ana vives - Academia.edu (original) (raw)

Papers by ana vives

Research paper thumbnail of Use of amyloid PET scans in the clinical management of patients with cognitive decline in a naturalistic setting at a tertiary memory disorders clinic

Alzheimers & Dementia, Dec 1, 2021

Amyloid PET(aPET) is used to aid differential diagnosis, increase diagnostic confidence and assis... more Amyloid PET(aPET) is used to aid differential diagnosis, increase diagnostic confidence and assist with management of patients with cognitive decline. In the United States, aPETs are not often used because they are costly and not covered by insurance. VA Boston Healthcare System provides a unique opportunity where aPETs are available for clinical purposes and are ordered to assist in the differential diagnosis of patients with cognitive decline when clinically relevant. This study aims to determine which factors are associated with the use of aPET for diagnostic confirmation of AD in a naturalistic setting at a tertiary memory disorders clinic and to determine which factors predict an abnormal result.

Research paper thumbnail of Primary Writing Tremor

PubMed, 2018

Background: Primary writing tremor (PWT) is a rare condition; tremor occurs primarily while writi... more Background: Primary writing tremor (PWT) is a rare condition; tremor occurs primarily while writing rather than during other tasks. Phenomenology shown: We illustrate the phenomenology of PWT and point out associated subtle dystonic posturing on neurological examination. Educational value: PWT is a tremor disorder that shares clinical features with both dystonia and essential tremor.

Research paper thumbnail of Head Injury Exposure in Veterans Presenting to Memory Disorders Clinic: An Observational Study of Clinical Characteristics and Relationship of Event-Related Potentials and Imaging Markers

Frontiers in Neurology, Jun 14, 2021

Traumatic brain injury (TBI) and repetitive head impacts (RHI) related to blasts or contact sport... more Traumatic brain injury (TBI) and repetitive head impacts (RHI) related to blasts or contact sports are commonly reported among military service members. However, the clinical implications of remote TBI and RHI in veterans remains a challenge when evaluating older veterans at risk of neurodegenerative conditions including Alzheimer's disease (AD) and Chronic Traumatic Encephalopathy (CTE). This study aimed to test the hypothesis that veterans in a memory disorders clinic with remote head injury would be more likely to have neurodegenerative clinical diagnoses, increased rates of amyloid PET positivity, higher prevalence of cavum septum pellucidi/vergae, and alterations in event-related potential (ERP) middle latency auditory evoked potentials (MLAEPs) and long latency ERP responses compared to those without head injuries. Methods: Older veterans aged 50-100 were recruited from a memory disorders clinic at VA Boston Healthcare system with a history of head injury (n = 72) and without head injury history (n = 52). Patients were classified as reporting prior head injury including TBI and/or RHI exposure based on self-report and chart review. Participants underwent MRI to determine presence/absence of cavum and an ERP auditory oddball protocol. Results: The head injury group was equally likely to have a positive amyloid PET compared to the non-head injury group. Additionally, the head injury group were less likely to have a diagnosis of a neurodegenerative condition than those without head injury. P200 target amplitude and MLAEP amplitudes for standard and target tones were decreased in the head injury group compared to the non-head injury group while P3b amplitude did not differ. Conclusions: Veterans with reported remote head injury evaluated in a memory disorders clinic were not more likely to have a neurodegenerative diagnosis or imaging Turk et al. Head Injury in Veterans markers of neurodegeneration than those without head injury. Decreased P200 target and MLAEP target and standard tone amplitudes in the head injury group may be relevant as potential diagnostic markers of remote head injury.

Research paper thumbnail of Reversible Amnestic Cognitive Impairment in a Patient With Brain Sagging Syndrome

Neurology, May 29, 2020

A. Vives-Rodriguez reports no disclosures. K. Turk is supported by a grant from the Alzheimer's A... more A. Vives-Rodriguez reports no disclosures. K. Turk is supported by a grant from the Alzheimer's Association. E. Vassey served on the Alzheimer's disease scientific advisory board and received honoraria from Biogen and received research support from Neuronetrix, Inc. T. Singhal reports no disclosures. C. Cho served on the North American Spine Society Board of Directors and received reimbursement of travel expenses only. A. Budson has been a consultant for Eli Lilly, Corium, Cognito, and Sage, and a clinical trial investigator for Biogen, Eli Lilly, vTv therapeutics, and Cognito.

