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Shih LC, Stevenson MT, Bellows S, Fasano A, Kuo SH, Lyons KE, Moore H, Shill HA, Shukla AW, Singer C, Elble RJ. Validation of a New Patient-Reported Outcome Measure of the Functional Impact of Essential Tremor on Activities of Daily Living. Tremor Other Hyperkinet Mov (N Y) 2024; 14:26. [PMID: 38765931 PMCID: PMC11100532 DOI: 10.5334/tohm.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
Background The Essential Tremor Rating Assessment Scale (TETRAS) is a popular scale for essential tremor (ET), but its activities of daily living (ADL) and performance (P) subscales are based on a structured interview and physical exam. No patient-reported outcome (PRO) scale for ET has been developed according to US regulatory guidelines. Objective Develop and validate a TETRAS PRO subscale. Methods Fourteen items, rated 0-4, were derived from TETRAS ADL and structured cognitive interviews of 18 ET patients. Convergent validity analyses of TETRAS PRO versus TETRAS ADL, TETRAS-P, and the Quality of Life in Essential Tremor Questionnaire (QUEST) were computed for 67 adults with ET or ET plus. Test-retest reliability was computed at intervals of 1 and 30 days. The influence of mood (Hospital Anxiety and Depression Scale, HADS) and coping behaviors (Essen Coping Questionnaire, ECQ) was examined with multiple linear regression. Results TETRAS PRO was strongly correlated (r > 0.7) with TETRAS ADL, TETRAS-P, and QUEST and exhibited good to excellent reliability (Cronbach alpha 95%CI = 0.853-0.926; 30-day test-retest intraclass correlation 95%CI = 0.814-0.921). The 30-day estimate of minimum detectable change (MDC) was 6.6 (95%CI 5.2-8.0). TETRAS-P (rsemipartial = 0.607), HADS depression (rsemipartial = 0.384), and the coping strategy of information seeking and exchange of experiences (rsemipartial = 0.176) contributed statistically to TETRAS PRO in a multiple linear regression (R2 = 0.67). Conclusions TETRAS PRO is a valid and reliable scale that is influenced strongly by tremor severity, moderately by mood (depression), and minimally by coping skills. The MDC for TETRAS PRO is probably sufficient to detect clinically important change.
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Affiliation(s)
- Ludy C. Shih
- Beth Israel Deaconess Medical Center, Department of Neurology, Boston, MA 02215, US
- Harvard Medical School, Boston, MA 02215, US
| | | | - Steven Bellows
- Baylor College of Medicine, Department of Neurology, Houston, TX, US
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
- Krembil Brain Institute, Toronto, Ontario, Canada
| | - Sheng-Han Kuo
- Columbia University, Department of Neurology, New York, NY, US
| | - Kelly E. Lyons
- University of Kansas Medical Center, Department of Neurology, US
| | - Henry Moore
- University of Miami School of Medicine, Department of Neurology, Miami, FL, US
| | | | - Aparna Wagle Shukla
- Fixel Institute for Neurological Diseases, University of Florida, Department of Neurology, Gainesville, FL, US
| | - Carlos Singer
- University of Miami School of Medicine, Department of Neurology, Miami, FL, US
| | - Rodger J. Elble
- Southern Illinois University School of Medicine, Department of Neurology, Springfield, IL, US
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O'Shea SA, Shih LC. Global Epidemiology of Movement Disorders: Rare or Underdiagnosed? Semin Neurol 2023; 43:4-16. [PMID: 36893797 DOI: 10.1055/s-0043-1764140] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
In this manuscript, we review the epidemiology of movement disorders including Parkinson's disease (PD), atypical parkinsonism, essential tremor, dystonia, functional movement disorders, tic disorders, chorea, and ataxias. We emphasize age-, sex-, and geography-based incidence and prevalence, as well as notable trends including the rising incidence and prevalence of PD. Given the growing global interest in refining clinical diagnostic skills in recognizing movement disorders, we highlight some key epidemiological findings that may be of interest to clinicians and health systems tasked with diagnosing and managing the health of patients with movement disorders.
