Neurology. Clinical practice最新文献

{"title":"Cranial Neuropathies-Easy to See, Hard to Diagnose: Toward an Integrated Diagnostic Framework for Rare Conditions.","authors":"Adele Ratti, Luca Bosco, Christian Laurini, Luca Angelini, Benedetta Sorrenti, Massimo Filippi, Stefano Carlo Previtali, Yuri Matteo Falzone","doi":"10.1212/CPJ.0000000000200661","DOIUrl":"10.1212/CPJ.0000000000200661","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cranial neuropathies are a frequent reason for neurologic consultation, yet they remain diagnostically challenging because of a broad etiologic spectrum and overlapping clinical presentations. This review aims to support clinicians in achieving an accurate and timely diagnosis by classifying cranial neuropathies according to the main pathogenic mechanisms, with particular attention to rare and underrecognized entities, and by proposing a clinician-oriented diagnostic algorithm to improve diagnostic precision and efficiency.</p><p><strong>Recent findings: </strong>A comprehensive and structured synthesis of the causes of cranial neuropathies is currently lacking. Available literature is largely confined to single-cranial nerve reviews or disease-specific settings and further limited by inconsistent terminology that may blur the distinction between peripheral cranial nerve involvement and brainstem nuclear syndromes. As a result, an integrated framework to guide diagnostic reasoning in daily practice remains unavailable. Recent advances in antibody testing, neurogenetics, high-resolution neuroimaging, and targeted immunotherapies have expanded the diagnostic and therapeutic landscape, increasing the need for an updated, mechanism-based approach that can be readily applied in clinical practice.</p><p><strong>Summary: </strong>We identify major etiologic categories associated with cranial neuropathies, including immune-mediated and rheumatologic diseases, paraproteinemic disorders, hereditary conditions, and infectious and compressive etiologies. For each category, we summarize representative disorders, underlying pathophysiologic mechanisms, and practical diagnostic clues, and we highlight relevant mimics that may complicate the differential diagnosis. We then propose a three-tier diagnostic algorithm integrating clinical pattern recognition with brain MRI, CSF analysis, and targeted neurophysiologic studies. By systematically combining clinical, imaging, and laboratory data, this framework is intended to increase diagnostic accuracy and support early recognition of uncommon but treatable causes of cranial neuropathy.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 6","pages":"e200661"},"PeriodicalIF":3.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OnabotulinumtoxinA for Painful Foot Dystonia in Parkinson Disease: A Randomized, Double-Blind, Placebo-Controlled Trial.","authors":"Yasamin Mahjoub, Beatrice Achen, Parisa Alizadeh, Ali Abusrair, Gabriel Amorelli, Alicja Cieslak, Nancy Labelle, Tracy Hammer, Carol Pantella, Veronica Bruno","doi":"10.1212/CPJ.0000000000200659","DOIUrl":"10.1212/CPJ.0000000000200659","url":null,"abstract":"<p><strong>Background and objectives: </strong>Pain associated with foot dystonia is a common and disabling symptom of Parkinson disease (PD), often occurring during OFF periods, yet frequently refractory to medication optimization. Evidence supporting treatments for dystonia-related pain in PD remains limited. This study evaluated the efficacy and safety of onabotulinumtoxinA (BTXA) for pain associated with foot dystonia in patients with PD.</p><p><strong>Methods: </strong>This single-center, randomized, double-blind, placebo-controlled trial assessed outcomes at 6 and 12 weeks, followed by a 12-week open-label extension. Adults with unilateral PD and painful foot dystonia refractory to medication optimization were randomized 1:1 to receive BTXA (100 units) or placebo using a guided injection protocol targeting the tibialis posterior, extensor hallucis longus, and flexor digitorum brevis. The primary outcome was change from baseline in dystonia-related pain assessed using Item 5 of the King's Parkinson's Disease Pain Scale (KPPS). Secondary outcomes included responder rates (≥30% pain reduction), KPPS Domain 3 total score, KPPS Item 5 pain severity and frequency subitems, Visual Analogue Scale (VAS) pain, Clinical Global Impression, motor outcomes (Movement Disorder Society-Unified Parkinson's Disease Rating Scale III and IV), quality of life, and safety.