Research paper thumbnail of Impact of amyloid PET in the clinical care of US Veterans in a Tertiary Memory Disorders Clinic

Alzheimers & Dementia, Dec 1, 2022

BackgroundPrior studies assessing the clinical impact of amyloid PET have been limited to assessm... more BackgroundPrior studies assessing the clinical impact of amyloid PET have been limited to assessments before and after the scan. We aim to characterize the impact of amyloid PET in a veterans population with cognitive decline by comparing differences in clinical management within two years of follow‐up.MethodsThe current retrospective observational study includes all patients seen for an initial evaluation for cognitive complaints in the Memory Disorders Clinic at the VA Boston Healthcare System from October 2016 to January 2020. Clinical impact outcomes within two years of follow‐up were compared between patients with and without an aPET scan. Poisson regressions, negative binomial regressions, and binomial logistic regression were used for the analysis. Age, cognitive syndrome, follow‐up time, clinical diagnosis after initial evaluation and MoCA scores were used as covariates. Additionally, propensity score matching was performed to balance confounders between the two groups. To further understand the clinical impact outcomes in the aPET group, multiple regressions were performed within the group.ResultsFive‐hundred‐sixty‐five veterans were included in the analysis. Thirty‐five percent of patients underwent aPET imaging in addition to routine diagnostic workup. The study was positive in 72 patients (36.56%). Having an aPET, in addition to the usual diagnostic workup, was associated with a longer follow‐up time, and a higher diagnostic variability at follow‐up. We did not find an association between aPET use and the number of additional diagnostic studies ordered, early cholinesterase inhibitors prescription, or referrals to social work, research and clinical trials. When analyzing the same clinical utility outcomes within the group with an aPET, we found that a positive result was associated with fewer additional diagnostic tests, less diagnostic variability at follow up visits, more cholinesterase inhibitors prescription, and more research referrals.ConclusionsIn medically complex populations, aPET positivity might be lower than prior studies have described, used more to “rule out” than confirm the diagnosis of Alzheimer’s disease. This lower positivity rate results in less robust differences in classically explored clinical impact variables when comparing patients with and without an aPET.

Research paper thumbnail of Impact of amyloid PET in the clinical care of veterans in a tertiary memory disorders clinic

Alzheimer's & Dementia: Translational Research & Clinical Interventions, 2022

IntroductionWe aimed to characterize the clinical impact of amyloid PET (APET) in a veteran popul... more IntroductionWe aimed to characterize the clinical impact of amyloid PET (APET) in a veteran population with cognitive decline by comparing differences in management between those who did and did not have an APET.MethodsThis was a retrospective observational study. Poisson regressions and logistic regression were used for comparisons.ResultsOut of 565 veterans, 197 underwent APET; positivity rate was 36.55%. Having an APET was associated with longer follow‐up, and increased diagnostic variability; it was not associated with number of additional studies, cholinesterase inhibitors prescription, or referrals to research. A positive APET was associated with less diagnostic variability, fewer additional tests, greater cholinesterase inhibitor prescriptions, and more research referrals.DiscussionIn a medically complex, real‐world population, APET yielded lower positivity rates and was not associated with classical clinical utility variables when comparing patients with and without an APET. APET may be used more to “rule out” rather than to confirm Alzheimer's disease.Highlights Amyloid PET was associated with longer follow‐up, and higher diagnostic variability.No association was seen with cholinesterase inhibitors prescription, or referrals to research.In complex patients, expected amyloid PET positivity rates are lower than previously described.Amyloid PETs were used to “rule out” AD than to confirm the diagnosis of AD.

Research paper thumbnail of Home-Based Electronic Cognitive Therapy in Patients With Alzheimer Disease: Feasibility Randomized Controlled Trial

JMIR formative research, Sep 12, 2022

If this is a JMIR submission, please provide the manuscript tracking number under "other" (The ms... more If this is a JMIR submission, please provide the manuscript tracking number under "other" (The ms tracking number can be found in the submission acknowledgement email, or when you login as author in JMIR. If the paper is already published in JMIR, then the ms tracking number is the four-digit number at the end of the DOI, to be found at the bottom of each published article in JMIR) #34450 You're editing your response. Sharing this URL allows others to also edit your response.

Research paper thumbnail of Structural and functional brain changes in hepatic and neurological Wilson disease

Brain Imaging and Behavior, Nov 26, 2020

Wilson disease (WD) can manifest with hepatic or neuropsychiatric symptoms. Our understanding of ... more Wilson disease (WD) can manifest with hepatic or neuropsychiatric symptoms. Our understanding of the in vivo brain changes in WD, particularly in the hepatic phenotype, is limited. Thirty subjects with WD and 30 age-and gender-matched controls participated. WD group underwent neuropsychiatric assessment. Unified WD Rating Scale neurological exam scores were used to determine neurological (WDN, score > 0) and hepatic-only (WDH, score 0) subgroups. All subjects underwent 3 Tesla anatomical and resting-state functional MRI. Diffusion tensor imaging (DTI) and susceptibility-weighted imaging (SWI) were performed only in the WD group. Volumetric, DTI, and functional connectivity analyses were performed to determine betweengroup differences. WDN and WDH groups were matched in demographic and psychiatric profiles. The entire WD group compared to controls showed significant thinning in the bilateral superior frontal cortex. The WDN group compared to control and WDH groups showed prominent structural brain changes including significant striatal and thalamic atrophy, more subcortical hypointense lesions on SWI, and diminished white matter integrity in the bilateral anterior corona radiata and corpus callosum. However, the WDH group also showed significant white matter volume loss compared to controls. The functional connectivity between the frontostriatal nodes was significantly reduced in the WDN group, whereas that of the hippocampus was significantly increased in the WDH group compared to controls. In summary, structural and functional brain changes were present even in neurologically non-manifesting WD patients in this cross-sectional study. Longitudinal brain MRI scans may be useful as biomarkers for prognostication and optimization of treatment strategies in WD.

