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Weber I, Zagona-Prizio C, Sivesind TE, Adelman M, Szeto MD, Liu Y, Sillau SH, Bainbridge J, Klawitter J, Sempio C, Dunnick CA, Leehey MA, Dellavalle RP. Oral Cannabidiol for Seborrheic Dermatitis in Patients With Parkinson Disease: Randomized Clinical Trial. JMIR Dermatol 2024; 7:e49965. [PMID: 38466972 DOI: 10.2196/49965] [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: 06/15/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Seborrheic dermatitis (SD) affects 18.6%-59% of persons with Parkinson disease (PD), and recent studies provide evidence that oral cannabidiol (CBD) therapy could reduce sebum production in addition to improving motor and psychiatric symptoms in PD. Therefore, oral CBD could be useful for improving symptoms of both commonly co-occurring conditions. OBJECTIVE This study investigates whether oral CBD therapy is associated with a decrease in SD severity in PD. METHODS Facial photographs were collected as a component of a randomized (1:1 CBD vs placebo), parallel, double-blind, placebo-controlled trial assessing the efficacy of a short-term 2.5 mg per kg per day oral sesame solution CBD-rich cannabis extract (formulated to 100 mg/mL CBD and 3.3 mg/mL THC) for reducing motor symptoms in PD. Participants took 1.25 mg per kg per day each morning for 4 ±1 days and then twice daily for 10 ±4 days. Reviewers analyzed the photographs independently and provided a severity ranking based on the Seborrheic Dermatitis Area and Severity Index (SEDASI) scale. Baseline demographic and disease characteristics, as well as posttreatment SEDASI averages and the presence of SD, were analyzed with 2-tailed t tests and Pearson χ2 tests. SEDASI was analyzed with longitudinal regression, and SD was analyzed with generalized estimating equations. RESULTS A total of 27 participants received a placebo and 26 received CBD for 16 days. SD severity was low in both groups at baseline, and there was no treatment effect. The risk ratio for patients receiving CBD, post versus pre, was 0.69 (95% CI 0.41-1.18; P=.15), compared to 1.20 (95% CI 0.88-1.65; P=.26) for the patients receiving the placebo. The within-group pre-post change was not statistically significant for either group, but they differed from each other (P=.07) because there was an estimated improvement for the CBD group and an estimated worsening for the placebo group. CONCLUSIONS This study does not provide solid evidence that oral CBD therapy reduces the presence of SD among patients with PD. While this study was sufficiently powered to detect the primary outcome (efficacy of CBD on PD motor symptoms), it was underpowered for the secondary outcomes of detecting changes in the presence and severity of SD. Multiple mechanisms exist through which CBD can exert beneficial effects on SD pathogenesis. Larger studies, including participants with increased disease severity and longer treatment periods, may better elucidate treatment effects and are needed to determine CBD's true efficacy for affecting SD severity. TRIAL REGISTRATION ClinicalTrials.gov NCT03582137; https://clinicaltrials.gov/ct2/show/NCT03582137.
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Affiliation(s)
- Isaac Weber
- Mercy Hopsital St. Louis, St. Louis, MO, United States
| | - Caterina Zagona-Prizio
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Torunn E Sivesind
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Madeline Adelman
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Mindy D Szeto
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Ying Liu
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jacquelyn Bainbridge
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jost Klawitter
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Cristina Sempio
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Maureen A Leehey
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States
- Dermatology Service, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, United States
- Colorado School of Public Health, Aurora, CO, United States
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Pelak VS, Krishnan V, Serva S, Pressman P, Mahmood A, Noteboom L, Bettcher BM, Sillau SH, Callen AL, Thaker AA. Lobar Microbleeds in the Posterior Cortical Atrophy Syndrome: A Comparison to Typical Alzheimer's Disease. Curr Neurol Neurosci Rep 2024; 24:27-33. [PMID: 38261145 DOI: 10.1007/s11910-024-01330-5] [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] [Accepted: 12/14/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE OF THE STUDY Posterior cortical atrophy is a clinico-radiographical syndrome that presents with higher-order visual dysfunction and is most commonly due to Alzheimer's disease. Understanding factors associated with atypical presentations of Alzheimer's disease, such as posterior cortical atrophy (PCA), holds promise to shape our understanding of AD pathophysiology. Thus, we aimed to compare MRI evidence of lobar microbleeds (LMBs) in posterior cortical atrophy (PCA) syndrome to typical AD (tAD) and to assess and compare MRI evidence of cerebral amyloid angiopathy (CAA) in each group. FINDINGS We retrospectively collected clinical and MRI data from participants with PCA (n = 26), identified from an institutional PCA registry, and participants with tAD (n = 46) identified from electronic health records from a single institution. LMBs were identified on susceptibility-weighted imaging (SWI); the Fazekas grade of white matter disease was assessed using FLAIR images, and Boston criteria version 2.0 for cerebral amyloid angiopathy were applied to all data. The proportion of participants with PCA and LMB (7.7%) was lower than for tAD (47.8%) (p = 0.005). The frequency of "probable" CAA was similar in both groups, while "possible" CAA was more frequent in tAD (30.4%) than PCA (0%) (p = 0.001). The Fazekas grades were not different between groups. Lobar microbleeds on SWI were not more common in PCA than in typical AD. Clinicopathological investigations are necessary to confirm these findings. The factors that contribute to the posterior cortical atrophy phenotype are unknown.
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Affiliation(s)
- Victoria S Pelak
- Department of Neurology, University of Colorado School of Medicine, 12631 East 17 Avenue, Mail Stop B185, Aurora, CO, 80045, USA.
| | - Vishal Krishnan
- Department of Neurology, University of Colorado School of Medicine, 12631 East 17 Avenue, Mail Stop B185, Aurora, CO, 80045, USA
| | - Stephanie Serva
- Department of Neurology, University of Colorado School of Medicine, 12631 East 17 Avenue, Mail Stop B185, Aurora, CO, 80045, USA
| | - Peter Pressman
- Department of Neurology, University of Colorado School of Medicine, 12631 East 17 Avenue, Mail Stop B185, Aurora, CO, 80045, USA
| | - Asher Mahmood
- Department of Neurology, University of Colorado School of Medicine, 12631 East 17 Avenue, Mail Stop B185, Aurora, CO, 80045, USA
| | - Lily Noteboom
- Department of Neurology, University of Colorado School of Medicine, 12631 East 17 Avenue, Mail Stop B185, Aurora, CO, 80045, USA
| | - Brianne M Bettcher
- Department of Neurology, University of Colorado School of Medicine, 12631 East 17 Avenue, Mail Stop B185, Aurora, CO, 80045, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, 12631 East 17 Avenue, Mail Stop B185, Aurora, CO, 80045, USA
| | - Andrew L Callen
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ashesh A Thaker
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
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3
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Kluger BM, Katz M, Galifianakis NB, Pantilat SZ, Hauser JM, Khan R, Friedman C, Vaughan CL, Goto Y, Long SJ, Martin CS, Dini M, McQueen RB, Palmer L, Fairclough D, Seeberger LC, Sillau SH, Kutner JS. Patient and Family Outcomes of Community Neurologist Palliative Education and Telehealth Support in Parkinson Disease. JAMA Neurol 2024; 81:39-49. [PMID: 37955923 PMCID: PMC10644250 DOI: 10.1001/jamaneurol.2023.4260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/29/2023] [Indexed: 11/14/2023]
Abstract
Importance Parkinson disease and related disorders (PDRD) are the fastest growing neurodegenerative illness in terms of prevalence and mortality. As evidence builds to support palliative care (PC) for PDRD, studies are needed to guide implementation. Objective To determine whether PC training for neurologists and remote access to a PC team improves outcomes in patients with PDRD in community settings. Design, Setting, and Participants This pragmatic, stepped-wedge comparative effectiveness trial enrolled and observed participants from 19 community neurology practices supported by PC teams at 2 academic centers from March 8, 2017, to December 31, 2020. Participants were eligible if they had PDRD and moderate to high PC needs. A total of 612 persons with PDRD were referred; 253 were excluded. Patients were excluded if they had another diagnosis meriting PC, were receiving PC, or were unable or unwilling to follow study procedures. Patients received usual care or the intervention based on when their community neurologist was randomized to start the intervention. Data were analyzed from January 2021 to September 2023. Intervention The intervention included (1) PC education for community neurologists and (2) team-based PC support via telehealth. Main Outcomes and Measures The primary outcomes were differences at 6 months in patient quality of life (QOL; measured by the Quality of Life in Alzheimer Disease Scale [QOL-AD]) and caregiver burden (Zarit Burden Interview) between the intervention and usual care. Results A total of 359 patients with PDRD (233 men [64.9%]; mean [SD] age, 74.0 [8.8] years) and 300 caregivers were enrolled. At 6 months, compared with usual care, participants receiving the intervention had better QOL (QOL-AD score, 0.09 [95% CI, -0.63 to 0.82] vs -0.88 [95% CI, -1.62 to -0.13]; treatment effect estimate, 0.97; 95% CI, 0.07-1.86; P = .03). No significant difference was observed in caregiver burden (Zarit Burden Interview score, 1.19 [95% CI, 0.16 to 2.23] vs 0.55 [95%, -0.44 to 1.54]; treatment effect estimate, 0.64; 95% CI, -0.62 to 1.90; P = .32). Advance directive completion was higher under the intervention (19 of 38 [50%] vs 6 of 31 [19%] among those without directives at the beginning of the study; P = .008). There were no differences in other outcomes. Conclusions and Relevance PC education for community neurologists and provision of team-based PC via telehealth is feasible and may improve QOL and advance care planning. Overall treatment effects were small and suggest opportunities to improve both the intervention and implementation. Trial Registration ClinicalTrials.gov Identifier: NCT03076671.
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Affiliation(s)
- Benzi M. Kluger
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
- Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Maya Katz
- Department of Neurology, Stanford University, Stanford, California
| | | | - Steven Z. Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco
| | - Joshua M. Hauser
- Division of Palliative Medicine, Department of Medicine, Northwestern Medicine, Chicago, Illinois
| | - Ryan Khan
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado, Aurora
| | - Cari Friedman
- Parkinson Association of the Rockies, University of Denver, Denver, Colorado
| | | | - Yuika Goto
- Department of Palliative Care, University of California, San Francisco
| | - S. Judith Long
- Department of Palliative Care, University of California, San Francisco
| | | | - Megan Dini
- Parkinson’s Foundation, Denver, Colorado
| | - R. Brett McQueen
- Department of Clinical Pharmacy, University of Colorado School of Medicine, Aurora
| | - Laura Palmer
- Quality and Process Improvement, University of Colorado School of Medicine, Aurora
| | - Diane Fairclough
- Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora
| | - Lauren C. Seeberger
- Department of Neurology, Charleston Area Medical Center Institute for Academic Medicine, Charleston, West Virginia
| | - Stefan H. Sillau
- Department of Neurology, School of Public Health, University of Colorado, Aurora
| | - Jean S. Kutner
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora
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Pulver RL, Kronberg E, Medenblik LM, Kheyfets VO, Ramos AR, Holtzman DM, Morris JC, Toedebusch CD, Sillau SH, Bettcher BM, Lucey BP, McConnell BV. Mapping sleep's oscillatory events as a biomarker of Alzheimer's disease. Alzheimers Dement 2024; 20:301-315. [PMID: 37610059 PMCID: PMC10840635 DOI: 10.1002/alz.13420] [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: 04/26/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Memory-associated neural circuits produce oscillatory events including theta bursts (TBs), sleep spindles (SPs), and slow waves (SWs) in sleep electroencephalography (EEG). Changes in the "coupling" of these events may indicate early Alzheimer's disease (AD) pathogenesis. METHODS We analyzed 205 aging adults using single-channel sleep EEG, cerebrospinal fluid (CSF) AD biomarkers, and Clinical Dementia Rating® (CDR®) scale. We mapped SW-TB and SW-SP neural circuit coupling precision to amyloid positivity, cognitive impairment, and CSF AD biomarkers. RESULTS Cognitive impairment correlated with lower TB spectral power in SW-TB coupling. Cognitively unimpaired, amyloid positive individuals demonstrated lower precision in SW-TB and SW-SP coupling compared to amyloid negative individuals. Significant biomarker correlations were found in oscillatory event coupling with CSF Aβ42 /Aβ40 , phosphorylated- tau181 , and total-tau. DISCUSSION Sleep-dependent memory processing integrity in neural circuits can be measured for both SW-TB and SW-SP coupling. This breakdown associates with amyloid positivity, increased AD pathology, and cognitive impairment. HIGHLIGHTS At-home sleep EEG is a potential biomarker of neural circuits linked to memory. Circuit precision is associated with amyloid positivity in asymptomatic aging adults. Levels of CSF amyloid and tau also correlate with circuit precision in sleep EEG. Theta burst EEG power is decreased in very early mild cognitive impairment. This technique may enable inexpensive wearable EEGs for monitoring brain health.
