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Murphy J, Factor-Litvak P, Goetz R, Lomen-Hoerth C, Nagy PL, Hupf J, Singleton J, Woolley S, Andrews H, Heitzman D, Bedlack RS, Katz JS, Barohn RJ, Sorenson EJ, Oskarsson B, Fernandes Filho JAM, Kasarskis EJ, Mozaffar T, Rollins YD, Nations SP, Swenson AJ, Koczon-Jaremko BA, Mitsumoto H. Cognitive-behavioral screening reveals prevalent impairment in a large multicenter ALS cohort. Neurology 2016; 86:813-20. [PMID: 26802094 PMCID: PMC4793785 DOI: 10.1212/wnl.0000000000002305] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/05/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To characterize the prevalence of cognitive and behavioral symptoms using a cognitive/behavioral screening battery in a large prospective multicenter study of amyotrophic lateral sclerosis (ALS). METHODS Two hundred seventy-four patients with ALS completed 2 validated cognitive screening tests and 2 validated behavioral interviews with accompanying caregivers. We examined the associations between cognitive and behavioral performance, demographic and clinical data, and C9orf72 mutation data. RESULTS Based on the ALS Cognitive Behavioral Screen cognitive score, 6.5% of the sample scored below the cutoff score for frontotemporal lobar dementia, 54.2% scored in a range consistent with ALS with mild cognitive impairment, and 39.2% scored in the normal range. The ALS Cognitive Behavioral Screen behavioral subscale identified 16.5% of the sample scoring below the dementia cutoff score, with an additional 14.1% scoring in the ALS behavioral impairment range, and 69.4% scoring in the normal range. CONCLUSIONS This investigation revealed high levels of cognitive and behavioral impairment in patients with ALS within 18 months of symptom onset, comparable to prior investigations. This investigation illustrates the successful use and scientific value of adding a cognitive-behavioral screening tool in studies of motor neuron diseases, to provide neurologists with an efficient method to measure these common deficits and to understand how they relate to key clinical variables, when extensive neuropsychological examinations are unavailable. These tools, developed specifically for patients with motor impairment, may be particularly useful in patient populations with multiple sclerosis and Parkinson disease, who are known to have comorbid cognitive decline.
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Affiliation(s)
- Jennifer Murphy
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT.
| | - Pam Factor-Litvak
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Raymond Goetz
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Catherine Lomen-Hoerth
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Peter L Nagy
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Jonathan Hupf
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Jessica Singleton
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Susan Woolley
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Howard Andrews
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Daragh Heitzman
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Richard S Bedlack
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Jonathan S Katz
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Richard J Barohn
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Eric J Sorenson
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Björn Oskarsson
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - J Americo M Fernandes Filho
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Edward J Kasarskis
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Tahseen Mozaffar
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Yvonne D Rollins
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Sharon P Nations
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Andrea J Swenson
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Boguslawa A Koczon-Jaremko
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
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