Understanding Data and Opportunities Focused on Value: A Single-Center Experience in Headache Care.

Background And Objectives: Headache syndromes are highly prevalent, disabling, and costly. Our goals were to (1) describe headache care delivery and costs in a system and (2) identify opportunities for the system to collect, organize, or analyze health care data to facilitate value-based headache care delivery.

Methods: We performed a descriptive, retrospective cohort study using data from a large integrated health system (July 2018-July 2021).

Association of the Area Deprivation Index With Dementia Basic Workup and Diagnosis in Central and Western Virginia: A Cross-Sectional Study.

Background And Objectives: The Area Deprivation Index (ADI) provides a validated and multidimensional metric of areal disadvantage. Our goals were to determine if the ADI influences the likelihood of receiving workup based on published guidelines and an etiologic diagnosis of dementia in Central and Western Virginia.

Methods: We collected deidentified data from the electronic health record of individuals aged 50-105 years diagnosed with dementia at the University of Virginia (UVA) Medical Center (2016-2021) and at Carillion Clinic (2018-2021).

Primary Palliative Care in Huntington's Disease.

Background: Palliative care practices, including communication about patient-centered goals of care and advance care planning (ACP), have the potential to enhance care throughout the course of Huntington's disease (HD) and related disorders. The goal of our project was to develop a pilot program that integrates primary palliative care practices with interdisciplinary care for HD.

Objectives: (1) To train HD team members to facilitate goals of care and ACP conversations at all stages of HD; (2) To create materials for care planning in HD focused on patient-centered goals of care and health-related quality of life; and (3) To modify clinic workflow to include goals of care and ACP discussions.

Practical Considerations in the Administration of Aducanumab for the Neurologist.

Aducanumab (Aduhelm), developed by the biotechnology firm Biogen in Cambridge, MA, was approved using the less common accelerated approval pathway by the Federal Drug Administration (FDA) reserved for treatments that fill a significant unmet need. Its approval on June 7, 2021, has been met with an outpouring of opinions from prescribers, insurers, advocacy groups, and hospital systems regarding its risk-benefit profile. Originally approved for all forms of Alzheimer disease (AD), the FDA updated aducanumab's labeling on July 8, 2021, for "treatment in patients with mild cognitive impairment (MCI) or mild dementia stage of disease, the population in which treatment was initiated in clinical trials.

Paroxysmal Hypothermia With Prominent Parkinsonian Features After Suprachiasmatic Tumor Resection.

Paroxysmal hypothermia (PH) is a rare syndrome of stereotyped episodes of hypothermia, bradycardia, and altered mental status occurring in patients with hypothalamic lesions. Prior cases have mentioned bradykinesia, ataxia, and dysarthria, but parkinsonism has not been described as a specific feature of PH. We report two patients, an adult and a child, who developed PH after suprachiasmatic tumor resection, both with clinical presentations notable for prominent parkinsonian features despite no evidence of parkinsonism during the intervening months and years.

Multi-Dimensional, Short-Timescale Quantification of Parkinson's Disease and Essential Tremor Motor Dysfunction.

Parkinson's disease (PD) is a progressive movement disorder characterized by heterogenous motor dysfunction with fluctuations in severity. Objective, short-timescale characterization of this dysfunction is necessary as therapies become increasingly adaptive. This study aims to characterize a novel, naturalistic, and goal-directed tablet-based task and complementary analysis protocol designed to characterize the motor features of PD.

Response to Letter to the Editor.

In Response To: Walker RH. Reply to: Tardive dyskinesia-like syndrome due to drugs that do not block dopamine receptors: rare or non-existent: literature review. Tremor Other Hyperkinet Mov.

Tardive Dyskinesia-like Syndrome Due to Drugs that do not Block Dopamine Receptors: Rare or Non-existent: Literature Review.

Background: Although tardive dyskinesia (TD) is most commonly defined as a movement disorder caused by chronic exposure to dopamine-receptor-blocking drugs (DRBDs), it has also been thought to result from exposure to some non-DRBDs.

Methods: We critiqued many reviews making the association between non-DRBDs and a TD-like syndrome and almost all case reports. We checked whether cases met criteria for the diagnosis of TD-like syndrome and whether DRBDs had been excluded.

Is Diffusion Tensor Imaging a Good Biomarker for Early Parkinson's Disease?

To assess white matter abnormalities in Parkinson's disease (PD). A hundred and thirty-two patients with PD (mean age 60.93 years; average disease duration 7.

Parkinson's disease: A Quick Update.

Parkinson's disease is a neurodegenerative disorder characterized by motor and non-motor symptoms. Although the diagnosis still relies on the presence of motor signs, new diagnostic criteria have been proposed to incorporate recent observations in order to improve accuracy. The cornerstone of therapy remains dopamine replacement with L-Dopa.

Tardive dyskinesia: Epidemiology.