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Affiliation(s)
- Rachelle L. Pulver
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Eugene Kronberg
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Lindsey M. Medenblik
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Vitaly O. Kheyfets
- Department of Pediatric Critical Care MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Alberto R. Ramos
- Department of NeurologyUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - David M. Holtzman
- Department of NeurologyWashington University School of MedicineSt LouisMissouriUSA
- Knight Alzheimer Disease Research CenterWashington University School of MedicineSt LouisMissouriUSA
- Hope Center for Neurological DisordersWashington University School of MedicineSt LouisMissouriUSA
| | - John C. Morris
- Department of NeurologyWashington University School of MedicineSt LouisMissouriUSA
- Knight Alzheimer Disease Research CenterWashington University School of MedicineSt LouisMissouriUSA
- Hope Center for Neurological DisordersWashington University School of MedicineSt LouisMissouriUSA
| | | | - Stefan H Sillau
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Brianne M. Bettcher
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Brendan P. Lucey
- Department of NeurologyWashington University School of MedicineSt LouisMissouriUSA
- Knight Alzheimer Disease Research CenterWashington University School of MedicineSt LouisMissouriUSA
- Hope Center for Neurological DisordersWashington University School of MedicineSt LouisMissouriUSA
| | - Brice V. McConnell
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterUniversity of Colorado School of MedicineAuroraColoradoUSA
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5
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Corigliano MR, Carlson AM, Sillau SH, Stabio ME. An innovative 3D-printed model of the cerebral arterial circle for dental gross anatomy. J Dent Educ 2023. [PMID: 38129320 DOI: 10.1002/jdd.13440] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/06/2023] [Accepted: 12/17/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Michael R Corigliano
- Modern Human Anatomy Program, University of Colorado Anschutz Medical Campus, Aurora, Pennsylvania, USA
| | - Aaron M Carlson
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stefan H Sillau
- Department of Neurology, Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Maureen E Stabio
- Modern Human Anatomy Program, Department of Cell and Developmental Biology, Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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6
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Pulver RL, Kronberg E, Medenblik LM, Kheyfets VO, Ramos AR, Holtzman DM, Morris JC, Toedebusch CD, Sillau SH, Bettcher BM, Lucey BP, McConnell BV. Mapping Sleep's Oscillatory Events as a Biomarker of Alzheimer's Disease. bioRxiv 2023:2023.02.15.528725. [PMID: 36824720 PMCID: PMC9949053 DOI: 10.1101/2023.02.15.528725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Objective Memory-associated neural circuits produce oscillatory events within single-channel sleep electroencephalography (EEG), including theta bursts (TBs), sleep spindles (SPs) and multiple subtypes of slow waves (SWs). Changes in the temporal "coupling" of these events are proposed to serve as a biomarker for early stages of Alzheimer's disease (AD) pathogenesis. Methods We analyzed data from 205 aging adults, including single-channel sleep EEG, cerebrospinal fluid (CSF) AD-associated biomarkers, and Clinical Dementia Rating® (CDR®) scale. Individual SW events were sorted into high and low transition frequencies (TF) subtypes. We utilized time-frequency spectrogram locations within sleep EEG to "map" the precision of SW-TB and SW-SP neural circuit coupling in relation to amyloid positivity (by CSF Aβ 42 /Aβ 40 threshold), cognitive impairment (by CDR), and CSF levels of AD-associated biomarkers. Results Cognitive impairment was associated with lower TB spectral power in both high and low TF SW-TB coupling (p<0.001, p=0.001). Cognitively unimpaired, amyloid positive aging adults demonstrated lower precision of the neural circuits propagating high TF SW-TB (p<0.05) and low TF SW-SP (p<0.005) event coupling, compared to cognitively unimpaired amyloid negative individuals. Biomarker correlations were significant for high TF SW-TB coupling with CSF Aβ 42 /Aβ 40 (p=0.005), phosphorylated-tau 181 (p<0.005), and total-tau (p<0.05). Low TF SW-SP coupling was also correlated with CSF Aβ 42 /Aβ 40 (p<0.01). Interpretation Loss of integrity in neural circuits underlying sleep-dependent memory processing can be measured for both SW-TB and SW-SP coupling in spectral time-frequency space. Breakdown of sleep's memory circuit integrity is associated with amyloid positivity, higher levels of AD-associated pathology, and cognitive impairment.
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Kendall LV, Boyd TD, Sillau SH, Bosco‐Lauth A, Markham N, Fong D, Clarke P, Tyler KL, Potter H. The Potential Alzheimer’s Disease Drug, GM‐CSF, Enhances the Anti‐Viral Immune Response and Reduces Mortality in a Mouse Model of COVID‐19. Alzheimers Dement 2022. [DOI: 10.1002/alz.068357] [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: 12/24/2022]
Affiliation(s)
| | - Timothy D. Boyd
- University of Colorado Alzheimer’s and Cognition Center University of Colorado Anschutz Med Aurora CO USA
| | - Stefan H Sillau
- University of Colorado Alzheimer’s and Cognition Center Anschutz Medical Campus Aurora CO USA
| | | | - Neil Markham
- University of Colorado Alzheimer’s and Cognition Center University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Derek Fong
- University of Colorado Anschutz Medical Camous Aurora CO USA
| | - Penny Clarke
- University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Kenneth L. Tyler
- University of Colorado School of Medicine Aurora CO USA
- Denver VA Medical Center Denver CO USA
| | - Huntington Potter
- Department of Neurology University of Colorado Alzheimer’s and Cognition Center and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
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Macchi ZA, Seshadri S, Ayele R, Bock M, Long J, Coats H, Miyasaki J, Pantilat SZ, Katz M, Santos EJ, Sillau SH, Lum HD, Kluger BM. Aggression Towards Caregivers in Parkinson's Disease and Related Disorders: A Mixed Methods Study. Mov Disord Clin Pract 2022; 9:920-931. [PMID: 36247911 PMCID: PMC9547131 DOI: 10.1002/mdc3.13555] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/03/2022] [Accepted: 06/29/2022] [Indexed: 11/09/2022] Open
Abstract
Background Aggression is one manifestation of behavioral disturbances in neurodegenerative disease with emerging literature suggesting a high prevalence in Parkinson's disease and related disorders (PDRD). Objectives Our aim was to describe characteristics, associated factors, and consequences of aggression towards caregivers in PDRD. Methods This is a convergent mixed methods study, leveraging data from 296 PDRD patient-caregiver dyads in a clinical trial of palliative care and semi-structured interviews with a subgroup of 14 caregivers who reported aggression. The primary outcome was baseline caregiver-reported aggression. Using multivariate linear regression, baseline dyad characteristics (eg, measures of disease, psychosocial issues, caregiver strain) were examined to identify factors associated with aggression. Thematic analysis of interviews was used to augment these findings. Results Associated variables included disease duration (r = 0.15, P < 0.05), patient grief (r = 0.22, P< 0.001), symptom burden (r = 0.18, r < 0.01), resistance to care (r = 0.40, P < 0.01), caregivers' depression (r = 0.16, P < 0.05), and caregiving burden (r = 0.34, P < 0.001). We identified five themes: (1) Aggressive behaviors range from verbal abuse to threats of physical violence; (2) Caregivers believe that aggressive behaviors result from the difficulty patients experience in coping with disease progression and related losses; (3) Caregivers' stress and mental health are worsened by aggressive behaviors; (4) Aggressive behaviors negatively affect patient-caregiver relationships; (5) Caregivers are ill-prepared to manage aggressive behaviors and cope with the consequences on their own. Conclusions Aggression in PDRD is driven by diverse factors (eg, grief, fluctuations in cognition) with serious consequences for caregivers. Neurologists and movement specialists should consider screening for aggression while prioritizing caregiver education and wellbeing.
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Affiliation(s)
- Zachary A. Macchi
- Behavioral Neurology|Neuropalliative Sections, Department of NeurologyUniversity of Colorado AnschutzAuroraColoradoUSA
| | - Sandhya Seshadri
- Department of Neurology and MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Roman Ayele
- Denver‐Seattle Center of Innovation at Eastern Colorado VA Healthcare SystemDenverColoradoUSA
| | - Meredith Bock
- Weill Institute for NeuroscienceUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- San Francisco Veteran's Affairs Health Care SystemSan FranciscoCaliforniaUSA
| | - Judith Long
- Division of Palliative Medicine, Department of MedicineUniversity of California, San FranciscoCaliforniaUSA
| | - Heather Coats
- College of NursingUniversity of Colorado AnschutzAuroraColoradoUSA
| | - Janis Miyasaki
- Division of Neurology, Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Steven Z. Pantilat
- Division of Palliative Medicine, Department of MedicineUniversity of California, San FranciscoCaliforniaUSA
| | - Maya Katz
- Department of Neurology and Neurological SciencesStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Elizabeth J. Santos
- Division of Geriatric Mental Health and Memory CareUniversity of Rochester School of Medicine and DentistryRochesterNew YorkUSA
| | - Stefan H. Sillau
- Behavioral Neurology|Neuropalliative Sections, Department of NeurologyUniversity of Colorado AnschutzAuroraColoradoUSA
| | - Hillary D. Lum
- Division of Geriatric Medicine, Department of MedicineUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Benzi M. Kluger
- Behavioral Neurology|Neuropalliative Sections, Department of NeurologyUniversity of Colorado AnschutzAuroraColoradoUSA
- Department of Neurology and MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
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9
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McConnell BV, Kronberg E, Medenblik LM, Kheyfets VO, Ramos AR, Sillau SH, Pulver RL, Bettcher BM. The Rise and Fall of Slow Wave Tides: Vacillations in Coupled Slow Wave/Spindle Pairing Shift the Composition of Slow Wave Activity in Accordance With Depth of Sleep. Front Neurosci 2022; 16:915934. [PMID: 35812239 PMCID: PMC9260314 DOI: 10.3389/fnins.2022.915934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/03/2022] [Indexed: 11/21/2022] Open
Abstract
Slow wave activity (SWA) during sleep is associated with synaptic regulation and memory processing functions. Each cycle of non-rapid-eye-movement (NREM) sleep demonstrates a waxing and waning amount of SWA during the transitions between stages N2 and N3 sleep, and the deeper N3 sleep is associated with an increased density of SWA. Further, SWA is an amalgam of different types of slow waves, each identifiable by their temporal coupling to spindle subtypes with distinct physiological features. The objectives of this study were to better understand the neurobiological properties that distinguish different slow wave and spindle subtypes, and to examine the composition of SWA across cycles of NREM sleep. We further sought to explore changes in the composition of NREM cycles that occur among aging adults. To address these goals, we analyzed subsets of data from two well-characterized cohorts of healthy adults: (1) The DREAMS Subjects Database (n = 20), and (2) The Cleveland Family Study (n = 60). Our analyses indicate that slow wave/spindle coupled events can be characterized as frontal vs. central in their relative distribution between electroencephalography (EEG) channels. The frontal predominant slow waves are identifiable by their coupling to late-fast spindles and occur more frequently during stage N3 sleep. Conversely, the central-associated slow waves are identified by coupling to early-fast spindles and favor occurrence during stage N2 sleep. Together, both types of slow wave/spindle coupled events form the composite of SWA, and their relative contribution to the SWA rises and falls across cycles of NREM sleep in accordance with depth of sleep. Exploratory analyses indicated that older adults produce a different composition of SWA, with a shift toward the N3, frontal subtype, which becomes increasingly predominant during cycles of NREM sleep. Overall, these data demonstrate that subtypes of slow wave/spindle events have distinct cortical propagation patterns and differ in their distribution across lighter vs. deeper NREM sleep. Future efforts to understand how slow wave sleep and slow wave/spindle coupling impact memory performance and neurological disease may benefit from examining the composition of SWA to avoid potential confounds that may occur when comparing dissimilar neurophysiological events.
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Affiliation(s)
- Brice V. McConnell
- Department of Neurology, University of Colorado, Denver, Denver, CO, United States
- *Correspondence: Brice V. McConnell,
| | - Eugene Kronberg
- Department of Neurology, University of Colorado, Denver, Denver, CO, United States
| | - Lindsey M. Medenblik
- Department of Neurology, University of Colorado, Denver, Denver, CO, United States
| | - Vitaly O. Kheyfets
- Pediatric Critical Care Medicine, University of Colorado, Denver, Denver, CO, United States
| | - Alberto R. Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Stefan H. Sillau
- Department of Neurology, University of Colorado, Denver, Denver, CO, United States
| | - Rachelle L. Pulver
- Department of Neurology, University of Colorado, Denver, Denver, CO, United States
| | - Brianne M. Bettcher
- Department of Neurology, University of Colorado, Denver, Denver, CO, United States
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10
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Kletenik I, Holden SK, Sillau SH, O'Connell N, MacGillivray L, Mack J, Haddock B, Ashworth Dirac M, David AS, Nicholson TR, Attaripour Isfahani SN, Maurer CW, Lidstone SC, Hallett M, LaFaver K, Berman BD, Stone J. Gender disparity and abuse in functional movement disorders: a multi-center case-control study. J Neurol 2022; 269:3258-3263. [PMID: 35098346 PMCID: PMC10202134 DOI: 10.1007/s00415-021-10943-6] [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] [Received: 11/22/2021] [Accepted: 12/21/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND To determine gender differences in rates of sexual and physical abuse in functional movement disorders compared to controls and evaluate if the gender disparity of functional movement disorders is associated with abuse history. METHODS We performed a retrospective case-control study of self-reported trauma data from 696 patients (512 women) with functional movement disorders from six clinical sites compared to 141 controls (98 women) and population data. Chi-square was used to assess gender and disorder associations; logistic regression was used to model additive effects of abuse and calculate the attributable fraction of abuse to disorder prevalence. RESULTS Higher rates of sexual abuse were reported by women (35.3%) and men (11.5%) with functional movement disorders compared to controls (10.6% of women; 5.6% of men). History of sexual abuse increased the likelihood of functional movement disorders among women by an odds ratio of 4.57 (95% confidence interval 2.31-9.07; p < 0.0001) and physical abuse by an odds ratio of 2.80 (95% confidence interval 1.53-5.12; p = 0.0007). Population attributable fraction of childhood sexual abuse to functional movement disorders in women was 0.12 (0.05-0.19). No statistically significant associations were found in men, but our cohort of men was underpowered despite including multiple sites. CONCLUSIONS Our study suggests that violence against women may account for some of the gender disparity in rates of functional movement disorders. Most people with functional movement disorders do not report a history of abuse, so it remains just one among many relevant risk factors to consider.
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Affiliation(s)
- Isaiah Kletenik
- Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, 9016H, Boston, MA, 02115, USA.
