflammation Center (SJP, JMG), Department of Neurology, and Department of Pathology and Laboratory Medicine (SA), University of California San Francisco; Neurological Institute of Athens (EK), Greece; and Department of Pathology (LTG), University of São Paulo Medical School, Brazil. S.A. is currently affiliated with Boston Children's Hospital, MA
| | - Jeffrey M Gelfand
- Memory and Aging Center (EK, GN, GT, BLM, GDR, LTG) and Multiple Sclerosis and Neuroinflammation Center (SJP, JMG), Department of Neurology, and Department of Pathology and Laboratory Medicine (SA), University of California San Francisco; Neurological Institute of Athens (EK), Greece; and Department of Pathology (LTG), University of São Paulo Medical School, Brazil. S.A. is currently affiliated with Boston Children's Hospital, MA
| | - Gautam Tammewar
- Memory and Aging Center (EK, GN, GT, BLM, GDR, LTG) and Multiple Sclerosis and Neuroinflammation Center (SJP, JMG), Department of Neurology, and Department of Pathology and Laboratory Medicine (SA), University of California San Francisco; Neurological Institute of Athens (EK), Greece; and Department of Pathology (LTG), University of São Paulo Medical School, Brazil. S.A. is currently affiliated with Boston Children's Hospital, MA
| | - Bruce L Miller
- Memory and Aging Center (EK, GN, GT, BLM, GDR, LTG) and Multiple Sclerosis and Neuroinflammation Center (SJP, JMG), Department of Neurology, and Department of Pathology and Laboratory Medicine (SA), University of California San Francisco; Neurological Institute of Athens (EK), Greece; and Department of Pathology (LTG), University of São Paulo Medical School, Brazil. S.A. is currently affiliated with Boston Children's Hospital, MA
| | - Gil D Rabinovici
- Memory and Aging Center (EK, GN, GT, BLM, GDR, LTG) and Multiple Sclerosis and Neuroinflammation Center (SJP, JMG), Department of Neurology, and Department of Pathology and Laboratory Medicine (SA), University of California San Francisco; Neurological Institute of Athens (EK), Greece; and Department of Pathology (LTG), University of São Paulo Medical School, Brazil. S.A. is currently affiliated with Boston Children's Hospital, MA
| | - Lea T Grinberg
- Memory and Aging Center (EK, GN, GT, BLM, GDR, LTG) and Multiple Sclerosis and Neuroinflammation Center (SJP, JMG), Department of Neurology, and Department of Pathology and Laboratory Medicine (SA), University of California San Francisco; Neurological Institute of Athens (EK), Greece; and Department of Pathology (LTG), University of São Paulo Medical School, Brazil. S.A. is currently affiliated with Boston Children's Hospital, MA
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Possin KL, Merrilees J, Bonasera SJ, Bernstein A, Chiong W, Lee K, Wilson L, Hooper SM, Dulaney S, Braley T, Laohavanich S, Feuer JE, Clark AM, Schaffer MW, Schenk AK, Heunis J, Ong P, Cook KM, Bowhay AD, Gearhart R, Chodos A, Naasan G, Bindman AB, Dohan D, Ritchie C, Miller BL. Development of an adaptive, personalized, and scalable dementia care program: Early findings from the Care Ecosystem. PLoS Med 2017; 14:e1002260. [PMID: 28323819 PMCID: PMC5360211 DOI: 10.1371/journal.pmed.1002260] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Katherine Possin and colleagues report on the implementation, development, and early findings of the Care Ecosystem, an adaptive, personalized, and scalable dementia care program.
