Neurology. Clinical practice最新文献

{"title":"Efficacy and Safety of Perampanel in Patients With Brain Tumor-Related Epilepsy: A Systematic Review and Meta-Analysis.","authors":"Anderson M P Da Silva, Ocílio Ribeiro Gonçalves, Gabriel Caruso Novaes Tudella, Giovana Menegucci, Augusto Utida Klostermann, Maria E Scheffer Valverde, Patrick Froelich Meldola, Ahmet Gunkan, Gustavo Sousa Noleto","doi":"10.1212/CPJ.0000000000200636","DOIUrl":"10.1212/CPJ.0000000000200636","url":null,"abstract":"<p><strong>Purpose of review: </strong>Epileptic seizures are a common and often debilitating complication in patients with brain tumors, significantly affecting quality of life and clinical outcomes. Brain tumor-related epilepsy (BTRE) is characterized by complex pathophysiologic mechanisms, notably glutamate-mediated neuronal hyperexcitability within the peritumoral environment. Perampanel, a selective, noncompetitive antagonist of the AMPA glutamate receptor, represents a mechanistically targeted antiseizure medication that may be particularly suited to this context. This review aims to systematically evaluate and synthesize the available evidence regarding the efficacy and safety of perampanel in patients with BTRE, focusing on seizure control, oncologic outcomes, and tolerability in real-world clinical settings.</p><p><strong>Recent findings: </strong>A systematic search of PubMed, Embase, and Cochrane Library identified 8 observational studies involving a total of 382 patients with brain tumors and associated seizures treated with perampanel. Across studies, 57.0% of patients were male, and the mean participant age ranged from 43 to 58 years. Pooled analyses demonstrated that 42% (95% CI 27%-59%) of patients achieved seizure freedom, while 46% (95% CI 31%-61%) experienced a ≥50% reduction in seizure frequency. Oncological progression was reported in 39% (95% CI 17%-65%) of patients, with no evidence of perampanel effect on tumor behavior. Adverse events occurred in 26% (95% CI 17%-38%) of patients, most of which were mild to moderate and consistent with the known safety profile of perampanel.</p><p><strong>Summary: </strong>Perampanel is associated with meaningful seizure control in a substantial proportion of patients with brain tumor-related epilepsy, including high rates of seizure freedom and significant seizure reduction. Importantly, its use does not appear to influence oncologic progression nor substantially increase the incidence of adverse events. Although limited by the nonrandomized nature of the available studies, these findings support perampanel as a valuable therapeutic option for symptomatic seizure management in BTRE, with potential utility in both adjunctive treatment strategies and palliative care settings. Further prospective and controlled studies are warranted to better define its optimal role and long-term impact in this complex patient population.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200636"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13312988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339603","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":"Altered EEG in Creutzfeldt-Jakob Disease: Improving Diagnostic Accuracy Using American Clinical Neurophysiology Society 2021 Criteria.","authors":"Evelyn Berger-Sieczkowski, Gudrun Zulehner, Sigrid Klotz, Guenther Regelsberger, Lukas Haider, Silvia Bonelli-Nauer, Karin Trimmel, Ellen Gelpi","doi":"10.1212/CPJ.0000000000200642","DOIUrl":"10.1212/CPJ.0000000000200642","url":null,"abstract":"<p><strong>Background and objectives: </strong>Creutzfeldt-Jakob disease (CJD) is a rapidly progressive neurodegenerative disease characterized by significant changes in EEG and structural alterations on MRI. Both are integrated in the current World Health Organization (WHO) surveillance criteria of CJD. We aimed to re-evaluate the EEG recordings, along with clinical and MRI data, in patients with different subtypes of definite CJD by applying the adapted American Clinical Neurophysiology Society (ACNS) criteria, 2021.</p><p><strong>Methods: </strong>Fifty-one routine EEG recordings in 16 patients with sporadic CJD were reanalyzed.