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
- Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Behavioral Neurology Section, University of Colorado School of Medicine, Aurora, CO, USA
- Movement Disorders Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicola O'Connell
- Department of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Dublin, Ireland
| | - Lindsey MacGillivray
- Division of Psychiatry, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - Joel Mack
- Department of Psychiatry, Northwest Parkinson's Disease Research, Education, and Clinical Center, Portland, OR, USA
- Department of Neurology, Veterans Affairs Portland Health Care System, Portland, OR, USA
| | - Beatrix Haddock
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - M Ashworth Dirac
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
- Departments of Health Metrics and Family Medicine, University of Washington, Seattle, WA, USA
| | - Anthony S David
- Institute of Mental Health, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Timothy R Nicholson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Carine W Maurer
- Department of Neurology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Sarah C Lidstone
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and the University of Toronto, Toronto, ON, Canada
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Kathrin LaFaver
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Neurology, Movement Disorder Division, University of Louisville, Louisville, KY, USA
| | - Brian D Berman
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
- Movement Disorders Center, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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11
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Kendall LV, Boyd TD, Sillau SH, Bosco-Lauth A, Markham N, Fong D, Clarke P, Tyler KL, Potter H. GM-CSF Promotes Immune Response and Survival in a Mouse Model of COVID-19. Res Sq 2022:rs.3.rs-1213395. [PMID: 35118463 PMCID: PMC8811947 DOI: 10.21203/rs.3.rs-1213395/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
COVID-19 results in increased expression of inflammatory cytokines, but inflammation-targeting clinical trials have yielded poor to mixed results. Our studies of other disorders with an inflammatory component, including Alzheimer's disease, chemobrain, Down syndrome, normal aging, and West Nile Virus infection, showed that treatment with the 'pro-inflammatory' cytokine granulocyte-macrophage colony stimulating factor (GM-CSF) in humans or mouse models alleviated clinical, behavioral, and pathological features. We proposed that human recombinant GM-CSF (sargramostim) be repurposed to promote both the innate and adaptive immune responses in COVID-19 to reduce viral load and mortality1. Here, we report the results of a placebo-controlled study of GM-CSF in human ACE2 transgenic mice inoculated intranasally with SARS-CoV2 virus, a model of COVID-19. Infection resulted in high viral titers in lungs and brains and over 85% mortality. GM-CSF treatment beginning one day after infection increased anti-viral antibody titers, lowered mean lung viral titers proportionately (p=0.0020) and increased the odds of long-term survival by up to 5.8-fold (p=0.0358), compared to placebo. These findings suggest that, as an activator of both the innate and adaptive immune systems, GM-CSF/sargramostim may be an effective COVID-19 therapy with the potential to protect from re-infection more effectively than treatment with antiviral drugs or monoclonal antibodies.
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Affiliation(s)
- L V Kendall
- Colorado State University, Department of Microbiology, Immunology and Pathology, Fort Collins, CO
| | - T D Boyd
- University of Colorado Alzheimer's and Cognition Center, Aurora, CO
- Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Aurora, CO
| | - S H Sillau
- University of Colorado Alzheimer's and Cognition Center, Aurora, CO
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
| | - A Bosco-Lauth
- Colorado State University, Department of Biomedical Sciences, Fort Collins, CO
| | - N Markham
- University of Colorado Alzheimer's and Cognition Center, Aurora, CO
- Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Aurora, CO
| | - D Fong
- Department of Pathology, University of Colorado Anschutz School of Medicine, Aurora, CO
| | - P Clarke
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
| | - K L Tyler
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
- Denver VA Medical Center, Denver CO
- Departments of Immunology and Microbiology, and Medicine, University of Colorado School of Medicine, Aurora, CO
| | - H Potter
- University of Colorado Alzheimer's and Cognition Center, Aurora, CO
- Linda Crnic Institute for Down Syndrome, University of Colorado School of Medicine, Aurora, CO
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
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12
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Potter H, Boyd TD, Ahmed MM, Kendall LV, Sillau SH, Coughlan CM, Clarke P, Stonedahl S, Chial HJ. Inflammation and innate immune system activation in neurodegeneration, Down syndrome, aging, and infection: Therapeutic target or partner? Alzheimers Dement 2021. [DOI: 10.1002/alz.056681] [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: 11/12/2022]
Affiliation(s)
- Huntington Potter
- Department of Neurology University of Colorado Alzheimer’s and Cognition Center and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Timothy D. Boyd
- Department of Neurology University of Colorado Alzheimer's and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Md. Mahiuddin Ahmed
- Department of Neurology University of Colorado Alzheimer’s and Cognition Center and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
| | | | - Stefan H Sillau
- University of Colorado Alzheimer's and Cognition Center Anschutz Medical Campus Aurora CO USA
| | - Christina M Coughlan
- Department of Neurology University of Colorado Alzheimer's and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Penny Clarke
- University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Sarah Stonedahl
- University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Heidi J Chial
- Department of Neurology University of Colorado Alzheimer’s and Cognition Center and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
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13
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Johnson NR, Wang AC, Coughlan CM, Sillau SH, Lucero EM, Viltz L, Markham N, Allen C, Dhanasekaran AR, Chial HJ, Potter H. Identification of small molecule drugs that target apolipoprotein E4‐catalyzed amyloid‐β fibrillization: A new therapeutic approach to Alzheimer’s disease. Alzheimers Dement 2021. [DOI: 10.1002/alz.054678] [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: 11/06/2022]
Affiliation(s)
- Noah R Johnson
- Department of Neurology University of Colorado Alzheimer's and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Athena Ching‐Jung Wang
- Department of Neurology University of Colorado Alzheimer’s and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Christina M Coughlan
- Department of Neurology University of Colorado Alzheimer's and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Stefan H Sillau
- Department of Neurology University of Colorado Alzheimer's and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Esteban M Lucero
- Department of Neurology University of Colorado Alzheimer's and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Lisa Viltz
- Department of Neurology University of Colorado Alzheimer's and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Neil Markham
- Department of Neurology University of Colorado Alzheimer's and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Cody Allen
- Department of Neurology University of Colorado Alzheimer's and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
| | - A. Ranjitha Dhanasekaran
- Department of Neurology University of Colorado Alzheimer's and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Heidi J Chial
- Department of Neurology University of Colorado Alzheimer's and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Huntington Potter
- Department of Neurology University of Colorado Alzheimer's and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado Anschutz Medical Campus Aurora CO USA
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14
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Koljack CE, Miyasaki J, Prizer LP, Katz M, Galifianakis N, Sillau SH, Kluger BM. Predictors of Spiritual Well-Being in Family Caregivers for Individuals with Parkinson's Disease. J Palliat Med 2021; 25:606-613. [PMID: 34818097 DOI: 10.1089/jpm.2020.0797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/12/2022] Open
Abstract
Background: Parkinson's disease (PD) is a common neurodegenerative illness that causes disability through both motor and nonmotor symptoms. Family caregivers provide substantial care to persons living with PD, often at great personal cost. While spiritual well-being and spirituality have been suggested to promote resiliency in caregivers of persons living with cancer and dementia, this issue has not been explored in PD. Objective: The aim of this study was to identify predictors of spiritual well-being in PD patients' caregivers. Design: A cross-sectional analysis was performed. Our primary outcome measure, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp), was measured in caregivers alongside measures of patient quality of life, symptom burden, global function, grief, and spiritual well-being and caregiver mood, burden, and perceptions of patient quality of life. Univariate correlation and multiple regression were used to determine associations between predictor variables and caregiver FACIT-Sp. Setting/Subjects: PD patient/caregiver dyads were recruited through three academic medical centers in the United States and Canada and regional community support groups. Results: We recruited 183 dyads. Patient faith, symptom burden, health-related quality of life, depression, motor function, and grief were significant predictors of caregiver spiritual well-being. Predictive caregiver factors included caregiver depression and anxiety. These factors remained significant in combined models, suggesting that both patient and caregiver factors make independent contributions to caregiver spiritual well-being. Conclusions: The present study suggests that both patient and caregiver factors are associated with spiritual well-being in PD. Further study is needed to understand the causal relationship of these factors and whether interventions to support caregiver spiritual well-being improve outcomes for caregivers or patients. Clinicaltrials.gov registration NCT02533921.
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Affiliation(s)
- Claire E Koljack
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Janis Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - Maya Katz
- Department of Neurology, University of California San Francisco Medical Center, San Francisco, California, USA
| | - Nick Galifianakis
- Department of Neurology, University of California San Francisco Medical Center, San Francisco, California, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Benzi M Kluger
- Department of Neurology and Medicine, University of Rochester Medical Center, Rochester, New York, USA
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15
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McConnell BV, Kronberg E, Teale PD, Sillau SH, Fishback GM, Kaplan RI, Fought AJ, Dhanasekaran AR, Berman BD, Ramos AR, McClure RL, Bettcher BM. The Aging Slow Wave: A Shifting Amalgam of Distinct Slow Wave and Spindle Coupling Subtypes Define Slow Wave Sleep Across the Human Lifespan. Sleep 2021; 44:6276901. [PMID: 33999194 PMCID: PMC8503831 DOI: 10.1093/sleep/zsab125] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 07/06/2020] [Revised: 03/14/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Slow wave and spindle coupling supports memory consolidation, and loss of coupling is linked with cognitive decline and neurodegeneration. Coupling is proposed to be a possible biomarker of neurological disease, yet little is known about the different subtypes of coupling that normally occur throughout human development and aging. Here we identify distinct subtypes of spindles within slow wave upstates and describe their relationships with sleep stage across the human lifespan. METHODS Coupling within a cross-sectional cohort of 582 subjects was quantified from stages N2 and N3 sleep across ages 6-88 years old. Results were analyzed across the study population via mixed model regression. Within a subset of subjects, we further utilized coupling to identify discrete subtypes of slow waves by their coupled spindles. RESULTS Two different subtypes of spindles were identified during the upstates of (distinct) slow waves: an "early-fast" spindle, more common in stage N2 sleep, and a "late-fast" spindle, more common in stage N3. We further found stages N2 and N3 sleep contain a mixture of discrete subtypes of slow waves, each identified by their unique coupled-spindle timing and frequency. The relative contribution of coupling subtypes shifts across the human lifespan, and a deeper sleep phenotype prevails with increasing age. CONCLUSIONS Distinct subtypes of slow waves and coupled spindles form the composite of slow wave sleep. Our findings support a model of sleep-dependent synaptic regulation via discrete slow wave/spindle coupling subtypes and advance a conceptual framework for the development of coupling-based biomarkers in age-associated neurological disease.
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Affiliation(s)
- Brice V McConnell
- Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Eugene Kronberg
- Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Peter D Teale
- Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Stefan H Sillau
- Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Grace M Fishback
- Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Rini I Kaplan
- Psychological & Brain Sciences Boston University, Boston, MA, USA
| | - Angela J Fought
- Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | - Brian D Berman
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA.,Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Alberto R Ramos
- Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Brianne M Bettcher
- Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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16
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Potter H, Woodcock JH, Boyd TD, Coughlan CM, O'Shaughnessy JR, Borges MT, Thaker AA, Raj BA, Adamszuk K, Scott D, Adame V, Anton P, Chial HJ, Gray H, Daniels J, Stocker ME, Sillau SH. Safety and efficacy of sargramostim (GM-CSF) in the treatment of Alzheimer's disease. Alzheimers Dement (N Y) 2021; 7:e12158. [PMID: 33778150 PMCID: PMC7988877 DOI: 10.1002/trc2.12158] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/05/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Inflammatory markers have long been observed in the brain, cerebrospinal fluid (CSF), and plasma of Alzheimer's disease (AD) patients, suggesting that inflammation contributes to AD and might be a therapeutic target. However, non-steroidal anti-inflammatory drug trials in AD and mild cognitive impairment (MCI) failed to show benefit. Our previous work seeking to understand why people with the inflammatory disease rheumatoid arthritis are protected from AD found that short-term treatment of transgenic AD mice with the pro-inflammatory cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) led to an increase in activated microglia, a 50% reduction in amyloid load, an increase in synaptic area, and improvement in spatial memory to normal. These results called into question the consensus view that inflammation is solely detrimental in AD. Here, we tested our hypothesis that modulation of the innate immune system might similarly be used to treat AD in humans by investigating the ability of GM-CSF/sargramostim to safely ameliorate AD symptoms/pathology. METHODS A randomized, double-blind, placebo-controlled trial was conducted in mild-to-moderate AD participants (NCT01409915). Treatments (20 participants/group) occurred 5 days/week for 3 weeks plus two follow-up (FU) visits (FU1 at 45 days and FU2 at 90 days) with neurological, neuropsychological, blood biomarker, and imaging assessments. RESULTS Sargramostim treatment expectedly changed innate immune system markers, with no drug-related serious adverse events or amyloid-related imaging abnormalities. At end of treatment (EOT), the Mini-Mental State Examination score of the sargramostim group increased compared to baseline (P = .0074) and compared to placebo (P = .0370); the treatment effect persisted at FU1 (P = .0272). Plasma markers of amyloid beta (Aβ40 [decreased in AD]) increased 10% (P = .0105); plasma markers of neurodegeneration (total tau and UCH-L1) decreased 24% (P = .0174) and 42% (P = .0019), respectively, after sargramostim treatment compared to placebo. DISCUSSION The innate immune system is a viable target for therapeutic intervention in AD. An extended treatment trial testing the long-term safety and efficacy of GM-CSF/sargramostim in AD is warranted.