</p><p><strong>Results: </strong>Thirty-three participants were randomized (BTXA, n = 16; placebo, n = 17). BTXA resulted in significantly greater reduction in dystonia-related pain assessed by KPPS Item 5 total score compared with placebo at 6 weeks (mean difference -3.60), with effects sustained at 12 weeks (<i>p</i> < 0.001). The between-group effect size for the primary outcome was large (Hedges' g -1.33; 95% CI -2.13 to -0.53). Improvements were observed in KPPS Item 5 pain severity and frequency and in KPPS Domain 3 total scores at 6 and 12 weeks. VAS pain was reduced at 6 weeks, with no significant between-group difference at 12 weeks. Responder rates (≥30% pain reduction) were higher with BTXA at both 6 and 12 weeks (75.0% vs ≤ 11.8 and 5.6%, respectively; <i>p</i> < 0.001). No differences were observed in motor outcomes, quality of life, or adverse events, which were mild.</p><p><strong>Discussion: </strong>BTXA reduced pain associated with foot dystonia in PD without adversely affecting motor outcomes and was well tolerated, supporting its use as a targeted treatment for this disabling symptom.</p><p><strong>Trial registration information: </strong>NCT04277247.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 6","pages":"e200659"},"PeriodicalIF":3.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Youth Football and the Epidemic of Pediatric Brain Injury: Neurologic and Psychiatric Outcomes in a Cohort of 72,025 Concussions.","authors":"Isaac B Thorman, Eric Feldstein, Ariel Sacknovitz, Aryan Malhotra, Michael C Schubert, Fawaz Al-Mufti, Dennis J Keselman, Patricia E McGoldrick, Carrie R Muh, Steven M Wolf","doi":"10.1212/CPJ.0000000000200656","DOIUrl":"10.1212/CPJ.0000000000200656","url":null,"abstract":"<p><strong>Background and objectives: </strong>Sports-related traumatic brain injury (TBI) is among the most common causes of long-term neurologic and psychiatric morbidity in children and young adults. Football, in particular, has been implicated as a leading source of TBI, yet large-scale comparative studies across sports and developmental stages are limited. The objective of this study was to quantify the burden of football-related TBI in youth compared with other sports and recreational activities, and to evaluate long-term neurologic and psychiatric outcomes across developmental stages.</p><p><strong>Methods: </strong>This retrospective cohort study used the TriNetX Research Network, encompassing >150 million patients. Children and young adults (≤25 years) with a first TBI and activity cause of morbidity recorded on the day of injury were identified based on ICD-10 codes. Patients with TBI were compared with patients with lower leg fractures in the same activity with no recorded TBI on neurologic, psychiatric, and developmental outcomes. Attributable risks were calculated between TBI and lower leg fracture patients matched 1:1 on age category and sex. Prevalent cases were excluded. Multivariate Cox proportional hazard models adjusted for age category, sex, and activity compared the risk of each outcome across activities.</p><p><strong>Results: </strong>Compared with other sports, football had the greatest quantity and severity of TBIs. Football accounted for 19.4% of 72,025 identified activity-related TBIs (mean age, 13.9 years; 32% female). Repeat TBI occurred in 37% of football injuries (32% overall). Attributable risks of football TBIs included neurologic outcomes (chronic headache, 23%; visual impairment and blindness, 5%; and neurodevelopmental disorders, 0.5%) and psychiatric outcomes (anxiety disorders, 5%; depressive disorders, 3%; substance use disorders, 1%; and violence and suicidality, 0.5%). TBIs at early ages were associated with mood and developmental disorders, while TBIs at later ages were associated with substance use disorders.