</p><p><strong>Results: </strong>Generalized slowing, according to standard terminology, was present in 94% of patients. Generalized periodic discharges (GPDs) and generalized rhythmic delta activity (GRDA), as defined by the 2021 ACNS criteria, occurred frequently (31% and 38%, respectively). The differentiation from ictal activity may be challenging because 25% (4/16) of the patients fulfilled the criteria of the recently proposed ictal-interictal continuum (IIC) in at least 1 EEG. By contrast, no status epilepticus (SE) was observed. The EEG alterations varied among the different CJD molecular subgroups: more cortical involvement in MM/MV1 and mixed MM/MV1 + 2C histotypes was associated with periodic discharges (PDs) (57% and 80%) and also IIC (43% and 20%). We could not detect any PD or IIC in patients with the VV1 or MV2K (predominant subcortical pathology) histotype.</p><p><strong>Discussion: </strong>Assessing the EEGs according to the 2021 ACNS criteria may help prevent misdiagnosis of nonconvulsive status epilepticus, and repetitive recordings may help in earlier diagnosis of CJD.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 4","pages":"e200642"},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13352215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148422334","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 Message From the Editors to Our Reviewers: 2025.","authors":"Luca Bartolini, Kathryn Kvam, David J Brooks, Neil A Busis, Amanda L Jagolino-Cole, John Ney","doi":"10.1212/CPJ.0000000000200629","DOIUrl":"https://doi.org/10.1212/CPJ.0000000000200629","url":null,"abstract":"","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 3","pages":"e200629"},"PeriodicalIF":3.2,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Intracranial Hemorrhage Detection: Real-World Experience in a Large Comprehensive Stroke Center.","authors":"Aakanksha Sriwastwa, Michael Oswald, Kara Weiss, Bin Zhang, Yasmin Ninette Aziz, Achala Vagal","doi":"10.1212/CPJ.0000000000200607","DOIUrl":"10.1212/CPJ.0000000000200607","url":null,"abstract":"<p><strong>Background and objectives: </strong>Automated intracranial hemorrhage (ICH) detection tools are widespread, yet data are limited regarding their performance in real-world practice.</p><p><strong>Methods: </strong>We retrospectively analyzed noncontrast CT head images of consecutive code stroke patients from January 2022 to February 2023 at a comprehensive stroke center. Patients were included if their indication was stroke, and images were assessed by the automated platform. Radiology reports were considered the gold standard. The primary outcome was the performance of the automated software tool compared with that of board-certified radiologists in ICH detection. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated using SAS software.</p><p><strong>Results: </strong>Of 1,434 code stroke CT scans, 1,402 (98%) were analyzed using the automated detection tool. Thirty-two studies were considered nondiagnostic because of severe motion degradation, and these were excluded. The mean patient age was 67 ± 16 years, with 51% of patients being women and 65% of patients being White. The software tool accurately identified 105 of 129 ICH cases (81%) and 1,255 of the 1,273 non-ICH cases (99%). The sensitivity, specificity, positive predictive value, and negative predictive value with 95% CIs were 81% (74%-88%), 99% (98%-99%), 85% (78%-91%), and 98% (97%-99%), respectively. Automated software sensitivity was highest for intra-axial hemorrhage (IAH) at 94%. Extra-axial hemorrhage (EAH) had a sensitivity of just 43%. Sensitivity of mixed IAH and EAH was 89%, representing a significant increase from isolated EAH.</p><p><strong>Discussion: </strong>Automated ICH detection software demonstrates high accuracy in detecting ICH in real-world practice. Sensitivity for IAH is particularly high, with detection of EAH reaching acceptable parameters when co-presenting with IAH but lacking in isolation.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 3","pages":"e200607"},"PeriodicalIF":3.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13020556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147574908","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":"Temporal Trends in the Frequency of Concomitant Cancer and Cerebrovascular Disease Diagnoses in the United States.","authors":"Morin Beyeler, Lillie Lanphier, Cenai Zhang, Ava Leigh Liberman, Scott T Tagawa, Simon Mantha, Hooman Kamel, Babak Benjamin Navi","doi":"10.1212/CPJ.0000000000200614","DOIUrl":"10.1212/CPJ.0000000000200614","url":null,"abstract":"<p><strong>Background and objectives: </strong>Cancer is associated with vascular disease. Modern cancer treatments, particularly targeted agents and immunotherapy, have extended survival from cancer. We aimed to determine whether the co-prevalence of cancer and cerebrovascular disease diagnoses among outpatients has increased over time along with these advances.