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Affiliation(s)
- Sarah A O'Shea
- Department of Neurology, Columbia University, Vagelos College of Physicians and Surgeons, New York City, New York
| | - Ludy C Shih
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.,Department of Neurology, Boston Medical Center, Boston, Massachusetts
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The Pharmacotherapeutic Landscape for Essential Tremor: Quantifying the Level of Unmet Need From a Patient and Epidemiologic Perspective. Clin Neuropharmacol 2022; 45:99-104. [PMID: 35696617 DOI: 10.1097/wnf.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Essential tremor (ET) is one of the most common neurological diseases. Despite this high prevalence, treatment options remain limited. Recent advances in mechanistic research have led to renewed interest in developing newer pharmacotherapeutic agents. Although this is promising, there remains surprisingly little knowledge of the magnitude of the vast ET patient population who would benefit from and/or engage with such agents. This is because the vast bulk of ET patients in the population has milder tremor and does not seek medical care for their tremor. How many of these would be interested in taking a new agent? Hence, the level of unmet need, from the patient perspective and from a public health perspective, is totally unclear. In this article, the author systematically reviews peer-reviewed data on several pertinent questions that relate to this unmet need. The questions are as follows: (1) What proportion of the population of ET cases sees a health care provider for their tremor? (2) What proportion of the ET population has a tremor that is severe enough for them to want to take a medication for their tremor? (3) How do other factors such as age, sex, education, health literacy, and locale affect the receptivity to treatment in ET? (4) What is the patient use of the current ET medications? (5) Is the unmet need greater in some groups of ET cases than others? For each of these questions, available data are carefully reviewed and analyzed, and gaps in knowledge identified for further investigation.
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Howlett WP, Urasa SJ, Maro VP, Walker RW, Kilonzo KG, Howlett PJ, Dekker MCJ. Neurological disorders in Northern Tanzania: A 6-year prospective hospital-based case series. Afr Health Sci 2022; 22:269-284. [PMID: 36032440 PMCID: PMC9382522 DOI: 10.4314/ahs.v22i1.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The burden of neurological disorders is large and altered by the HIV epidemic. Objectives We describe the pattern of neurological disorders and their association with HIV infection in adult patients attending a consultant hospital in Northern Tanzania. Methods In this prospective cross-sectional study, we collected data on adult neurological referrals over a 6-year period between 2007-13. The odds of HIV infection, across neurological categories adjusted for age and sex, was calculated. Results Of 2037 participants, 54.8% were male and 45.2% were female. The median age of participants was 43 years. The results for HIV screening were available for 992/2037 (48.7%) patients, of whom 306 (30.8%) were seropositive. The most frequent neurological disorders were cerebrovascular disease (19.9%), paraplegia (13.6%), and peripheral neuropathies (8%). Taken together CNS infection accounted for 278/2037 (13.6%). The adjusted odds (aOR) of HIV infection was highest amongst infections; brain abscesses (aOR 107, 95% CI 35.1-470.4) and meningitis/encephalitis (aOR 40.1, 95% CI 13.6-172.9), but also raised in cerebrovascular disease, paraplegia, peripheral neuropathies, cranial nerve palsies, seizures, cerebllar disorders, movement disorders, motor neuron disease and headache. Conclusion The main pattern of neurological disorders in Northern Tanzania is presented. The odds of HIV infection was highest in CNS infections and in a wide range of non-communicable neurological disorders.
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Affiliation(s)
- William P Howlett
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
- Centre for International Health University of Bergen, Bergen Norway
| | - Sarah J Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Venance P Maro
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Richard W Walker
- Department of Medicine, North Tyneside General Hospital, Rake Lane, North Shields, Tyne, and Wear NE29 8NH
| | - Kajiru G Kilonzo
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Patrick J Howlett
- Royal Brompton and Harefield Hospital Trust Fulham Road, London, SW3 6HP
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Abstract
Essential tremor (ET) is one of the most common movement disorders, with a reported >60 million affected individuals worldwide. The definition and underlying pathophysiology of ET are contentious. Patients present primarily with motor features such as postural and action tremors, but may also have other non-motor features, including cognitive impairment and neuropsychiatric symptoms. Genetics account for most of the ET risk but environmental factors may also be involved. However, the variable penetrance and challenges in validating data make gene-environment analysis difficult. Structural changes in cerebellar Purkinje cells and neighbouring neuronal populations have been observed in post-mortem studies, and other studies have found GABAergic dysfunction and dysregulation of the cerebellar-thalamic-cortical circuitry. Commonly prescribed medications include propranolol and primidone. Deep brain stimulation and ultrasound thalamotomy are surgical options in patients with medically intractable ET. Further research in post-mortem studies, and animal and cell-based models may help identify new pathophysiological clues and therapeutic targets and, together with advances in omics and machine learning, may facilitate the development of precision medicine for patients with ET.
