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Background: As the Hispanic/Latino (HL) population grows, so too does the need for HL family caregivers for persons with dementia. HL caregivers tend to have less education, lower health literacy, and lower income, each uniquely compounding burden. Research is needed to appropriately tailor interventions for this population. Objective: A systematic review and meta-analysis was conducted to 1) provide an updated review of non-pharmacologic intervention studies for HL dementia caregivers, 2) characterize promising interventions, and 3) highlight opportunities for future research. Methods: Databases were searched for articles evaluating non-pharmacologic interventions for HL dementia caregivers. Studies were excluded if target populations did not include HLs or if no intervention was delivered. Data were extracted and random effects meta-analysis was performed on two primary outcomes: caregiver depression and burden. Effect sizes were calculated as pre- and post-intervention standardized mean differences (SMD), and further depression subgroup meta-analysis was performed. Other secondary outcome measures (e.g., perceived social support, caregiver knowledge, anxiety) were evaluated qualitatively. Results: Twenty-three studies were identified. Most included multiple components pertaining to psychosocial support, caregiver education, and community resource facilitation. Many studies were successful in improving caregiver outcomes, though intervention design varied. Meta-analysis revealed minimal to moderate heterogeneity and small effect size in improving depressive symptoms (SMD = –0.31, 95% CI –0.46 to –0.16; I2 = 50.16%) and burden (SMD = –0.28, 95% CI –0.37 to –0.18; I2 = 11.06%). Conclusion: Although intervention components varied, many reported outcome improvements. Future studies may benefit from targeting physical health, addressing sociocultural and economic contexts of caregivers, and leveraging technology.

Background: An association between chronic infectious diseases and development of dementia has been suspected for decades, based on the finding of pathogens in postmortem brain tissue and on serological evidence. However, questions remain regarding confounders, reverse causality, and how accurate, reproducible and generalizable those findings are. Objective: Investigate whether exposure to Herpes simplex (manifested as herpes labialis), Chlamydophila pneumoniae (C. pneumoniae), Helicobacter pylori (H. pylori), and cytomegalovirus (CMV) modifies the risk of dementia in a populational cohort. Methods: Questionnaires regarding incidence of herpes infections were administered to Original Framingham Study participants (n = 2,632). Serologies for C. pneumoniae, H. pylori, and CMV were obtained in Original (n = 2,351) and Offspring cohort (n = 3,687) participants. Participants are under continuous dementia surveillance. Brain MRI and neuropsychological batteries were administered to Offspring participants from 1999–2005. The association between each infection and incident dementia was tested with Cox models. Linear models were used to investigate associations between MRI or neuropsychological parameters and serologies. Results: There was no association between infection serologies and dementia incidence, total brain volume, and white matter hyperintensities. Herpes labialis was associated with reduced 10-year dementia risk (HR 0.66, CI 0.46–0.97), but not for the duration of follow-up. H. pylori antibodies were associated with worse global cognition (β –0.14, CI –0.22, –0.05). Conclusion: We found no association between measures of chronic infection and incident dementia, except for a reduction in 10-year dementia risk for patients with herpes labialis. This unexpected result requires confirmation and further characterization, concerning antiviral treatment effects and capture of episodes.

Background: Depressive symptoms predict increased risk for dementia decades before the emergence of cognitive symptoms. Studies in older adults provide preliminary evidence for an association between depressive symptoms and amyloid-β (Aβ) and tau accumulation. It is unknown if similar alterations are observed in midlife when preventive strategies may be most effective. Objective: The study aim was to evaluate the association between depressive symptoms and cerebral Aβ and tau in a predominately middle-aged cohort with examination of the apolipoprotein (APOE) ɛ4 allele as a moderator. Methods: Participants included 201 adults (mean age 53±8 years) who underwent 11C-Pittsburgh Compound B amyloid and 18F-Flortaucipir tau positron emission tomography (PET) imaging. Depressive symptoms were evaluated with the Center for Epidemiological Studies Depression Scale (CES-D) at the time of PET imaging, as well as eight years prior. Associations between depressive symptoms at both timepoints, as well as depression (CES-D≥16), with regional Aβ and tau PET retention were evaluated with linear regression adjusting for age and sex. Interactions with the APOE ɛ4 allele were explored. Results: Depressive symptoms and depression were not associated with PET outcomes in the overall sample. However, among APOE ɛ4 allele carriers, there was a significant cross-sectional association between depressive symptoms and increased tau PET uptake in the entorhinal cortex (β= 0.446, SE = 0.155, p = 0.006) and amygdala (β= 0.350, SE = 0.133, p = 0.012). Conclusion: Although longitudinal studies are necessary, the results suggest that APOE ɛ4 carriers with depressive symptoms may present with higher susceptibility to early tau accumulation in regions integral to affective regulation and memory consolidation.

