Stigma intersectionality and its impact on an epilepsy stigma self-management program.

Introduction: Perceived stigma is a common and distressing experience among people with epilepsy (PWE), particularly those with additional marginalized identities. Our team developed RISE ABOVE, a self-paced online stigma self-management program, to reduce stigma-related distress. This secondary analysis of pilot data examined how intersecting stigmas (i.

Diagnostic Challenges in the Neuropsychology of Epilepsy: Report of the ILAE Neuropsychology Task Force Diagnostic Methods Commission: 2021-2025.

Increasingly, it has been recognized that non-seizure-related factors influence how people with epilepsy perform on neuropsychological tests. Therefore, neuropsychologists need to recognize the constellation of factors that can contribute to the neurocognitive presentation of a person with epilepsy and consider these factors in the interpretation of their assessment results. In this paper, we highlight common scenarios prompting the need to account for such factors when conducting and interpreting neuropsychological assessments.

Effects of Initiating Different Antidepressant Subclasses on Motor Vehicle Crash Risk Among Older Adults With Depression.

Background: Antidepressants are prescribed for depression among older adults but might increase the risk of motor vehicle crash (MVC) through adverse effects (AEs) like sedation, dizziness, and blurred vision. Antidepressant subclasses may have different MVC risks since AE risks vary across subclasses. Our objective was to estimate the comparative one-year risks of MVC upon initiating atypical (AA) or tricyclic (TCA) versus selective serotonin reuptake inhibitor (SSRI) antidepressants.

Feasibility and acceptability of an online epilepsy stigma self-management program.

Introduction: Stigma is a prevalent source of distress in people with epilepsy. We developed a self-paced online stigma self-management program for adults with epilepsy (Reducing Internalized Stigma in Epilepsy: A Behavioral Online Video Education, RISE ABOVE).

Materials And Methods: Twenty socio-demographically diverse participants completed RISE ABOVE over an average of 3.

Medication adherence feedback with older adults with cognitive impairment: a mixed Methods study.

Older adults with cognitive impairment are at risk of medication-taking errors. This study assessed the impact of providing medication adherence feedback to cognitively impaired older adults. Forty participants with mild cognitive impairment or mild dementia had their medication adherence electronically monitored for 8 weeks.

Experience from a Fast-Track Multidisciplinary Clinic Integrating Movement Disorders Neurologists in Normal Pressure Hydrocephalus Evaluation.

In this prospective observational cohort study, we provide preliminary findings from a same-day multidisciplinary fast-tracked normal pressure hydrocephalus (NPH) clinic; incorporating the expertise of movement disorders neurologists, emphasizing the clinical characteristics, consensus classification, and management of patients referred for suspected NPH. We evaluated 111 patients (male/female: 67/44) from April 2022 to May 2023. Based on the multidisciplinary team consensus, 52 (46.

Medication Changes Among Older Drivers Involved in Motor Vehicle Crashes.

Importance: Although older adults may use potentially driver-impairing (PDI) medications that can produce psychomotor impairment, little is known about changes to PDI medication use among older adults from the time before to the time after a motor vehicle crash (MVC).

Objective: To quantify use of and changes in PDI medications among older adults before and after an MVC.

Design, Setting, And Participants: This cohort study used linked Medicare claims and police-reported MVC data on 154 096 person-crashes among 121 846 older drivers.

Validating the Fluctuating Mental Status Evaluation in Neurocritically Ill Patients With Acute Stroke.

Objectives: Neurocritically ill patients are at high risk for developing delirium, which can worsen the long-term outcomes of this vulnerable population. However, existing delirium assessment tools do not account for neurologic deficits that often interfere with conventional testing and are therefore unreliable in neurocritically ill patients. We aimed to determine the accuracy and predictive validity of the Fluctuating Mental Status Evaluation (FMSE), a novel delirium screening tool developed specifically for neurocritically ill patients.

Implications of using administrative healthcare data to identify risk of motor vehicle crash-related injury: the importance of distinguishing crash from crash-related injury.

Background: Administrative healthcare databases, such as Medicare, are increasingly used to identify groups at risk of a crash. However, they only contain information on crash-related injuries, not all crashes. If the driver characteristics associated with crash and crash-related injury differ, conflating the two may result in ineffective or imprecise policy interventions.

Nonbenzodiazepine hypnotics and police-reported motor vehicle crash risk among older adults: a sequential target trial emulation.

Nonbenzodiazepine hypnotics ("Z-drugs") are prescribed for insomnia but might increase the risk of motor vehicle crash (MVC) among older adults through prolonged drowsiness and delayed reaction times. We estimated the effect of initiating Z-drug treatment on the 12-week risk of MVC in a sequential target trial emulation. After linking New Jersey driver licensing and police-reported MVC data to Medicare claims, we emulated a new target trial each week (July 1, 2007, to October 7, 2017) in which Medicare fee-for-service beneficiaries were classified as Z-drug-treated or untreated at baseline and followed for an MVC.

Anticholinergic and sedative medication use in older patients with cognitive concerns.