</p><p><strong>Methods: </strong>This was a time-series cross-sectional analysis of outpatient visits in the US National Ambulatory Medical Care Survey from 2005 to 2019. The primary cohort included patient visits with a diagnosis of cerebrovascular disease (ischemic or hemorrhagic stroke or TIA). We used joinpoint regression to evaluate temporal trends in the frequency of concomitant cancer diagnoses during the study period. We used logistic regression, adjusting for demographics and stroke risk factors, to assess the relationship between survey year and cancer diagnoses.</p><p><strong>Results: </strong>After applying sampling weights, this analysis represented an estimated 245,093,640 visits by patients with a cerebrovascular disease diagnosis. The mean patient age for the overall cohort was 69.4 years (SD, 15.9), and 51.0% were women. Among patients with cerebrovascular disease, 27,294,617 visits (11.1%) included a concomitant diagnosis of cancer. The percentage of visits listing a concomitant cancer diagnosis increased from 7.7% (95% CI 4.6%-10.7%) in 2005 to 15.3% (95% CI, 6.1%-24.5%) in 2019. Joinpoint regression analysis demonstrated a significant increase in cancer diagnoses from 2005 to 2019, with an annual percentage change of 3.5% (95% CI, 0.2%-6.9%). In multivariable logistic regression analysis, the co-prevalence of cancer and cerebrovascular disease increased linearly over time (adjusted odds ratio per year, 1.04; 95% CI, 1.00-1.08).</p><p><strong>Discussion: </strong>From 2005 to 2019, the proportion of US ambulatory visits with concomitant diagnoses of cerebrovascular disease and cancer steadily increased from 7.7% to 15.3%. Because data on the timing of diagnoses are unavailable in NAMCS, this analysis could not determine whether these diagnoses were related, and which came first. Future population-based studies including data on the timing and etiology of stroke and cancer diagnoses are needed to better elucidate the potential causal link between these diseases.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 3","pages":"e200614"},"PeriodicalIF":3.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13133921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874626","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":"Optimizing Antiseizure Medication Taper in the Epilepsy Monitoring Unit.","authors":"Kerry C Nix, Nina J Ghosn, Kevin Xie, William Ojemann, Colin A Ellis, Genna J Waldman, Eli Cornblath, Erin Conrad, Devin Ma, Brian Litt","doi":"10.1212/CPJ.0000000000200606","DOIUrl":"10.1212/CPJ.0000000000200606","url":null,"abstract":"<p><strong>Background and objectives: </strong>Inpatient video-EEG epilepsy monitoring aims to provide a safe environment for antiseizure medication (ASM) tapering to precipitate seizures, which is often required for diagnosis and treatment. However, there is no standardized taper protocol across institutions, which may contribute to increased morbidity through longer hospitalizations if the taper is too mild and bilateral tonic-clonic seizures (BTCSs) if too aggressive. This study investigates how ASM taper influences length of stay (LOS) and patient outcomes in the epilepsy monitoring unit (EMU), aiming to develop guidelines for medication taper strategies to maximize diagnostic yield while minimizing patient risk.</p><p><strong>Methods: </strong>We used natural language processing to extract data from electronic medical records of 639 patients admitted to the University of Pennsylvania EMU between 2017 and 2023. We estimated ASM load, the total normalized sum of all ASM serum concentrations based on dose-dependent pharmacokinetic models, throughout each hospitalization. We applied LASSO (Least Absolute Shrinkage and Selection Operator) regression and mixed-effects models to identify predictors of LOS and BTCS risk as a function of taper speed and percentage of baseline ASM load in patients with (hBTCS) and without (nBTCS) a history of BTCS.