Neurology. Clinical practice最新文献

{"title":"Management of Patients With Mild Cognitive Impairment in the Era of Anti-Amyloid Therapy: A Worldwide Neurology Survey.","authors":"Graham A McLeod, Aaron R Switzer, Luca Bartolini, Alonso Gonzalo Zea Vera, Eric E Smith, Aravind Ganesh","doi":"10.1212/CPJ.0000000000200507","DOIUrl":"10.1212/CPJ.0000000000200507","url":null,"abstract":"<p><strong>Background and objectives: </strong>The aim of this study was to explore practice patterns in managing mild cognitive impairment (MCI). The investigation and management of MCI is considered important because it offers the opportunity to potentially stave off conversion to dementia. However, there are few data on current practices/approaches in this area, especially worldwide; such data can help identify potential disparities and anticipate adoption of new therapies.</p><p><strong>Methods: </strong>We performed a worldwide electronic survey of neurology practitioners through the Practice Current section of <i>Neurology</i>® <i>Clinical Practice</i> with clinical and practice-related questions in November 2019-August 2021 and repeated it in May-October 2023 after the FDA's approval of aducanumab and lecanemab but before the approval of donanemab. Clinical questions addressed access to and utilization of diagnostic investigations, pharmacologic and nonpharmacologic management of MCI, and (in 2023) attitudes toward novel anti-amyloid agents. Responses were compared using the Fisher exact test and multivariable logistic regression adjusted for region, regional income, year of survey response, years in practice, and number of cognitive patients seen annually.</p><p><strong>Results: </strong>We received 1,257 responses from 95 countries, including 237 cognitive subspecialists and 464 respondents from low-/middle-income countries. On multivariable analysis, cognitive subspecialists were more likely than other practitioners to investigate MCI with a lumbar puncture (aOR 1.90, 95% CI 1.32-2.73), luorodeoxyglucose-PET (FDG-PET) (aOR 1.45, 95% CI 1.00-2.10) and to offer pharmacotherapy if investigations suggested neurodegeneration (aOR 1.92, 95% CI 1.29-2.85). Regionally, respondents from Europe, Latin America, and Asia were more likely than those from the United States/Canada to order FDG-PET (e.g., Europe: aOR 2.38, 95% CI 1.29-4.39) and amyloid PET (Europe: aOR 3.30, 95% CI 1.85-5.87), controlling for reported access to these tests. Pharmacologic and nonpharmacologic approaches were comparable between cognitive subspecialists and other respondents. Despite concerns about safety (77.1% expressed being somewhat or very concerned), attitudes toward prescribing new anti-amyloid agents were similar among all respondents, reflecting a generally favorable attitude (e.g., 62% would prescribe anti-amyloid therapy if it was available).</p><p><strong>Discussion: </strong>Our results highlight practice differences among cognitive subspecialists and other practitioners worldwide in the management of MCI. Attitudes toward anti-amyloid therapy indicate cautious optimism, with concerns about side effects but a general interest to prescribe.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200507"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528934","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":"Erratum: Psychosis in Neurocognitive Disorder Among Ethnoculturally Diverse Older Persons.","authors":"Estevana Isaac, Carolyn Wei Zhu, Monica Rivera Mindt, Albert L Siu, Alex Federman, Kristine Yaffe, Barbara G Vickrey, Jenifer Voeks, Parul Agarwal, Derrick Brooks, Omobolanle Ayo, Mary Sano","doi":"10.1212/CPJ.0000000000200509","DOIUrl":"10.1212/CPJ.0000000000200509","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1212/CPJ.0000000000200467.].</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200509"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608917","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, Relapses, and Pseudo-Relapses in Individuals With Multiple Sclerosis.","authors":"Amber Salter, Samantha Lancia, Mudita Sharma, Gary R Cutter, Robert J Fox, Ruth Ann Marrie","doi":"10.1212/CPJ.0000000000200493","DOIUrl":"10.1212/CPJ.0000000000200493","url":null,"abstract":"<p><strong>Background and objectives: </strong>Infections are associated with an increased risk of relapse and pseudo-relapse in persons with multiple sclerosis (MS). However, the relationship with relapses and pseudo-relapses after SARS-CoV-2 infections (COVID) vs other infections in MS is poorly understood. Therefore, we compared the occurrence of relapse and pseudo-relapse after COVID and other infections with noninfected participants with MS.