Background: Huntington's disease (HD) results in motor, cognitive, and psychosocial impairments.Little is known about the specific relationships among cognitive, psychosocial, and simple and complex motor task performance.Objective: The objective of this pilot study was to explore performance on motor, cognitive, and behavioral measures between individuals with HD and healthy controls, and to determine the relationships among specific domains of cognitive function and motor function and pain.Methods: Individuals with HD and healthy controls performed a battery of cognitive, motor, and survey measures (i.e., fall reports, quality of life, and pain) in a single session.We examined differences between individuals with HD and controls, as well as relationships among motor, cognitive, and survey measures.Results: Four individuals with HD (mean(SD) age: 62.5(14.5);symptom duration: 5.8(7.1); 1 female) and six healthy controls (age: 50.7(9.7);6 females) completed this study.There was no significant difference between groups for age, gender, or years of education.As expected, individuals with HD performed significantly worse on motor and cognitive testing, as evidenced by slower walking (p = 0.019), poorer lower extremity coordination (p = 0.038), poorer working memory (p = 0.010), and worse pain severity (p = 0.010).Poorer working memory was significantly related to poorer performance timed walking (r = -0.705;p = 0.023); lower extremity coordination (r = -0.657;p = 0.039); and dual-tasks (r = -0.760;p = 0.011), as well as reports of more falls (r = -0.709;p = 0.022).Poorer cognitive processing speed was specifically related to worse dual-task performance (r = -0.733;p = 0.016).Worse pain severity was significantly related to slower timed walking (r = 0.679; p = 0.031); poorer lower extremity coordination (r = 0.743; p = 0.014); and worse dual-task performance (r = 0.731; p = 0.016), as well as poorer working memory (r > -0.811; p < 0.004) and reports of more falls (r = 0.713; p = 0.021).Conclusions: Individuals with HD experience declines in motor and cognitive performance, as well as increased pain, compared to healthy controls.Quick and easily administered motor tests, such as timed walking and lower extremity coordination, as well as surveys to assess pain, may be useful in determining underlying cognitive impairments in working memory and processing speed.Assessment of these factors may help clinicians to tailor rehabilitation protocols to improve outcomes in persons with HD.

Introduction: Acute ischemic stroke (AIS) caused by large vessel occlusions (LVOs) has high morbidity and mortality. Reliable prehospital identification of LVOs may improve patient care, hospital routing and ultimately outcomes. This analysis characterizes current expert opinion on preferred stroke scales for field assessment of LVOs, factors driving scale preferences and associated research data gaps in a sample of multidisciplinary key stakeholders who care for patients with AIS. Methods: In total, 248 HCPs from 4 specific disciplines responsible for AIS patient care were asked to participate in an in-person survey. The survey was administered by trained interviewers using structured interviews between Sep 2017 and Jan 2018. Responses were analyzed overall and stratified by HCP type with descriptive statistics. Results: Of 169 participating HCPs, 22% were general neurologists, 25% neuro-interventionalists, 24% emergency department physicians (38% emergency medical system [EMS] directors), 26% stroke coordinators and 2% other. Most respondents were from comprehensive stroke centers (64%) and represented a broad US geography. Among the respondents, 86% agreed or strongly agreed that prehospital stroke scales are effective in identifying LVOs, and 63% (n=107) had a preferred prehospital LVO scale ( Table ). Among those who stated a preference (n=107), 65% cited practical considerations for their choice (eg, ease of use, already in use by local EMS) and 46% cited the scale’s properties (psychometric or clinical). Regarding the greatest need in the prehospital assessment of stroke (n=169), 56% of respondents called for more research on LVO scales, 24% for other prehospital assessment tools and 26% for EMS training and standardization. Conclusions: The majority of HCPs surveyed support the use of prehospital LVO scales but request further research. No one scale was preferred over another.

During the dual-therapy era, many patients with chronic hepatitis C discontinued therapy for reasons other than lack of efficacy (non-LOE). We determined whether selected patient characteristics predicted non-LOE discontinuation using national databases of U.S. veterans with Genotypes 1-4. We identified U.S. veterans in the Veterans Health Administration system in 2004-2009 who had hepatitis C-confirming RNA laboratory results and initiated therapy with pegylated interferon and ribavirin. We used a rule to classify patients who discontinued pegylated interferon early, based on pharmacy refill and viral response data. Multivariate Cox regression was used to identify predictors of non-LOE discontinuation. Of 321,238 patients with a hepatitis C International Classification of Diseases, Ninth Revision, code, 15,297 (4.8%) met all inclusion criteria. Non-LOE discontinuers comprised 30.3% of patients. For Genotypes 1-4, the predictors (adjusted hazard ratio) of greatest magnitude were comorbidities of myocardial infarction/congestive heart failure (1.36), renal disease (1.34), and platelets 100/mm or more (1.38). For Genotypes 2 and 3, predictors of greatest magnitude were Black race (1.30), myocardial infarction/congestive heart failure (1.84), albumin 3.5 mg/dl or more (1.65), sleep aid use (1.32), and poor persistence with antidepressants (1.31) and antihypertensive agents (1.37). Our study suggests that many host factors may have contributed to non-LOE dual-therapy discontinuation in veterans and may possibly predict non-LOE discontinuation in triple therapy.

