The final month of 2020 saw fifteen new publications written or co-written by members of the Duke Department of Neurology. Sneha Mantri, MD, MS, was a lead author of a new study examining factors contributing to burnout and moral injury among health-care workers at Duke. Our Neuromuscular Disease faculty wrote multiple studies advancing our understanding of myasthenia gravis, including how the COVID-19 pandemic is affecting people with this condition. Other articles answered questions about stroke, Parkinson’s, and other diseases. Read short summaries of each of these publications, and find links to the original articles below.
Parkinson’s Disease and Movement Disorders
- Burt Scott, MD, PhD, contributed to a new study that examined changes in the retina and choroid of eyes in individuals with Parkinson’s disease. The cross-sectional study found that individuals with Parkinson’s had significant differences in vessel and perfusion density, showing potential for a non-invasive biomarker for this condition. Read the full study in JAMA Ophthalmology.
General and Community Neurology
- Sneha Mantri, MD, MS, was the first author of a Journal of Nervous and Mental Disease study that examined moral injury symptoms among health-care professionals at Duke. Nearly 1 in 4 (23.9%) of professionals had symptoms causing moderate or greater impairment. Burnout, recent medical errors, and lower religiosity were associated with greater moral injury. Read the full article here.
Multiple Sclerosis and Neuroimmunology
- The COVID-19 pandemic has added new complexity to care for many chronic diseases, including multiple sclerosis. One model to quickly and effectively share information for this condition is Project ECHO, a videoconference-based education and case consultation program offered to providers caring for patients with MS. Mark Skeen, MD, was part of a team reporting on this project. Read that article in Multiple Sclerosis and Related Disorders.
Neuromuscular Disease
- A new study offers important evidence about the use of non-invasive ventilation for ALS patients in hospice care. Senior author Rick Bedlack, MD, PhD, and colleagues performed a retrospective cross-sectional study of patients, finding those who continued on non-invasive ventilation had a similar length of stay without incurring overwhelming financial or administrative costs. Read that article in the American Journal of Hospice and Palliative Care.
- A new study answers important questions about the immune profiles associated with autoimmune seronegative myasthenia gravis (SN MG). Senior authors Jeffrey Guptill, MD, MHS, John Yi, PhD (Department of Surgery), and colleagues performed high‐dimensional flow cytometry on blood samples from SN MG patients, healthy controls, and acetylcholine receptor antibody MG patients. The team found reduced plasmablast frequencies were strongly associated with a SN MG diagnosis, making them a potential diagnostic biomarker in the future. Shruti Raja, MD, Lisa Hobson-Webb, MD, Karissa Gable, MD, Vern Juel, MD, and Natalia Gonzalez, MD, contributed to theMuscle and Nerve article, which is available here.
- Patients with myasthenia gravis may be particularly vulnerable during the COVID-19 pandemic from risks of worsening disease, potential adverse effects of COVID-19, and a limited ability to fight off infection related to immunosuppressive treatments. Lead authors Yingkai Li, MD, PhD, and Jeffrey Guptill, MD, MPH, and colleagues in our Neuromuscular Division (Douglas Emmett, the DCRI’s Marjan Cobbaert, MPH, Donald Sanders, MD, Vern Juel, MD, Lisa Hobson-Webb, MD, Janice Massey, MD, Karissa Gable, MD, Shruti Raja, MD, and Natalia Gonzalez, MD) conducted a survey of nearly 2,000 patients at Duke to better understand how patients are experiencing the COVID‐19 pandemic, including where they receive relevant information, how it has affected medical care, and what measures they use to protect themselves. Read what they found in Muscle and Nerve.
Memory Disorders
- A new case report case report highlights the importance of assessing clinical trajectory in patients with rapidly progressing dementia. Lead authors Andy Liu, MD, and Elijah Lackey, MD, as well as Jodi Hawes, MD, wrote the case report for Case Reports in Neurological Medicine. Read it here.
- Sarah Cook, PhD, was a co-author of a recent article in Neuropsychology that used comprehensive neuropsychological criteria to identify patients with mild cognitive impairment (MCI) in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study. The team found that NP criteria identified a proportion of MCI and reversion rate within ACTIVE that is consistent with prior studies involving community-dwelling samples. Read more about the study here.
- Brenda Plassman, PhD, was the senior author of a new study examining cognitive decline in relation to hearing loss, vision loss, or the loss of both senses. Their analysis of nearly 300 older individuals found a significant association between hearing loss, dual sensory loss and faster cognitive decline. Read that study in the Journal of the American Geriatric Society.
Neurocritical Care
- The shortage of available donor lungs remains an impediment to life-saving organ donation for those with end-stage pulmonary disease. Cherylee Chang, MD, wrote an editorial discussing the significance of this problem, factors limiting the availability of lungs for donation, and risks and benefits of deepening the pool of potential donors. Read that article in Critical Care Medicine.
Stroke
- Wayneho Kam, MD, and Nada El-Husseini, MD, wrote a new chapter in the ASPC Manual of Preventive Cardiology. The chapter, “Prevention of Ischemic Stroke,” provides the latest evidence-based practice guidelines on the primary prevention of ischemic stroke, focusing on nine vascular risk factors and their conferred stroke risk. Read that chapter here.
- A new study by senior author Ying Xian, MD, PhD, Daniel Laskowitz, MD, MHS, and colleagues examined how changes in informed consent policies affected door-to-needle times in stroke patients receiving thrombolytic therapy with tissue plasminogen activator (tPA). Their analysis of nearly 1,000 patients found that changing policy to require verbal rather than written consent reduced door to needle times by 5.6 minutes on average. Read the full study in the Journal of Stroke and Cerebrovascular Disease.
- Xian also contributed to a new study examining the American Heart Association’s Target: Stroke quality initiative, which disseminated feasible strategies to shorten door-to-needle times for thrombolytic therapy. Xian and colleagues at the DCRI analyzed date from nearly 1500 Get with the Guidelines-Stroke hospitals, finding that door-to-needle times decreased from 80 to 68 minutes on average. Read that study here.
Translational Brain Sciences
- Tatiana Segura, PhD, was the senior author of a new review article examining the role macrophages play in the body’s inflammatory and self-repairing processes, as well as how to engineer biomaterials that steer macrophages for tissue regeneration. Read that article in Frontiers in Bioengineering and Biotechnology.
- While the APOE4 gene appears to increase Alzheimer’s disease risk by increasing neuroinflammation, the specific neuroinflammatory pathways involved are unclear. A team including Michael Lutz, PhD, analyzed targeted proteomic data from samples of cerebrospinal fluid using a linear regression model adjusting for age, sex, and APOE4 copy number, and additional linear models also adjusting for AD clinical status or for CSF Aβ, tau, or p-tau levels. Read what they found in the Journal of Alzheimer’s Disease.