</p><p><strong>Discussion: </strong>Football is the single leading source of pediatric sports-related TBI, associated with high recurrence rates, substantial neurologic and psychiatric sequelae, and altered developmental trajectories. These findings highlight football as a critical public health priority and support stronger preventive measures, including delaying tackle football participation and regulating institutional promotion of youth football.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 6","pages":"e200656"},"PeriodicalIF":3.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Video Head Impulse Testing for Acute Dizziness in Stroke Protocols: A Prospective Pilot Study.","authors":"Alexander Vorobyev, Sinead Farrelly, Audrey Rebecca Hartis, Emily Monsch, Christine Strange, Habib Rizk, Christine Anne Holmstedt","doi":"10.1212/CPJ.0000000000200672","DOIUrl":"10.1212/CPJ.0000000000200672","url":null,"abstract":"<p><strong>Background and objectives: </strong>Dizziness is a common emergency department (ED) concern, yet posterior-circulation strokes can be difficult to detect with standard clinical tools and neuroimaging alone. Quantitative video head impulse test (vHIT) provides an objective bedside measure of vestibulo-ocular reflex function and can help differentiate central from peripheral causes of acute dizziness.</p><p><strong>Methods: </strong>We conducted a prospective, single-center feasibility and diagnostic-accuracy study of adults (18-90 years) presenting on an ED stroke pathway for acute dizziness. vHIT was performed within 48 hours of presentation, after completion of standard stroke evaluation. Two vestibular-trained clinicians, blinded to clinical and imaging data, classified vHIT as peripheral, central, equivocal, or poor quality. The reference standard (stroke vs nonstroke) was the final diagnosis adjudicated by stroke neurologists using all clinical information, noncontrast CT, and MRI when available. Diagnostic metrics for stroke were calculated for interpretable vHIT studies and in an intention-to-diagnose analysis.</p><p><strong>Results: </strong>Thirty patients underwent vHIT; 11 (36.7%) had acute ischemic stroke and 19 (63.3%) had nonstroke diagnoses. Interpretable vHIT results (central or peripheral pattern) were obtained in 23 of 30 patients (76.7%). Overall, vHIT patterns were central in 19 (63.3%), peripheral in 4 (13.3%), equivocal in 3 (10.0%), and poor quality in 4 (13.3%). Among strokes, 9 of 11 (81.8%) had a central pattern and none had a peripheral pattern. In the primary analysis of interpretable studies, vHIT sensitivity and negative predictive value for stroke were both 100%, while specificity was 28.6% and overall accuracy was 56.5%. In the intention-to-diagnose analysis including all patients, sensitivity and negative predictive value remained 100%, with specificity at 21.1% and accuracy at 50.0%.</p><p><strong>Discussion: </strong>Our findings suggest that vHIT was feasible in most ED stroke-pathway patients with acute dizziness and demonstrated high sensitivity and negative predictive value when a clearly peripheral pattern was present, supporting its potential role as an adjunctive rule-out tool. However, specificity was low, and nearly one-quarter of studies were equivocal or poor quality, limiting its use as a standalone diagnostic test. With further validation and larger studies, vHIT may help support more targeted use of hospital admissions, diagnostic workups, and ED stroke resources in patients without evidence of central pathology.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 6","pages":"e200672"},"PeriodicalIF":3.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Meaningfulness of Donanemab in Early Symptomatic Alzheimer Disease: Data From the Randomized Phase 3 TRAILBLAZER-ALZ 2 Trial.","authors":"Alireza Atri, Liana G Apostolova, Atsushi Iwata, Alette M Wessels, Alexandra Atkins, Ming Lu, Wenyu Ye, Sinéad Ryan, Erin Gautier Doty","doi":"10.1212/CPJ.0000000000200663","DOIUrl":"10.1212/CPJ.0000000000200663","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 6","pages":"e200663"},"PeriodicalIF":3.