BackgroundsExercise is an attractive, widely accessible intervention to promote cardiovascular health; however, evidence that exercise improves brain health is sparse. Here, we hypothesized that aerobic exercise would improve brain health of sedentary older adults, as reflected by cognition health, sleep macro- and micro-architecture, and brain age index (BAI), a biomarker of brain health derived from the overnight sleep electroencephalogram (EEG).MethodsSedentary older adults were recruited to complete a 12-week aerobic exercise. Home wearable devices were used to monitor heart rate and overnight sleep EEG over the period. NIH Toolbox Cognition Battery, in-lab overnight polysomnography, cardiopulmonary exercise testing and multiplex cytokine assay were employed to determine pre- and post-exercise brain health, exercise capacity and plasma proteins.Results26 participants completed the initial assessment and exercise program, and 24 completed all procedures. Participants significantly increased maximal oxygen consumption (VO2max) and decreased resting and sleeping heart rate after the exercise regimen. Cognition performances were significantly improved following the exercise program while no significant differences were seen in BAI and sleep macro- and micro-architecture. Plasma IL-4 was elevated while IL-8 was reduced after the exercise regimen. Home sleep data revealed a 3.59% increase in the percentage of N3 sleep over a 12-week.ConclusionsWe conclude that cognitive function and N3 sleep were improved by a 12-week moderate-intensity exercise program in sedentary older adults, associated with improvements in VO2max and plasma cytokine profiles. Our data show the value of integrating multi-modal assessments to study the effect of brain health targeted approaches.FundingDr. Westover received support during this work from the McCance Center for Brain Health, the Glenn Foundation for Medical Research and the American Federation for Aging Research through a Breakthroughs in Gerontology Grant; through the American Academy of Sleep Medicine through an AASM Foundation Strategic Research Award; by the Football Players Health Study (FPHS) at Harvard University; from the Department of Defense through a subcontract from Moberg ICU Solutions, Inc, and by grants from the NIH (R01NS102190, R01NS102574, R01NS107291, RF1AG064312, R01AG062989, R01AG073410), and NSF (2014431). Dr. Wrann was supported by a SPARC Award from the McCance Center for Brain Health. Dr. Tanzi and Dr. Zhang were supported by the Cure Alzheimer’s Fund.Clinical trial numberNational Clinical Trial: NCT04210882One Sentence SummaryWe observed that exercise improved slow wave sleep, increased circulating neuroprotective cytokines and improved cognition health in older adults.

Background and ObjectivesLoneliness is common, and its prevalence is rising. The relationship of loneliness with subsequent dementia and the early preclinical course of Alzheimer disease and related dementia (ADRD) remains unclear. Thus, the primary objective of this study was to determine the association of loneliness with 10-year all-cause dementia risk and early cognitive and neuroanatomic imaging markers of ADRD vulnerability.MethodsThis was a retrospective analysis of prospectively collected data from the population-based Framingham Study cohorts (September 9, 1948–December 31, 2018). Eligible participants had loneliness assessed and were dementia-free at baseline. Loneliness was recorded with the Center for Epidemiologic Studies Depression Scale, defined conservatively as feeling lonely ≥3 days in the past week. The main outcomes were incident dementia over a 10-year period, cognition, and MRI brain volumes and white matter injury.ResultsOf 2,308 participants (mean age 73 [SD 9] years, 56% women) who met eligibility in the dementia sample, 14% (329 of 2,308) developed dementia and 6% (144 of 2,308) were lonely. Lonely (versus not lonely) adults had higher 10-year dementia risk (age-, sex-, and education-adjusted hazard ratio 1.54, 95% CI 1.06–2.24). Lonely participants APOE ε4 alleles had a 3-fold greater risk (adjusted hazard ratio 3.03, 95% CI, 1.63–5.62). Among 1,875 persons without dementia who met eligibility in the cognition sample (mean age 62 [SD 9] years, 54% women), loneliness associated with poorer executive function, lower total cerebral volume, and greater white matter injury.DiscussionOver 10 years of close clinical dementia surveillance in this cohort study, loneliness was associated with increased dementia risk; this tripled in adults whose baseline risk would otherwise be relatively low on the basis of age and genetic risk, representing a majority of the US population. Loneliness was also associated with worse neurocognitive markers of ADRD vulnerability, suggesting an early pathogenic role. These findings may have important clinical and public health implications given observed loneliness trends.Classification of EvidenceThis study provides Class I evidence that loneliness increases the 10-year risk of developing dementia.