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Affiliation(s)
- Huntington Potter
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Jonathan H. Woodcock
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Timothy D. Boyd
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Christina M. Coughlan
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - John R. O'Shaughnessy
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Manuel T. Borges
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- Department of RadiologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Ashesh A. Thaker
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- Department of RadiologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | | | | | | | - Vanesa Adame
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Paige Anton
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Heidi J. Chial
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
- Linda Crnic Institute for Down SyndromeUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Helen Gray
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Joseph Daniels
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Michelle E. Stocker
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
| | - Stefan H. Sillau
- Department of NeurologyUniversity of Colorado School of MedicineAuroraColoradoUSA
- University of Colorado Alzheimer's and Cognition CenterAuroraColoradoUSA
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17
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Simpson JR, Lin CT, Sieja A, Sillau SH, Pell J. Optimizing the electronic health record: An inpatient sprint addresses provider burnout and improves electronic health record satisfaction. J Am Med Inform Assoc 2021; 28:628-631. [PMID: 33029643 PMCID: PMC7936398 DOI: 10.1093/jamia/ocaa231] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/02/2020] [Accepted: 09/14/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We sought reduce electronic health record (EHR) burden on inpatient clinicians with a 2-week EHR optimization sprint. MATERIALS AND METHODS A team led by physician informaticists worked with 19 advanced practice providers (APPs) in 1 specialty unit. Over 2 weeks, the team delivered 21 EHR changes, and provided 39 one-on-one training sessions to APPs, with an average of 2.8 hours per provider. We measured Net Promoter Score, thriving metrics, and time spent in the EHR based on user log data. RESULTS Of the 19 APPs, 18 completed 2 or more sessions. The EHR Net Promoter Score increased from 6 to 60 postsprint (1.0; 95% confidence interval, 0.3-1.8; P = .01). The NPS for the Sprint itself was 93, a very high rating. The 3-axis emotional thriving, emotional recovery, and emotional exhaustion metrics did not show a significant change. By user log data, time spent in the EHR did not show a significant decrease; however, 40% of the APPs responded that they spent less time in the EHR. CONCLUSIONS This inpatient sprint improved satisfaction with the EHR.
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Affiliation(s)
- Jennifer R Simpson
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Chen-Tan Lin
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amber Sieja
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stefan H Sillau
- Department of Neurology and Biostatistics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan Pell
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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18
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Groth CL, Brown M, Honce JM, Shelton E, Sillau SH, Berman BD. Cervical Dystonia Is Associated With Aberrant Inhibitory Signaling Within the Thalamus. Front Neurol 2021; 11:575879. [PMID: 33633655 PMCID: PMC7900407 DOI: 10.3389/fneur.2020.575879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/24/2020] [Accepted: 09/14/2020] [Indexed: 12/20/2022] Open
Abstract
Objective: The objective of this study is to investigate whether alterations in the neurotransmission of gamma-aminobutyric acid (GABA) in the thalamus are present in patients with cervical dystonia compared to healthy controls. Methods: GABA magnetic resonance spectroscopy was used to investigate concentration levels of GABA in the thalamus of cervical dystonia patients (n = 17) compared to healthy controls (n = 18). Additionally, a focused post hoc analysis of thalamic GABAA receptor availability data in a similar cohort (n = 15 for both groups) using data from a previously collected 11C-flumazenil positron emission tomography study was performed. Group comparisons for all evaluations were performed using two-sided t-tests with adjustments for age and sex, and Bonferroni correction for multiple comparisons was applied. Spearman's coefficient was used to test correlations. Results: We found significantly reduced GABA+/Cre levels in the thalamus of cervical dystonia patients compared to controls, and these levels positively correlated with disease duration. Although mean thalamic GABAA receptor availability did not differ between patients and controls, GABAA availability negatively correlated with both disease duration and dystonia severity. Conclusions: These findings support that aberrant inhibitory signaling within the thalamus contributes to the pathophysiology of cervical dystonia. Additionally, these results suggest that an inadequate ability to compensate for the loss of GABA through upregulation of GABAA receptors may underlie more severe symptoms.
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Affiliation(s)
- Christopher L Groth
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States.,Department of Neurology, University of Colorado Anschutz Medical, Aurora, CO, United States
| | - Mark Brown
- Department of Radiology, University of Colorado Anschutz Medical, Aurora, CO, United States
| | - Justin M Honce
- Department of Radiology, University of Colorado Anschutz Medical, Aurora, CO, United States
| | - Erika Shelton
- Department of Neurology, University of Colorado Anschutz Medical, Aurora, CO, United States
| | - Stefan H Sillau
- Department of Neurology, University of Colorado Anschutz Medical, Aurora, CO, United States
| | - Brian D Berman
- Department of Neurology, University of Colorado Anschutz Medical, Aurora, CO, United States.,Department of Radiology, University of Colorado Anschutz Medical, Aurora, CO, United States.,Neurology Section, Denver VA Medical Center, Aurora, CO, United States
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19
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Potter H, Woodcock JH, Boyd T, Sillau SH, O'Shaugnessy JR, Borges TT, Thaker AA. Double‐blind placebo‐controlled trial of the safety and efficacy of GM‐CSF/sargramostim in subjects with mild‐to‐moderate Alzheimer’s disease. Alzheimers Dement 2020. [DOI: 10.1002/alz.046497] [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: 11/10/2022]
Affiliation(s)
- Huntington Potter
- Department of Neurology University of Colorado Alzheimer’s and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado, Anschutz Medical Campus Aurora CO USA
- Linda Crnic Institute for Down Syndrome Aurora CO USA
| | - Jonathan H. Woodcock
- University of Colorado Alzheimer's and Cognition Center Anschutz Medical Campus Aurora CO USA
| | - Timothy Boyd
- Linda Crnic Institute for Down Syndrome Aurora CO USA
- Department of Neurology University of Colorado Alzheimer's and Cognition Center, and the Linda Crnic Institute for Down Syndrome University of Colorado, Anschutz Medical Campus Aurora CO USA
| | - Stefan H. Sillau
- University of Colorado Alzheimer's and Cognition Center Anschutz Medical Campus Aurora CO USA
| | - John R. O'Shaugnessy
- University of Colorado Alzheimer's and Cognition Center Anschutz Medical Campus Aurora CO USA
| | - Thomas T Borges
- University of Colorado Alzheimer's and Cognition Center Anschutz Medical Campus Aurora CO USA
| | - Ashesh A. Thaker
- University of Colorado Alzheimer's and Cognition Center Anschutz Medical Campus Aurora CO USA
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20
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Abstract
Background Incidence of cardiovascular disease in young adults is unabated. Increased prevalence of self-reported atherosclerotic risk factors may be driving this trend. The goal of this study was to examine whether the prevalence of atherosclerotic risk factors in young adults is increasing over time using both self-report and standard clinical criteria. Methods and Results Data from young adults, aged 20 to 45 years, in the National Health and Nutrition Examination Survey from 1999/2000 to 2013/2014 were analyzed. Risk factor prevalence of hypertension, diabetes mellitus, and hyperlipidemia was measured using clinical criteria and self-report. Smoking was based on self-report only, and obesity was based clinically on body mass index and waist to height ratio. Prevalence by survey was adjusted for age, sex, and race/ethnicity. By clinical criteria, adjusted prevalence of any 3 risk factors (hypertension, diabetes mellitus, and hyperlipidemia) declined slightly from 21.8% to 18.9% ( P for trend=0.05). However, by self-report, the adjusted prevalence of any 3 risk factors increased from 17.8% to 26.5% ( P<0.01). Hypertension was unchanged by clinical criteria ( P=0.32) but increased by self-report ( P<0.08). Diabetes mellitus, by clinical diagnosis and self-report, remained unchanged ( P=0.35 and P=0.29, respectively). Hyperlipidemia, by clinical criteria, declined over time ( P<0.01), but increased by self-report ( P<0.01). Smoking declined ( P<0.01), and obesity increased by both body mass index ( P<0.01) and waist/height ratio ( P<0.01). Conclusions The perception that young adult risk factors are increasing is consistent with increasing self-reported risk factors. However, evidence does not suggest that clinical risk factor prevalence overall has increased in young adults.
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Affiliation(s)
- Michelle H Leppert
- 1 Department of Neurology University of Colorado Anschutz Medical Campus Aurora CO.,2 Colorado Cardiovascular Outcomes Research Group Denver CO
| | - Sharon N Poisson
- 1 Department of Neurology University of Colorado Anschutz Medical Campus Aurora CO
| | - Stefan H Sillau
- 1 Department of Neurology University of Colorado Anschutz Medical Campus Aurora CO
| | - Jonathan D Campbell
- 3 Department of Clinical Pharmacy University of Colorado Anschutz Medical Campus Aurora CO
| | - P Michael Ho
- 2 Colorado Cardiovascular Outcomes Research Group Denver CO.,4 Cardiology Section VA Eastern Colorado Health Care System Denver CO.,5 Division of Cardiology University of Colorado Anschutz Medical Campus Aurora CO
| | - James F Burke
- 6 Department of Neurology University of Michigan Health System Ann Arbor MI
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21
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Berman BD, Groth CL, Shelton E, Sillau SH, Sutton B, Legget KT, Tregellas JR. Hemodynamic responses are abnormal in isolated cervical dystonia. J Neurosci Res 2020; 98:692-703. [PMID: 31692015 PMCID: PMC7015799 DOI: 10.1002/jnr.24547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/14/2019] [Revised: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 01/04/2023]
Abstract
Neuroimaging studies using functional magnetic resonance imaging (fMRI), which measures brain activity by detecting the changes in blood oxygenation levels, are advancing our understanding of the pathophysiology of dystonia. Neurobiological disturbances in dystonia, however, may affect neurovascular coupling and impact the interpretability of fMRI studies. We evaluated here whether the hemodynamic response patterns during a behaviorally matched motor task are altered in isolated cervical dystonia (CD). Twenty-five CD patients and 25 healthy controls (HCs) underwent fMRI scanning during a paced finger tapping task (nondystonic task in patients). Imaging data were analyzed using a constrained principal component analysis-a statistical method that combines regression analysis and principal component analysis and enables the extraction of task-related functional networks and determination of the spatial and temporal hemodynamic response patterns associated with the task performance. Data from three patients and two controls were removed due to excessive movement. No significant differences in demographics or motor performance were observed. Three task-associated functional brain networks were identified. During task performance, reduced hemodynamic responses were seen in a sensorimotor network and in a network that included key nodes of the default mode, executive control and visual networks. During rest, reductions in hemodynamic responses were seen in the cognitive/visual network. Lower hemodynamic responses within the primary sensorimotor network in patients were correlated with the increased dystonia severity. Pathophysiological disturbances in isolated CD, such as alterations in inhibitory signaling and dopaminergic neurotransmission, may impact neurovascular coupling. Not accounting for hemodynamic response differences in fMRI studies of dystonia could lead to inaccurate results and interpretations.
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Affiliation(s)
- Brian D. Berman
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
- Neurology Section, Denver VA Medical Center, Aurora, CO, USA
| | - Christopher L. Groth
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Erica Shelton
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
| | - Stefan H. Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
| | - Brianne Sutton
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
| | - Kristina T. Legget
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
| | - Jason R. Tregellas
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO
- Research Service, Denver VA Medical Center, Aurora, CO USA
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22
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Berman BD, Groth CL, Sillau SH, Pirio Richardson S, Norris SA, Junker J, Brüggemann N, Agarwal P, Barbano RL, Espay AJ, Vizcarra JA, Klein C, Bäumer T, Loens S, Reich SG, Vidailhet M, Bonnet C, Roze E, Jinnah HA, Perlmutter JS. Risk of spread in adult-onset isolated focal dystonia: a prospective international cohort study. J Neurol Neurosurg Psychiatry 2020; 91:314-320. [PMID: 31848221 PMCID: PMC7024047 DOI: 10.1136/jnnp-2019-321794] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Isolated focal dystonia can spread to muscles beyond the initially affected body region, but risk of spread has not been evaluated in a prospective manner. Furthermore, body regions at risk for spread and the clinical factors associated with spread risk are not well characterised. We sought here to prospectively characterise risk of spread in recently diagnosed adult-onset isolated focal dystonia patients. METHODS Patients enrolled in the Dystonia Coalition with isolated dystonia affecting only the neck, upper face, hand or larynx at onset of symptoms were included. Timing of follow-up visits was based on a sliding scale depending on symptom onset and ranged from 1 to 4 years. Descriptive statistics, Kaplan-Meier survival curves and Cox proportional hazard regression models were used to assess clinical characteristics associated with dystonia spread. RESULTS 487 enrolled participants (68.3% women; mean age: 55.6±12.2 years) met our inclusion/exclusion criteria. Spread was observed in 50% of blepharospasm, 8% of cervical dystonia, 17% of hand dystonia and 16% of laryngeal dystonia cases. Most common regions for first spread were the oromandibular region (42.2%) and neck (22.4%) for blepharospasm, hand (3.5%) for cervical dystonia and neck for hand (12.8%) and laryngeal (15.8%) dystonia. Increased spread risk was associated with a positive family history (HR=2.18, p=0.012) and self-reported alcohol responsiveness (HR=2.59, p=0.009). CONCLUSIONS Initial body region affected in isolated focal dystonia has differential risk and patterns of spread. Genetic factors likely influence the risk of spread. These findings can aid clinical prognostication and inform future investigations into potential disease-modifying treatments.
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Affiliation(s)
- Brian D Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Stefan H Sillau
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | | | - Scott A Norris
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Johanna Junker
- Department of Neurology, University of Luebeck, Luebeck, Germany.,Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Norbert Brüggemann
- Department of Neurology, University of Luebeck, Luebeck, Germany.,Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Pinky Agarwal
- Booth Gardner Parkinson's Center, Evergreen Health, Kirkland, Washington, USA
| | - Richard L Barbano
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Alberto J Espay
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Joaquin A Vizcarra
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christine Klein
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Tobias Bäumer
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Sebastian Loens
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany
| | - Stephen G Reich
- Department of Neurology, University of Maryland Medical Centre, Baltimore, Maryland, USA
| | - Marie Vidailhet
- Department of Neurology, Salpetriere Hospital, Paris, France
| | - Cecilia Bonnet
- Department of Neurology, Salpetriere Hospital, Paris, France
| | - Emmanuel Roze
- Department of Neurology, Salpetriere Hospital, Paris, France
| | - Hyder A Jinnah
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Joel S Perlmutter
- Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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23
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Kletenik I, Sillau SH, Isfahani SA, LaFaver K, Hallett M, Berman BD. Gender as a Risk Factor for Functional Movement Disorders: The Role of Sexual Abuse. Mov Disord Clin Pract 2019; 7:177-181. [PMID: 32071936 DOI: 10.1002/mdc3.12863] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 06/26/2019] [Revised: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 12/16/2022] Open
Abstract
Background The prevalence of functional movement disorders is 2 to 3 times higher in women than in men. Trauma and adverse life events are important risk factors for developing functional movement disorders. On a population level, rates of sexual abuse against women are higher when compared with the rates against men. Objectives To determine gender differences in rates of sexual abuse in functional movement disorders compared with other neurologic disorders and evaluate if the gender prevalence is influenced by higher rates of sexual abuse against women. Methods We performed a case-control series including 199 patients with functional movement disorders (149 women) and 95 controls (60 women). We employed chi-squared test to assess gender and sexual abuse associations and Bayes formula to condition on sexual abuse. Results Our analysis showed an association between sexual abuse and functional movement disorders in women (odds ratio, 4.821; 95% confidence interval, 2.089-12.070; P < 0.0001), but not men. Bayesian analysis found the functional movement disorder prevalence ratio between women and men conditional on sexual abuse to be 4.87 times the unconditioned ratio. Conclusions There is a statistically significant association between sexual abuse and functional movement disorders in women and a greater likelihood that women who are sexually abused will develop functional movement disorders than men who are sexually abused. Our findings suggest that the increased prevalence of functional movement disorders in women is associated, at least in part, with sexual abuse and its sequelae; however, further research is needed to explore the role of other traumatic and nontraumatic factors.