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infection Risk During Rituximab Therapy in Multiple Sclerosis: Effect of Dosing Interval and Age.","authors":"Gorm Pihl-Jensen, Maria Lie Selle, Jan Harald Aarseth, Kjell-Morten Myhr, Øivind Torkildsen, Ola Nakken, Trygve Holmøy","doi":"10.1212/CPJ.0000000000200664","DOIUrl":"10.1212/CPJ.0000000000200664","url":null,"abstract":"<p><strong>Background and objectives: </strong>Rituximab is the most frequently used disease-modifying therapy in multiple sclerosis (MS) in Norway. Extended dosing intervals beyond 6 months may offer the same efficacy, but the impact on infection risk is unclear. We examined how dosing frequency and age affect infection risk in rituximab-treated patients with MS.</p><p><strong>Methods: </strong>We conducted a nation-wide observational study linking compulsory Norwegian health registries with the Norwegian MS registry. Registry data captured hospital-treated infections and further infections requiring prescription treatment and/or physician contact with primary practice. Data were analyzed using the Prentice, Williams, and Peterson model with clustering on subject to account for longitudinal design, recurrent rituximab infusions and recurrent infection events while adjusting for relevant explanatory variables. Rituximab interval length was modelled as the number of rituximab infusions within 2 years. Age was grouped into 5-year intervals.</p><p><strong>Results: </strong>Among 3,410 patients (13,811 treatment episodes between 2010 and June 2022), 13,774 infections occurred, including 971 hospital-treated events. Compared with 4 infusions over 2 years (6-month intervals), extended dosing was associated with a lower risk of any infection (hazard ratio [HR] 0.90 [95% CI 0.82-0.99]) for 2 infusions; (HR 0.78 [95% CI 0.69-0.88] for 1 infusion). A reduced risk of hospital-treated infections was observed only for 1 infusion per 2 years relative to 4, and this was not robust in sensitivity analyses and not present for the subgroup of infections associated with overnight hospital stay. Patients ≥60 years had a significantly higher risk of hospital-treated infections (HR 1.36 [95% CI 1.07-1.71]).</p><p><strong>Discussion: </strong>Extended rituximab intervals are associated with reduced overall infection risk, but the benefit for hospital-treated infections is limited. Age ≥60 years independently increases the risk of hospital-treated infections. These findings support cautious interval extension and careful risk-benefit assessment in older patients.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 6","pages":"e200664"},"PeriodicalIF":3.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Gatekeeper's Dilemma: Why Sustainable Functional/Dissociative Seizure Care Begins With Referral.","authors":"Meagan M Watson, Mackenzi L Moore, Ashley Parker, Wesley T Kerr, Jared J Woodward, Laura A Strom","doi":"10.1212/CPJ.0000000000200666","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200666","url":null,"abstract":"<p><strong>Background and objectives: </strong>Functional neurologic disorders (FNDs) are highly prevalent across neurologic service lines, with functional/dissociative seizures (FDSs) being the most common FND symptom. Despite clear diagnostic criteria and evidence-based treatments, people with FDSs are frequently misdiagnosed, stigmatized, or routed through ineffective care. A key driver of these gaps is the referral process. This study evaluates referral patterns into an established ambulatory, multidisciplinary FDS program, identifies reasons for referral ineligibility, and proposes targeted interventions to promote sustainable development.</p><p><strong>Methods: </strong>A retrospective analysis was conducted of patients referred to the University of Colorado (CU) FDS treatment program over 6 months. Demographics, referral characteristics, documentation availability, and program enrollment were abstracted from the electronic health record. Multivariable logistic regression identified factors associated with referral ineligibility, fulfillment of International League Against Epilepsy (ILAE) FDS criteria, and successful acquisition of diagnostic records.