</p><p><strong>Results: </strong>Taper speed did not correlate with BTCS risk, although absolute ASM load did. Median ASM loads at seizure occurrence were 51% of baseline in the hBTCS group, 41% in the nBTCS group, and 39% in the unclear group. BTCS occurred at higher ASM loads in patients with hBTCS vs nBTCS. Median ASM loads at first EMU seizure were 33% for both hBTCS and nBTCS groups, while the unclear group had first seizures at lower loads (25% of baseline). Time to first seizure and number of baseline ASMs were positively correlated with longer hospital stays, suggesting that sequential medication taper delayed seizures and prolonged LOS without altering BTCS risk.</p><p><strong>Discussion: </strong>Patient history and ASM load are critical factors in predicting BTCS. Rapid taper to approximately 50% baseline ASM load may more efficiently produce seizures without increased BTCS risk in patients without BTCS history. Individualized taper protocols remain advised, particularly for severe epilepsies. This study provides a foundation for quantitative, evidence-based guidelines to optimize ASM reduction strategies for safely precipitating seizures in EMUs.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 3","pages":"e200606"},"PeriodicalIF":3.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147932054","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":"Health Care Utilization in Refractory Migraine: A Cross-Sectional Analysis of a Cross-Institutional Electronic Health Care Records Database.","authors":"Leon S Moskatel, Liza Smirnoff, Hope O'Brien, Hayley Striegel, John Ney, Michael J Marmura, Dharti Dua, Jennifer Robblee","doi":"10.1212/CPJ.0000000000200615","DOIUrl":"10.1212/CPJ.0000000000200615","url":null,"abstract":"<p><strong>Background and objectives: </strong>Refractory migraine (RM) is associated with substantial disability, yet its clinical and health care utilization patterns remain poorly characterized in large, real-world populations. Understanding how preventive treatment progression relates to health care use and patient characteristics may inform earlier identification and care strategies. We sought to evaluate demographic, clinical, and health care utilization patterns in chronic migraine according to the number of preventive medication trials using a large cross-institutional electronic health record (EHR) database.</p><p><strong>Methods: </strong>We conducted a retrospective observational study using the Epic Cosmos Cross-institutional EHR Database from January 1, 2016, to December 31, 2024. Adults with chronic migraine (International Classification of Diseases, Tenth Edition code G43.7) were included. Preventive medication trials were categorized into 5 classes: antihypertensives, antidepressants, antiseizure agents, calcitonin gene-related peptide-targeted therapies, and onabotulinumtoxinA. We evaluated demographics, comorbidities, and health care utilization metrics, including inpatient or outpatient dihydroergotamine (DHE) infusions, emergency department (ED) visits for headache, MRI brain orders, and patient EHR portal recency (MyChart). Marginal changes were defined as the percentage point change in outcomes between medication classes. Chi-squared tests and analysis of variance were used with significance set at <i>p</i> < 0.05.</p><p><strong>Results: </strong>A total of 1,572,698 patients were identified by our search criteria; 21.2% were prescribed no preventive medications and 2.5% were prescribed all 5 classes, meeting the study's definition of RM. Health care utilization increased significantly with each additional medication class. The greatest marginal increases occurred between zero to 1 classes for MyChart access (43-day decrease), 1 to 2 classes for ED visits (+9.2%), and 4 to 5 classes for DHE administration (+6.1%) and MRI brain orders (+4.9%). Patients prescribed more preventive classes were older, a higher percentage female sex, White race, with public insurance, residence in the Northeast United States, and live in less socially vulnerable areas. Comorbidity burden increased progressively, with 94.6% of refractory patients having at least 1 comorbidity, most commonly anxiety (78.1%), depression (71.5%), hypertension (56.0%), and asthma (36.3%). All differences were statistically significant (<i>p</i> < 0.001).