</p><p><strong>Methods: </strong>In spring 2023, we surveyed participants from the North American Research Committee on Multiple Sclerosis Registry regarding whether they had had a COVID infection, other infections, relapses, and pseudo-relapses. Recent infections, occurring in the 6 months before the survey, were used to categorize participants into groups: recent COVID, non-COVID infection (with no history of ever having COVID), COVID and non-COVID infections, or uninfected.</p><p><strong>Results: </strong>Of the 4,787 participants eligible for analysis, 2,927 participants were included, of whom 294 (10%) had a recent COVID infection; 853 (29.1%) had 1 recent infection other than COVID; 246 (8.4%) had a recent COVID and non-COVID infection; and 1,534 (52.4%) had no infection with COVID nor any infection within the past 6 months (uninfected). Compared with no infections, non-COVID infection was associated with a 39% increased likelihood of relapse (1.39, 95% CI [1.04-1.87]), whereas a recent COVID infection was associated with a decreased likelihood of relapse (0.45 [0.23, 0.87]), adjusting for covariates. All infection groups were associated with increased odds of pseudo-relapse compared with the uninfected group (non-COVID infections: 1.78 [1.44, 2.20]; COVID infection: 1.80 [1.32, 2.45]; COVID and non-COVID infection: 3.04 [2.24, 4.12]).</p><p><strong>Discussion: </strong>Because individuals with MS are at increased risk of infections, the association of infections with relapses and pseudo-relapses is clinically important. The high prevalence of acute worsening after infection, regardless of the type of infection, compared with those with no reported infection, needs to be considered in the management of persons with MS.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200493"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285791","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":"Erratum: Herpes Zoster Infections With Multiple Sclerosis Disease-Modifying Therapies: A Real-World Pharmacovigilance Study.","authors":"Alexandra Balshi, Grace Leuenberger, John Dempsey, Nova Manning, Ursela Baber, Jacob A Sloane","doi":"10.1212/CPJ.0000000000200505","DOIUrl":"10.1212/CPJ.0000000000200505","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1212/CPJ.0000000000200462.].</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200505"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285780","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":"\"Not Everything That Can Be Counted Counts, and Not Everything That Counts Can Be Counted\".","authors":"Adam C Webb","doi":"10.1212/CPJ.0000000000200514","DOIUrl":"10.1212/CPJ.0000000000200514","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200514"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575928","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":"Diagnostic Journey and Health Care Burden of Patients With Creutzfeldt-Jakob Disease in the United States: A Real-World Evidence Study.","authors":"Emily Kutrieb, Montserrat Vera Llonch, Derek Weycker, Steven M Kymes, Duncan Brown, Anne V Smith, Robert S Pulido, Brian Appleby","doi":"10.1212/CPJ.0000000000200502","DOIUrl":"10.1212/CPJ.0000000000200502","url":null,"abstract":"<p><strong>Background and objectives: </strong>Evidence on the diagnostic journey and health care burden of patients with Creutzfeldt-Jakob disease (CJD) in the United States is limited. A real-world evidence study using a US health care claims database was undertaken to address this gap.</p><p><strong>Methods: </strong>A retrospective observational cohort study was conducted using data from the Merative MarketScan Research Databases (01/2012-12/2020). Study population comprised adults aged 18 years or older with evidence of CJD (initial diagnosis = index date), no evidence of selected neurologic conditions after the last CJD diagnosis, and health care coverage during the 12-month pre-index period; adults meeting selection criteria are referred herein as \"patients with CJD.\" Diagnostic journey was detailed based on evidence of symptoms and alternative neurologic conditions during the pre-index period as well as time to death (based on a proxy). Health care burden was summarized through levels of all-cause health care utilization and expenditures during the pre/post-index periods.