Research paper thumbnail of Treatment of Neurological Symptoms in Wilson Disease

Clinical gastroenterology, 2018

Brain copper accumulation commonly causes neurological symptoms in Wilson disease (WD). Many of t... more Brain copper accumulation commonly causes neurological symptoms in Wilson disease (WD). Many of the neurological manifestations that are present in WD involve movement disorders such as tremor, dysarthria, parkinsonism, dystonia, and gait impairment. Current de-coppering therapy provides in most cases only partial improvement of the neurological aspects of WD, and the use of medications to treat residual neurological symptoms is commonly required to improve patients’ quality of life. The evidence assessing the efficacy of different therapeutic options for movement disorders in WD is limited. This chapter aims to review the most common neurological manifestations in WD and the therapeutic options currently available.

Research paper thumbnail of The association between electrophysiological and neuropsychological measures and cardiovascular disease in patients with Alzheimer’s Disease dementia

Alzheimer's & Dementia

BackgroundElectrophysiological and neuropsychological measures are useful markers of Alzheimer’s ... more BackgroundElectrophysiological and neuropsychological measures are useful markers of Alzheimer’s Disease (AD); however, it is still unclear how these measures relate to the cardiovascular profile of AD patients, and their influence on disease progression and management. Our study examined how electrophysiological and neuropsychological measures are associated with cardiovascular risk factors and the severity of small vessel disease among patients with AD dementia.MethodData were collected using a seven‐electrode COGNISION™ rig in 185 older veterans from the VA Boston Healthcare system memory disorders clinic. EEG/ERP data were recorded while participants completed a three‐tone auditory oddball task. All subjects were administered a neuropsychological battery composed of 8 subtests. Through review of medical history, we selected a subset of patients (N = 46) that met the following criteria: core clinical criteria for probable AD dementia, ≥ 65 years of age, and MMSE score between 20 ...

Research paper thumbnail of Patient Companionship in a Movement Disorders Clinic: Outside Assistance Inside the Office

Frontiers in Neurology, Mar 5, 2019

Objective: We (1) report whether a companion (i.e., spouse, relative, aide) accompanied our conse... more Objective: We (1) report whether a companion (i.e., spouse, relative, aide) accompanied our consecutive outpatients with a range of movement disorders, (2) identified the set of patient characteristics that was associated with the need for a visit companion, and (3) characterized the role(s) of these companions during the visit. Our overarching goals were to further understand patient needs and the extent of their support networks, and to enrich the clinician-patient interface. Methods: Two-hundred consecutive patients were enrolled from the Movement Disorders Clinic at Yale School of Medicine. We noted whether patients were accompanied by another person during the visit and documented the role of the visit companion during the encounter. Results: One-hundred-twenty-eight of 200 patients (64.0%) brought a companion, with these being spouses (44.8%), adult children (24.1%) or an aide, nurse or social worker (14.5%). Patients who were unemployed (odds ratio [OR] = 5.32, p = 0.019), had a diagnosis of Parkinson's disease or other Parkinsonian syndromes (OR = 10.61, p = 0.001), or were dependent in any instrumental activities of daily living (iADLs) (OR = 4.99, p = 0.005) or basic activities of daily living (bADLs) (OR = 5.81, p = 0.02), had increased odds of presenting to the clinical visit with a visit companion. Visit companions' main roles involved communication (86.7%) and transportation (84.4%). Conclusion: Visit companions were commonly present during movement disorders outpatient visits-two-thirds of patients were accompanied. A number of factors increased the odds of requiring such a companion by 4-or 5-fold.

Research paper thumbnail of Amyloid PET ordering practices in a memory disorders clinic

Alzheimer's & Dementia: Translational Research & Clinical Interventions, 2022

Research paper thumbnail of Home-Based Electronic Cognitive Therapy in Patients With Alzheimer Disease: Feasibility Randomized Controlled Trial

JMIR Formative Research

Background Can home-based computerized cognitive training programs be a useful tool to sustain co... more Background Can home-based computerized cognitive training programs be a useful tool to sustain cognition and quality of life in patients with Alzheimer disease (AD)? To date, the progressive nature of the disease has made this question difficult to answer. Computerized platforms provide more accessibility to cognitive trainings; however, the feasibility of long-term, home-based computerized programs for patients with AD dementia remains unclear. Objective We aimed to investigate the feasibility of a 24-week home-based intervention program using the Constant Therapy app and its preliminary efficacy on cognition in patients with AD. Constant Therapy is a program developed for patients with speech and cognitive deficits. We hypothesized that patients with AD would use Constant Therapy daily over the course of the 24-week period. Methods Data were collected over a 48-week period. We recruited participants aged between 50 and 90 years with a diagnosis of mild cognitive impairment due to ...