The term tardive syndrome (TS) encompasses a few different phenomenologic conditions, some of which occur in isolation and others in association with each other. This, along with the unusual confound for a drug side effect, in which increased use of the drug improves the problem, and the need for most patients to continue taking the offending drug, makes understanding the epidemiology difficult and unreliable. While the change from the "first generation" to the "second generation" of antipsychotic drugs is generally believed to have reduced the incidence of TS, prospective research studies have not supported that contention.

Exploratory structural assessment in craniocervical dystonia: Global and differential analyses.

Introduction: Our goal was to investigate the cortical thickness and subcortical volume in subjects with craniocervical dystonia and its subgroups.

Methods: We studied 49 subjects, 17 with cervical dystonia, 18 with blepharospasm or oromandibular dystonia, and 79 healthy controls. We performed a whole group analysis, followed by a subgroup analysis.

Cerebellar Gray Matter Alterations in Huntington Disease: A Voxel-Based Morphometry Study.

Neuropathological and neuroimaging studies in Huntington disease (HD) have suggested a role for the cerebellum. Our goal was to perform a detailed evaluation of cerebellar morphology. We performed the Unified HD rating scale (UHDRS) and Montreal cognitive assessment (MOCA) in 26 HD patients and 26 healthy controls.

Nonmotor Symptoms in Parkinson's Disease.

Nonmotor symptoms (NMSs) in Parkinson's disease (PD) have become increasingly recognized as major determinants of quality of life across cultures worldwide. Behavioral symptoms include dementia, depression, anxiety, apathy, and fatigue. Somatic symptoms include hypotension, constipation, diaphoresis, and pain.

Pattern of Reduced Functional Connectivity and Structural Abnormalities in Parkinson's Disease: An Exploratory Study.

Background: MRI brain changes in Parkinson's disease (PD) are controversial.

Objectives: We aimed to describe structural and functional changes in PD.

Methods: Sixty-six patients with PD (57.

Differential Pattern of Cerebellar Atrophy in Tremor-Predominant and Akinetic/Rigidity-Predominant Parkinson's Disease.

Parkinson's disease (PD) is an akinetic-rigid disorder characterized by basal ganglia dysfunction and a possible cerebello-thalamo-cortical circuit involvement. This study aims to investigate the pattern of cerebellar involvement in PD and to assess whether it correlates with clinical parameters. MRI scans were acquired from 50 healthy controls (HC) and 63 patients; 44 were classified as tremor-predominant-PD (PDT) and 19 as akinetic/rigidity-predominant-PD (PDAR).

Does Side of Onset Influence the Pattern of Cerebral Atrophy in Parkinson's Disease?

Background: Imaging studies have revealed widespread neurodegeneration in Parkinson's disease (PD), but only a few considered the issue of asymmetrical clinical presentations.

Objective: To investigate if the side of onset influences the pattern of gray matter (GM) atrophy in PD.

Methods: Sixty patients (57.

Fatigue and Its Associated Factors in Spinocerebellar Ataxia Type 3/Machado-Joseph Disease.

Fatigue has been described in several neurodegenerative diseases, reducing quality of life. A systematic evaluation of this clinical feature is lacking in SCA3/MJD. The aim of this study was to evaluate the frequency and the factors associated with fatigue in SCA3/MJD.

Nonneurological Involvement in Late-Onset Friedreich Ataxia (LOFA): Exploring the Phenotypes.

Friedreich's ataxia (FDRA) is the most common inherited ataxia worldwide, caused by homozygous GAA expansions in the FXN gene. Patients usually have early onset ataxia, areflexia, Babinski sign, scoliosis and pes cavus, but at least 25 % of cases have atypical phenotypes. Disease begins after the age of 25 in occasional patients (late-onset Friedreich ataxia (LOFA)).

Longitudinal magnetic resonance imaging study shows progressive pyramidal and callosal damage in Friedreich's ataxia.

Introduction: Spinal cord and peripheral nerves are classically known to be damaged in Friedreich's ataxia, but the extent of cerebral involvement in the disease and its progression over time are not yet characterized. The aim of this study was to evaluate longitudinally cerebral damage in Friedreich's ataxia.

Methods: We enrolled 31 patients and 40 controls, which were evaluated at baseline and after 1 and 2 years.

Dystonia in Machado-Joseph disease: Clinical profile, therapy and anatomical basis.

Introduction: Dystonia is frequent in Machado-Joseph disease, but several important aspects are not yet defined, such as the detailed clinical profile, response to treatment and anatomical substrate.

Methods: We screened 75 consecutive patients and identified those with dystonia. The Burke-Marsden-Fahn Dystonia Rating Scale was employed to quantify dystonia severity.

Asymptomatic carotid stenosis is associated with gray and white matter damage.

Background: Cognitive deficits in patients with asymptomatic carotid stenosis have been reported. The ultimate mechanism of cognitive deficits remains unclear and might be related to subtle structural brain damage.

Aims: The aim of the present study was to evaluate the presence of subtle white and grey matter abnormalities associated with asymptomatic carotid stenosis.