</p><p><strong>Discussion: </strong>Higher health care utilization, greater comorbidity burden, and distinct geographic patterns are observed with increasing numbers of preventive medication trials in chronic migraine. These findings highlight the complexity of RM and underscore the need for earlier identification and more equitable access to comprehensive migraine care.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 3","pages":"e200615"},"PeriodicalIF":3.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13155700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874630","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":"Feasibility for a Community-Based Parkinson Disease Cohort in Hawaii.","authors":"Emma Krening, Ruby Shuman, Malika Faouzi, Kenny Thai, Fay Gao, Caroline M Tanner, G Webster Ross, Michiko K Bruno","doi":"10.1212/CPJ.0000000000200603","DOIUrl":"10.1212/CPJ.0000000000200603","url":null,"abstract":"<p><strong>Background and objectives: </strong>Most of the research in Parkinson disease (PD) has been conducted in White populations. There is a gap in the understanding of PD in other racial/ethnic groups, such as Asian Americans (AAs) and Native Hawaiians or Pacific Islanders (NHPIs). Therefore, we aimed to test the feasibility of a longitudinal cohort and understand attitudes and barriers to research participation in a pilot study of AA, NHPI, and White patients with PD in Hawai'i.</p><p><strong>Methods: </strong>We conducted a prospective pilot study of AA, NHPI, and White patients with PD, without dementia, to compare characteristics between racial groups' self-reported quality of life (QoL), interest in participating in research, health care utilization, and barriers to accessing health care, at baseline and 6-month follow-up visits. This was a single-center study completed at the Parkinson's and Movement Disorder Center at The Queen's Medical Center in Honolulu, Hawai'i from March 2023 to June 2024.</p><p><strong>Results: </strong>Of 146 patients screened for eligibility, 79 completed study enrollment (mean 68.8 years, male = 59%). Demographics, PD history, and questionnaires from baseline and follow-up visits were analyzed for 78 participants (AA = 27, NHPI = 26, White = 25), with 1 participant who dropped out. Differences were found between groups' household income, comfort with technology, and awareness of advanced PD therapies. There was no significant difference between groups' self-reported QoL, barriers to PD care, and attitudes toward clinical research.</p><p><strong>Discussion: </strong>AA and NHPI patients with PD in this study were no less apt to participate in research compared with White patients with PD. Although there were no significant differences in the variables evaluated among different racial subgroups, our results warrant further research.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 3","pages":"e200603"},"PeriodicalIF":3.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147623419","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":"Association of Military Sexual Trauma With Migraine and Migraine-Related Health Care Utilization Among Post-9/11 US Veterans.","authors":"John Ney, Brenda Fenton, Amy S Grinberg, Daniel G Rogers, Elizabeth K Seng, Manali Avinash Phadke, Elinor K Laffargue, Cynthia A Brandt, Jason J Sico","doi":"10.1212/CPJ.0000000000200618","DOIUrl":"10.1212/CPJ.0000000000200618","url":null,"abstract":"<p><strong>Background and objectives: </strong>Military sexual trauma (MST) is increasingly recognized in US veterans. MST is associated with psychiatric disease, substance abuse, and pain conditions, including headache. Little is known about the relationship between MST and specific headache disorders.</p><p><strong>Methods: </strong>This retrospective cross-sectional study analyzed administrative data from the Women Veterans Cohort Study, a sample of post-9/11 US veterans enrolled for Veterans Health Administration care. A positive MST screen in the electronic medical record defined exposure. We extracted demographic and clinical data from administrative coding for migraine and relevant confounders, comparing between subgroups with χ² tests. Health care utilization variables included designated sites of care and prescribed acute and preventive treatments and were evaluated with multivariable logit, negative binomial (nb), and zero-inflated nb models.