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Affiliation(s)
- Katherine L. Possin
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Jennifer Merrilees
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Stephen J. Bonasera
- Division of Geriatrics, Department of Internal Medicine, Home Instead Center for Successful Aging, Omaha, Nebraska, United States of America
| | - Alissa Bernstein
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
| | - Winston Chiong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Kirby Lee
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Leslie Wilson
- Department of Medicine and Clinical Pharmacy, University of California, San Francisco, San Francisco, California, United States of America
| | - Sarah M. Hooper
- UCSF/UC Consortium on Law, Science & Health Policy, UC Hastings College of the Law, San Francisco, California, United States of America
| | - Sarah Dulaney
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Tamara Braley
- Division of Geriatrics, Department of Internal Medicine, Home Instead Center for Successful Aging, Omaha, Nebraska, United States of America
| | - Sutep Laohavanich
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Julie E. Feuer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Amy M. Clark
- Division of Geriatrics, Department of Internal Medicine, Home Instead Center for Successful Aging, Omaha, Nebraska, United States of America
| | - Michael W. Schaffer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - A. Katrin Schenk
- Department of Physics, Randolph College, Lynchburg, Virginia, United States of America
| | - Julia Heunis
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Paulina Ong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Kristen M. Cook
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Angela D. Bowhay
- Division of Geriatrics, Department of Internal Medicine, Home Instead Center for Successful Aging, Omaha, Nebraska, United States of America
| | - Rosalie Gearhart
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Anna Chodos
- Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Georges Naasan
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
| | - Andrew B. Bindman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
- Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital and Trauma Center, San Francisco, California, United States of America
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, United States of America
| | - Christine Ritchie
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California, United States of America
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Naasan G, Rabinovici GD, Ghosh P, Elofson JD, Miller BL, Coppola G, Karydas A, Fong J, Perry D, Lee SE, Yokoyama JS, Seeley WW, Kramer JH, Weiner MW, Schuff N, Jagust WJ, Grinberg LT, Pribadi M, Yang Z, Sears R, Klein E, Wojta K, Rosen HJ. Amyloid in dementia associated with familial FTLD: not an innocent bystander. Neurocase 2016; 22:76-83. [PMID: 26040468 PMCID: PMC4662906 DOI: 10.1080/13554794.2015.1046458] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patients with frontotemporal lobar degeneration (FTLD) can show superimposed amyloid pathology, though the impact of amyloid on the clinical presentation of FTLD is not well characterized. This cross-sectional case-control study compared clinical features, fluorodeoxyglucose-positron emission tomography metabolism and gray matter volume loss in 30 patients with familial FTLD in whom amyloid status was confirmed with autopsy or Pittsburgh compound B-PET. Compared to the amyloid-negative patients, the amyloid-positive patients performed significantly worse on several cognitive tests and showed hypometabolism and volume loss in more temporoparietal regions. Our results suggest that in FTLD amyloid positivity is associated with a more Alzheimer's disease-like pattern of neurodegeneration.
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Affiliation(s)
- Georges Naasan
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Gil D Rabinovici
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Pia Ghosh
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Jonathan D Elofson
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Bruce L Miller
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Giovanni Coppola
- d Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine , University of California , Los Angeles , CA , USA
| | - Anna Karydas
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Jamie Fong
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - David Perry
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Suzee E Lee
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Jennifer S Yokoyama
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - William W Seeley
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Joel H Kramer
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Michael W Weiner
- b Department of Radiology , University of California , San Francisco , CA , USA
| | - Norbert Schuff
- b Department of Radiology , University of California , San Francisco , CA , USA
| | - William J Jagust
- c School of Public Health , University of California Berkeley and Lawrence Berkeley National Laboratory , Berkeley , CA , USA
| | - Lea T Grinberg
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
| | - Mochtar Pribadi
- d Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine , University of California , Los Angeles , CA , USA
| | - Zhongan Yang
- d Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine , University of California , Los Angeles , CA , USA
| | - Renee Sears
- d Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine , University of California , Los Angeles , CA , USA
| | - Eric Klein
- d Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine , University of California , Los Angeles , CA , USA
| | - Kevin Wojta
- d Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine , University of California , Los Angeles , CA , USA
| | - Howard J Rosen
- a Memory and Aging Center, Department of Neurology , University of California , San Francisco , CA , USA