</p><p><strong>Results: </strong>A total of 215 patients with CJD qualified for inclusion in the study population. The mean duration from first symptom to initial CJD diagnosis was 5.0 months, and 80% of patients had ≥3 symptoms, most commonly altered mental status (82%), gait/coordination disturbance (60%), and malaise/fatigue (44%). Most patients (63%) also had ≥1 alternative diagnosis, including cerebrovascular disease (49%), peripheral vertigo (11%), and Alzheimer disease (7%); the mean duration from first alternative diagnosis to initial CJD diagnosis was 2.4 months. The mean (median) time to death (proxy) from first symptom was 7.9 (6.6) months and from initial CJD diagnosis was 2.9 (1.1) months. During the 12-month pre-index period, mean (95% CI) cumulative health care expenditures were $35,493 ($28,914-$42,722); by the end of the post-index period, cumulative expenditures averaged $93,601 ($78,878-$109,776) per patient.</p><p><strong>Discussion: </strong>Study findings suggest that, in US clinical practice, patients with CJD present with one or more clinical symptoms affecting motor, cognitive, or other domains, and many alternative diagnoses are considered, which may prolong the diagnostic journey. Study findings also suggest that health care expenditures-especially proximate to the initial CJD diagnosis-are notably high. CJD should be considered in the differential diagnosis of adults with rapidly progressing dementia or motor disturbance.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200502"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528932","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":"Transfer to Adult Care in Epilepsy: A Nationwide Population-Based Register Study.","authors":"Rianne J M Goselink, Hampus Hörling, Anna Eklund, Colin Reilly, Johan Zelano","doi":"10.1212/CPJ.0000000000200491","DOIUrl":"10.1212/CPJ.0000000000200491","url":null,"abstract":"<p><strong>Background and objectives: </strong>Adolescence is a crucial life period, which is extra challenging for young persons with epilepsy (YPE), coinciding with transfer from pediatric to adult care. Knowledge on medical and socioeconomic effects of this care transfer is scarce. The aim of this study was to determine medical and socioeconomic outcomes after transfer to adult care in YPE and to identify risk factors of poor outcome.</p><p><strong>Methods: </strong>We conducted a population-based retrospective follow-up study of all individuals in Sweden with epilepsy during their 18th year of life over 5 consecutive years. The data were extracted from 5 comprehensive national registries for 2013-2021.</p><p><strong>Results: </strong>A total of 2,491 adolescents with epilepsy were identified (prevalence 0.46%). Mortality was 0.7% with a standardized mortality rate of 13 compared with the total adolescent population. In patients with an epilepsy-related specialist care contact before the age of 18 years (n = 1719), 22% did not have a planned follow-up visit in specialist care in the 2 following years. The proportion of adolescents who consulted acute medical care for epilepsy increased from 3% to 7% after age 18. Loss to follow-up and acute medical care visits were positively correlated with socioeconomic factors such as lower income, foreign background, and geographic region.</p><p><strong>Discussion: </strong>A gap in care exists for adolescents with epilepsy after transfer to adult medical care with an increase in epilepsy-related emergency care visits and a decrease in planned specialist care follow-up. A poor epilepsy care outcome is associated with lower economic status, foreign background, and more remote geographic region. The pattern of health care consumption suggests that socioeconomic and geographic factors augment known difficulties in transition to adult epilepsy care and highlights that interventions are needed to ensure optimal outcomes.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200491"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528938","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":"A Qualitative Analysis of Physician Communication During Brain Death Conversations: Dead With a Heartbeat.","authors":"Anoushka Rao, Jason X Shen, Paul Graham Fisher, David Magnus","doi":"10.1212/CPJ.0000000000200484","DOIUrl":"10.1212/CPJ.0000000000200484","url":null,"abstract":"<p><strong>Background and objectives: </strong>In recent decades, many legal cases have resulted from physicians ineffectively communicating to a family that their loved one is brain dead (brain dead/death by neurologic criteria [BD/DNC]). Although the definition of BD/DNC has recently undergone revision, little research has been conducted to establish optimal approaches in communicating BD/DNC status to families. The aim of this study was to characterize what highly experienced physicians perceive to be the best communication practices and language choices during BD/DNC conversations.