Bobby Lazzara, MD

looked at the most common neurological diagnoses leading to hospitalization for the homeless, and whether the characteristic of being homeless is an independent risk factor for 30-day readmission based on a patient’s diagnosis.

The study encompassed almost 2 million individuals with a primary neurologic diagnosis. Of the group, the homelessness rate was 0.37%. Seizures and traumatic brain injury were the most common diagnosis in the homeless.

After controlling for multiple variables, homelessness was associated with increased 30-day readmission rates.

No surprises here in this study...but, we are getting closer to identifying interventions that can help the homeless population with neurologic disease.

1. Rosendale N, Guterman EL, Betjemann JP, et al. 

Hospital admission and readmission among homeless patients with neurologic disease.

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A large study may bring us closer to identifying interventions that can help the homeless population with neurologic disease.

Readmissions in the Homeless Population

 compared 26 former NFL players with cognitive and neuropsychiatric symptoms with 31 controls looking at tau deposition with positron emission tomography.

Why? Because the neuropatholical diagnosis of chronic traumatic encephalopathy (CTE) from repetitive head impacts is based on a specific pattern of tau deposition with minimal amyloid deposition, which distinguishes it from other disorders like Alzheimer disease.

Tau deposition was higher in former players compared with controls in three regions:

Participants did not have elevated amyloid beta levels and there was no association between tau and scores on cognitive or neuropsychiatric tests.

The study is a small cohort and more research is needed, but how are you counseling patients and families about the risks and benefits of playing sports with repetitive head blows and the risk of CTE?

Tau Positron-Emission Tomography in Former National Football League Players

How are you counseling patients and families about the risks and benefits of playing sports with repetitive head blows and the risk of CTE?

Tau Deposition Patterns in Retired NFL Football Players

of 32 participants looked at the relationship of retinal blood ï¬ow and vessel density to early onset Alzheimer disease (AD) and mild cognitive impairment.

Patients with early onset AD and mild cognitive impairment were matched 1:1 with a control group. Evaluation of retinal blood ï¬ow and vessel density was done with optical coherence tomography angiography.

Patients with early cognitive impairment associated with AD showed a signiï¬cant decline in parafoveal blood ï¬ow and vascular density. The authors suggest these parameters when evaluated with optical coherence tomography angiography could have potential utility as an early  biomarker in AD.

Parafoveal vessel loss and correlation between peripapillary vessel density and cognitive performance in amnestic mild cognitive impairment and early Alzheimer's Disease on optical coherence tomography angiography

A prospective case controlled study looked at the relationship of retinal blood ﬂow and vessel density to early onset Alzheimer disease and mild cognitive impairment.

Alzheimer Disease and Retinal Blood Flow

In a recent multicenter double-blind placebo controlled delay start trial, 

 looked at at levodopa/carbidopa administration soon after the diagnosis of Parkinson disease (PD). The study compared treatment at 80 weeks with 40 weeks of placebo followed by 40 weeks of treatment.

The primary outcome was an analysis of the Unified Parkinson’s Disease Rating Score between the two groups to determine if therapy should be initiated after diagnosis or if a delay had any effects on altering the course of the disease.

The findings...the difference in the progression of the disease between the two groups was not significant.

Levodopa for Early Parkinson Disease: Some Answers, More Questions

1. Verschuur CVM, Suwijn SR, Boel JA, et al. 

Randomized Delayed-Start Trial of Levodopa in Parkinson's Disease

A study looked at at levodopa/carbidopa administration soon after the diagnosis of Parkinson disease.

Bobby Lazzara, MD

Articles

Readmissions in the Homeless Population

Tau Deposition Patterns in Retired NFL Football Players

Alzheimer Disease and Retinal Blood Flow

Parkinson Disease: When to Treat?