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Louis ED, McCreary M. How Common is Essential Tremor? Update on the Worldwide Prevalence of Essential Tremor. Tremor Other Hyperkinet Mov (N Y) 2021; 11:28. [PMID: 34277141 PMCID: PMC8269764 DOI: 10.5334/tohm.632] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background Essential tremor (ET) is among the most prevalent movement disorders. Comprehensive reviews of disease prevalence were published in 1998 and 2010 but not since then. We reviewed the prevalence of ET in population-based epidemiological studies, derived a precise summary estimate of prevalence from these studies, and examined differences in prevalence across studies. We used two methods: a descriptive-analytical approach and a meta-analysis. Methods A PUBMED search yielded 14 published papers since the 2010 review. Results There were 42 population-based prevalence studies (23 countries and 6 continents). In a meta-analysis, pooled prevalence (all ages) = 1.33%, with statistically significant heterogeneity across studies (I2 = 99.3%, p < 0.0001). In additional descriptive analyses, median crude prevalence (all ages) = 0.4% and mean = 0.67%. Prevalence increased markedly with age, and especially with advanced age. In the meta-analysis, prevalence (age ≥ 65 years) = 5.79%, and in descriptive analyses, median crude prevalence (age ≥ 60-65) = 5.9% and mean = 8.0%. In the oldest age groups, median prevalence = 9.3%, with several studies reporting values >20%. The prevalence increased by 74% for every decade increase in age (p < 0.0001). Gender did not impact the prevalence of ET (p = 0.90). Discussion Precise prevalence estimates are important because they form the numerical basis for public health initiatives and offer clues about underlying biological factors of mechanistic importance. The prevalence of ET among those age ≥ 65 is similar to that reported for Alzheimer's disease in elders, suggesting that ET may be the most common neurodegenerative disease.
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Affiliation(s)
- Elan D. Louis
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Morgan McCreary
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
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Song P, Zhang Y, Zha M, Yang Q, Ye X, Yi Q, Rudan I. The global prevalence of essential tremor, with emphasis on age and sex: A meta-analysis. J Glob Health 2021; 11:04028. [PMID: 33880180 PMCID: PMC8035980 DOI: 10.7189/jogh.11.04028] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Essential tremor (ET) is one of the most common neurological disorders that impairs quality of life and leads to disability and social handicap. It was estimated that approximate 0.9% of people worldwide were affected by ET. The last decade has seen new investigations on the epidemiology of ET, enabling us to provide an up-to-date estimation of ET prevalence, with emphasis on age and sex. Methods We searched PubMed, Medline, Embase and Global Health for studies that reported the prevalence of ET in the general population. Potential sources of heterogeneity were examined by age-adjusted meta-regression. The age- and sex-specific prevalence of ET was constructed with a multilevel mixed-effects meta-regression. Results A total of 29 articles were included in our systematic review and meta-analysis. The prevalence of ET increased dramatically with advancing age, where the prevalence estimate in people aged under 20 years was 0.04% (95% confidence interval [CI] = 0.00-0.29) and that in elderly aged 80 years and above was 2.87% (95% CI = 1.07-7.49). ET was consistently more common in males than in females. In 2020, the overall prevalence of ET in the general population was 0.32% (95% CI = 0.12-0.91), and the prevalence was higher in males (0.36%, 95% CI = 0.14-1.03) than in females (0.28%, 95% CI = 0.11-0.79). In 2020, the number of people affected by ET was 24.91million (95% CI = 9.51-70.92), among whom 56% were males. Conclusions This study provides an up-to-date estimation of ET prevalence in the general population throughout the whole life span, with emphasis on age and sex. The adoption of an internationally acknowledged diagnostic strategy is prompted in future epidemiological investigations. Protocol registration PROSPERO (CRD42020203979)
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Affiliation(s)
- Peige Song
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yan Zhang
- Faculty of Life Science and Medicine, Kings College London, London, UK
| | - Mingming Zha
- Medical School Southeast University, Nanjing, Jiangsu, China
| | - Qingwen Yang
- Medical School Southeast University, Nanjing, Jiangsu, China
| | - Xinxin Ye
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qian Yi
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Igor Rudan
- Centre for Global Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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Otubogun FM, Akinyemi R, Ogunniyi S. Burden of adult neurological diseases in Odeda Area, Southwest Nigeria. BMJ Neurol Open 2020; 2:e000062. [PMID: 33681795 PMCID: PMC7903184 DOI: 10.1136/bmjno-2020-000062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background Few population-based studies have been conducted to determine the burden of neurological diseases in sub-Saharan Africa. A better understanding of the magnitude and impact of these disorders is pivotal to effective planning and provision of neurological services. Methods A cross-sectional survey of 2392 adults in Odeda Local Government Area, Ogun State, Southwest Nigeria was conducted between May and June 2015. Trained non-medical interviewers administered a screening instrument designed to measure the prevalence of neurological diseases and disability, while positive responders were subsequently examined by neurologists. Diagnoses were made clinically according to well-established criteria. Results The mean age of respondents was 37.2±16.1 years. A total of 842 cases of neurological diseases/disability were diagnosed in 815 individuals (26 individuals with more than one disorder). The all-cause neurological morbidity rate was 352 per 1000, while the crude prevalence rates of common neurological disorders were 304.3 per 1000 for primary headaches, 16.3 per 1000 for tropical ataxic neuropathy, 7.11 per 1000 for stroke, 5.85 per 1000 for essential tremor and 4.18 per 1000 for Parkinson’s disease. Neurological years lost due to disability was 2806.18 per 100 000. Conclusion This study provides evidence of a high neurological disease burden within the communities surveyed, which may be representative of Southwest Nigeria. In comparison with findings from previous studies within the same region, this report suggests a persistence of toxiconutritional disorders and postinfectious neurological sequelae on one hand and increased prevalence of non-communicable neurological disorders such as stroke and Parkinson’s disease.