</p><p><strong>Results: </strong>Of 318 individuals referred (mean age 38 years; 72% female; 67% White, 15% Hispanic/Latino), 47% were enrolled in the CU FDS program, while 53% were ineligible, primarily because of incomplete diagnostic documentation (30%). While 56% of referrals originated from neurology, only 42% met ILAE-concordant, probable diagnostic criteria. Multivariable logistic regression identified insurance status as the strongest predictor of ineligibility, with uninsured patients (odds ratio (OR) 12.40, <i>p</i> < 0.01) and Medicaid recipients (OR 2.39, <i>p</i> = 0.01) facing higher risk of ineligibility than those with private insurance. Conversely, inpatient status (OR 0.15, 0 < 0.01) and Hispanic ethnicity (OR 0.40, <i>p</i> = 0.04) were protective against ineligibility, and patients referred from inpatient settings were more likely to meet probable ILAE criteria (OR 10.08, <i>p</i> < 0.01).</p><p><strong>Discussion: </strong>FDS care is a shared clinical responsibility. Health care professionals' referral practices are critical for the feasibility and sustainability of FDS programs, particularly when referring patients who use public insurance (i.e., Medicaid). Of equal importance is understanding the limitations of health care systems' operational processes (e.g., scheduling). Unless purposefully included, FDS is not a default diagnosis. Therefore, when operational processes change, FDS is easily forgotten. As such, active engagement through thoughtful referral practices, use of established diagnostic guidelines (e.g., ILAE recommendations), and maintaining accountability for the patient rather than relying on referral as a final step are essential.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 6","pages":"e200666"},"PeriodicalIF":3.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149112443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What We Do Not Know: The Workforce and Economics of Neurology in the United States.","authors":"John Ney","doi":"10.1212/CPJ.0000000000200673","DOIUrl":"10.1212/CPJ.0000000000200673","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 6","pages":"e200673"},"PeriodicalIF":3.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic Variation in Diagnostic Codes Associated With Mild Cognitive Impairment, Alzheimer Disease, and Related Dementias.","authors":"Sahar F Zafar, Lidia M V R Moura, Brittany Gorham, Esther Ndemo, Stephanie Swanson, Gregory S Day, Matthew Schelke, Benjamin R Kummer, Neeta Garg, Andrew Michael Wilson, Lyell K Jones","doi":"10.1212/CPJ.0000000000200658","DOIUrl":"10.1212/CPJ.0000000000200658","url":null,"abstract":"<p><strong>Background and objectives: </strong>Mild cognitive impairment (MCI), Alzheimer disease (AD), and AD-related dementias (ADRD) are growing public health concerns. Regional, demographic, and clinical differences in these diagnoses and associated comorbid conditions may inform strategies to improve prevention, care, and outcomes. To assess the demographic and geographic distribution of patients in the United States with coded MCI or AD/ADRD, the prevalence of common comorbidities, and the frequency and timing of progression to complicated MCI or AD/ADRD within 180 days, using data from the American Academy of Neurology's former Axon Registry.</p><p><strong>Methods: </strong>This observational study included adults aged 50-89 years with at least 1 outpatient encounter between 2017 and 2023 in 201 participating US neurology practices. Registry data were linked to the Centers for Disease Control and Prevention's 2019 Social Determinants of Health data set to assign patients to geographic regions. ICD-10 codes were used to identify MCI and AD/ADRD diagnoses, define comorbid conditions, and classify \"complicated\" MCI or AD/ADRD (e.g., with behavioral disturbances). The primary outcomes were odds of coded MCI/AD/ADRD, prevalence of top comorbidities, and proportion of patients progressing to complicated MCI/AD/ADRD within 180 days of initial diagnosis, stratified by region.</p><p><strong>Results: </strong>Of 1,144,081 individuals with at least 1 documented outpatient encounter, 146,273 (12.8%) had MCI or AD/ADRD ICD codes. Of those, 65,088 (44.5%) were in the South, 35,027 (23.9%) in the Midwest, 30,008 (20.5%) in the Northeast, and 16,134 (11.0%) in the West. Unadjusted odds of MCI/AD/ADRD codes were 0.170 (Northeast), 0.155 (South), 0.134 (West), and 0.125 (Midwest). Among those with uncomplicated MCI or AD/ADRD at first encounter, the highest proportion of progression to complicated codes within 180 days was in the Northeast (2.04%), followed by the West (1.91%), South (1.24%), and Midwest (1.06%). Common comorbidities included hypertension, depression or mood disorders, and gait abnormalities.