Regular use of opioids and dementia, cognitive measures, and neuroimaging outcomes among UK Biobank participants with chronic non-cancer pain.

Introduction: We investigated the association between regular opioid use and incident dementia, neuroimaging outcomes, and cognitive measures.

Methods: Cox regression was used to assess the association between opioid use and incident dementia among197,673 UK Biobank participants with chronic non-cancer pain. Linear and logistic regression were applied to explore the associations between opioid use and dementia-related neuroimaging and cognitive function outcomes.

Is there a relationship between opioid use and transient global amnesia?

Background And Purpose: Opioid-associated amnestic syndrome (OAS) and transient global amnesia (TGA) are conditions with clinical overlap. We therefore sought to determine whether opioid use might be associated with TGA.

Methods: Data from the Massachusetts Department of Public Health Syndromic Surveillance program were queried to ascertain the frequency of opioid use among emergency department (ED) encounters for TGA compared to that for all other ED visits between January 2019 and June 2023.

Longitudinal Imaging in a Patient With Opioid-associated Amnestic Syndrome.

Since 2012, individuals with a history of opioid misuse have infrequently been observed to develop a sudden-onset amnestic syndrome associated with bilateral hippocampal-restricted diffusion on MRI. Follow-up imaging of this opioid-associated amnestic syndrome (OAS) has revealed persistent hippocampal abnormalities. Given these observations, as well as neuropathological studies demonstrating excessive tau deposition in the hippocampi and other brain regions of individuals with opioid misuse, we describe longitudinal imaging of a patient with a history of OAS from presentation through 53 months later, when tau positron emission tomography (PET) was performed.

Application of an Existing Syndromic Surveillance System to Quantify Possible Cases of Opioid-associated Amnestic Syndrome in Massachusetts.

Objectives: In recent years, an opioid-associated amnestic syndrome (OAS) was identified in Massachusetts through elicited reporting by health care providers (traditional surveillance, TS). Whether OAS occurs more frequently and with a wider spatiotemporal distribution in Massachusetts remains unclear. We compared the frequency and spatiotemporal characteristics of emergency department (ED) visits for possible OAS (pOAS) using a pre-existing syndromic surveillance system (SyS) with OAS cases captured through TS.

Neurotoxicology Syndromes Associated with Drugs of Abuse.

Substance use disorders-and their associated neurologic complications-are frequently encountered by neurologists as well as emergency room physicians, internists, psychiatrists, and medical intensivists. Prominent neurologic sequelae of drug abuse, such as seizure and stroke, are common and often result in patients receiving medical attention. However, less overt neurologic manifestations, such as dysautonomia and perceptual disturbances, may be initially misattributed to primary medical or psychiatric illness, respectively.

Opioid-associated amnestic syndrome: Description of the syndrome and validation of a proposed definition.

Objective: An opioid-associated amnestic syndrome (OAS) characterized by acute onset memory loss and bilateral hippocampal signal abnormalities on brain imaging in the setting of a history of opioid use, most notably fentanyl, has been reported. To date, however, there is no case definition to assist neurologists and other clinicians in identifying this syndrome. A multi-disciplinary collaboration of physicians, including neurologists, propose diagnostic criteria for OAS using cases that have been published in the medical literature or presented at conferences.

Connecting the dots: an association between opioids and acute hippocampal injury.

Acute hippocampal injury represents a relatively rare cause of amnesia. Interestingly however, between 2012 and 2017, 18 patients were reported at hospitals in Massachusetts with sudden-onset amnesia in the setting of complete diffusion-weighted hyperintensity of both hippocampi on magnetic resonance imaging. Notably, 17 of the 18 patients tested positive for opioids or had a recorded history of opioid use.

Cluster of an Unusual Amnestic Syndrome - Massachusetts, 2012-2016.

In November 2015, a neurologist in the Boston, Massachusetts, area reported four cases of an uncommon amnestic syndrome involving acute and complete ischemia of both hippocampi, as identified by magnetic resonance imaging (MRI), to the Massachusetts Department of Public Health (MDPH) (1). A subsequent e-mail alert, generated by the Massachusetts Board of Registration in Medicine and sent to relevant medical specialists (including neurologists, neuroradiologists, and emergency physicians), resulted in the identification of 10 additional cases that had occurred during 2012-2016. All 14 patients (mean and median age = 35 years) had been evaluated at hospitals in eastern Massachusetts.

Complete, bilateral hippocampal ischemia: a case series.

Acute and complete ischemia of the hippocampi represents a rare cause of amnesia. This paper describes the features of four such cases presenting to a single tertiary care center over a 3-year period. Interestingly, in three instances, toxicology screening was positive for opioids at the time of presentation, while in the fourth, there was a known, reportedly remote, history of heroin use.

Accuracy of administrative diagnostic data for pathologically confirmed cases of Creutzfeldt-Jakob disease in Massachusetts, 2000-2008.

Background: Creutzfeldt-Jakob disease (CJD) is a transmissible disorder that is monitored by public health authorities at the state and national levels in the United States. Little is known about the current accuracy and concurrence of CJD diagnoses across national and state sources of surveillance data.

Methods: Using multiple sources, including the National Prion Disease Pathology Surveillance Center (NPDPSC) registry, we sought to identify all deceased Massachusetts patients with pathologically diagnosed CJD between 2000 and 2008.

Veterans health administration information systems as a resource for rare disorders research: Creutzfeldt-Jakob disease as a paradigm.

Objective: To illustrate the application of Veterans Health Administration (VHA) information systems in both clinical and epidemiologic investigations of a rare disease, our specific aims were: (1) to determine the number and incidence of Creutzfeldt-Jakob disease (CJD) diagnoses in the VHA from fiscal year (FY) 1997 through FY 2010 and (2) to describe the relevant clinical features associated with those diagnoses.

Methods: The VHA Medical SAS Datasets were queried for all unique, incident CJD diagnoses between FY 1997 and 2010. Electronic health records were then reviewed to validate diagnoses using modified criteria.

Clinical features of sporadic fatal insomnia.

Recent advances in neuropathology, genotyping, and physiochemical characterization of proteins have allowed for the classification and verification of MM2-thalamic Creutzfeldt-Jakob disease (CJD). CJD is a fatal neurodegenerative illness belonging to the transmissible spongiform encephalopathies, also known as prion diseases. Sporadic CJD is generally classified by the genotype at codon 129 of the prion protein gene and the distinct physiochemical features of the pathologic prion protein (PrP(sc)).

Is surgery a risk factor for Creutzfeldt-Jakob disease? Outcome variation by control choice and exposure assessments.

Objective: To determine whether methodological differences explain divergent results in case-control studies examining surgery as a risk factor for Creutzfeldt-Jakob disease (CJD).

Methods: After case-control studies were systematically identified using PubMed, we performed a homogeneity analysis and applied models to effect sizes (odds ratio [OR] with 95% confidence interval [CI]) using 2 parameters: type of control subject used and consistency of data ascertainment. The hospitals and communities were located in Europe, Japan, and Australia.

A systematic review of sporadic Creutzfeldt-Jakob disease clusters: do clinical, epidemiologic, and genetic features reflect infectious clustering mechanisms?

Background: While the cause of sporadic Creutzfeldt-Jakob disease (sCJD) is unknown, case clustering could suggest infectious transmission in some instances.

Methods: Publications of sCJD clusters were systematically identified and pooled to determine if their clinical, epidemiologic, and genetic features reflected potential infectious clustering mechanisms.

Results: The search yielded five clusters involving 23 cases.