</p><p><strong>Results: </strong>Of 846,435 veterans screened for MST, 4.4% of veterans had a positive screen, whereas 9.5% had migraines. Veterans with migraine and a positive MST screen (21.7%) were more often non-White (45.3% vs 38.6%, <i>p</i> < 0.001), and 33 or less years old (55% vs 53%, <i>p</i> < 0.001) than veterans with migraine and a negative MST screen (9.0%). Adjusting for sex, the odds of migraine were greater for veterans with a positive MST screen (OR 1.62, 95% CI 1.57-1.67). Veterans with migraine and a positive MST screen were no more likely to receive triptan medications than veterans with migraine (46.2% vs 45.7%, <i>p</i> = 0.47) although were more likely to be prescribed opioids (36.1% vs 33.4%, <i>p</i> ≤ 0.001), compared with those with migraine and a negative MST screen. After controlling for sex, comorbidities (including chronic pain conditions), treatments, and other health care use, health care utilization was increased among migraine veterans with a positive MST screen, compared with migraine veterans without a positive MST screen for primary care (IRR 1.06, 95% CI 1.04-1.08, <i>p</i> < 0.001) and emergency department care (IRR 1.14, (95% CI 1.07-1.22), whereas neurology visits were not increased (IRR 0.97, 95% CI 0.92-1.02).</p><p><strong>Discussion: </strong>Veterans with a positive MST screen constitute a vulnerable population more likely to have migraine, take opioid medications, and use emergency departments for migraine care.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 3","pages":"e200618"},"PeriodicalIF":3.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13155698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875307","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":"Evaluating the Duke Iterative Cognitive Examination Against the Montreal Cognitive Assessment: Validity and Clinical Utility.","authors":"Christine Park, Thomas J Farrer, Jill Z Stuart, Kim G Johnson, Michael W Lutz, Richard J O'Brien, Carolina E Quiroga Del Rio, Paula-Ann E Chin, Deborah C Koltai","doi":"10.1212/CPJ.0000000000200617","DOIUrl":"10.1212/CPJ.0000000000200617","url":null,"abstract":"<p><strong>Background and objectives: </strong>Rapid and valid cognitive screening tools are a mainstay of clinical practice in the assessment of mild cognitive impairment and dementia. Although there are several available tools, there is concern for reduced sensitivity over time. This study evaluates the Duke Iterative Cognitive Examination (DICE) to establish concurrent validity with the Montreal Cognitive Assessment (MoCA) and to establish the clinical utility of the DICE in differentiating clinical groups.</p><p><strong>Methods: </strong>Participants were enrolled prospectively and included a convenience sample of 126 healthy older adults, 59 individuals with mild cognitive impairment (MCI), and 66 with dementia, all age 55+. All participants were administered the MoCA and the DICE in counterbalanced order. Spearman rank-order correlation examined the relationship between DICE and MoCA scores. Likelihood ratio (L-R) chi-square tests assessed the predictive value of cognitive scores, age, sex, and education in diagnostic classification. Receiver operating characteristic curve analyses evaluated classification accuracy for both tests.</p><p><strong>Results: </strong>The correlation between the DICE and MoCA was strong, suggesting concurrent validity (<i>ρ</i> = 0.89, <i>p</i> < 0.001). Both measures significantly predicted diagnostic groups and demonstrated strong classification accuracy (MoCA AUC = 0.97 (controls), 0.85 (MCI), 0.95 (dementia); DICE AUC = 0.97, 0.94, 0.83, respectively).</p><p><strong>Discussion: </strong>The DICE performed comparably to the MoCA in the current sample of older healthy adults and clinical groups with MCI and dementia. Findings suggest that the DICE is a reasonable and valid screening measure, and future studies should examine other psychometric aspects of the test, such as test-retest reliability, latent factor structure, and longitudinal clinical prediction.</p>","PeriodicalId":19136,"journal":{"name":"Neurology. Clinical practice","volume":"16 3","pages":"e200617"},"PeriodicalIF":3.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13108909/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147875266","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}