Study Objectives Alterations in sleep spindles have been linked to cognitive impairment. This finding has contributed to a growing interest in identifying sleep-based biomarkers of cognition and neurodegeneration, including sleep spindles. However, flexibility surrounding spindle definitions and algorithm parameter settings present a methodological challenge. The aim of this study was to characterize how spindle detection parameter settings influence the association between spindle features and cognition and to identify parameters with the strongest association with cognition. Methods Adult patients (n = 167, 49 ± 18 years) completed the NIH Toolbox Cognition Battery after undergoing overnight diagnostic polysomnography recordings for suspected sleep disorders. We explored 1000 combinations across seven parameters in Luna, an open-source spindle detector, and used four features of detected spindles (amplitude, density, duration, and peak frequency) to fit linear multiple regression models to predict cognitive scores. Results Spindle features (amplitude, density, duration, and mean frequency) were associated with the ability to predict raw fluid cognition scores (r = 0.503) and age-adjusted fluid cognition scores (r = 0.315) with the best spindle parameters. Fast spindle features generally showed better performance relative to slow spindle features. Spindle features weakly predicted total cognition and poorly predicted crystallized cognition regardless of parameter settings. Conclusions Our exploration of spindle detection parameters identified optimal parameters for studies of fluid cognition and revealed the role of parameter interactions for both slow and fast spindles. Our findings support sleep spindles as a sleep-based biomarker of fluid cognition.

Observational studies suggest psychosocial factors such as social support and loneliness are associated with vulnerability for frailty in older adults, but less is known about the generalizability of these putative psychosocial mechanisms in underrepresented groups. Thus, we evaluated whether better telecommunication social support and lower levels of loneliness were associated with decreased frailty and increased functional ability using a unique longitudinal cohort of rural South African older adults. We conducted generalized estimating equation and robust regression analyses using cross-sectional data from 347 participants in the HAALSI (Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa) Dementia Cohort. Social support via telecommunication and self-reported loneliness were measured using standard assessments and modeled as exposure variables. Outcomes were frailty (measured using Fried’s frailty phenotype) and functional status (measured by instrumental activities of daily living, IADLs). Lower level of telecommunication social support was associated with higher impairment in ability to perform IADLs. This association persisted after additional adjustments for depression (beta -0.007, 95 % CI -0.016, 0.001) and vascular risk factors (beta -0.012, 95 % CI -0.020, 0.003). No associations were observed in relating telecommunication social support and loneliness with frailty. Among rural South African Black older adults, lower telecommunication-based social support was associated with greater risk of impairment in functional ability. Although further validation is required for possible reverse causality, our findings suggest that future intervention studies focused on promoting telecommunication-based social support to preserve independent functioning may be merited.

Social distancing has been a critical public health measure for the COVID-19 pandemic, yet a long history of research strongly suggests that loneliness and social isolation play a major role in several cognitive health issues. What is the true severity and extent of risks involved and what are potential approaches to balance these competing risks? This review aimed to summarize the neurological context of social isolation and loneliness in population health and the long-term effects of social distancing as it relates to neurocognitive aging, health, and Alzheimer’s disease and related dementias. The full scope of the underlying causal mechanisms of social isolation and loneliness in humans remains unclear partly because its study is not amenable to randomized controlled trials; however, there are many detailed experimental and observational studies that may provide a hypothesis-generating theoretical framework to better understand the pathophysiology and underlying neurobiology. To address these challenges and inform future studies, we conducted a topical review of extant literature investigating associations of social isolation and loneliness with relevant biological, cognitive, and psychosocial outcomes, and provide recommendations on how to approach the need to fill key knowledge gaps in this important area of research.

Objective The amyotrophic lateral sclerosis (ALS) trial outcome measures are clinic based. Active and passive smartphone data can provide important longitudinal information about ALS progression outside the clinic. Methods We used Beiwe, a research platform for smartphone‐based digital phenotyping, to collect active (self‐report ALSFRS‐R surveys and speech recordings) and passive (phone sensors and logs) data from patients with ALS for approximately 24 weeks. In clinics, at baseline and every 3 months, we collected vital capacity, ALSFRS‐R, and ALS‐CBS at enrollment, week 12, and week 24. We also collected ALSFRS‐R by telephone at week 6. Results Baseline in‐clinic ALSFRS‐R and smartphone self‐report correlation was 0.93 (P