</p><p><strong>Discussion: </strong>These findings highlight geographic and demographic variations in coded MCI/AD/ADRD prevalence and progression. Future studies should address underlying factors and the impact of comorbidities on outcomes, ultimately guiding more targeted approaches to dementia prevention and management. Future studies that phenotype AD/ADRD beyond the use of ICD codes can further validate the results.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 6","pages":"e200658"},"PeriodicalIF":3.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13621341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burnout Factors in Neurology: A Survey Assessing Key Factors Among US Academic Faculty.","authors":"Janet Guo, Parneet Grewal, Craig Ziegler, Sasha Alick-Lindstrom, Christa O'Hana S Nobleza, Doris Kung, Suma Shah, Halley B Alexander, Natasha Frost, Kamala Rodrigues, Sarah Durica, Seema Nagpal, June Yoshii-Contreras, Katherine Zarroli, Padmaja Sudhakar, Chen Zhao, Sol De Jesus, Deborah Young Bradshaw, Nicole Brescia, Nancy Foldvary-Schaefer, Laura M Tormoehlen, Sneha Mantri, Ailing Eileen Yang, Annie He, Cynthia Zheng, Julie K Silver, Alyssa F Westring, Jane B Allendorfer, Sima Patel, Neishay Ayub","doi":"10.1212/CPJ.0000000000200668","DOIUrl":"10.1212/CPJ.0000000000200668","url":null,"abstract":"<p><strong>Objectives: </strong>Burnout can impair clinical judgment and is prevalent across all medical subspecialties. Neurology, in particular, is associated with high rates of burnout and low satisfaction with work-life balance.</p><p><strong>Methods: </strong>A standardized survey using the abbreviated Maslach Burnout Inventory was administered from December 2020 to March 2022. Faculty from 19 academic neurology departments in the United States participated. Demographic, career, compensation, equity, domestic circumstances, parental leave, and burnout data were collected as part of the Women in Neurology Collaborative Study. Statistical analysis was performed using IBM SPSS version 30.0 and R version 4.4.4.</p><p><strong>Results: </strong>Among the 311 neurology faculty participants, 185 (59.5%) identified as women and 277 (89.1%) were clinical faculty members. The mean reported duration of practice was 14.4 years (SD 11.3 years). Approximately 98.4% (n = 306/311) of respondents reported experiencing moderate-to-high levels of burnout. Burnout and depersonalization were consistently high across all career stages (>96.6%), while the subscale of emotional exhaustion (EE) rose significantly by the late-career stage (<i>p</i> < 0.001). Moderate-to-high EE among neurology faculty was associated with sex, academic rank, and career stage. In unadjusted analyses, leadership titles and research involvement were associated with higher rates of EE but were not statistically significant after adjustment for career stage and respective career advancement indicator. Participants in leadership positions had significantly higher observed rates of EE compared with those without leadership roles (<i>p</i> = 0.002). Participants who reported a history of involvement in funded research had significantly higher rates of EE compared with those with no history of funded research (<i>p</i> = 0.001). Among individuals in the mid-career stage, full professors had significantly higher odds of EE compared with assistant professors (OR = 6.00, 95% CI 1.34-26.81; <i>p</i> = 0.019). No significant differences in the rate of overall burnout were detected by sex, academic rank, career stage, or career advancement indicators.</p><p><strong>Discussion: </strong>High burnout and EE rates among academic neurology faculty were common across career stages, with EE rising significantly among late-career faculty members. Higher EE rates were also seen among faculty with leadership roles and funded research involvement, although these associations were not significant after adjustment. Neurology departments may consider measures aimed at reducing burnout in the future, with particular attention to faculty in late-career stages.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 6","pages":"e200668"},"PeriodicalIF":3.7,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}