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Affiliation(s)
- Isaiah Kletenik
- Department of Neurology University of Colorado School of Medicine Aurora Colorado USA.,Behavioral Neurology Section University of Colorado School of Medicine Aurora Colorado USA
| | - Stefan H Sillau
- Department of Neurology University of Colorado School of Medicine Aurora Colorado USA
| | - Sanaz Attaripour Isfahani
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda Maryland USA
| | - Kathrin LaFaver
- Department of Neurology, Movement Disorder Division University of Louisville Louisville Kentucky USA.,Department of Neurology Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke National Institutes of Health Bethesda Maryland USA
| | - Brian D Berman
- Department of Neurology University of Colorado School of Medicine Aurora Colorado USA.,Movement Disorders Center University of Colorado School of Medicine Aurora Colorado USA
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24
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Macchi ZA, Koljack CE, Miyasaki JM, Katz M, Galifianakis N, Prizer LP, Sillau SH, Kluger BM. Patient and caregiver characteristics associated with caregiver burden in Parkinson's disease: a palliative care approach. Ann Palliat Med 2019; 9:S24-S33. [PMID: 31735048 DOI: 10.21037/apm.2019.10.01] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/02/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disorder associated with caregiver burden. Higher rates of burden are associated with adverse outcomes for caregivers and patients. Our aim was to understand patient and caregiver predictors of caregiver burden in PD from a palliative care approach. METHODS We conducted a cross-sectional analysis of baseline data from PD patients and caregivers in a randomized trial of outpatient palliative care at three study sites: University of Colorado, University of Alberta, and University of California San Francisco. The primary outcome measure of caregiver burden, the Zarit Burden Interview (ZBI), was compared against the following patient and caregiver variables: site of care, age, disease/caretaking duration, presence of atypical parkinsonism, race, income, education level, deep brain stimulation status, the Unified Parkinson's Disease Rating Scale (UPDRS) and Edmonton Symptom Assessment System Revised: Parkinson Disease (ESAS) for symptom severity and burden, the Montreal Cognitive Assessment (MoCA) for cognitive function, Quality of Life in Alzheimer's Disease (QOL-AD) scale for patient and caregiver perspectives on patient general quality of life, Parkinson's Disease Questionnaire 39 (PDQ-39) scale for health-related quality of life, Hospital Anxiety and Depression Scale (HADS) for patient and caregiver mood, Prolonged Grief Questionnaire, Functional Assessment of Chronic Illness Therapy- Spiritual Well-Being (FACIT-SP) of patient and caregiver, and Palliative Performance Scale for functional status. A stepwise multivariate linear regression model was used to determine associations with ZBI. RESULTS A total of 175 patients (70.9% male; average age 70.7±8.1 years; average disease duration 117.2±82.6 months), and 175 caregivers (73.1% female; average age 66.1±11.1 years) were included. Patient spiritual well-being (FACIT-SP Faith subscale, r2=0.024, P=0.0380), patient health-related quality of life (PDQ-39, r2=0.161, P<0.0001), caregiver depression (HADS Depression, r2=0.062, P=0.0014), caregiver anxiety (HADS Anxiety, r2=0.077, P=0.0002), and caregiver perspective on patient quality of life (QOL-AD Caregiver Perspective, r2=0.088, P<0.0001) were significant contributors to ZBI scores. CONCLUSIONS Patient and caregiver factors contribute to caregiver burden in persons living with PD. These results suggest targets for future interventions to improve caregiver support.
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Affiliation(s)
- Zachary A Macchi
- Department of Neurology, University of Colorado School of Medicine, CO 80045, USA
| | - Claire E Koljack
- Department of Neurology, University of Colorado School of Medicine, CO 80045, USA
| | - Janis M Miyasaki
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, T6G 2G3, Canada
| | - Maya Katz
- Department of Neurology, University of California San Francisco Medical Center, San Francisco, CA 94122, USA
| | - Nick Galifianakis
- Department of Neurology, University of California San Francisco Medical Center, San Francisco, CA 94122, USA
| | - Lindsay P Prizer
- Department of Medicine, Emory University, Atlanta, GA, 30322, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, CO 80045, USA
| | - Benzi M Kluger
- Department of Neurology, University of Colorado School of Medicine, CO 80045, USA.
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25
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Holden SK, Koljack CE, Prizer LP, Sillau SH, Miyasaki JM, Kluger BM. Measuring quality of life in palliative care for Parkinson's disease: A clinimetric comparison. Parkinsonism Relat Disord 2019; 65:172-177. [PMID: 31253494 PMCID: PMC6774894 DOI: 10.1016/j.parkreldis.2019.06.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 06/14/2019] [Accepted: 06/22/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Quality of life (QOL) assessments allow for more complete evaluation of patients' lived experiences in relation to chronic conditions, such as Parkinson's disease (PD). In palliative care, such instruments are vital to ensure QOL issues are catalogued and addressed for patients. However, little is known regarding the psychometric properties of quality of life scales for use in palliative care for PD, specifically. METHODS 210 participants with parkinsonian disorders, who participated in a larger palliative intervention clinical trial, completed four quality of life scales (PDQ-39, PROMIS-29, QOL-AD, and McGill QOL) at baseline and post-intervention. Psychometric properties, including internal consistency and concurrent validity, were examined. Factor analyses were performed to evaluate relationships between scale items. Minimal clinically important differences (MCID) and responsiveness were calculated for each scale. RESULTS All scales demonstrated good internal consistency and concurrent validity. Factor analyses revealed few deviations from the defined subdomains of the scales. Mean absolute MCID values were estimated at 12.7, 10.9, 3.9, and 18.9 for PDQ-39, PROMIS-29, QOL-AD, and McGill QOL, respectively. The PDQ-39 and PROMIS-29 demonstrated higher responsiveness to palliative intervention, while the QOL-AD was more responsive in the control group. CONCLUSIONS The PDQ-39, PROMIS-29, QOL-AD, and McGill QOL are all valid for use in PD palliative care, though subdomains of the scales in this population may differ slightly from those initially defined. We recommend the use of PDQ-39 and PROMIS-29 as outcome measures in clinical trials for palliative care in PD, though the QOL-AD may be superior for tracking disease progression.
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Affiliation(s)
- Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Claire E Koljack
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Janis M Miyasaki
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Canada
| | - Benzi M Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
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26
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McConnell BV, Kaplan RI, Teale PD, Kronberg E, Broussard JL, Guzetti JR, Sillau SH, Dhanasekaran AR, Kluger BM, Berman BD. Feasibility of home-based automated transcranial electrical stimulation during slow wave sleep. Brain Stimul 2019; 12:813-815. [PMID: 30819658 DOI: 10.1016/j.brs.2019.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Rini I Kaplan
- University of Colorado, Anschutz Medical Campus, USA
| | - Peter D Teale
- University of Colorado, Anschutz Medical Campus, USA
| | | | - Josiane L Broussard
- University of Colorado, Anschutz Medical Campus, USA; Colorado State University, USA
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27
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Kowalski RG, Schimpf B, Wilson D, Poisson SN, Nyerg EM, Carrera E, Bernard TJ, Vela-Duarte D, Simpson JR, Kluger BM, Taylor MR, Sillau SH, Jones WJ. Abstract WP323: Significant Reduction in Prehospital Evaluation and Door-to-Treatment Times With a Mobile Stroke Unit. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Derek Wilson
- Neurology, Univ of Colorado Sch of Medicine, Aurora, CO
| | | | - Eric M Nyerg
- Neuroradiology, Univ of Colorado Sch of Medicine, Aurora, CO
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28
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Vela-Duarte D, Sillau SH, Nyberg E, Castellanos P, Chastain D, Franco-Paredes C, Henao-Martínez AF. Abstract TP258: Clinical and Radiographic Features of Stroke in Cryptococcal Meningoencephalitis in a US Cohort Study. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp258] [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: 11/16/2022]
Abstract
Background:
Cryptococcal meningitis can present with small vessel vasculitis and ischemic stroke. Acute and chronic infection carry a high mortality in both immunocompetent and immunocompromised patients. Among the survivors, multiple neurological deficit cause marked disability. Predictors of poor outcome and stroke recurrence remain unrecognized.
Methods:
We aim to describe clinical and radiographic features of stroke in a prospectively collected cohort of patients with Cryptococcal meningitis. A retrospective analysis of neuroimaging studies, cerebrospinal fluid(CSF) and clinical presentation was performed at the University of Colorado Hospital between 2000-2018. A multivariable logistic regression model was constructed to explore associations between dichotomous variables and informed as risk ratios. A T-Test and Wilcoxon test were applied to means of continuous variables. Fisher's exact test and contingency tables were used.
Results:
A total of 42 patients had cryptococcal meningitis, of which 31 had available imaging. Ischemic stroke was present in 8 patients (26%). Most strokes were acute (75%), lacunar (100%), multiple (88%), bilateral (63%) and localized in the basal ganglia (75%). Hyponatremia carried a RR: 5.7 (95% CI, 1.7-34.1) p=0.005. Other variables such malignancy, basal exudates, cryptococcoma, meningeal enhancement, hydrocephalus and CSF WBC did not seem to increase or reduce the risk of stroke. Anemia and hyponatremia were associated with presence of stroke, p=0.02 and p=0.03, respectively. Every unit decrease in hemoglobin is associated with 0.26 times the risk of ischemic stroke, (95% CI, 1.7-34.1) p=0.0312. Cryptococcal meningitis lead to death in 13 patients (30%) and 3 (14%) in patients with pulmonary manifestations only.
Conclusion:
Cryptococcal meningitis carries a high risk of neurologic complications, including lacunar stroke, particularly in the basal ganglia. Predisposing risk factors include anemia and hyponatremia regardless of the immune status of the patients. We report a mortality comparable to developing countries in the setting of a center of reference. The most common radiographic features of cryptococcal vasculitic infection may play a role in the high mortality of the population.
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Affiliation(s)
| | | | - Eric Nyberg
- Radiology, Univ of Colorado Denver, Aurora, CO
| | | | - Daniel Chastain
- Dept of Clinical and Administrative Pharmacy, Univ of Georgia College of Pharmacy, Albany, GA
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29
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Holden SK, Medina LD, Hoyt B, Sillau SH, Berman BD, Goldman JG, Weintraub D, Kluger BM. Validation of a performance-based assessment of cognitive functional ability in Parkinson's disease. Mov Disord 2018; 33:1760-1768. [PMID: 30306618 DOI: 10.1002/mds.27487] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 05/16/2018] [Revised: 07/13/2018] [Accepted: 08/08/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Outcome measures that capture functional abilities related to cognition offer the potential to demonstrate real-world effectiveness of cognitive-enhancing treatments. However, distinguishing functional disability related to cognition from that attributed to motor symptoms can be difficult in PD. A performance-based functional assessment allows for direct observation of activity of daily living skills and separation of cognitive from motoric disabilities. OBJECTIVES Validate the University of California San Diego Performance-Based Skills Assessment in PD. METHODS One hundred PD participants, ranging from normal cognition to dementia, completed the University of California San Diego Performance-Based Skills Assessment, a performance-based measure of cognitively demanding activities of daily living, as well as a neuropsychological battery and motor examination. Cognitive classification was determined by consensus conference, blinded to University of California San Diego Performance-Based Skills Assessment scores. Psychometric properties of the University of California San Diego Performance-Based Skills Assessment, including internal consistency, test-retest and inter-rater reliability, and discriminant validity for dementia, were examined. RESULTS The University of California San Diego Performance-Based Skills Assessment demonstrated strong internal consistency (Cronbach's α = 0.82) and test-retest reliability (r = 0.89) and correlated strongly with global cognition (Mattis Dementia Rating Scale: r = 0.80; P < 0.001). University of California San Diego Performance-Based Skills Assessment regression models indicated greater contribution from cognitive explanatory variables (marginal partial: R2 = 0.33) than motor variables (marginal partial: R2 = 0.05), controlling for age, education, disease duration, and l-dopa equivalent dose. Additionally, the University of California San Diego Performance-Based Skills Assessment exhibited strong discriminant validity for dementia (area under the curve = 0.91). CONCLUSIONS The University of California San Diego Performance-Based Skills Assessment is a valid measure of functional abilities related to cognition rather than motor symptoms in PD. Furthermore, it reliably distinguishes demented from nondemented participants. The University of California San Diego Performance-Based Skills Assessment may be considered as an outcome measure that combines cognitive and functional abilities in treatment trials for cognitive impairment in PD. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Brian Hoyt
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brian D Berman
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Neurology Section, Denver VA Medical Center, Denver, Colorado, USA
| | - Jennifer G Goldman
- Department of Neurological Sciences, Section of Parkinson's Disease and Movement Disorders, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel Weintraub
- Parkinson's Disease and Mental Illness Research Education, Clinical and Education Centers, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.,Departments of Psychiatry and Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Benzi M Kluger
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Klepitskaya O, Liu Y, Sharma S, Sillau SH, Tsai J, Walters AS. Deep brain stimulation improves restless legs syndrome in patients with Parkinson disease. Neurology 2018; 91:e1013-e1021. [PMID: 30111549 DOI: 10.1212/wnl.0000000000006162] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 06/14/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study the effect of subthalamic nucleus (STN) deep brain stimulation (DBS) in patients with Parkinson disease (PD) and moderate to severe restless legs syndrome (RLS) on their RLS symptoms. METHODS Patients undergoing STN DBS surgery for PD completed the International RLS Study Group Rating Scale (IRLS) and RLS Quality of Life (QoL) questionnaires preoperatively and postoperatively at 6 months, 1 year, and 2 years. The primary outcome measure was IRLS sum score and subscales (severity and impact) and the secondary measure was RLS QoL scores. Differences among the mean scores over time were analyzed using mixed model regression. RESULTS Twenty-two patients were enrolled. The preoperative IRLS sum scores were 19.59 ± 6.95, severity subscale 12.91 ± 4.33, impact subscale 4.45 ± 2.72, and transformed RLS QoL score 68.30 ± 20.26. The differences between preoperative and averaged postoperative scores were IRLS sum score -7.80, severity subscale -5.50, impact subscale -1.20, and RLS QoL 4.73. The overall F tests demonstrated differences among the times for the means of the IRLS sum and subscales: p < 0.05. There were no correlations between RLS symptoms improvement and PD motor symptoms improvement or reduction in PD medications. Half of the patients had at least 50% improvement and 27% had resolution of their RLS symptoms (IRLS = 0). CONCLUSIONS STN DBS significantly decreased RLS symptoms in patients with PD despite a decrease in dopaminergic treatment. This improvement was sustained over a 2-year period. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for patients with PD and moderate to severe RLS, STN DBS improves RLS symptoms.