Evidence suggests exposure to particulate matter with aerodynamic diameter

Background and Purpose— Although depression is a risk factor for stroke in large prospective studies, it is unknown whether these conditions have a shared genetic basis. Methods— We applied a polygenic risk score (PRS) for major depressive disorder derived from European ancestry analyses by the Psychiatric Genomics Consortium to a genome-wide association study of ischemic stroke in the Stroke Genetics Network of National Institute of Neurological Disorders and Stroke. Included in separate analyses were 12 577 stroke cases and 25 643 controls of European ancestry and 1353 cases and 2383 controls of African ancestry. We examined the association between depression PRS and ischemic stroke overall and with pathogenic subtypes using logistic regression analyses. Results— The depression PRS was associated with higher risk of ischemic stroke overall in both European ( P =0.025) and African ancestry ( P =0.011) samples from the Stroke Genetics Network. Ischemic stroke risk increased by 3.0% (odds ratio, 1.03; 95% confidence interval, 1.00–1.05) for every 1 SD increase in PRS for those of European ancestry and by 8% (odds ratio, 1.08; 95% confidence interval, 1.04–1.13) for those of African ancestry. Among stroke subtypes, elevated risk of small artery occlusion was observed in both European and African ancestry samples. Depression PRS was also associated with higher risk of cardioembolic stroke in European ancestry and large artery atherosclerosis in African ancestry persons. Conclusions— Higher polygenic risk for major depressive disorder is associated with increased risk of ischemic stroke overall and with small artery occlusion. Additional associations with ischemic stroke subtypes differed by ancestry.

Drug trials in Alzheimer disease and related dementias remain unsuccessful. However, evidence demonstrating how these illnesses affect people based on socioeconomic1 and related modifiable factors2 suggests that perhaps we should also target social determinants of health. These determinants underlie how social conditions—structures, institutions, relationships—influence health and are alterable throughout a person’s lifespan. Thus, understanding how social determinants influence brain health is crucial to inform public policy, identify high-risk individuals for cost-effective risk reduction, and improve population health interventions so all persons can thrive. But details of social determinants in neurologic conditions remain unclear and, compounding the complexity, these conditions change alongside social, political, and economic circumstances.

Key Points Question What is the association of different forms of social support with an early neuroanatomical marker of Alzheimer disease vulnerability and cognitive function? Findings In this cross-sectional study, high (vs low) availability of supportive listening was associated with cognitive resilience, which indicated better global cognitive function than expected for lower cerebral volume. This association was absent for other forms of social support. Meaning In psychosocial interventions and related public health strategies to promote neurocognitive health, precise targeting of specific forms of social support, such as supportive listening, may be warranted., Importance Cognitive resilience refers to the general capacity of cognitive processes to be less susceptible to differences in brain structure from age- and disease-related changes. Studies suggest that supportive social networks reduce Alzheimer disease and related disorder (ADRD) risk by enhancing cognitive resilience, but data on specific social support mechanisms are sparse. Objective To examine the association of individual forms of social support with a global neuroanatomical measure of early ADRD vulnerability and cognition. Design, Setting, and Participants This retrospective cross-sectional analysis used prospectively collected data from Framingham Study participants without dementia, stroke, or other neurological conditions who underwent brain magnetic resonance imaging and neuropsychological testing at the same visit. Data from this large, population-based, longitudinal cohort were collected from June 6, 1997, to December 13, 1999 (original cohort), and from September 11, 1998, to October 26, 2001 (offspring cohort). Data were analyzed from May 22, 2017, to June 1, 2021. Exposures Total cerebral volume and, as a modifying exposure variable, self-reported availability of 5 types of social support measured by the Berkman-Syme Social Network Index. Main Outcomes and Measures The primary outcome was a global measure of cognitive function. Cognitive resilience was defined as the modification of total cerebral volume’s association with cognition, such that smaller β estimates (presented in SD units) indicate greater cognitive resilience (ie, better cognitive performance than estimated by lower total cerebral volume). Results The study included 2171 adults (164 in the original cohort and 2007 in the offspring cohort; mean [SD] age, 63 [10] years; 1183 [54%] female). High listener availability was associated with greater cognitive resilience (β = 0.08, P, This cross-sectional study uses data from the Framingham Study to examine whether different forms of social support are associated with Alzheimer disease vulnerability and cognitive function.

Social and behavioral factors, also termed social determinants of health, are increasingly established risk factors for incident and recurrent stroke, both ischemic and hemorrhagic stroke, yet improvement in addressing these factors remains insufficient.1 There is a lack of clarity on who should share in accountability for reducing risk (eg, patients, providers, or health systems) and what interventions are practical, cost-effective, and scalable.2 For the purpose of this review, we will use the definition of an intervention as a set of actions with a coherent objective to bring about change or produce identifiable outcomes.3 We first review the published literature to summarize the relevant research on previous behavioral interventions for prevention of stroke and other related conditions, the theoretical frameworks underpinning these behavioral interventions, and then propose a new conceptual model for more effective implementation of social and behavioral interventions for stroke prevention. Successful implementation will require adequately addressing the known inherent barriers to behavioral interventions and the ambiguity of financial responsibility and accountability among the various stakeholders. Because new tools, such as digital phenotyping, social network analysis, machine learning, and gamification, have emerged for facilitating, measuring, and improving existing behavioral interventions, a promising new paradigm in behavioral change has emerged. Table 1 categorizes the various behavioral interventions by operational level, risk factor targets, and tactics that range from the simple (eg, provider referral for behavior change program) to the complex (eg, multifaceted, multidomain intervention).4 Table 2 summarizes the prior interventions specific to stroke prevention covered in 3 major systematic Cochrane reviews. Because the evidence suggests that modifiable risk factors are often not effectively managed after a stroke or transient ischemic attack, the first review sought to identify interventions for improving control of 6 major modifiable risk factors5 of blood pressure, lipids, atrial fibrillation, diabetes mellitus, …