Research paper thumbnail of Impact of amyloid PET in the clinical care of US Veterans in a Tertiary Memory Disorders Clinic

Alzheimer's & Dementia

Research paper thumbnail of Impact of amyloid PET in the clinical care of veterans in a tertiary memory disorders clinic

Alzheimer's & Dementia: Translational Research & Clinical Interventions

Introduction: We aimed to characterize the clinical impact of amyloid PET (APET) in a veteran pop... more Introduction: We aimed to characterize the clinical impact of amyloid PET (APET) in a veteran population with cognitive decline by comparing differences in management between those who did and did not have an APET. Methods: This was a retrospective observational study. Poisson regressions and logistic regression were used for comparisons. Results: Out of 565 veterans, 197 underwent APET; positivity rate was 36.55%. Having an APET was associated with longer follow-up, and increased diagnostic variability; it was not associated with number of additional studies, cholinesterase inhibitors prescription, or referrals to research. A positive APET was associated with less diagnostic variability, fewer additional tests, greater cholinesterase inhibitor prescriptions, and more research referrals. Discussion: In a medically complex, real-world population, APET yielded lower positivity rates and was not associated with classical clinical utility variables when comparing patients with and without an APET. APET may be used more to "rule out" rather than to confirm Alzheimer's disease.

Research paper thumbnail of Peak alpha frequency and N200 latency as predictors of neuropsychological performance in a memory disorders clinic

Alzheimer's & Dementia, 2021

Research paper thumbnail of Amyloid PET ordering practices in a memory disorders clinic

Alzheimer's & Dementia: Translational Research & Clinical Interventions

Research paper thumbnail of Treatment of Neurological Symptoms in Wilson Disease

Clinical Gastroenterology, 2018

Brain copper accumulation commonly causes neurological symptoms in Wilson disease (WD). Many of t... more Brain copper accumulation commonly causes neurological symptoms in Wilson disease (WD). Many of the neurological manifestations that are present in WD involve movement disorders such as tremor, dysarthria, parkinsonism, dystonia, and gait impairment. Current de-coppering therapy provides in most cases only partial improvement of the neurological aspects of WD, and the use of medications to treat residual neurological symptoms is commonly required to improve patients’ quality of life. The evidence assessing the efficacy of different therapeutic options for movement disorders in WD is limited. This chapter aims to review the most common neurological manifestations in WD and the therapeutic options currently available.

Research paper thumbnail of Use of amyloid PET scans in the clinical management of patients with cognitive decline in a naturalistic setting at a tertiary memory disorders clinic

Alzheimer's & Dementia, 2021

Research paper thumbnail of Beliefs about the COVID‐19 pandemic, trust in government, and vaccine intention in older adults with cognitive impairment in the United States and Italy

Alzheimer's & Dementia, 2021

The degree and spread of misinformation regarding the COVID-19 pandemic has been prolific, influe... more The degree and spread of misinformation regarding the COVID-19 pandemic has been prolific, influencing individuals of all ages. We examined belief in misinformation in older individuals with and without cognitive impairment in Boston, MA (United States) and Chieti (Italy). The purpose of this investigation was to compare the two cohorts on specific misconceptions, trust in media and government, perceived risk regarding COVID-19, and their relation to COVID-19 vaccine hesitancy and intention. Forty-seven subjects from the U.S. (mean age = 75.4, SD = 9.4) and 134 subjects from Italy (mean age = 72.2, SD = 7.7) were administered a telephone neuropsychological battery and MoCA. One hundred twenty-two individuals (67.4%) met the cutoff for cognitive impairment. Individuals answered a COVID-19 Misinformation Questionnaire and Perceived Risk Scale. A Vaccine Hesitancy Scale was administered 4-6 months after the initial assessment. Comparisons were made between the two cohorts using binary logistic regression, controlling for age, education, and cognitive status (i.e., MoCA). Individuals in the Italian cohort demonstrated greater perceived risk of contracting COVID-19 and also greater trust in the government as a source of information. A large proportion of the sample (N=160; 88.4%) rated the media as not at all trustworthy. Greater cognitive impairment was predictive of misconception endorsement. Further, individuals in the U.S. cohort were approximately four times as likely as individuals in the Italian cohort to believe that that COVID-19 was a bioweapon developed by a government or terrorist organization. Trust indices were not related to misconception belief. Examination of vaccine hesitancy, and confirmation of the preliminary analyses, will be undertaken following completed recruitment and testing. When individuals hold knowledge that is incorrect, the consequences can be manifold. From our preliminary analyses, we found that trust in government was not related to misconception endorsement; however, differences emerged between the U.S. and Italian cohorts. This examination provides a broad, cultural context to complex health beliefs, with specific implications for health behaviors such as vaccine intention, for individuals with and without cognitive impairment.