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Affiliation(s)
- Olga Klepitskaya
- From the Department of Neurology (O.K., Y.L., S.H.S., J.T.), University of Colorado Denver, Aurora; University of Rochester (S.S.), NY; and Division of Sleep Medicine (A.S.W.), Vanderbilt University School of Medicine, Nashville, TN.
| | - Ying Liu
- From the Department of Neurology (O.K., Y.L., S.H.S., J.T.), University of Colorado Denver, Aurora; University of Rochester (S.S.), NY; and Division of Sleep Medicine (A.S.W.), Vanderbilt University School of Medicine, Nashville, TN
| | - Saloni Sharma
- From the Department of Neurology (O.K., Y.L., S.H.S., J.T.), University of Colorado Denver, Aurora; University of Rochester (S.S.), NY; and Division of Sleep Medicine (A.S.W.), Vanderbilt University School of Medicine, Nashville, TN
| | - Stefan H Sillau
- From the Department of Neurology (O.K., Y.L., S.H.S., J.T.), University of Colorado Denver, Aurora; University of Rochester (S.S.), NY; and Division of Sleep Medicine (A.S.W.), Vanderbilt University School of Medicine, Nashville, TN
| | - Jean Tsai
- From the Department of Neurology (O.K., Y.L., S.H.S., J.T.), University of Colorado Denver, Aurora; University of Rochester (S.S.), NY; and Division of Sleep Medicine (A.S.W.), Vanderbilt University School of Medicine, Nashville, TN
| | - Arthur S Walters
- From the Department of Neurology (O.K., Y.L., S.H.S., J.T.), University of Colorado Denver, Aurora; University of Rochester (S.S.), NY; and Division of Sleep Medicine (A.S.W.), Vanderbilt University School of Medicine, Nashville, TN
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Potter H, Woodcock JH, Boyd T, Sillau SH, Borges TT, Bettcher BM, Daniels J, Heffernan KS. O1‐12‐01: PHASE II STUDY DATA ON SAFETY AND EFFICACY OF GM‐CSF/LEUKINE
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IN MILD‐TO‐MODERATE ALZHEIMER'S DISEASE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2396] [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: 11/30/2022]
Affiliation(s)
- Huntington Potter
- Linda Crnic Institute for Down SyndromeAuroraCOUSA
- University of Colorado Anschutz Medical CampusAuroraCOUSA
| | | | - Timothy Boyd
- Linda Crnic Institute for Down SyndromeUniversity of Colorado Anschutz Medical CampusAuroraCOUSA
| | | | | | | | - Joseph Daniels
- University of Colorado Anschutz Medical CampusAuroraCOUSA
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Oushy S, Sillau SH, Ney DE, Damek DM, Youssef AS, Lillehei KO, Ormond DR. New-onset seizure during and after brain tumor excision: a risk assessment analysis. J Neurosurg 2018; 128:1713-1718. [DOI: 10.3171/2017.2.jns162315] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEProphylactic use of antiepileptic drugs (AEDs) in seizure-naïve brain tumor patients remains a topic of debate. This study aimed to characterize a subset of patients at highest risk for new-onset perioperative seizures (i.e., intraoperative and postoperative seizures occurring within 30 days of surgery) who may benefit from prophylactic AEDs.METHODSThe authors conducted a retrospective case-control study of all adults who had undergone tumor resection or biopsy at the authors’ institution between January 1, 2004, and June 31, 2015. All patients with a history of preoperative seizures, posterior fossa tumors, pituitary tumors, and parasellar tumors were excluded. A control group was matched to the seizure patients according to age (± 0 years). Demographic data, clinical status, operative data, and postoperative course data were collected and analyzed.RESULTSAmong 1693 patients who underwent tumor resection or biopsy, 549 (32.4%) had never had a preoperative seizure. Of these 549 patients, 25 (4.6%) suffered a perioperative seizure (Group 1). A total of 524 patients (95.4%) who remained seizure free were matched to Group 1 according to age (± 0 years), resulting in 132 control patients (Group 2), at an approximate ratio of 1:5. There were no differences between the patient groups in terms of age, sex, race, relationship status, and neurological deficits on presentation. Histological subtype (infiltrating glioma vs meningioma vs other, p = 0.041), intradural tumor location (p < 0.001), intraoperative cortical stimulation (p = 0.004), and extent of resection (less than gross total, p = 0.002) were associated with the occurrence of perioperative seizures.CONCLUSIONSWhile most seizure-naïve brain tumor patients do not benefit from perioperative seizure prophylaxis, such treatment should be considered in high-risk patients with supratentorial intradural tumors, in patients undergoing intraoperative cortical stimulation, and in patients in whom subtotal resection is likely.
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Affiliation(s)
| | | | - Douglas E. Ney
- 2Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Denise M. Damek
- 2Neurology, University of Colorado School of Medicine, Aurora, Colorado
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Dingman AL, Stence NV, O'Neill BR, Sillau SH, Chapman KE. Seizure Severity Is Correlated With Severity of Hypoxic-Ischemic Injury in Abusive Head Trauma. Pediatr Neurol 2018; 82:29-35. [PMID: 29625848 DOI: 10.1016/j.pediatrneurol.2017.12.003] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The objective of this study was to characterize hypoxic-ischemic injury and seizures in abusive head trauma. METHODS We studied 58 children with moderate or severe traumatic brain injury due to abusive head trauma. Continuous electroencephalograms and magnetic resonance images were scored. RESULTS Electrographic seizures (51.2%) and hypoxic-ischemic injury (77.4%) were common in our cohort. Younger age was associated with electrographic seizures (no seizures: median age 13.5 months, interquartile range five to 25 months, versus seizures: 4.5 months, interquartile range 3 to 9.5 months; P = 0.001). Severity of hypoxic-ischemic injury was also associated with seizures (no seizures: median injury score 1.0, interquartile range 0 to 3, versus seizures: 4.5, interquartile range 3 to 8; P = 0.01), but traumatic injury severity was not associated with seizures (no seizures: mean injury score 3.78 ± 1.68 versus seizures: mean injury score 3.83 ± 0.95, P = 0.89). There was a correlation between hypoxic-ischemic injury severity and seizure burden when controlling for patient age (rs=0.61, P < 0.001). The ratio of restricted diffusion volume to total brain volume (restricted diffusion ratio) was smaller on magnetic resonance imaging done early (median restricted diffusion ratio 0.03, interquartile range 0 to 0.23 on magnetic resonance imaging done within two days versus median restricted diffusion ratio 0.13, interquartile range 0.01 to 0.43 on magnetic resonance imaging done after two days, P = 0.03). CONCLUSIONS Electrographic seizures are common in children with moderate to severe traumatic brain injury from abusive head trauma, and therefore children with suspected abusive head trauma should be monitored with continuous electroencephalogram. Severity of hypoxic-ischemic brain injury is correlated with severity of seizures, and evidence of hypoxic-ischemic injury on magnetic resonance imaging may evolve over time. Therefore children with a high seizure burden should be reimaged to evaluate for evolving hypoxic-ischemic injury.
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Affiliation(s)
- Andra L Dingman
- Department of Pediatrics, Division of Child Neurology, University of Colorado Anschuts Medical Campus, Aurora, Colorado.
| | - Nicholas V Stence
- Department of Radiology, Division of Pediatric Radiology, University of Colorado Anschuts Medical Campus, Aurora, Colorado
| | - Brent R O'Neill
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Colorado Anschuts Medical Campus, Aurora, Colorado
| | - Stefan H Sillau
- Department of Neurology, University of Colorado Anschuts Medical Campus, Aurora, Colorado
| | - Kevin E Chapman
- Department of Pediatrics, Division of Child Neurology, University of Colorado Anschuts Medical Campus, Aurora, Colorado
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Buard I, Sciacca DM, Martin CS, Rogers S, Sillau SH, Greher MR, Chen R, Kluger BM. Transcranial magnetic stimulation does not improve mild cognitive impairment in Parkinson's disease. Mov Disord 2017; 33:489-491. [PMID: 29178298 DOI: 10.1002/mds.27246] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/13/2017] [Accepted: 10/22/2017] [Indexed: 01/16/2023] Open
Affiliation(s)
- Isabelle Buard
- Department of Neurology, University of Colorado Denver, Aurora, Colorado, USA
| | - David M Sciacca
- Department of Neuroscience, Regis University, Denver, Colorado, USA
| | - Christine S Martin
- Department of Neurology, University of Colorado Denver, Aurora, Colorado, USA
| | - Sarah Rogers
- Department of Neurology, University of Colorado Denver, Aurora, Colorado, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado Denver, Aurora, Colorado, USA
| | - Michael R Greher
- Department of Neurosurgery, University of Colorado Denver, Aurora, Colorado, USA
| | - Robert Chen
- Krembil Research Institute and Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Benzi M Kluger
- Department of Neurology, University of Colorado Denver, Aurora, Colorado, USA
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Holden SK, Finseth T, Sillau SH, Berman BD. Progression of MDS-UPDRS Scores Over Five Years in De Novo Parkinson Disease from the Parkinson's Progression Markers Initiative Cohort. Mov Disord Clin Pract 2017; 5:47-53. [PMID: 29662921 DOI: 10.1002/mdc3.12553] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [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: 01/07/2023] Open
Abstract
Background The Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UDPRS) is a commonly used tool to measure Parkinson disease (PD) progression. Longitudinal changes in MDS-UPDRS scores in de novo PD have not been established. Objective Determine progression rates of MDS-UPDRS scores in de novo PD. Methods 362 participants from the Parkinson's Progression Markers Initiative, a multicenter longitudinal cohort study of de novo PD, were included. Longitudinal progression of MDS-UPDRS total and subscale scores were modeled using mixed model regression. Results MDS-UPDRS scores increased in a linear fashion over five years in de novo PD. MDS-UPDRS total score increased an estimated 4.0 points/year, Part I 0.25 points/year, Part II 1.0 points/year, and Part III 2.4 points/year. Conclusions The expected average progression of MDS-UPDRS scores in de novo PD from this study can assist in clinical monitoring and provide comparative data for detection of disease modification in treatment trials.
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Affiliation(s)
- Samantha K Holden
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Taylor Finseth
- Department of Neurology, Aurora St. Luke's Medical Center, Milwaukee, WI
| | - Stefan H Sillau
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Brian D Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO USA.,Neurology Section, Denver VA Medical Center, Denver, CO USA
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Vollmer B, Nair KV, Sillau SH, Corboy J, Vollmer T, Alvarez E. Comparison of fingolimod and dimethyl fumarate in the treatment of multiple sclerosis: Two-year experience. Mult Scler J Exp Transl Clin 2017; 3:2055217317725102. [PMID: 28839949 PMCID: PMC5564884 DOI: 10.1177/2055217317725102] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [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: 04/14/2017] [Accepted: 07/06/2017] [Indexed: 11/22/2022] Open
Abstract
Background Fingolimod (FTY) and dimethyl fumarate (DMF) are multiple sclerosis (MS) oral therapies that became available in 2010 and 2013, respectively. Objective The objective of this article is to compare discontinuation rates, efficacy, and adverse events (AEs) of FTY and DMF over two years. Methods Patients prescribed FTY or DMF at the Rocky Mountain MS Center at University of Colorado prior to October 2013 were identified. Clinician-reported data were retrospectively collected. Primary outcome was discontinuation of drug by the end of year two. Reasons for discontinuation were evaluated. Results A total of 271 FTY and 342 DMF patients were evaluated. Patients had a mean age of 42.5 (FTY) and 45.8 (DMF) years and were predominantly female (72.0% FTY; 69.6% DMF) and white (86.3% FTY; 82.2% DMF). At ≤24 months, 93 (34.3%) and 161 (47.1%) discontinued FTY and DMF, respectively, with an unadjusted odds ratio (OR) of 1.70 (1.23–2.37, p = 0.002), or 1.69 (1.16–2.46, p = 0.006) for the doubly robust propensity score weighted estimator. Primary reason for discontinuation was AEs, which were less likely for FTY 46 (17.0%) compared to DMF 82 (24.0%) (OR 1.54, 1.03–2.31, p = 0.035). Discontinuation due to disease activity (FTY (10%) DMF (11.1%); OR 1.13, 0.67–1.90, p = 0.647) and breakthrough disease activity, regardless of discontinuation (FTY (34.7%) DMF (33.6%); OR 0.95, 0.68–1.34, p = 0.783), were similar. Conclusions The odds of discontinuation were less for FTY than DMF, and were driven by AEs for both drugs.