Introduction Mechanisms underlying social determinants of stroke and dementia are unclear and brain-derived neurotrophic factor (BDNF) may contribute as a molecular link. Methods Using the Framingham Study, we examined social relationship measures as predictors of higher serum BDNF level and cumulative incidence of stroke and dementia. Results Among 3294 participants, controlling for age and sex, isolation trended with lower BDNF (odds ratio = 0.69 [0.47–1.00]). Participants with more companionship had reduced risk for stroke (hazard ratio [HR] = 0.59 [0.41–0.83]) and dementia (HR = 0.67 [0.49–0.92]). Greater emotional support was associated with higher BDNF (odds ratio = 1.27 [1.04–1.54]), reduced dementia risk (HR = 0.69 [0.51–0.94], and among smokers, reduced stroke risk (HR = 0.23 [0.10–0.57]). Associations persisted after additional adjustments. BDNF partly mediated the total effect between emotional support and dementia risk. Conclusions Availability of social support appears to be associated with increased BDNF levels and, in certain subsets, reduce risk of subsequent dementia and stroke, thus warranting study of these pathways to understand their role in neuroprotection.

A 56-year-old previously healthy man presented with cognitive complaints. He described forgetting recent conversations and leaving tasks unfinished. He reported no problems with long-term memory, no personality changes, and he continued to perform all activities of daily living (ADLs) independently. His initial neurologic examination was normal, including a perfect score on the Mini-Mental State Examination (MMSE). Over the next 2 years, he developed difficulty reading his analog watch, managing finances, and making simple calculations while shopping. He also reported difficulty tying his necktie.

OBJETIVOS: Identificar las características de pacientes con infertilidad e hiperprolactinemia (HPRL). MÉTODO: Se revisó 464 historias clínicas de 39 mujeres del Servicio de Infertilidad del Hospital Arzobispo Loayza (HAL); seleccionándose las que tenían por lo menos 2 dosajes de prolactina (PRL) sérica mayores de 25 ng/ml, edades entre 15 y 42 años, tiempo de infertilidad > 1 año y vida sexual activa. RESULTADOS: Las pacientes con HPRL representan el 8,4% de mujeres infértiles del HAL. Del ellos, 56,4% tenía PRL entre 26 y 50 ng/mL; edad promedio de 33,1 años y tiempo de enfermedad de 5,4 años. Los antecedentes más relevantes fueron: aborto (48,7%), galactorrea (35,9%), trastornos menstruales (25,6%), relaciones sexuales insatisfactorias (23,1%) y ejercicio físico (23,1%). Los hallazgos clínicos más importantes fueron: galactorrea (46,2%), índice de masa corporal > 25 (44,8%) y fase lútea inadecuada (43,6%). Los diagnósticos etiológicos más frecuentes fueron: HPRL idiopática (53,8%) y fisiológica (20,5%). Las pacientes con microadenoma de hipófisis tuvieron niveles de PRL significativamente mayores que mujeres con otras etiologías de HPRL (p

We describe a case of psychogenic nonepileptic seizures as an example of what has been called the demanding encounter in clinical neurology. Patients in these encounters are more likely to see themselves as informed consumers who expect to receive requested diagnostic tests and treatments from health care providers, potentially creating a conflict over treatment goals and appropriate limit setting. Demanding encounters are associated with physician burnout and patient dissatisfaction. We survey some of the ethical frameworks introduced to navigate this type of encounter. We argue that physicians are obligated to identify the underlying beliefs that are leading to requests for unnecessary testing and treatment and that, by addressing these beliefs, providers have the best chance of establishing a respectful, meaningful therapeutic relationship with their patients.

Emerging evidence suggests microRNAs (miRNAs) may play an important role in explaining variation in stroke risk and recovery in humans, yet there are still few longitudinal studies examining the association between whole blood miRNAs and stroke. Accounting for multiple testing and adjusting for potentially confounding technical and clinical variables, here we show that whole blood miR-574-3p expression was significantly lower in participants with chronic stroke compared to non-cases. To explore the functional relevance of our findings, we analyzed miRNA-mRNA whole blood co-expression, pathway enrichment, and brain tissue gene expression. Results suggest miR-574-3p is involved in neurometabolic and chronic neuronal injury response pathways, including brain gene expression of DBNDD2 and ELOVL1. These results suggest miR-574-3p plays a role in regulating chronic brain and systemic cellular response to stroke and thus may implicate miR-574-3p as a partial mediator of long-term stroke outcomes.