</p><p><strong>Methods: </strong>In this qualitative study, we conducted semistructured, in-depth interviews with physician leaders in the field of BD/DNC between September 2023 and January 2024. All interviews were conducted through Zoom. Twenty expert physician participants were recruited from multiple institutions across the United States through convenience sampling. Participants were current or former attending physicians whose practices at academic institutions involved communication with families about BD/DNC in either the pediatric or adult setting. Participants completed a Qualtrics form containing questions about their demographic background and practice characteristics, including an estimate of the number of times they communicated BD/DNC to patient families. Semistructured interviews were conducted with each of the participants and included hypothetical scenarios and views about best practices.</p><p><strong>Results: </strong>Using 20 qualitative interview transcripts, we identified multiple areas of agreement and disagreement among expert physicians regarding best practices in communicating BD/DNC status. While physicians concurred on specific language to use and avoid, they differed on whether to use the word \"coma,\" on when to introduce the possibility of brain death, and on whether to analogize with cardiac death. There was strong agreement on the utility of visualization through imaging and family attendance at BD/DNC testing. Finally, physicians were in consensus that multiple family meetings with the same providers are crucial for successful BD/DNC communication.</p><p><strong>Discussion: </strong>This study described main convergences and divergences in physician language during BD/DNC conversations and used qualitative data to present a \"train journey\" theory of ideal physician communication with families. By investigating and improving physician communication styles during BD/DNC conversations, the medical community may ameliorate the legal and medical fallout that results from clinical miscommunication.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200484"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285779","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 Impact of Social Determinants of Health on Morbidity and Mortality Outcomes in Patients With Intracerebral Hemorrhage: Nationwide Study.","authors":"Tatiana Abou-Mrad, Syed Ibad Khalid, Pranav Mirpuri, Fady T Charbel","doi":"10.1212/CPJ.0000000000200494","DOIUrl":"10.1212/CPJ.0000000000200494","url":null,"abstract":"<p><strong>Background and objectives: </strong>Understanding the impact of social determinants of health (SDoH) on clinical outcomes in conditions such as intracerebral hemorrhage (ICH) is crucial for enhancing patient management and improving health policy. The aim of this study was to assess the impact of SDoH on the prognosis and clinical outcomes of patients with ICH.</p><p><strong>Methods: </strong>This retrospective study used the MARINER165 national administrative database, encompassing medical and surgical claims from January 2010 to October 2022. It adhered to the Strengthening the Reporting of Observational Studies in Epidemiology reporting guidelines. Patients with ICH were identified using International Classification of Diseases and Current Procedural Terminology codes. Propensity score matching generated 2 cohorts based on SDoH presence. Primary outcomes focused on functional status at 30 days and survival rates at 90 days and 1 year. Functional outcomes included the rates of tracheostomy and gastronomy tube placement, wheelchair dependency, mobility scores, and readmission within 30 days after ICH. Kaplan-Meier survival analysis was used to determine survival rates at 90 days and 1 year after index event. A significance level of <i>p</i> < 0.05 was applied.