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Shinagawa S, Naasan G, Karydas AM, Coppola G, Pribadi M, Seeley WW, Trojanowski JQ, Miller BL, Grinberg LT. Clinicopathological Study of Patients With C9ORF72-Associated Frontotemporal Dementia Presenting With Delusions. J Geriatr Psychiatry Neurol 2015; 28:99-107. [PMID: 25342578 PMCID: PMC4408221 DOI: 10.1177/0891988714554710] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/15/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several clinical studies point to a high prevalence of psychotic symptoms in frontotemporal dementia associated with C9ORF72 mutations, but clinicopathological studies addressing the association between C9ORF72 mutations and delusions are lacking. METHOD Seventeen patients with pathologically proven frontotemporal lobar degeneration (FTLD) associated with C9ORF72 mutations were identified from Neurodegenerative Disease Brain Bank. Of the 17 cases with C9ORF72 mutation, 4 exhibited well-defined delusions. The clinical history, neurological examination, neuropsychological testing, neuroimaging analysis, and postmortem assessment of the patients with delusions were evaluated and compared with the other cases. RESULT The content of the delusions was mixed including persecution, infidelity, and grandiosity. All cases showed parkinsonism; voxel-based morphometry analysis showed greater precuneus atrophy in patients with delusions than those without delusions. All 4 had unclassifiable FTLD with TAR DNA-binding protein inclusions, with characteristics of both type A and type B. Three cases had additional τ pathology and another had α-synuclein pathology. CONCLUSION C9ORF72 carriers with well-defined delusions likely associated with additional pathologies and parietal atrophy in neuroimaging. Patients presenting with middle-aged onset of delusions should be screened for C9ORF72 mutations, especially if family history and parkinsonism are present.
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Affiliation(s)
- Shunichiro Shinagawa
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA,Department of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan
| | - Georges Naasan
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Anna M. Karydas
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Giovanni Coppola
- Department of Psychiatry, University of California, Los Angeles, CA, USA,Department of Neurology, University of California, Los Angeles, CA, USA
| | - Mochtar Pribadi
- Department of Psychiatry, University of California, Los Angeles, CA, USA,Department of Neurology, University of California, Los Angeles, CA, USA
| | - William W. Seeley
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA,Department of Pathology, University of California, San Francisco, CA, USA
| | - John Q. Trojanowski
- Center for Neurodegenerative Disease Research, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Bruce L. Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Lea T. Grinberg
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA,Department of Pathology, University of California, San Francisco, CA, USA
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Liljegren M, Naasan G, Temlett J, Perry DC, Rankin KP, Merrilees J, Grinberg LT, Seeley WW, Englund E, Miller BL. Criminal behavior in frontotemporal dementia and Alzheimer disease. JAMA Neurol 2015; 72:295-300. [PMID: 25559744 DOI: 10.1001/jamaneurol.2014.3781] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Neurodegenerative diseases can cause dysfunction of neural structures involved in judgment, executive function, emotional processing, sexual behavior, violence, and self-awareness. Such dysfunctions can lead to antisocial and criminal behavior that appears for the first time in the adult or middle-aged individual or even later in life. OBJECTIVE To investigate the frequency and type of criminal behavior among patients with a diagnosed dementing disorder. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective medical record review of 2397 patients who were seen at the University of California, San Francisco, Memory and Aging Center between 1999 and 2012, including 545 patients with Alzheimer disease (AD), 171 patients with behavioral variant of frontotemporal dementia (bvFTD), 89 patients with semantic variant of primary progressive aphasia, and 30 patients with Huntington disease. Patient notes containing specific keywords denoting criminal behavior were reviewed. Data were stratified by criminal behavior type and diagnostic groups. MAIN OUTCOMES AND MEASURES Frequencies of criminal behavior and χ² statistics were calculated. RESULTS Of the 2397 patients studied, 204 (8.5%) had a history of criminal behavior that emerged during their illness. Of the major diagnostic groups, 42 of 545 patients (7.7%) with AD, 64 of 171 patients (37.4%) with bvFTD, 24 of 89 patients (27.0%) with semantic variant of primary progressive aphasia, and 6 of 30 patients (20%) with Huntington disease exhibited criminal behavior. A total of 14% of patients with bvFTD were statistically significantly more likely to present with criminal behavior compared with 2% of patients with AD (P < .001) and 6.4% were statistically significantly more likely to exhibit violence compared with 2% of patients with AD (P = .003). Common manifestations of criminal behavior in the bvFTD group included theft, traffic violations, sexual advances, trespassing, and public urination in contrast with those in the AD group, who commonly committed traffic violations, often related to cognitive impairment. CONCLUSIONS AND RELEVANCE Criminal behavior is more common in patients with bvFTD and semantic variant of primary progressive aphasia than in those with AD and is more likely to be an early manifestation of the disorder. Judicial evaluations of criminality in the demented individual might require different criteria than the classic "insanity defense" used in the American legal system; these individuals should be treated differently by the law. The appearance of new-onset criminal behavior in an adult should elicit a search for frontal and anterior temporal brain disease and for dementing disorders.