Background: Anticholinergic (AC) and sedative medications are a risk factor for cognitive impairment. This study sought to characterize AC and sedative use in older patients seen for outpatient neuropsychological evaluation and evaluate their associations with different cognitive domains. We hypothesized that AC and sedative use would be associated with worse attention/processing speed (AP), executive functioning (EF), and memory.

Medication management error types: Associations with mild cognitive impairment subtype.

Medication management errors are suspected to be prevalent among older adults with mild cognitive impairment (MCI). This study examined types of simulated medication-taking errors in cognitively normal older adults (CN;  = 131), single domain amnestic MCI (sdMCI,  = 91), and multi-domain MCI (mdMCI,  = 44). Errors were measured using the medication management ability assessment (MMAA).

Compensatory Strategy Intervention: What Older Patients Want and Why.

Objective: Compensatory strategies can improve performance of instrumental activities of daily living in people with cognitive impairment. This study investigated patient interest in compensatory strategy interventions and preference for various intervention formats.

Methods: Semi-structured qualitative interviews with 38 older adults with cognitive impairment queried motivation to improve strategy use and interest in intervention formats/delivery methods.

Changes in the burden of medications that may impair driving among older adults before and after a motor vehicle crash.

Background: Medications are one of the most easily modifiable risk factors for motor vehicle crashes (MVCs) among older adults, yet limited information exists on how the use of potentially driver-impairing (PDI) medications changes following an MVC. Therefore, we examined the number and types of PDI medication classes dispensed before and after an MVC.

Methods: This observational study included Medicare fee-for-service beneficiaries aged ≥67 years who were involved in a police-reported MVC in New Jersey as a driver between 2008 and 2017.

Rest-activity patterns associated with delirium in patients with intracerebral hemorrhage.

Background: Delirium is an acute cognitive disturbance frequently characterized by abnormal psychomotor activity and sleep-wake cycle disruption. However, the degree to which delirium affects activity patterns in the acute period after stroke is unclear. We aimed to examine these patterns in a cohort of patients with intracerebral hemorrhage (ICH).

Integrated psychological care services within seizure settings: Key components and implementation factors among example services in four ILAE regions: A report by the ILAE Psychiatry Commission.

Mental health comorbidities are prevalent and problematic in patients with seizures but often suboptimally managed. To address common gaps in care, the Integrated Mental Health Care Pathways Task Force of the International League Against Epilepsy (ILAE) Psychiatry Commission was tasked with providing education and guidance on the integration of mental health management (e.g.

Distance From Home to Motor Vehicle Crash Location: Implications for License Restrictions Among Medically-At-Risk Older Drivers.

In 30 states, licensing agencies can restrict the distance from home that "medically-at-risk" drivers are permitted to drive. However, where older drivers crash relative to their home or how distance to crash varies by medical condition is unknown. Using geocoded crash locations and residential addresses linked to Medicare claims, we describe how the relationship between distance from home to crash varies by driver characteristics.

The complementary utility of cognitive testing and the medication management ability assessment in older adults.

Objective: Older adults are susceptible to cognitive declines that may limit independence. Though neuropsychologists opine about risk of functional decline, the degree to which cognitive testing and in-office simulations approximate everyday behavior is unclear. We assessed the complementary utility of cognitive testing and the face-valid Medication Management Ability Assessment (MMAA) to predict medication management among older adults.

Healthy Lifestyle Behaviors and Viewpoints Among Members of an Alzheimer Prevention Registry.

Background: Research on Alzheimer disease and related dementias is increasingly focused on preventative strategies to target modifiable risk factors (eg, exercise, diet, cognitive stimulation) to reduce risk of cognitive decline, though it remains difficult for adults to adopt and maintain these behaviors on their own.

Methods/participants: In this survey study, we examined knowledge about modifiable risk factors for dementia, engagement in healthy lifestyle behaviors, and associated barriers/facilitators in an Alzheimer disease prevention registry of at-risk, cognitively normal adults (n=135: 77% female; 96% Caucasian and non-Hispanic; mean age=66.1; 79% with family history of dementia; 46% with subjective memory decline).

Diverse experiences and approaches to tele neuropsychology: Commentary and reflections over the past year of COVID-19.

In response to the coronavirus disease 2019 (COVID-19) pandemic, neuropsychologists rapidly adopted teleneuropsychology (TeleNP) services to ensure continued clinical care. Prior to COVID-19, TeleNP was not widely used nor was it included in the majority of traditional practice or training models across graduate, internship, and postdoctoral programs. Out of necessity, the pandemic was a catalyst that promoted greater adoption of TeleNP services.

Common biomarkers of physiologic stress and associations with delirium in patients with intracerebral hemorrhage.

Purpose: To examine associations between physiologic stress and delirium in the setting of a direct neurologic injury.

Materials And Methods: We obtained initial neutrophil-to-lymphocyte ratio (NLR), glucose, and troponin in consecutive non-comatose patients with non-traumatic intracerebral hemorrhage (ICH) over 1 year, then used multivariable regression models to determine associations between each biomarker and incident delirium. Delirium diagnoses were established using DSM-5-based methods, with exploratory analyses further categorizing delirium as first occurring <24 h ("early-onset") or > 24 h after presentation ("later-onset").