Research paper thumbnail of Use of amyloid PET scans in the clinical management of patients with cognitive decline in a naturalistic setting at a tertiary memory disorders clinic

Alzheimers & Dementia, Dec 1, 2021

Amyloid PET(aPET) is used to aid differential diagnosis, increase diagnostic confidence and assis... more Amyloid PET(aPET) is used to aid differential diagnosis, increase diagnostic confidence and assist with management of patients with cognitive decline. In the United States, aPETs are not often used because they are costly and not covered by insurance. VA Boston Healthcare System provides a unique opportunity where aPETs are available for clinical purposes and are ordered to assist in the differential diagnosis of patients with cognitive decline when clinically relevant. This study aims to determine which factors are associated with the use of aPET for diagnostic confirmation of AD in a naturalistic setting at a tertiary memory disorders clinic and to determine which factors predict an abnormal result.

Research paper thumbnail of Primary Writing Tremor

PubMed, 2018

Background: Primary writing tremor (PWT) is a rare condition; tremor occurs primarily while writi... more Background: Primary writing tremor (PWT) is a rare condition; tremor occurs primarily while writing rather than during other tasks. Phenomenology shown: We illustrate the phenomenology of PWT and point out associated subtle dystonic posturing on neurological examination. Educational value: PWT is a tremor disorder that shares clinical features with both dystonia and essential tremor.

Research paper thumbnail of Head Injury Exposure in Veterans Presenting to Memory Disorders Clinic: An Observational Study of Clinical Characteristics and Relationship of Event-Related Potentials and Imaging Markers

Frontiers in Neurology, Jun 14, 2021

Traumatic brain injury (TBI) and repetitive head impacts (RHI) related to blasts or contact sport... more Traumatic brain injury (TBI) and repetitive head impacts (RHI) related to blasts or contact sports are commonly reported among military service members. However, the clinical implications of remote TBI and RHI in veterans remains a challenge when evaluating older veterans at risk of neurodegenerative conditions including Alzheimer's disease (AD) and Chronic Traumatic Encephalopathy (CTE). This study aimed to test the hypothesis that veterans in a memory disorders clinic with remote head injury would be more likely to have neurodegenerative clinical diagnoses, increased rates of amyloid PET positivity, higher prevalence of cavum septum pellucidi/vergae, and alterations in event-related potential (ERP) middle latency auditory evoked potentials (MLAEPs) and long latency ERP responses compared to those without head injuries. Methods: Older veterans aged 50-100 were recruited from a memory disorders clinic at VA Boston Healthcare system with a history of head injury (n = 72) and without head injury history (n = 52). Patients were classified as reporting prior head injury including TBI and/or RHI exposure based on self-report and chart review. Participants underwent MRI to determine presence/absence of cavum and an ERP auditory oddball protocol. Results: The head injury group was equally likely to have a positive amyloid PET compared to the non-head injury group. Additionally, the head injury group were less likely to have a diagnosis of a neurodegenerative condition than those without head injury. P200 target amplitude and MLAEP amplitudes for standard and target tones were decreased in the head injury group compared to the non-head injury group while P3b amplitude did not differ. Conclusions: Veterans with reported remote head injury evaluated in a memory disorders clinic were not more likely to have a neurodegenerative diagnosis or imaging Turk et al. Head Injury in Veterans markers of neurodegeneration than those without head injury. Decreased P200 target and MLAEP target and standard tone amplitudes in the head injury group may be relevant as potential diagnostic markers of remote head injury.

Research paper thumbnail of Reversible Amnestic Cognitive Impairment in a Patient With Brain Sagging Syndrome

Neurology, May 29, 2020

A. Vives-Rodriguez reports no disclosures. K. Turk is supported by a grant from the Alzheimer's A... more A. Vives-Rodriguez reports no disclosures. K. Turk is supported by a grant from the Alzheimer's Association. E. Vassey served on the Alzheimer's disease scientific advisory board and received honoraria from Biogen and received research support from Neuronetrix, Inc. T. Singhal reports no disclosures. C. Cho served on the North American Spine Society Board of Directors and received reimbursement of travel expenses only. A. Budson has been a consultant for Eli Lilly, Corium, Cognito, and Sage, and a clinical trial investigator for Biogen, Eli Lilly, vTv therapeutics, and Cognito.