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Affiliation(s)
- Madeleine Liljegren
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Georges Naasan
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Julia Temlett
- Department of Medicine, University of Notre Dame, Fremantle, Australia
| | - David C Perry
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Jennifer Merrilees
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Elisabet Englund
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
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Naasan G, Irani SR, Bettcher BM, Geschwind MD, Gelfand JM. Episodic bradycardia as neurocardiac prodrome to voltage-gated potassium channel complex/leucine-rich, glioma inactivated 1 antibody encephalitis. JAMA Neurol 2015; 71:1300-4. [PMID: 25133690 DOI: 10.1001/jamaneurol.2014.1234] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE Voltage-gated potassium channel complex antibody (VGKCc-Ab) encephalitis is an immunotherapy-responsive syndrome usually associated with causative antibodies that target the leucine-rich, glioma inactivated 1 (LGI1) protein. Although it is expressed throughout the brain, LGI1 is not known to be expressed in cardiac tissue. We describe a novel neurocardiac prodrome of VGKCc-Ab/LGI1-encephalitis. OBSERVATIONS Among 14 patients with VGKCc/LGI1-Ab encephalitis evaluated in the University of California, San Francisco Autoimmune Encephalitis Clinic and Rapid Dementia Research Program, 3 patients (2 men and 1 woman; aged 53, 55, and 64 years) exhibited episodic bradycardia that preceded the onset of encephalopathy by approximately 2 months and was severe enough to lead to pacemaker implantation. Serum LGI1-Ab results were positive when tested at the time of the subsequent encephalopathy. All 3 patients developed hyponatremia; none had faciobrachial dystonic seizures or malignancy. Brain magnetic resonance imaging was abnormal in 2 cases. None of the patients experienced further symptomatic bradyarrythmias after 1.7 to 7 years of follow-up. CONCLUSIONS AND RELEVANCE Episodic bradycardia is a distinctive neurocardiac prodrome of VGKCc/LGI1-Ab encephalitis. The neuroanatomical localization most likely relates to insular and temporal lobe involvement, cortical regions that modulate cardiac autonomic function. Further study is needed to determine if recognition of this neurocardiac prodrome and earlier institution of immunosuppression can prevent the development of encephalopathy.