Presentamos un caso de un paciente varón de 21 años de edad, quien tiene una historia de consumo de sustanciaspsicoactivas, con criterios de dependencia a cocaína y ketamina, además de probables desórdenes psiquiátricosrelacionados. La ketamina es un anestésico considerado dentro de las drogas de club, produce un cuadro de dependenciasevero y su uso se ha incrementado en los últimos años. (Rev Neuropsiquiatr 2010;73:62-65).

To better identify stroke survivors at risk for depression who may benefit from early prevention through targeted strategies in the acute-subacute poststroke period, we examined 118 Framingham Heart Study stroke survivors with longitudinal prestroke depression assessments. Among those who developed poststroke depression, most lacked a history of depressive symptoms 5 years prior to their stroke. Sex (female), advanced age, and prestroke factors (smoking and functional dependence) were associated with new-onset depression poststroke. These findings suggest fully characterizing and accounting for prestroke factors, including psychosocial and behavioral determinants, may inform the predictive modeling needed to determine whether targeted preventive trials early in stroke recovery will improve stroke outcomes.

Objective To compare postoperative seizure-free survival between older and younger adults. Methods A retrospective cohort of 107 temporal lobe epilepsy patients with a diagnosis of mesial temporal sclerosis (MTS) received anterior temporal lobectomy (ATL) between 1993 and 2014. We divided the lower three quartiles (younger) and top quartile (older, all 47+ years) of patients, then reviewed patient registry and electronic medical records to determine time to first self-reported seizure after ATL, the primary outcome (mean = 3.5 years of follow-up, SD = 3.6). We also assessed Engel classifications, intraoperative and postoperative treatment complications, and social disability. We used Cox proportional hazard models to assess the association between individual traits and time of seizure recurrence. Results During follow-up, 35/107 (32.7%) patients had post-operative seizure(s). After adjustment for potential confounders there were no significant differences in the probability of post-operative seizures between the older and younger groups, though we had limited precision (hazard ratio of 0.67 [0.28–1.59]), (p = 0.36). There were more treatment complications and disability in older patients (18% vs. 1.3% for any complications, 84.62% vs. 58.23% for driving disability, and 84.6% vs. 60.7% for work disability, p Conclusion Older patients appear to have more complications after ATL, compared with younger patients. Age, however, does not appear to have a large independent association with seizure recurrence.

Background: Although poststroke depression is a common and devastating consequence of stroke, few studies have examined the occurrence and correlates of developing depression among stroke survivors without a history of depression before the stroke. Hypothesis: Using data on post-menopausal women from the Women’s Health Initiative (WHI), we estimated the odds of new-onset depression poststroke (NDPS) and assessed the associations of psychosocial and other factors with NDPS. Methods: We analyzed data from 1433 respondents who were stroke-free at enrollment and had no self-reported history of depression prior to their non-fatal ischemic stroke, and had information regarding stroke severity. NDPS was assessed in the five-year period after stroke using the Center for Epidemiologic Studies Depression Scale or new antidepressant medication use. Unadjusted 5-year depression rates are presented by demographic, comorbid, and psychosocial factors measured pre-stroke. Vascular territory of stroke is given by the Oxfordshire classification. Logistic regression provided odds ratios of NDPS controlling for multiple covariates. Results: New-onset depression post ischemic stroke occurred in 21.4% (306/1433) of the analytic cohort and varied by stroke outcome as measured by the Glasgow scale ranging from 16.7% of those with good recovery to 31.5% of those severely disabled. Women with total anterior circulation infarction had the highest level (45.8%) of NDPS while those with lacunar infarction had the lowest (19.1%). Among those with ischemic stroke and good recovery (n=754), moderate level of optimism was associated with a reduced odds of NDPS (compared to low optimism, OR, 0.29; 95%CI, 0.14-0.63) adjusting for demographics, behavioral factors, and comorbidities. Cynical hostility, social support, and traumatic life events were unassociated with NDPS. Conclusions: New-onset depression is common after ischemic stroke among post-menopausal women. Though rarely studied in poststroke depression, psychosocial factors (specifically optimism) may play a role in reducing risk for new-onset depression after stroke.