Research paper thumbnail of Impact of amyloid PET in the clinical care of US Veterans in a Tertiary Memory Disorders Clinic

Alzheimers & Dementia, Dec 1, 2022

BackgroundPrior studies assessing the clinical impact of amyloid PET have been limited to assessm... more BackgroundPrior studies assessing the clinical impact of amyloid PET have been limited to assessments before and after the scan. We aim to characterize the impact of amyloid PET in a veterans population with cognitive decline by comparing differences in clinical management within two years of follow‐up.MethodsThe current retrospective observational study includes all patients seen for an initial evaluation for cognitive complaints in the Memory Disorders Clinic at the VA Boston Healthcare System from October 2016 to January 2020. Clinical impact outcomes within two years of follow‐up were compared between patients with and without an aPET scan. Poisson regressions, negative binomial regressions, and binomial logistic regression were used for the analysis. Age, cognitive syndrome, follow‐up time, clinical diagnosis after initial evaluation and MoCA scores were used as covariates. Additionally, propensity score matching was performed to balance confounders between the two groups. To further understand the clinical impact outcomes in the aPET group, multiple regressions were performed within the group.ResultsFive‐hundred‐sixty‐five veterans were included in the analysis. Thirty‐five percent of patients underwent aPET imaging in addition to routine diagnostic workup. The study was positive in 72 patients (36.56%). Having an aPET, in addition to the usual diagnostic workup, was associated with a longer follow‐up time, and a higher diagnostic variability at follow‐up. We did not find an association between aPET use and the number of additional diagnostic studies ordered, early cholinesterase inhibitors prescription, or referrals to social work, research and clinical trials. When analyzing the same clinical utility outcomes within the group with an aPET, we found that a positive result was associated with fewer additional diagnostic tests, less diagnostic variability at follow up visits, more cholinesterase inhibitors prescription, and more research referrals.ConclusionsIn medically complex populations, aPET positivity might be lower than prior studies have described, used more to “rule out” than confirm the diagnosis of Alzheimer’s disease. This lower positivity rate results in less robust differences in classically explored clinical impact variables when comparing patients with and without an aPET.

Research paper thumbnail of Impact of amyloid PET in the clinical care of veterans in a tertiary memory disorders clinic

Alzheimer's & Dementia: Translational Research & Clinical Interventions, 2022

IntroductionWe aimed to characterize the clinical impact of amyloid PET (APET) in a veteran popul... more IntroductionWe aimed to characterize the clinical impact of amyloid PET (APET) in a veteran population with cognitive decline by comparing differences in management between those who did and did not have an APET.MethodsThis was a retrospective observational study. Poisson regressions and logistic regression were used for comparisons.ResultsOut of 565 veterans, 197 underwent APET; positivity rate was 36.55%. Having an APET was associated with longer follow‐up, and increased diagnostic variability; it was not associated with number of additional studies, cholinesterase inhibitors prescription, or referrals to research. A positive APET was associated with less diagnostic variability, fewer additional tests, greater cholinesterase inhibitor prescriptions, and more research referrals.DiscussionIn a medically complex, real‐world population, APET yielded lower positivity rates and was not associated with classical clinical utility variables when comparing patients with and without an APET. APET may be used more to “rule out” rather than to confirm Alzheimer's disease.Highlights Amyloid PET was associated with longer follow‐up, and higher diagnostic variability.No association was seen with cholinesterase inhibitors prescription, or referrals to research.In complex patients, expected amyloid PET positivity rates are lower than previously described.Amyloid PETs were used to “rule out” AD than to confirm the diagnosis of AD.

Research paper thumbnail of Home-Based Electronic Cognitive Therapy in Patients With Alzheimer Disease: Feasibility Randomized Controlled Trial

JMIR formative research, Sep 12, 2022

If this is a JMIR submission, please provide the manuscript tracking number under "other" (The ms... more If this is a JMIR submission, please provide the manuscript tracking number under "other" (The ms tracking number can be found in the submission acknowledgement email, or when you login as author in JMIR. If the paper is already published in JMIR, then the ms tracking number is the four-digit number at the end of the DOI, to be found at the bottom of each published article in JMIR) #34450 You're editing your response. Sharing this URL allows others to also edit your response.

Research paper thumbnail of Structural and functional brain changes in hepatic and neurological Wilson disease

Brain Imaging and Behavior, Nov 26, 2020

Wilson disease (WD) can manifest with hepatic or neuropsychiatric symptoms. Our understanding of ... more Wilson disease (WD) can manifest with hepatic or neuropsychiatric symptoms. Our understanding of the in vivo brain changes in WD, particularly in the hepatic phenotype, is limited. Thirty subjects with WD and 30 age-and gender-matched controls participated. WD group underwent neuropsychiatric assessment. Unified WD Rating Scale neurological exam scores were used to determine neurological (WDN, score > 0) and hepatic-only (WDH, score 0) subgroups. All subjects underwent 3 Tesla anatomical and resting-state functional MRI. Diffusion tensor imaging (DTI) and susceptibility-weighted imaging (SWI) were performed only in the WD group. Volumetric, DTI, and functional connectivity analyses were performed to determine betweengroup differences. WDN and WDH groups were matched in demographic and psychiatric profiles. The entire WD group compared to controls showed significant thinning in the bilateral superior frontal cortex. The WDN group compared to control and WDH groups showed prominent structural brain changes including significant striatal and thalamic atrophy, more subcortical hypointense lesions on SWI, and diminished white matter integrity in the bilateral anterior corona radiata and corpus callosum. However, the WDH group also showed significant white matter volume loss compared to controls. The functional connectivity between the frontostriatal nodes was significantly reduced in the WDN group, whereas that of the hippocampus was significantly increased in the WDH group compared to controls. In summary, structural and functional brain changes were present even in neurologically non-manifesting WD patients in this cross-sectional study. Longitudinal brain MRI scans may be useful as biomarkers for prognostication and optimization of treatment strategies in WD.

