Search

Inclusion is the deliberate practice of ensuring that each individual is heard, all personal traits are respected, and all can make meaningful contributions to achieve their full potential. As coronavirus disease 2019 spreads globally and across the United States, we have viewed this pandemic through the lens of equity and inclusion. Here, we discuss how this pandemic has magnified preexisting health and social disparities and will summarize why inclusion is an essential tool to traverse this uncertain terrain and discuss strategies that can be implemented at organizational and individual levels to improve inclusion and address inequities moving forward.

The Humanities section of the February 12 issue of Neurology® included an article titled “Lucky and the root doctor.” In this piece, the author describes his previous encounters with a black patient and his wife, and recounts dialogues in which the author is introduced to some of the patient's health beliefs, which differ widely from his own. Unfortunately, and perhaps unintentionally, the piece frames these interactions in the context of a highly problematic portrayal of race. Many Neurology readers reacted to the article, expressing concern over the negative racial overtones and calling for immediate corrective action. The article was quickly retracted, and a formal letter of apology and action plan was subsequently issued by the editor-in-chief of Neurology .1

Evolution of the US health care system has been punctuated by periods of rapid change. In the coming decades there will be meaningful and potentially disruptive developments in health care delivery mechanisms, the policy environment, and the populations for whom we provide care. Neurologists will need to adapt to changing patient expectations, market dynamics, and regulatory structures to thrive in the future health care environment. This article describes a forecast of potential changes in the US health care system by 2035, an assessment of the implications for the field of neurology, and a rationale for long-term strategic planning to prepare.

In a thriving and just society, all constituents must have equitable access to basic human needs, without which all components of that society will eventually fail. This is the basis for the fundamental necessity of health equity, which can be described as the absence of health disparities or disadvantages that are conferred on individuals or particular societal groups. More constructively, health equity requires that every individual has a just and fair chance to attain the highest standard of health possible. The coronavirus disease 2019 (COVID-19) pandemic provides a striking example of health inequity as evidenced by the disproportionate burden of disease observed in certain groups, particularly Black and Latino patients. While compelling, the racial and ethnic disparities related to COVID-19 are neither unique nor surprising. A large and growing body of literature describes significant inequities in health care broadly and within the field of neurology specifically.1,2

ObjectiveTo test the hypothesis that repetitive head impacts (RHIs), like those from contact sport play and traumatic brain injury (TBI) have long-term neuropsychiatric and cognitive consequences, we compared middle-age and older adult participants who reported a history of RHI and/or TBI with those without this history on measures of depression and cognition.MethodsThis cross-sectional study included 13,323 individuals (mean age, 61.95; 72.5% female) from the Brain Health Registry who completed online assessments, including the Ohio State University TBI Identification Method, the Geriatric Depression Scale (GDS-15), and the CogState Brief Battery and Lumos Labs NeuroCognitive Performance Tests. Inverse propensity-weighted linear regressions accounting for age, sex, race/ethnicity, and education tested the effects of RHI and TBI compared to a non-RHI/TBI group.ResultsA total of 725 participants reported RHI exposure (mostly contact sport play and abuse) and 7,277 reported TBI (n = 2,604 with loss of consciousness [LOC]). RHI (β, 1.24; 95% CI, 0.36–2.12), TBI without LOC (β, 0.43; 95% CI, 0.31–0.54), and TBI with LOC (β, 0.75; 95% CI, 0.59–0.91) corresponded to higher GDS-15 scores. While TBI with LOC had the most neuropsychological associations, TBI without LOC had a negative effect on CogState Identification (β, 0.004; 95% CI, 0.001–0.01) and CogState One Back Test (β, 0.004; 95% CI, 0.0002–0.01). RHI predicted worse CogState One Back Test scores (β, 0.02; 95% CI, −0.01 to 0.05). There were RHI × TBI interaction effects on several neuropsychological subtests, and participants who had a history of both RHI and TBI with LOC had the greatest depression symptoms and worse cognition.ConclusionsRHI and TBI independently contributed to worse mid- to later-life neuropsychiatric and cognitive functioning.

A 34-year-old man with diffuse large B-cell lymphoma in complete remission presented with painful paresthesias of the thorax and proximal legs with loss of patellar reflexes bilaterally. Laboratory studies showed no evidence of autoimmune or infectious processes. CSF cytology was unremarkable. MRI showed enlarged, enhancing dorsal root ganglia (DRG) at L3-L4 bilaterally (figure, A). Whole-body PET showed avidity in these nerve roots and in T2 and T8 (figure, C) . Abnormalities on nerve conduction studies were isolated to sensory nerves affecting the same roots. Sensory ganglionopathies can occur with lymphomatous infiltration of the DRG, known as neurolymphomatosis, and can be the initial manifestation of lymphoma relapse.1,2

The study by Young and colleagues1 in this issue of Neurology® used a technique called magnetic resonance spectroscopy (MRS) to examine the brain chemistry of patients with HIV. MRS is a noninvasive method of measuring the levels of certain chemicals, or “metabolites,” in the brain. One metabolite, N -acetylaspartate (NAA), is a marker of healthy brain cells. Three other metabolites, choline (Cho), myo-inositol (MI), and glutamate (Glu), are markers of damaged brain cells and inflammation (see table).