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Affiliation(s)
| | - Kavita V Nair
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Denver, United States
| | | | - John Corboy
- Rocky Mountain MS Center at University of Colorado, USA
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Pelak VS, Sillau SH, Thaker AA. [P3–252]: HOMONYMOUS VISUAL FIELD DEFECTS IN POSTERIOR CORTICAL ATROPHY: VISUAL NEGLECT OR CORTICAL BLINDNESS? Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1466] [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: 11/16/2022]
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38
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Potter H, Woodcock JH, Boyd T, Sillau SH, Bettcher BM, Daniels J, Heffernan KS, Gray H. [P4–572]: INTERIM REPORT OF A PHASE 2 PILOT SAFETY AND EFFICACY TRIAL OF GM‐CSF/LEUKINE
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IN MILD‐TO‐MODERATE ALZHEIMER'S DISEASE. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.07.735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Timothy Boyd
- Linda Crnic Institute for Down Syndrome, University of Colorado Anschutz Medical CampusAuroraCOUSA
| | | | | | - Joseph Daniels
- University of Colorado Anschutz Medical CampusAuroraCOUSA
| | | | - Helen Gray
- University of Colorado, Anschutz Medical CampusAuroraCOUSA
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Berman BD, Junker J, Shelton E, Sillau SH, Jinnah HA, Perlmutter JS, Espay AJ, Jankovic J, Vidailhet M, Bonnet C, Ondo W, Malaty IA, Rodríguez R, McDonald WM, Marsh L, Zurowski M, Bäumer T, Brüggemann N. Psychiatric associations of adult-onset focal dystonia phenotypes. J Neurol Neurosurg Psychiatry 2017; 88:595-602. [PMID: 28438790 PMCID: PMC5659143 DOI: 10.1136/jnnp-2016-315461] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/09/2017] [Accepted: 03/19/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Depression and anxiety frequently accompany the motor manifestations of isolated adult-onset focal dystonias. Whether the body region affected when this type of dystonia first presents is associated with the severity of these neuropsychiatric symptoms is unknown. OBJECTIVES The aim of this study was to determine whether depression, anxiety and social anxiety vary by dystonia onset site and evaluate whether pain and dystonia severity account for any differences. METHODS Patients with isolated focal dystonia evaluated within 5 years from symptom onset, enrolled in the Natural History Project of the Dystonia Coalition, were included in the analysis. Individual onset sites were grouped into five body regions: cervical, laryngeal, limb, lower cranial and upper cranial. Neuropsychiatric symptoms were rated using the Beck Depression Inventory, Hospital Anxiety and Depression Scale and Liebowitz Social Anxiety Scale. Pain was estimated using the 36-Item Short Form Survey. RESULTS Four hundred and seventy-eight subjects met our inclusion criteria. High levels of depression, anxiety and social anxiety occurred in all groups; however, the severity of anxiety and social anxiety symptoms varied by onset site group. The most pronounced differences were higher anxiety in cervical and laryngeal, lower anxiety in upper cranial and higher social anxiety in laryngeal. Increases in pain were associated with worse neuropsychiatric symptom scores within all groups. Higher anxiety and social anxiety in laryngeal and lower anxiety in upper cranial persisted after correcting for pain and dystonia severity. CONCLUSION Anxiety and social anxiety severity vary by onset site of focal dystonia, and this variation is not explained by differences in pain and dystonia severity.
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Affiliation(s)
- Brian D Berman
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Neurology Section, VA Eastern Colorado Health Care System, Denver, Colorado, USA
| | - Johanna Junker
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany.,Department of Neurology, University of Luebeck, Luebeck, Germany
| | - Erika Shelton
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - H A Jinnah
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Joel S Perlmutter
- Departments of Neurology, Radiology, Neuroscience, Physical Therapy and Occupational Therapy, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Alberto J Espay
- Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Joseph Jankovic
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Marie Vidailhet
- Département de neurologie, Hôpital Pitié-Salpêtrière, Assistance Publique - Hopitaux de Paris, Paris, France.,UPMC Univ Paris 06, Inserm U1127, CNRS UMR 7225, UM 75, ICM, F-75013, Sorbonne Universites, Paris, France
| | - Cecilia Bonnet
- Département de neurologie, Hôpital Pitié-Salpêtrière, Assistance Publique - Hopitaux de Paris, Paris, France.,UPMC Univ Paris 06, Inserm U1127, CNRS UMR 7225, UM 75, ICM, F-75013, Sorbonne Universites, Paris, France
| | - William Ondo
- Department of Neurology, Houston Methodist, Houston, Texas, USA
| | - Irene A Malaty
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, USA
| | - Ramón Rodríguez
- Department of Internal Medicine, University of Central Florida, Orlando, Florida, USA
| | - William M McDonald
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia, USA
| | - Laura Marsh
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Mateusz Zurowski
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tobias Bäumer
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, Lübeck, Germany
| | - Norbert Brüggemann
- Institute of Neurogenetics, University of Luebeck, Luebeck, Germany.,Department of Neurology, University of Luebeck, Luebeck, Germany
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Martin JA, Messacar K, Yang ML, Maloney JA, Lindwall J, Carry T, Kenyon P, Sillau SH, Oleszek J, Tyler KL, Dominguez SR, Schreiner TL. Outcomes of Colorado children with acute flaccid myelitis at 1 year. Neurology 2017; 89:129-137. [PMID: 28615421 DOI: 10.1212/wnl.0000000000004081] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 03/27/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We describe long-term functional, neurodiagnostic, and psychosocial outcomes of a cohort of 12 children from Colorado diagnosed with acute flaccid myelitis (AFM) in 2014. METHODS Children were assessed every 3 months for 1 year or until clinical resolution. Assessments included neurologic examination, MRI, EMG/nerve conduction studies (NCS), functional measures (Assisting Hand Assessment, Hammersmith Functional Motor Scale), and Patient-Reported Outcomes Measurement Information System questionnaires. RESULTS Eight of 12 children completed the study. Six of 8 had persistent motor deficits at 1 year; 2 demonstrated full recovery. Four were not enrolled, 2 of whom reported full recovery. The 6 affected were weakest in proximal muscles, showing minimal to no improvement and significant atrophy at 1 year. All patients improved in distal muscle groups. Cranial nerve dysfunction resolved in 2 of 5 and improved in all. Four of 5 showed progressive functional improvement at 6 and 12 months. Two of 8 reported pain at 1 year. Three of 8 reported depressive symptoms. Repeat MRI was performed in 7 of 8 children a median of 7 months after onset and showed significant improvement or normalization in all but one child. Repeat EMG/NCS was performed on 4 children a median of 8 months after onset and showed ongoing denervation and chronic reinnervation in 3 children with persistent deficits. CONCLUSIONS At 1 year, children with AFM demonstrated functional gains but weakness persisted. EMG changes correlated with persistent deficits better than imaging. Despite improvements, AFM had substantial long-term functional effects on affected children.
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Affiliation(s)
- Jan A Martin
- From the Departments of Pediatrics (J.A. Martin, M.L.Y., T.L.S.), Infectious Diseases (K.M., S.R.D.), Hospital Medicine (K.M.), Radiology (J.A. Maloney), Child Psychiatry (J.L.), and Physical Medicine and Rehabilitation (T.C., P.K., J.O.), Section of Child Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora; and Departments of Neurology, Medicine, and Immunology-Microbiology and Neurology Service at the Denver Veterans Affairs Medical Center (S.H.S., K.L.T.), University of Colorado School of Medicine
| | - Kevin Messacar
- From the Departments of Pediatrics (J.A. Martin, M.L.Y., T.L.S.), Infectious Diseases (K.M., S.R.D.), Hospital Medicine (K.M.), Radiology (J.A. Maloney), Child Psychiatry (J.L.), and Physical Medicine and Rehabilitation (T.C., P.K., J.O.), Section of Child Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora; and Departments of Neurology, Medicine, and Immunology-Microbiology and Neurology Service at the Denver Veterans Affairs Medical Center (S.H.S., K.L.T.), University of Colorado School of Medicine
| | - Michele L Yang
- From the Departments of Pediatrics (J.A. Martin, M.L.Y., T.L.S.), Infectious Diseases (K.M., S.R.D.), Hospital Medicine (K.M.), Radiology (J.A. Maloney), Child Psychiatry (J.L.), and Physical Medicine and Rehabilitation (T.C., P.K., J.O.), Section of Child Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora; and Departments of Neurology, Medicine, and Immunology-Microbiology and Neurology Service at the Denver Veterans Affairs Medical Center (S.H.S., K.L.T.), University of Colorado School of Medicine
| | - John A Maloney
- From the Departments of Pediatrics (J.A. Martin, M.L.Y., T.L.S.), Infectious Diseases (K.M., S.R.D.), Hospital Medicine (K.M.), Radiology (J.A. Maloney), Child Psychiatry (J.L.), and Physical Medicine and Rehabilitation (T.C., P.K., J.O.), Section of Child Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora; and Departments of Neurology, Medicine, and Immunology-Microbiology and Neurology Service at the Denver Veterans Affairs Medical Center (S.H.S., K.L.T.), University of Colorado School of Medicine
| | - Jennifer Lindwall
- From the Departments of Pediatrics (J.A. Martin, M.L.Y., T.L.S.), Infectious Diseases (K.M., S.R.D.), Hospital Medicine (K.M.), Radiology (J.A. Maloney), Child Psychiatry (J.L.), and Physical Medicine and Rehabilitation (T.C., P.K., J.O.), Section of Child Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora; and Departments of Neurology, Medicine, and Immunology-Microbiology and Neurology Service at the Denver Veterans Affairs Medical Center (S.H.S., K.L.T.), University of Colorado School of Medicine
| | - Terri Carry
- From the Departments of Pediatrics (J.A. Martin, M.L.Y., T.L.S.), Infectious Diseases (K.M., S.R.D.), Hospital Medicine (K.M.), Radiology (J.A. Maloney), Child Psychiatry (J.L.), and Physical Medicine and Rehabilitation (T.C., P.K., J.O.), Section of Child Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora; and Departments of Neurology, Medicine, and Immunology-Microbiology and Neurology Service at the Denver Veterans Affairs Medical Center (S.H.S., K.L.T.), University of Colorado School of Medicine
| | - Patricia Kenyon
- From the Departments of Pediatrics (J.A. Martin, M.L.Y., T.L.S.), Infectious Diseases (K.M., S.R.D.), Hospital Medicine (K.M.), Radiology (J.A. Maloney), Child Psychiatry (J.L.), and Physical Medicine and Rehabilitation (T.C., P.K., J.O.), Section of Child Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora; and Departments of Neurology, Medicine, and Immunology-Microbiology and Neurology Service at the Denver Veterans Affairs Medical Center (S.H.S., K.L.T.), University of Colorado School of Medicine
| | - Stefan H Sillau
- From the Departments of Pediatrics (J.A. Martin, M.L.Y., T.L.S.), Infectious Diseases (K.M., S.R.D.), Hospital Medicine (K.M.), Radiology (J.A. Maloney), Child Psychiatry (J.L.), and Physical Medicine and Rehabilitation (T.C., P.K., J.O.), Section of Child Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora; and Departments of Neurology, Medicine, and Immunology-Microbiology and Neurology Service at the Denver Veterans Affairs Medical Center (S.H.S., K.L.T.), University of Colorado School of Medicine
| | - Joyce Oleszek
- From the Departments of Pediatrics (J.A. Martin, M.L.Y., T.L.S.), Infectious Diseases (K.M., S.R.D.), Hospital Medicine (K.M.), Radiology (J.A. Maloney), Child Psychiatry (J.L.), and Physical Medicine and Rehabilitation (T.C., P.K., J.O.), Section of Child Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora; and Departments of Neurology, Medicine, and Immunology-Microbiology and Neurology Service at the Denver Veterans Affairs Medical Center (S.H.S., K.L.T.), University of Colorado School of Medicine
| | - Kenneth L Tyler
- From the Departments of Pediatrics (J.A. Martin, M.L.Y., T.L.S.), Infectious Diseases (K.M., S.R.D.), Hospital Medicine (K.M.), Radiology (J.A. Maloney), Child Psychiatry (J.L.), and Physical Medicine and Rehabilitation (T.C., P.K., J.O.), Section of Child Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora; and Departments of Neurology, Medicine, and Immunology-Microbiology and Neurology Service at the Denver Veterans Affairs Medical Center (S.H.S., K.L.T.), University of Colorado School of Medicine
| | - Samuel R Dominguez
- From the Departments of Pediatrics (J.A. Martin, M.L.Y., T.L.S.), Infectious Diseases (K.M., S.R.D.), Hospital Medicine (K.M.), Radiology (J.A. Maloney), Child Psychiatry (J.L.), and Physical Medicine and Rehabilitation (T.C., P.K., J.O.), Section of Child Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora; and Departments of Neurology, Medicine, and Immunology-Microbiology and Neurology Service at the Denver Veterans Affairs Medical Center (S.H.S., K.L.T.), University of Colorado School of Medicine
| | - Teri L Schreiner
- From the Departments of Pediatrics (J.A. Martin, M.L.Y., T.L.S.), Infectious Diseases (K.M., S.R.D.), Hospital Medicine (K.M.), Radiology (J.A. Maloney), Child Psychiatry (J.L.), and Physical Medicine and Rehabilitation (T.C., P.K., J.O.), Section of Child Neurology, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora; and Departments of Neurology, Medicine, and Immunology-Microbiology and Neurology Service at the Denver Veterans Affairs Medical Center (S.H.S., K.L.T.), University of Colorado School of Medicine.