Research paper thumbnail of Treatment of Neurological Symptoms in Wilson Disease

Clinical gastroenterology, 2018

Brain copper accumulation commonly causes neurological symptoms in Wilson disease (WD). Many of t... more Brain copper accumulation commonly causes neurological symptoms in Wilson disease (WD). Many of the neurological manifestations that are present in WD involve movement disorders such as tremor, dysarthria, parkinsonism, dystonia, and gait impairment. Current de-coppering therapy provides in most cases only partial improvement of the neurological aspects of WD, and the use of medications to treat residual neurological symptoms is commonly required to improve patients’ quality of life. The evidence assessing the efficacy of different therapeutic options for movement disorders in WD is limited. This chapter aims to review the most common neurological manifestations in WD and the therapeutic options currently available.

Research paper thumbnail of The association between electrophysiological and neuropsychological measures and cardiovascular disease in patients with Alzheimer’s Disease dementia

Alzheimer's & Dementia

BackgroundElectrophysiological and neuropsychological measures are useful markers of Alzheimer’s ... more BackgroundElectrophysiological and neuropsychological measures are useful markers of Alzheimer’s Disease (AD); however, it is still unclear how these measures relate to the cardiovascular profile of AD patients, and their influence on disease progression and management. Our study examined how electrophysiological and neuropsychological measures are associated with cardiovascular risk factors and the severity of small vessel disease among patients with AD dementia.MethodData were collected using a seven‐electrode COGNISION™ rig in 185 older veterans from the VA Boston Healthcare system memory disorders clinic. EEG/ERP data were recorded while participants completed a three‐tone auditory oddball task. All subjects were administered a neuropsychological battery composed of 8 subtests. Through review of medical history, we selected a subset of patients (N = 46) that met the following criteria: core clinical criteria for probable AD dementia, ≥ 65 years of age, and MMSE score between 20 ...

Research paper thumbnail of Patient Companionship in a Movement Disorders Clinic: Outside Assistance Inside the Office

Frontiers in Neurology, Mar 5, 2019

Objective: We (1) report whether a companion (i.e., spouse, relative, aide) accompanied our conse... more Objective: We (1) report whether a companion (i.e., spouse, relative, aide) accompanied our consecutive outpatients with a range of movement disorders, (2) identified the set of patient characteristics that was associated with the need for a visit companion, and (3) characterized the role(s) of these companions during the visit. Our overarching goals were to further understand patient needs and the extent of their support networks, and to enrich the clinician-patient interface. Methods: Two-hundred consecutive patients were enrolled from the Movement Disorders Clinic at Yale School of Medicine. We noted whether patients were accompanied by another person during the visit and documented the role of the visit companion during the encounter. Results: One-hundred-twenty-eight of 200 patients (64.0%) brought a companion, with these being spouses (44.8%), adult children (24.1%) or an aide, nurse or social worker (14.5%). Patients who were unemployed (odds ratio [OR] = 5.32, p = 0.019), had a diagnosis of Parkinson's disease or other Parkinsonian syndromes (OR = 10.61, p = 0.001), or were dependent in any instrumental activities of daily living (iADLs) (OR = 4.99, p = 0.005) or basic activities of daily living (bADLs) (OR = 5.81, p = 0.02), had increased odds of presenting to the clinical visit with a visit companion. Visit companions' main roles involved communication (86.7%) and transportation (84.4%). Conclusion: Visit companions were commonly present during movement disorders outpatient visits-two-thirds of patients were accompanied. A number of factors increased the odds of requiring such a companion by 4-or 5-fold.

Research paper thumbnail of Amyloid PET ordering practices in a memory disorders clinic

Alzheimer's & Dementia: Translational Research & Clinical Interventions, 2022

Research paper thumbnail of Home-Based Electronic Cognitive Therapy in Patients With Alzheimer Disease: Feasibility Randomized Controlled Trial

JMIR Formative Research

Background Can home-based computerized cognitive training programs be a useful tool to sustain co... more Background Can home-based computerized cognitive training programs be a useful tool to sustain cognition and quality of life in patients with Alzheimer disease (AD)? To date, the progressive nature of the disease has made this question difficult to answer. Computerized platforms provide more accessibility to cognitive trainings; however, the feasibility of long-term, home-based computerized programs for patients with AD dementia remains unclear. Objective We aimed to investigate the feasibility of a 24-week home-based intervention program using the Constant Therapy app and its preliminary efficacy on cognition in patients with AD. Constant Therapy is a program developed for patients with speech and cognitive deficits. We hypothesized that patients with AD would use Constant Therapy daily over the course of the 24-week period. Methods Data were collected over a 48-week period. We recruited participants aged between 50 and 90 years with a diagnosis of mild cognitive impairment due to ...