Supplemental Digital Content is available in the text., Background and Purpose— Value-based health care aims to bring together patients and health systems to maximize the ratio of quality over cost. To enable assessment of healthcare value in stroke management, an international standard set of patient-centered stroke outcome measures was defined for use in a variety of healthcare settings. Methods— A modified Delphi process was implemented with an international expert panel representing patients, advocates, and clinical specialists in stroke outcomes, stroke registers, global health, epidemiology, and rehabilitation to reach consensus on the preferred outcome measures, included populations, and baseline risk adjustment variables. Results— Patients presenting to a hospital with ischemic stroke or intracerebral hemorrhage were selected as the target population for these recommendations, with the inclusion of transient ischemic attacks optional. Outcome categories recommended for assessment were survival and disease control, acute complications, and patient-reported outcomes. Patient-reported outcomes proposed for assessment at 90 days were pain, mood, feeding, selfcare, mobility, communication, cognitive functioning, social participation, ability to return to usual activities, and health-related quality of life, with mobility, feeding, selfcare, and communication also collected at discharge. One instrument was able to collect most patient-reported subdomains (9/16, 56%). Minimum data collection for risk adjustment included patient demographics, premorbid functioning, stroke type and severity, vascular and systemic risk factors, and specific treatment/care-related factors. Conclusions— A consensus stroke measure Standard Set was developed as a simple, pragmatic method to increase the value of stroke care. The set should be validated in practice when used for monitoring and comparisons across different care settings.

Structural magnetic resonance imaging studies provide evidence for sex differences in the human brain. Differences in surface area and the proportion of gray to white matter volume are observed, in particular in the parietal lobe. To our knowledge, no studies have examined sex differences in parietal lobe structure in younger populations or in the context of development. The present study evaluated sex differences in the structure of the parietal lobe in children aged 7 to 17 years. In addition, by adding a cohort of previously studied adults aged 18 to 50 years, sex differences in parietal lobe structure were examined across the age span of 7 to 50 years. Compared with the adult sample, the younger sample showed that the ratio of parietal lobe cortex to white matter was greater in female brains, but no sex differences in surface area. When examining the effects of age, surface area exhibited a significant sex-age interaction. In male brains, there was essentially no decrease in surfaces area over time, whereas in female brains, there was a significant decrease in surface area over time. These findings support the notion of structural sex differences in the parietal lobe, not only in the context of cross-sectional assessment but also in terms of differences in developmental trajectories.

OBJETIVOS: Determinar la prevalencia de depresión mayor durante el embarazo y establecer las características sociodemográficas y obstétricas de las mujeres embarazadas con depresión mayor atendidas en la consulta externa de un hospital de Lima, Perú. MÉTODOS: Estudio descriptivo transversal de asociación simple. Se analizaron 222 gestantes de 16 a 42 años con bajo riesgo obstétrico que acudieron a la consulta externa del Departamento de Obstetricia del Instituto Nacional Materno Perinatal de Lima, Perú, entre el 2 de junio y el 28 de noviembre de 2006. A cada embarazada se le aplicó la escala de depresión de Edimburgo y un cuestionario sobre datos sociodemográficos y obstétricos. Se determinó la relación entre las variables de estudio según la presencia de depresión mayor mediante las pruebas de la χ2 y de la Z, según el tipo de variable. RESULTADOS: De las 222 gestantes estudiadas, 89 (40,1%) presentaron depresión mayor. Las mujeres casadas tendían a deprimirse menos; las que no planificaron su embarazo y que presentaron complicaciones durante su gestación tendieron a deprimirse más que sus pares. No se encontró que la edad, el número de hijos, la edad gestacional, el nivel educacional, los antecedentes de aborto, el consumo de alcohol u otras sustancias, la falta de apoyo familiar y la percepción de tener problemas de pareja, familiares, económicos o personales influyeran en la frecuencia de depresión. CONCLUSIONES: La prevalencia de depresión mayor en las gestantes estudiadas fue muy elevada. Se debe prestar especial atención a las mujeres que manifiestan tener un embarazo no planificado y las que sufren complicaciones durante su embarazo, a fin de llegar a diagnósticos tempranos y aplicar tratamientos oportunos.OBJECTIVES: To determine the prevalence of major depression during pregnancy and to define the sociodemographic and obstetric characteristics of pregnant women with major depression treated by the outpatient clinic at a hospital in Lima, Peru. METHODS: A descriptive, cross-sectional study with simple association. The analysis consisted of 222 pregnant women 16-42 years of age with low obstetric risk who had visited the outpatient services of the Obstetrics Department at the National Materno-Perinatal Institute in Lima, Peru, from 2 June-28 November 2006. Each pregnant woman was given the Edinburgh Depression Scale and a questionnaire on sociodemographic and obstetric data. The relationship between the study variables was determined by the presence of major depression revealed through either χ2 or Z tests, depending on variable type. RESULTS: Of the 222 pregnant women studied, 89 (40.1%) had major depression. Fewer married women tended to be depressed; those with unplanned pregnancies and pregnancy complications were more often depressed than their peers. Age, number of children, gestational stage, educational level, history of abortion/miscarriage, consumption of alcohol or other drugs, lack of family support, and perceived marital, family, or financial problems were not found to influence depression frequency. CONCLUSIONS: The prevalence of major depression among pregnant women was very high. Special attention should be given to women with unplanned pregnancies and those experiencing complications during pregnancy, so that an early diagnosis can be made and appropriate treatment offered.