</p><p><strong>Results: </strong>A total of 481,754 patients with ICH were included, with 240,877 individuals in each cohort after matching. Gender distribution was balanced (50.5% female), and common comorbidities included hypertension (89%), depression (47%), and diabetes mellitus (45%). The SDoH group demonstrated pronounced disparities in food security (87%), social integration (14.2%), and physical environment (8.3%). At 30 days, this group experienced worse functional outcomes with higher rates of tracheostomy (2% vs 0.9%, <i>p</i> < 0.001) and G-tube placement (3.2% vs 1.5%, <i>p</i> < 0.001), increased wheelchair dependency (3.2% vs 2.5%, <i>p</i> < 0.001), and lower mobility scores (3.5 vs 2.7, <i>p</i> < 0.001), alongside higher readmission rates (9.8% vs 6.2%, <i>p</i> < 0.001). Despite these challenges, the SDoH cohort demonstrated better survival rates at both 90 days (78.1% vs 72.6%, <i>p</i> < 0.001) and 1 year (62.1% vs 57.6%, <i>p</i> < 0.001).</p><p><strong>Discussion: </strong>This study underscores significant disparities in functional outcomes and survival rates associated with SDoH among patients with ICH. It highlights the paradox where individuals with SDoH, despite facing greater health-related challenges and higher readmission rates, tend to survive longer. Integrating socioeconomic factors into patient management strategies is crucial for addressing these differences and improving overall health care outcomes.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200494"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528937","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":"Community Disadvantage Is Associated With More Severe Motor Symptoms in Parkinson Disease.","authors":"Emily J Hill, Samuel Blaise Marcucci, Kelly DeLano, Jesus Abanto, Russell P Sawyer, Luca Marsili, Kevin R Duque, Qin Sun, Daniel Woo, Carl D Langefeld, Deborah A Hall, Dawn Skirpan, Nathaly Chinchihualpa Paredes, Cynthia Spikes, Deepa Agrawal Bajaj, Nathan Gregor, Shea Stivers, Abhimanyu Mahajan, Jessica G Woo, Alberto J Espay","doi":"10.1212/CPJ.0000000000200506","DOIUrl":"10.1212/CPJ.0000000000200506","url":null,"abstract":"<p><strong>Background and objectives: </strong>The relationship between socioeconomic factors and Parkinson disease (PD) is unclear. Previous literature suggests a potential disconnect between the effect of socioeconomic status (SES) on PD risk and severity. A recent study found that people with PD in the United States were more likely to come from well-resourced communities. Multiple possible explanations were proposed, including that lower SES could be protective against PD risk. Other studies have found worsened PD symptoms and outcomes associated with lower individual SES. If environmental factors associated with lower SES influence PD biology in a way that worsens symptoms, those processes should also increase PD risk. We set out to determine whether community disadvantage, rather than individual SES, is associated with motor or cognitive symptom severity in PD and atypical parkinsonisms.</p><p><strong>Methods: </strong>Community disadvantage was defined using the Material Community Deprivation Index, a compound score of multiple poverty markers. In our Cincinnati Cohort Biomarkers Program, a cohort that includes PD and atypical parkinsonisms, we tested for associations between community disadvantage and motor symptom severity (Movement Disorders Society Unified PD Rating Scale part III; MDS-UPDRS III), motor disability (Hoehn and Yahr stage [HY]), and cognition (Montreal Cognitive Assessment [MoCA]). We considered age, sex, disease duration, levodopa equivalent daily dose, education years, and race as covariates in multiple regression analyses.</p><p><strong>Results: </strong>A total of 565 people with PD or atypical parkinsonisms were included (458 idiopathic PD and 107 atypical parkinsonisms). Their mean age was 69 years, and 65% were men. The mean disease duration was 7 years, and the mean MDS-UPDRS III score was 30. The majority (75%) were HY stage 2, and the mean cognitive screening score was nondemented (MoCA 25/30). Worse community disadvantage was significantly associated with worse MDS-UPDRS III score (β 1.58, <i>p</i> = 0.01; adjusted for age, sex, and disease duration) and HY stage (OR 1.27, <i>p</i> = 0.04, adjusted for age, sex, disease duration, and education years). Community disadvantage was not significantly associated with MoCA score (<i>p</i> = 0.45).</p><p><strong>Discussion: </strong>Community disadvantage was associated with worse motor symptom severity and motor disability in PD, suggesting that there are modifiable social and environmental factors that can affect parkinsonian symptom severity.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"15 4","pages":"e200506"},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144528931","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}