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Affiliation(s)
- Folajimi Morenikeji Otubogun
- Internal Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria.,Internal Medicine, University of Medical Sciences, Ondo, Nigeria
| | - Rufus Akinyemi
- Institute of Medical Research and Training, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria.,Neurology, University College Hospital Ibadan, Ibadan, Oyo, Nigeria
| | - Sola Ogunniyi
- Neurology, University College Hospital Ibadan, Ibadan, Oyo, Nigeria.,Medicine, University of Ibadan College of Medicine, Ibadan, Oyo, Nigeria
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Oluwole OG, Kuivaniemi H, Carr JA, Ross OA, Olaogun MOB, Bardien S, Komolafe MA. Parkinson's disease in Nigeria: A review of published studies and recommendations for future research. Parkinsonism Relat Disord 2018; 62:36-43. [PMID: 30573414 DOI: 10.1016/j.parkreldis.2018.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 11/02/2018] [Accepted: 12/07/2018] [Indexed: 12/15/2022]
Abstract
Parkinson's disease (PD) affects 1-2% of individuals above 60 years amounting to over 7 million people worldwide. Thus, PD has become an important contributor to the neurological disease burden. Nigeria is the most populous country in Africa, and alarmingly, approximately 5.25 million Nigerians are above 65 years and are therefore at risk for developing PD. We carried out a critical review of published literature on PD in Nigeria to summarize the findings and to evaluate gaps in knowledge. Seven electronic databases were searched for studies published in English before 18th July 2018. Search terms were ["Parkinson's disease" OR "Parkinson disease" OR "parkinsonian disorders" OR "Parkinsonism"] AND "Nigeria". A total of 44 articles (including eight reviews) published since 1969 were identified and reviewed. Amongst the original research articles, most (23) were on PD symptoms or prevalence. There were only two studies on genetics and two on environmental factors. The estimated crude prevalence of PD in Nigeria was lower (10-249/100 000) compared to studies published in Europe (65.6-12 500/100 000). Our findings suggest that PD is under-diagnosed in Nigeria. Possible environmental risk factors identified include blacksmithing and well-water contaminated with trace metals. Given the rising numbers of the ageing population in Nigeria, more studies to evaluate the prevalence and causes of PD in this country are urgently needed. To this end, more funding, resources and a workforce of well-trained neurologists and scientists are essential to manage the impending health burden of PD and related disorders in this country.
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Affiliation(s)
- Oluwafemi G Oluwole
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Helena Kuivaniemi
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jonathan A Carr
- Division of Neurology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, FL, USA
| | - Matthew O B Olaogun
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Soraya Bardien
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Morenikeji A Komolafe
- Neurology Unit, Department of Medicine, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria.
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Louis ED, Ottman R. How many people in the USA have essential tremor? Deriving a population estimate based on epidemiological data. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4:259. [PMID: 25157323 PMCID: PMC4137360 DOI: 10.7916/d8tt4p4b] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 07/21/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Essential tremor (ET) is often reported to be among the most prevalent movement disorders, yet the precise number of cases in the USA is not known. The goal of the current analyses was to use published data from epidemiological studies to derive an estimate of the number of people currently residing in the USA who have ET. METHODS A PubMed search was conducted to identify population-based prevalence studies of ET. The methodology of 34 identified studies was assessed. Then the three most methodologically rigorous studies were selected, and age-specific prevalence data were abstracted. US census data from 2012 were used to determine the population in the USA by 10-year age categories. RESULTS Using data from three studies, estimates of the number of ET cases (2012) ranged from 6.38 to 7.63 million (mean = 7.01 million). This corresponds to approximately 2.2% of the US population. DISCUSSION Knowing the number of ET cases in the USA is important in terms of estimating the medical burden on communities and society, and providing an objective metric on which to base health resource planning.
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Affiliation(s)
- Elan D Louis
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA ; Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York, NY, USA ; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA ; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Ruth Ottman
- GH Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA ; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA ; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA ; Division of Epidemiology, New York State Psychiatric Institute, New York, NY, USA
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