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Gitomer SA, Fountain CR, Kingdom TT, Getz AE, Sillau SH, Katial RK, Ramakrishnan VR. Clinical Examination of Tissue Eosinophilia in Patients with Chronic Rhinosinusitis and Nasal Polyposis. Otolaryngol Head Neck Surg 2016; 155:173-8. [PMID: 26980909 DOI: 10.1177/0194599816637856] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/17/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVE (1) Describe clinical and histopathologic findings in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). (2) Determine if tissue and serum eosinophilia predicts disease severity in CRSwNP. STUDY DESIGN Case series with chart review. SETTING Academic hospital specializing in respiratory and allergic disease. SUBJECTS Patients with CRSwNP treated from 2008 to 2010. METHODS Clinical data were collected; sinus computed tomography (CT) scans were scored according to the Lund-Mackay system; and surgical specimens were evaluated for degree of tissue eosinophilia. Statistical analysis was performed to compare eosinophilia with indicators of disease severity. RESULTS Seventy CRSwNP patients were included, with a mean Lund-Mackay score of 16.7; 62.1% of patients had severe asthma, and 62.9% were aspirin sensitive. Elevated tissue eosinophil level did not correlate with medication usage, olfactory symptoms, or Lund-Mackay scores, nor did it correlate with presence of asthma or aspirin-sensitivity (P = .09). Patients with mild asthma had significantly more tissue eosinophils versus patients with severe asthma, possibly because of the high amount of chronic corticosteroid use in severe asthmatics. There was no correlation between tissue and serum eosinophil counts (P = .97), but there was a significant positive correlation between CT score and peripheral eosinophil level (P < .05). CONCLUSIONS Higher serum eosinophil levels may indicate more extensive mucosal disease as measured on CT scan. Neither serum nor tissue eosinophilia predicted disease severity in our retrospective analysis of CRSwNP patients, and serum eosinophil level did not serve as a marker of tissue eosinophilia.
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Affiliation(s)
- Sarah A Gitomer
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Cynthia R Fountain
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Todd T Kingdom
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Anne E Getz
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stefan H Sillau
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rohit K Katial
- National Jewish Health, Division of Allergy and Immunology, Denver, Colorado, USA
| | - Vijay R Ramakrishnan
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Nagae LM, Honce JM, Tanabe J, Shelton E, Sillau SH, Berman BD. Microstructural Changes within the Basal Ganglia Differ between Parkinson Disease Subtypes. Front Neuroanat 2016; 10:17. [PMID: 26941615 PMCID: PMC4763054 DOI: 10.3389/fnana.2016.00017] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 12/15/2015] [Accepted: 02/08/2016] [Indexed: 11/13/2022] Open
Abstract
Diffusion tensor imaging (DTI) of the substantia nigra has shown promise in detecting and quantifying neurodegeneration in Parkinson disease (PD). It remains unknown, however, whether differences in microstructural changes within the basal ganglia underlie PD motor subtypes. We investigated microstructural changes within the basal ganglia of mild to moderately affected PD patients using DTI and sought to determine if microstructural changes differ between the tremor dominant (TD) and postural instability/gait difficulty (PIGD) subtypes. Fractional anisotropy, mean diffusivity, radial, and axial diffusivity were obtained from bilateral caudate, putamen, globus pallidus, and substantia nigra of 21 PD patients (12 TD and 9 PIGD) and 20 age-matched healthy controls. T-tests and ANOVA methods were used to compare PD patients, subtypes, and controls, and Spearman correlations tested for relationships between DTI and clinical measures. We found our cohort of PD patients had reduced fractional anisotropy within the substantia nigra and increased mean and radial diffusivity within the substantia nigra and globus pallidus compared to controls, and that changes within those structures were largely driven by the PIGD subtype. Across all PD patients fractional anisotropy within the substantia nigra correlated with disease stage, while in PIGD patients increased diffusivity within the globus pallidus correlated with disease stage and motor severity. We conclude that PIGD patients have more severely affected microstructural changes within the substantia nigra compared to TD, and that microstructural changes within the globus pallidus may be particularly relevant for the manifestation of the PIGD subtype.
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Affiliation(s)
- Lidia M Nagae
- Department of Radiology, University of Colorado Anschutz Medial Campus Aurora, CO, USA
| | - Justin M Honce
- Department of Radiology, University of Colorado Anschutz Medial Campus Aurora, CO, USA
| | - Jody Tanabe
- Department of Radiology, University of Colorado Anschutz Medial Campus Aurora, CO, USA
| | - Erika Shelton
- Department of Neurology, University of Colorado Anschutz Medial Campus Aurora, CO, USA
| | - Stefan H Sillau
- Department of Neurology, University of Colorado Anschutz Medial Campus Aurora, CO, USA
| | - Brian D Berman
- Department of Radiology, University of Colorado Anschutz Medial CampusAurora, CO, USA; Department of Neurology, University of Colorado Anschutz Medial CampusAurora, CO, USA; Neurology Section, Denver VA Medical CenterDenver, CO, USA
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Salazar M, Stinson KE, Sillau SH, Good L, Newman LS. Web-Based Electronic Health Records Improve Data Completeness and Reduce Medical Discrepancies in Employee Vaccination Programs. Infect Control Hosp Epidemiol 2015; 33:84-6. [DOI: 10.1086/663205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A Web-based electronic health record (EHR) system was compared with traditional paper-based documentation and vaccination tracking during the 2009 H1N1 influenza pandemic. In a cohort of 8,411 healthcare network employees, EHRs improved completeness of self-reported contraindication data and reduced medical discrepancies. Vaccination program quality and accuracy are enhanced by EHRs.Infect Control Hosp Epidemiol 2012;33(1):84-86
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Kingdom TT, Gitomer SA, Sillau SH, Katial RK, Ramakrishnan VR. Clinical Examination of Tissue Eosinophilia in Patients with Chronic Rhinosinusitis and Nasal Polyposis. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: (1) Describe clinical and histopathologic findings in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). (2) Determine if tissue and serum eosinophilia predict disease severity in CRSwNP. Methods: Patients with CRSwNP treated at an academic hospital specializing in respiratory and allergic disease from 2008 to 2010 were included in this study. Clinical information was collected retrospectively. Sinus computed tomography (CT) scans were scored by a single author according to the Lund-Mackay (LM-CT) system, and surgical specimens were evaluated by a single author for degree of tissue eosinophilia. Statistical analysis was performed with t test, chi-squared test, Fisher’s exact test, and multiple regression models. Results: Seventy CRSwNP patients were included. They had a mean LM-CT score of 16.7, 62.1% of patients had severe asthma, and 62.9% were aspirin sensitive. There was no significant correlation between tissue and serum eosinophil counts ( P = .97). There was a significant positive correlation between CT score and peripheral eosinophil level ( P < .05). Elevated tissue eosinophil level did not correlate with medication usage, olfactory symptoms ( P = .91), or Lund-Mackay scores ( P = .25), nor did it correlate with presence of asthma, but it may be elevated in aspirin-sensitive patients ( P = .09). Patients with mild asthma had significantly more tissue eosinophils when compared to patients with severe asthma, possibly because of the high amount of chronic corticosteroid use in severe asthmatics. Conclusions: Higher serum eosinophil levels may indicate worse mucosal disease as measured on CT scan, but neither serum nor tissue eosinophilia predicted disease severity in our population CRSwNP patients.
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Hawkins SMM, Taylor AL, Sillau SH, Mitchell MB, Rausch CM. Restrictive lung function in pediatric patients with structural congenital heart disease. J Thorac Cardiovasc Surg 2013; 148:207-11. [PMID: 24060364 DOI: 10.1016/j.jtcvs.2013.07.080] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 07/12/2013] [Accepted: 07/26/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We sought to describe the prevalence of restrictive lung function in structural congenital heart disease and to determine the effect of cardiothoracic surgical intervention. METHODS The data from a retrospective review of the spirometry findings from pediatric patients with structural congenital heart disease were compared with the data from 220 matched controls. Restrictive lung function was defined as a forced vital capacity of <80%, with a preserved ratio of the forced expiratory volume in the first second to forced vital capacity of >80%. RESULTS Of the children with congenital heart disease, 20% met the criteria for restrictive lung function compared with 13.2% of the controls (P = .03). The prevalence in those with congenital heart disease without a surgical history was similar to that of the controls (odds ratio, 0.62; 95% confidence interval, 0.34-1.13). Restrictive lung function was more likely if surgical intervention had occurred within the first year of life (odds ratio, 1.96; 95% confidence interval, 1.08-3.55; P < .0001). Those who had undergone both sternotomy and thoracotomy had a greater prevalence of restrictive lung function than those who had undergone sternotomy or thoracotomy alone (54.2% vs 25.6% and 23.5%, respectively; P < .0001). The prevalence of restrictive lung function increased significantly with each additional surgical intervention (odds ratio, 1.61; 95% confidence interval, 1.29-2.01; P < .0001). CONCLUSIONS Restrictive lung function was more prevalent in those with congenital heart disease after cardiothoracic surgical intervention than in the controls or patients without surgical intervention. The prevalence was also greater with surgical intervention at an earlier age. The risk was equivalent when sternotomy alone was compared with thoracotomy alone but was significantly greater when both sternotomy and thoracotomy were performed. The risk increased with each additional surgery performed.
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Affiliation(s)
| | - Amy L Taylor
- Division of Cardiology, Children's Hospital Colorado, Aurora, Colo
| | - Stefan H Sillau
- Department of Biostatistics and Informatics, University of Colorado, Aurora, Colo
| | - Max B Mitchell
- Department of Surgery, University of Colorado, Aurora, Colo
| | - Christopher M Rausch
- Department of Pediatrics, University of Colorado, Aurora, Colo; Division of Cardiology, Children's Hospital Colorado, Aurora, Colo.
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Fountain CR, Mudd PA, Ramakrishnan VR, Sillau SH, Kingdom TT, Katial RK. Characterization and treatment of patients with chronic rhinosinusitis and nasal polyps. Ann Allergy Asthma Immunol 2013; 111:337-41. [PMID: 24125137 DOI: 10.1016/j.anai.2013.07.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/10/2013] [Accepted: 07/13/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with chronic rhinosinusitis (CRS) and nasal polyps (NPs) may be subdivided into aspirin-sensitive (AS) and aspirin-tolerant (AT) populations. These cohorts are not well characterized. OBJECTIVE To examine phenotypic characteristics and determine the extent of medical/surgical interventions in patients with CRS+NP and to compare the AS with the AT subset in the CRS+NP sample. METHODS Retrospective chart review was performed at a tertiary academic respiratory hospital. Data included patient demographics, asthma severity, peripheral eosinophilia, Lund-Mackay computed tomographic score, symptomatic dysosmia, and therapeutic interventions. RESULTS Of the 182 patients included, 81 had aspirin sensitivity (45%) and 101 had aspirin tolerance (55%). Asthma was present in 94% of patients with CRS+NP (100% in AS subgroup vs 89% in AT subgroup, P = .001). Eighty-eight percent of the CRS+NP sample had moderate to severe persistent asthma. In the AS and AT subgroups, asthma severity was similar (P > .6). The CRS+NP sample showed a mean computed tomographic score of 14.0 (44% with eosinophilia and 46% with dysosmia). More severe sinus disease was noted in the AS group (Lund-Mackay computed tomographic scores, P = .002; olfactory symptoms, P = .001). Serum eosinophil levels were not statistically different between groups (51% in AS group, 39% in AT group, P > .1). CONCLUSION This study is one of the broadest reviews of patients with CRS+NP, with unique findings in the high prevalence of asthma in AS and AT patients, greater olfactory dysfunction in AS patients, and a minority of patients with CRS+NP and circulating eosinophils. Most AS patients do not have increased circulating eosinophils, as is often believed. These results shed further light on the association between asthma and upper respiratory tract disease in those with nasal polyposis.
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Higgins DM, Wischmeyer PE, Queensland KM, Sillau SH, Sufit AJ, Heyland DK. Relationship of vitamin D deficiency to clinical outcomes in critically ill patients. JPEN J Parenter Enteral Nutr 2012; 36:713-20. [PMID: 22523178 DOI: 10.1177/0148607112444449] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite the numerous disease conditions associated with vitamin D deficiency in the general population, the relationship of this deficiency to outcome in critically ill patients remains unclear. The objective of this study is to determine the burden of vitamin D deficiency in intensive care unit (ICU) patients and determine if it is associated with poor patient outcomes. METHODS The authors conducted an analysis of samples collected from a prospective study of 196 patients admitted to a medical/surgical ICU in a tertiary care hospital. They measured serum 25-hydroxyvitamin D at admission and up to 10 days following admission and followed patients prospectively for 28-day outcomes. RESULTS Of analyzable patients, 50 (26%) were deficient (≤30 nmol/L) and 109 (56%) were insufficient (>30 and ≤60 nmol/L). Baseline 25(OH)D levels decreased significantly in all patients after 3 days in the ICU and remained significantly lower through 10 days (P < .001). 25(OH)D status was not significantly associated with 28-day all-cause mortality (hazard ratio [HR], 0.89; 95% confidence interval, [CI] 0.37-2.24). Higher levels of 25(OH)D were associated with a shorter time-to-alive ICU discharge (HR, 2.11; 95% CI, 1.27-3.51). 25(OH)D-deficient patients showed a nonstatistically significant trend toward a higher infection rate (odds ratio [OR], 3.20; 95% CI, 0.784-13.07; P = .11) compared with patients with sufficient levels of 25(OH)D. CONCLUSIONS This study demonstrates significant decreases in vitamin D status over the duration of the patient's ICU stay. Low levels of vitamin D are associated with longer time to ICU discharge alive and a trend toward increased risk of ICU-acquired infection.
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Affiliation(s)
- David M Higgins
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
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