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Affiliation(s)
- Georges Naasan
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Sarosh R Irani
- Memory and Aging Center, Department of Neurology, University of California, San Francisco2Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, England
| | - Brianne M Bettcher
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Michael D Geschwind
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Jeffrey M Gelfand
- Comprehensive Center for Multiple Sclerosis and Neuroinflammation, Department of Neurology, University of California, San Francisco
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Osman H, Saliba M, Chaaya M, Naasan G. Interventions to reduce postpartum stress in first-time mothers: a randomized-controlled trial. BMC Womens Health 2014; 14:125. [PMID: 25315167 PMCID: PMC4287538 DOI: 10.1186/1472-6874-14-125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 09/29/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The postpartum period can be a challenging time particularly for first-time mothers. This study aimed to assess two different interventions designed to reduce stress in the postpartum among first-time mothers. METHODS Healthy first-time mothers with healthy newborns were recruited from hospitals in Beirut, Lebanon after delivery. The two interventions were a 20-minute film addressing common stressors in the postpartum period and a 24-hour telephone support hotline. Participants were randomized to one of four study arms to receive either the postpartum support film, the hotline service, both interventions, or a music CD (control). Participants were interviewed at eight to twelve weeks postpartum for assessment of levels of stress as measured by the Cohen Perceived Stress Scale (PSS-10). RESULTS Of the 632 eligible women, 552 (88%) agreed to participate in the study. Of those, 452 (82%) completed the study. Mean PSS-10 scores of mothers who received the film alone (15.76) or the film with the hotline service (15.86) were significantly lower than that of the control group (18.93) (p-value <0.01). Among mothers who received the hotline service alone mean PSS-10 score (16.98) was also significantly lower than that of the control group (p-value <0.05). CONCLUSIONS Both our postpartum support film and the 24-hour telephone hotline service reduced stress in the postpartum period in first-time mothers. These simple interventions can be easily implemented and could have an important impact on the mental wellbeing of new mothers. TRIAL REGISTRATION The trial was registered with clinicaltrials.gov (identifier # NCT00857051) on March 5, 2009.
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Affiliation(s)
- Hibah Osman
- />Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Matilda Saliba
- />Research Institute of McGill University Health Center, Montreal, Canada
| | - Monique Chaaya
- />Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Georges Naasan
- />Memory and Aging Center, Department of Neurology, University of California, San Francisco, USA
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Naasan G, Rosen HJ, Rabinovici GD, Miller BL, Elofson J, Coppola G, Karydas A, Fong J, Seeley W, Jagust W. O4‐01‐04: AMYLOID IN DEMENTIA ASSOCIATED WITH FAMILIAL FTLD: NOT AN INNOCENT BYSTANDER. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.04.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Georges Naasan
- University of California, San FranciscoSan FranciscoCaliforniaUnited States
| | - Howard J. Rosen
- University of California, San FranciscoSan FranciscoCaliforniaUnited States
| | | | - Bruce L. Miller
- UCSF Memory & Aging CenterSan FranciscoCaliforniaUnited States
| | - Jon Elofson
- University of California, San FranciscoSan FranciscoCaliforniaUnited States
| | | | - Anna Karydas
- University of California, San FranciscoSan FranciscoCaliforniaUnited States
| | - Jamie Fong
- University of California, San FranciscoSan FranciscoCaliforniaUnited States
| | - William Seeley
- University of California, San FranciscoSan FranciscoCaliforniaUnited States
| | - William Jagust
- University of California, BerkeleyBerkeleyCaliforniaUnited States
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Vossel KA, Beagle AJ, Rabinovici GD, Shu H, Lee SE, Naasan G, Hegde M, Cornes SB, Henry ML, Nelson AB, Seeley WW, Geschwind MD, Gorno-Tempini ML, Shih T, Kirsch HE, Garcia PA, Miller BL, Mucke L. Seizures and epileptiform activity in the early stages of Alzheimer disease. JAMA Neurol 2013; 70:1158-66. [PMID: 23835471 DOI: 10.1001/jamaneurol.2013.136] [Citation(s) in RCA: 454] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Epileptic activity associated with Alzheimer disease (AD) deserves increased attention because it has a harmful impact on these patients, can easily go unrecognized and untreated, and may reflect pathogenic processes that also contribute to other aspects of the illness. We report key features of AD-related seizures and epileptiform activity that are instructive for clinical practice and highlight similarities between AD and transgenic animal models