The Partners Neurology Residency Program spans two neurology departments in Boston. The neurology departments of the Brigham and Women's and Massachusetts General Hospitals comprise of 325 faculty members and 53 neurology residents. Given this large community and the vast number of opportunities that are available at these academic institutions, it is critical to have a system to disseminate information and inform the neurology community of important events. In the era of digital technology, email and web-based media provide an opportunity for efficient communication. One way in which this is accomplished is by means of a weekly newsletter detailing lectures, academic conferences and departmental meetings. This bulletin, our ‘Neurology Weekly Events,’ has become an important fixture in maintaining cohesion within the programme. Our weekly newsletter provides a comprehensive list of daily events for the upcoming week including time and …

OBJETIVOS: Determinar la prevalencia de depresion mayor durante el embarazo y establecer las caracteristicas sociodemograficas y obstetricas de las mujeres embarazadas con depresion mayor atendidas en la consulta externa de un hospital de Lima, Peru. METODOS: Estudio descriptivo transversal de asociacion simple. Se analizaron 222 gestantes de 16 a 42 anos con bajo riesgo obstetrico que acudieron a la consulta externa del Departamento de Obstetricia del Instituto Nacional Materno Perinatal de Lima, Peru, entre el 2 de junio y el 28 de noviembre de 2006. A cada embarazada se le aplico la escala de depresion de Edimburgo y un cuestionario sobre datos sociodemograficos y obstetricos. Se determino la relacion entre las variables de estudio segun la presencia de depresion mayor mediante las pruebas de la χ2 y de la Z, segun el tipo de variable. RESULTADOS: De las 222 gestantes estudiadas, 89 (40,1%) presentaron depresion mayor. Las mujeres casadas tendian a deprimirse menos; las que no planificaron su embarazo y que presentaron complicaciones durante su gestacion tendieron a deprimirse mas que sus pares. No se encontro que la edad, el numero de hijos, la edad gestacional, el nivel educacional, los antecedentes de aborto, el consumo de alcohol u otras sustancias, la falta de apoyo familiar y la percepcion de tener problemas de pareja, familiares, economicos o personales influyeran en la frecuencia de depresion. CONCLUSIONES: La prevalencia de depresion mayor en las gestantes estudiadas fue muy elevada. Se debe prestar especial atencion a las mujeres que manifiestan tener un embarazo no planificado y las que sufren complicaciones durante su embarazo, a fin de llegar a diagnosticos tempranos y aplicar tratamientos oportunos.

To determine the prevalence of major depression during pregnancy and to define the sociodemographic and obstetric characteristics of pregnant women with major depression treated by the outpatient clinic at a hospital in Lima, Peru.A descriptive, cross-sectional study with simple association. The analysis consisted of 222 pregnant women 16-42 years of age with low obstetric risk who had visited the outpatient services of the Obstetrics Department at the National Materno-Perinatal Institute in Lima, Peru, from 2 June-28 November 2006. Each pregnant woman was given the Edinburgh Depression Scale and a questionnaire on sociodemographic and obstetric data. The relationship between the study variables was determined by the presence of major depression revealed through either chi2 or Z tests, depending on variable type.Of the 222 pregnant women studied, 89 (40.1%) had major depression. Fewer married women tended to be depressed; those with unplanned pregnancies and pregnancy complications were more often depressed than their peers. Age, number of children, gestational stage, educational level, history of abortion/miscarriage, consumption of alcohol or other drugs, lack of family support, and perceived marital, family, or financial problems were not found to influence depression frequency.The prevalence of major depression among pregnant women was very high. Special attention should be given to women with unplanned pregnancies and those experiencing complications during pregnancy, so that an early diagnosis can be made and appropriate treatment offered.

As an epileptologist, I have frequently navigated a demanding encounter with a psychogenic nonepileptic seizure patient. While I do attempt to uncover what is driving my patient's desire to seek the diagnostic label of seizure disorder, this is easier said than done.1 I often find myself ill-equipped for the time-consuming work involved in exploring and uncovering the family dynamics, relationship issues, …

Lauren Boehm, in “Half Someone Else's: Discourse and Trauma in the PNES Patient” (2013), highlights the importance of “history-listening” rather than “history-taking” in evaluating patients who may...