The aim of this post hoc analysis from four prospective clinical trials was to determine if the association between anemia and increased SVR occurs in patients with cirrhosis treated with peginterferon alfa-2a/ribavirin. The results suggest that rates of anemia were similar in patients with and without cirrhosis (hemoglobin ≤10 g/dL 17.9 vs 18.5 %; ≥3 g/dL decrease in hemoglobin 74.3 vs 70.6 %, respectively). SVR rates were consistently higher in noncirrhotic patients with and without anemia; however, within each cohort, SVR rates were considerably higher in patients who experienced a ≥3.0 g/dL drop in hemoglobin level. Among patients with cirrhosis, SVR rates with and without a ≥3.0 g/dL drop in hemoglobin were 30.6 and 17.7 %. SVR rates were similar in cirrhotic patients with or without hemoglobin levels dropping to ≤10.0 g/dL (29.9 vs 26.7 %). This analysis confirmed that SVR rates are higher in patients who experience a >3.0 g/dL drop in hemoglobin during treatment with peginterferon alfa-2a/ribavirin and, for the first time, showed that this phenomenon occurs in patients with cirrhosis.

Background: Many patients with chronic hepatitis C virus (HCV) being treated with pegylated interferon (peg-IFN) plus ribavirin (RBV) do not respond to therapy and do not clear the virus. Standard of care during the era of dual therapy was to discontinue the patient’s therapy based on insufficient decreases in viral load after 12 and/or 24 weeks on therapy. Objectives: We identified patient characteristics that were significant predictors of discontinuation as a result of lack of efficacy (LOE) in a national database of US veterans with genotypes 1 and 4. Methods: We identified US veterans who received care at Veterans Affairs medical centers in 2004-2009 and who had lab-confirmed HCV diagnoses and initiated therapy with peg-IFN plus RBV. Patients who discontinued therapy early were classified as either LOE or non-LOE discontinuers based on pharmacy refill patterns and laboratory response data. Predictors of LOE discontinuation were identified using univariate and multivariable Cox proportional hazards modeling. Results: Of 321 238 HCV patients with an ICD-9 diagnosis code, 31 215 (9.7%) initiated dual therapy with peg-IFN plus RBV, and 10 333 (3.2%) met all inclusion criteria and were included in the analysis. Overall, 13.6% of the cohort was classified as LOE. Significant predictors of LOE discontinuation included treatment for drug abuse (hazard ratio [HR] = 2.18), age >65 years (HR = 1.75), antiretroviral therapy for HIV (HR = 1.48), black race (HR = 1.47), platelet count >100/mm 3 (HR = 1.46), and drug therapy for insomnia (HR = 1.40). Conclusions: We identified risk factors for discontinuation caused by LOE. Future work should focus on determining whether these characteristics are also predictive of triple-therapy LOE discontinuations.

BACKGROUND:Patients with chronic hepatitis C (HCV) frequently discontinued dual therapy with pegylated interferon alfa (Peg-IFN) plus ribavirin (RBV) before reaching the recommended duration of 48 or 24 weeks for genotypes (G) 1/4 or 2/3, respectively. We quantified rates of discontinuation despite efficacy (non-LOE) versus lack of efficacy (LOE) versus discontinuation for unknown reasons in a national database of United States veterans.METHODS:We identified a population-based cohort of U.S. veterans with encounters from 2004 through 2009 who had lab-confirmed HCV infection and initiated therapy with Peg-IFN plus RBV in Veterans Health Administration medical centers. Pharmacy data were used to determine therapy duration, defined as the sum of Peg-IFN days supplied. Patients "discontinued" if they failed to receive at least 44 (G1/4) or 20 weeks (G2/3) of therapy. We classified discontinuations as due to non-LOE, LOE, or unknown reasons using a classification rule based on treatment duration and laboratory confirmed response.RESULTS:Of 321,238 diagnosed HCV patients during the evaluation period, 9.7% initiated therapy and 6.4% met all other inclusion criteria. 54.9% of patients discontinued early; of these, 41.2% discontinued due to non-LOE reasons, 12.5% discontinued for LOE reasons, and 46.3% discontinued for unknown reasons. Among non-LOE discontinuers, most (60.1%) discontinued in the first 4 weeks of therapy, which constitutes 13.6% of all treated patients.CONCLUSIONS:We observed a high proportion of early discontinuations with dual-therapy regimens in a national cohort of HCV-infected veterans. If this trend persists in the triple-therapy era, then efforts must be undertaken to improve adherence.

Background: Pegylated interferon (PEG-IFN)/ribavirin (RBV)-related cytopenias have been associated with improved virological outcomes among hepatitis C virus (HCV)-monoinfected patients. This analysis evaluated PEG-IFN/RBV-related cytopenias with virological responses among HIV/HCV-coinfected patients. Methods: Pooled data from PARADIGM and AIDS Pegasys Ribavirin International CO-infection Trial (APRICOT) trials of HIV/HCV-infected patients treated with PEG-IFN/RBV. Virologic response was categorized as HCV RNA detectable (end of treatment nonresponders [ET-NR]) or nondetectable (end of treatment responders [ETR]). Declines in hemoglobin (Hgb), platelets, neutrophils, lymphocytes, and weight between the groups were compared via analysis of covariance and Cochran-Mantel-Haenszel test. Results: A total of 474 patients, 291 ET-NR and 183 ETR (67 relapsers, 116 with sustained virologic response), 81% male, 52% Caucasian, 88% noncirrhotic, and 67% nondetectable HIV. The ETR experienced greater Hgb declines (≥3.0 g/dL) from baseline (73.8% versus 55.0%; P < .0001), neutrophils ≤1 and ≤ 0.5 × 109/L (66.1% versus 56.4%; P = .0334 and 42.6% versus 33.3%; P = .0312, respectively), and lymphocytes ≤1.5 and ≤0.5 × 109/L (99.5% versus 87.6%; P < .0001 and 24.6% versus 14.9%; P =.0079, respectively). Conclusions: The HIV/HCV-coinfected patients with ETR experienced greater declines in Hgb, neutrophils, and lymphocytes than the ET-NR patients.