Neurodegenerative disease management最新文献

Aim: To evaluate adherence, healthcare resource utilization (HRU) and costs for glatiramer acetate (GA; injectable), dimethyl fumarate (oral) and teriflunomide (oral) in relapsing multiple sclerosis. Patients & methods: Retrospective analyses of a claims database. Results: Teriflunomide patients were older with more co-morbidities and fewer relapses versus GA and dimethyl fumarate. GA patients were mostly disease-modifying therapies (DMTs)-treatment naive. Treatment adherence was 61-70%. All DMTs reduced HRU versus pre-index. Costs were comparable across cohorts. High adherence reduced hospitalizations and several costs versus low adherers. Conclusion: Adherence rates were high and comparable with all DMTs. Similar (and high) reductions in HRU and costs occurred with all DMTs. High adherence improved economic outcomes versus low adherence. Thus, investing in adherence improvement is beneficial to improve outcomes in relapsing multiple sclerosis.

Aim: To examine three different accuracy metrics for evaluation of cognitive screening instruments: overall correct classification accuracy (Acc), the sum of true positives and negatives divided by the total number tested; balanced accuracy (balanced Acc), half of the sum of sensitivity and specificity; and unbiased accuracy (unbiased Acc), removing biasing effects of random associations between test results and disease prevalence. Materials & methods: Data from a prospective test accuracy study of Mini-Addenbrooke's Cognitive Examination were used to calculate and plot the Acc measures. Results: Each Acc metric resulted in a similar pattern of results across the range of Mini-Addenbrooke's Cognitive Examination cut-offs for diagnosis of both dementia and mild cognitive impairment. Acc and balanced Acc gave more optimistic outcomes (closer to possible maximum value of 1) than unbiased Acc. Conclusion: Unbiased Acc may have advantages over Acc and balanced Acc by removing biasing effects of random associations between test result and disease prevalence.

Aim: To evaluate a low carbohydrate/healthy fat/ketogenic diet (LCHF/KD) on symptoms, depression, anxiety and biomarkers in adults with Parkinson's disease (PD). Patients & methods: 16 adults ages 36-80 with PD participated in the intervention for 12 weeks. The study provided pre-post-study comparisons of biomarkers, weight, waist measurement, united Parkinson's Disease Rating Scale (UPDRS), Parkinson's Anxiety Scale (PAS) and Center for Epidemiologic Studies Depression Scale Revised-20 (CESD-R-20) Depression Scale. Results: Although LCHF/KD improves blood glucose in diabetes and seizure control in epilepsy, research gaps exist in this dietary intervention in PD. Statistically, significant improvements occurred in several measurements, PAS scores and Part I of the UPDRS. Conclusion: The LCHF/KD shows positive trends with improvements in biomarkers and anxiety symptoms. Further research is needed to evaluate dietary interventions for PD.

Chronic inflammatory demyelinating polyneuropathy, its variants and multifocal motor neuropathy belong to a spectrum of peripheral nerve disorders with complex dysimmune disease mechanisms. Awareness of the unique clinical phenotypes but also heterogeneity between patients is vital to arrive at early suspicion and ordering appropriate tests. This includes requirements for optimal electrodiagnostic protocol, aimed to capture sufficient electrophysiologic evidence for relevant abnormalities, a case-based approach on the eventual need to further expand the diagnostic armamentarium and correct reading of their results. Considerable phenotypical variation, diverse combinations of abnormalities found on diagnostic tests and heterogeneity in disease course and treatment response, all contribute to widespread differences in success rates on timely diagnosis and optimal treatment. We aim to provide a practical overview and guidance on relevant diagnostic and management strategies, including pitfalls and present a summary of the relevant novel developments in this field.

What is this summary about?: This is a plain language summary of an article originally published in the journal Frontiers in Neurology. People with multiple sclerosis (often shortened to MS) may have concerns about pregnancy and fertility. To understand more about these concerns, 332 people with MS in the USA, UK, France, Germany, Italy, and Spain took a survey with questions about how they made family planning decisions.

What were the results?: Most of the survey participants (around 82%) were women. The survey found that people with MS were less likely to have children than people without MS. Over half (56%) of people with MS said the disease impacted their family planning decisions in some way, almost one quarter (22%) significantly changed their plans for the timing of their pregnancy or number of children, and 14% decided against having children. For almost 4 out of 5 (81%) people with MS the main source of family planning information was healthcare professionals.

What do the results of the study mean?: Overall, MS significantly impacted patients' decisions about family planning.

Amantadine is an old, antiviral compound, which moderately improves motor behavior in Parkinson's disease. Its current resurgence results from an innovative, delayed uptake and extended release amantadine hydrochloride capsule, given at bedtime once daily. It is the only approved compound for reduction of involuntary movements, so called dyskinesia, in fluctuating orally levodopa treated patients. It additionally ameliorates 'OFF' intervals characterized by impaired motor behavior. These beneficial effects result from higher and more continuous brain delivery of amantadine. Future clinical research is warranted on preventive effects of this amantadine capsule combined with enzyme blockers of central monoamine oxidase B and peripheral catechol-O-methyltransferase on motor complications in orally levodopa treated patients, as all these pharmacological principles support the concept of continuous dopamine substitution.

Background: Accurate diagnosis and management of patients with rapidly progressive dementia may be challenging during the COVID-19 pandemic, which has negatively influenced the diagnostic performances, medical resource allocation and routine care for all non-COVID-19 diseases. Case presentation: We herein present a case of a 57-year-old male with rapidly progressive cognitive decline, headache, diplopia, myalgia, unsteady gait, aggression, depression, insomnia, hallucinations and delusions of persecution. COVID-19-associated encephalitis was briefly considered as a differential diagnosis. However, this hypothesis was rejected upon further investigation. A final diagnosis of sporadic Creutzfeldt-Jakob disease was made. Conclusion: A timely and accurate diagnosis of Creutzfeldt-Jakob disease gives patients and their families the chance to receive a good standard of healthcare and avoid extensive evaluations for other conditions.