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Frontera JA, Yang D, Medicherla C, Baskharoun S, Bauman K, Bell L, Bhagat D, Bondi S, Chervinsky A, Dygert L, Fuchs B, Gratch D, Hasanaj L, Horng J, Huang J, Jauregui R, Ji Y, Kahn DE, Koch E, Lin J, Liu S, Olivera A, Rosenthal J, Snyder T, Stainman R, Talmasov D, Thomas B, Valdes E, Zhou T, Zhu Y, Lewis A, Lord AS, Melmed K, Meropol SB, Thawani S, Troxel AB, Yaghi S, Balcer LJ, Wisniewski T, Galetta S. Trajectories of Neurologic Recovery 12 Months After Hospitalization for COVID-19: A Prospective Longitudinal Study. Neurology 2022; 99:e33-e45. [PMID: 35314503 PMCID: PMC9259089 DOI: 10.1212/wnl.0000000000200356] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/22/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Little is known about trajectories of recovery 12 months after hospitalization for severe COVID-19. METHODS We conducted a prospective, longitudinal cohort study of patients with and without neurologic complications during index hospitalization for COVID-19 from March 10, 2020, to May 20, 2020. Phone follow-up batteries were performed at 6 and 12 months after COVID-19 onset. The primary 12-month outcome was the modified Rankin Scale (mRS) score comparing patients with or without neurologic complications using multivariable ordinal analysis. Secondary outcomes included activities of daily living (Barthel Index), telephone Montreal Cognitive Assessment (t-MoCA), and Quality of Life in Neurologic Disorders (Neuro-QoL) batteries for anxiety, depression, fatigue, and sleep. Changes in outcome scores from 6 to 12 months were compared using nonparametric paired-samples sign test. RESULTS Twelve-month follow-up was completed in 242 patients (median age 65 years, 64% male, 34% intubated during hospitalization) and 174 completed both 6- and 12-month follow-up. At 12 months, 197/227 (87%) had ≥1 abnormal metric: mRS >0 (75%), Barthel Index <100 (64%), t-MoCA ≤18 (50%), high anxiety (7%), depression (4%), fatigue (9%), or poor sleep (10%). Twelve-month mRS scores did not differ significantly among those with (n = 113) or without (n = 129) neurologic complications during hospitalization after adjusting for age, sex, race, pre-COVID-19 mRS, and intubation status (adjusted OR 1.4, 95% CI 0.8-2.5), although those with neurologic complications had higher fatigue scores (T score 47 vs 44; p = 0.037). Significant improvements in outcome trajectories from 6 to 12 months were observed in t-MoCA scores (56% improved, median difference 1 point; p = 0.002) and Neuro-QoL anxiety scores (45% improved; p = 0.003). Nonsignificant improvements occurred in fatigue, sleep, and depression scores in 48%, 48%, and 38% of patients, respectively. Barthel Index and mRS scores remained unchanged between 6 and 12 months in >50% of patients. DISCUSSION At 12 months after hospitalization for severe COVID-19, 87% of patients had ongoing abnormalities in functional, cognitive, or Neuro-QoL metrics and abnormal cognition persisted in 50% of patients without a history of dementia/cognitive abnormality. Only fatigue severity differed significantly between patients with or without neurologic complications during index hospitalization. However, significant improvements in cognitive (t-MoCA) and anxiety (Neuro-QoL) scores occurred in 56% and 45% of patients, respectively, between 6 and 12 months. These results may not be generalizable to those with mild or moderate COVID-19.
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Affiliation(s)
- Jennifer A Frontera
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Dixon Yang
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Chaitanya Medicherla
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Samuel Baskharoun
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Kristie Bauman
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Lena Bell
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Dhristie Bhagat
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Steven Bondi
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Alexander Chervinsky
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Levi Dygert
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Benjamin Fuchs
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Daniel Gratch
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Lisena Hasanaj
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Jennifer Horng
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Joshua Huang
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Ruben Jauregui
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Yuan Ji
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - D Ethan Kahn
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Ethan Koch
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Jessica Lin
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Susan Liu
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Anlys Olivera
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Jonathan Rosenthal
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Thomas Snyder
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Rebecca Stainman
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Daniel Talmasov
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Betsy Thomas
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Eduard Valdes
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Ting Zhou
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Yingrong Zhu
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Ariane Lewis
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Aaron S Lord
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Kara Melmed
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Sharon B Meropol
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Sujata Thawani
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Andrea B Troxel
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Shadi Yaghi
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Laura J Balcer
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Thomas Wisniewski
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
| | - Steven Galetta
- From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI
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