of the disease. OBJECTIVE To describe common clinical characteristics and treatment outcomes of patients with amnestic mild cognitive impairment (aMCI) or early AD who also have epilepsy or subclinical epileptiform activity. DESIGN Retrospective observational study from 2007 to 2012. SETTING Memory and Aging Center, University of California, San Francisco. PATIENTS We studied 54 patients with a diagnosis of aMCI plus epilepsy (n = 12), AD plus epilepsy (n = 35), and AD plus subclinical epileptiform activity (n = 7). MAIN OUTCOMES AND MEASURES Clinical and demographic data, electroencephalogram (EEG) readings, and treatment responses to antiepileptic medications. RESULTS Patients with aMCI who had epilepsy presented with symptoms of cognitive decline 6.8 years earlier than patients with aMCI who did not have epilepsy (64.3 vs 71.1 years; P = .02). Patients with AD who had epilepsy presented with cognitive decline 5.5 years earlier than patients with AD who did not have epilepsy (64.8 vs 70.3 years; P = .001). Patients with AD who had subclinical epileptiform activity also had an early onset of cognitive decline (58.9 years). The timing of seizure onset in patients with aMCI and AD was nonuniform (P < .001), clustering near the onset of cognitive decline. Epilepsies were most often complex partial seizures (47%) and more than half were nonconvulsive (55%). Serial or extended EEG monitoring appeared to be more effective than routine EEG at detecting interictal and subclinical epileptiform activity. Epileptic foci were predominantly unilateral and temporal. Of the most commonly prescribed antiepileptics, treatment outcomes appeared to be better for lamotrigine and levetiracetam than for phenytoin. CONCLUSIONS AND RELEVANCE Common clinical features of patients with aMCI- or AD-associated epilepsy at our center included early age at onset of cognitive decline, early incidence of seizures in the disease course, unilateral temporal epileptic foci detected by serial/extended EEG, transient cognitive dysfunction, and good seizure control and tolerability with lamotrigine and levetiracetam. Careful identification and treatment of epilepsy in such patients may improve their clinical course.
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Affiliation(s)
- Keith A Vossel
- Gladstone Institute of Neurological Disease, San Francisco, California2Memory and Aging Center, Department of Neurology, University of California, San Francisco, California
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30
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Lamarre AK, Rascovsky K, Bostrom A, Toofanian P, Wilkins S, Sha SJ, Perry DC, Miller ZA, Naasan G, Laforce R, Hagen J, Takada LT, Tartaglia MC, Kang G, Galasko D, Salmon DP, Farias ST, Kaur B, Olichney JM, Quitania Park L, Mendez MF, Tsai PH, Teng E, Dickerson BC, Domoto-Reilly K, McGinnis S, Miller BL, Kramer JH. Interrater reliability of the new criteria for behavioral variant frontotemporal dementia. Neurology 2013; 80:1973-7. [PMID: 23635967 DOI: 10.1212/wnl.0b013e318293e368] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the interrater reliability of the new International Behavioural Variant FTD Criteria Consortium (FTDC) criteria for behavioral variant frontotemporal dementia (bvFTD). METHODS Twenty standardized clinical case modules were developed for patients with a range of neurodegenerative diagnoses, including bvFTD, primary progressive aphasia (nonfluent, semantic, and logopenic variant), Alzheimer disease, and Lewy body dementia. Eighteen blinded raters reviewed the modules and 1) rated the presence or absence of core diagnostic features for the FTDC criteria, and 2) provided an overall diagnostic rating. Interrater reliability was determined by κ statistics for multiple raters with categorical ratings. RESULTS The mean κ value for diagnostic agreement was 0.81 for possible bvFTD and 0.82 for probable bvFTD ("almost perfect agreement"). Interrater reliability for 4 of the 6 core features had "substantial" agreement (behavioral disinhibition, perseverative/compulsive, sympathy/empathy, hyperorality; κ = 0.61-0.80), whereas 2 had "moderate" agreement (apathy/inertia, neuropsychological; κ = 0.41-0.6). Clinician years of experience did not significantly influence rater accuracy. CONCLUSIONS The FTDC criteria show promise for improving the diagnostic accuracy and reliability of clinicians and researchers. As disease-altering therapies are developed, accurate differential diagnosis between bvFTD and other neurodegenerative diseases will become increasingly important.
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Affiliation(s)
- Amanda K Lamarre
- Memory and Aging Center, Department of Neurology, University of California San Francisco, USA.
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Habib Z, Mourani C, Naasan G, Hourani-Rizk R, Mikati MA. Venous sinus thrombosis in a renal transplant patient. Transplantation 2007; 83:825-7. [PMID: 17414720 DOI: 10.1097/01.tp.0000256327.28265.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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