Research paper thumbnail of Impact of amyloid PET in the clinical care of US Veterans in a Tertiary Memory Disorders Clinic

Alzheimer's & Dementia

Research paper thumbnail of Impact of amyloid PET in the clinical care of veterans in a tertiary memory disorders clinic

Alzheimer's & Dementia: Translational Research & Clinical Interventions

Introduction: We aimed to characterize the clinical impact of amyloid PET (APET) in a veteran pop... more Introduction: We aimed to characterize the clinical impact of amyloid PET (APET) in a veteran population with cognitive decline by comparing differences in management between those who did and did not have an APET. Methods: This was a retrospective observational study. Poisson regressions and logistic regression were used for comparisons. Results: Out of 565 veterans, 197 underwent APET; positivity rate was 36.55%. Having an APET was associated with longer follow-up, and increased diagnostic variability; it was not associated with number of additional studies, cholinesterase inhibitors prescription, or referrals to research. A positive APET was associated with less diagnostic variability, fewer additional tests, greater cholinesterase inhibitor prescriptions, and more research referrals. Discussion: In a medically complex, real-world population, APET yielded lower positivity rates and was not associated with classical clinical utility variables when comparing patients with and without an APET. APET may be used more to "rule out" rather than to confirm Alzheimer's disease.

Research paper thumbnail of Peak alpha frequency and N200 latency as predictors of neuropsychological performance in a memory disorders clinic

Alzheimer's & Dementia, 2021

Research paper thumbnail of Amyloid PET ordering practices in a memory disorders clinic

Alzheimer's & Dementia: Translational Research & Clinical Interventions

Research paper thumbnail of Treatment of Neurological Symptoms in Wilson Disease

Clinical Gastroenterology, 2018

Brain copper accumulation commonly causes neurological symptoms in Wilson disease (WD). Many of t... more Brain copper accumulation commonly causes neurological symptoms in Wilson disease (WD). Many of the neurological manifestations that are present in WD involve movement disorders such as tremor, dysarthria, parkinsonism, dystonia, and gait impairment. Current de-coppering therapy provides in most cases only partial improvement of the neurological aspects of WD, and the use of medications to treat residual neurological symptoms is commonly required to improve patients’ quality of life. The evidence assessing the efficacy of different therapeutic options for movement disorders in WD is limited. This chapter aims to review the most common neurological manifestations in WD and the therapeutic options currently available.

Research paper thumbnail of Use of amyloid PET scans in the clinical management of patients with cognitive decline in a naturalistic setting at a tertiary memory disorders clinic

Alzheimer's & Dementia, 2021

Research paper thumbnail of Beliefs about the COVID‐19 pandemic, trust in government, and vaccine intention in older adults with cognitive impairment in the United States and Italy

Alzheimer's & Dementia, 2021

The degree and spread of misinformation regarding the COVID-19 pandemic has been prolific, influe... more The degree and spread of misinformation regarding the COVID-19 pandemic has been prolific, influencing individuals of all ages. We examined belief in misinformation in older individuals with and without cognitive impairment in Boston, MA (United States) and Chieti (Italy). The purpose of this investigation was to compare the two cohorts on specific misconceptions, trust in media and government, perceived risk regarding COVID-19, and their relation to COVID-19 vaccine hesitancy and intention. Forty-seven subjects from the U.S. (mean age = 75.4, SD = 9.4) and 134 subjects from Italy (mean age = 72.2, SD = 7.7) were administered a telephone neuropsychological battery and MoCA. One hundred twenty-two individuals (67.4%) met the cutoff for cognitive impairment. Individuals answered a COVID-19 Misinformation Questionnaire and Perceived Risk Scale. A Vaccine Hesitancy Scale was administered 4-6 months after the initial assessment. Comparisons were made between the two cohorts using binary logistic regression, controlling for age, education, and cognitive status (i.e., MoCA). Individuals in the Italian cohort demonstrated greater perceived risk of contracting COVID-19 and also greater trust in the government as a source of information. A large proportion of the sample (N=160; 88.4%) rated the media as not at all trustworthy. Greater cognitive impairment was predictive of misconception endorsement. Further, individuals in the U.S. cohort were approximately four times as likely as individuals in the Italian cohort to believe that that COVID-19 was a bioweapon developed by a government or terrorist organization. Trust indices were not related to misconception belief. Examination of vaccine hesitancy, and confirmation of the preliminary analyses, will be undertaken following completed recruitment and testing. When individuals hold knowledge that is incorrect, the consequences can be manifold. From our preliminary analyses, we found that trust in government was not related to misconception endorsement; however, differences emerged between the U.S. and Italian cohorts. This examination provides a broad, cultural context to complex health beliefs, with specific implications for health behaviors such as vaccine intention, for individuals with and without cognitive impairment.