AAN Annual Meeting

HONOLULU – The way Dr. Robert C. Griggs sees it, neurology lags behind other medical specialties when it comes to practice-based research that emphasizes changing physician and patient behavior to optimize outcomes.

During his presidential address at the annual meeting of the American Academy of Neurology, he said that while surgeons, cardiologists, and other nonneurology specialists have implemented checklists, patient safety measures, system engineering, and outcome reporting, neurologists have been slow to adapt standardized care algorithms.

"I sometimes worry that when our academy practice guidelines state that there’s a lack of evidence [for a certain treatment], we say to ourselves, ‘Great. I can continue to do it my way,’ " said Dr. Griggs, professor of neurology, medicine, pathology, laboratory medicine, and pediatrics at the University of Rochester (N.Y.). "Changing physician and patient behavior has to move to the top of our agenda in order for us to bring the benefits of what we’ve worked hard to do for all of our patients."

He made his remarks while giving a progress report on the categories of T1, T2, and T3 translational science research in the neurology field. He defined T1 as laboratory work that translates the understanding of disease into new diagnostic tests, new treatments, and disease prevention, from mice up to the first work in humans.

"For T1 we’re brilliant" as a field, said Dr. Griggs, who also is a professor in the center for human experimental therapeutics at the university. "We’ve defined hundreds of mutated genes, we can make animal models, and we can find possible treatments off of small molecules that improve a mouse model. We’re not as good yet on gene-modified treatments, but on the whole, we’re confident that we will be able to do it soon."

He defined T2 as translating basic research into clinical trials for a diagnostic test, prevention strategy, or new treatment. This consists of phase 2, 3, and 4 clinical trials and includes cost/benefit analyses, as well as research on disparities and outcomes.

"We’re not quite as good at T2 research as we are in T1 research, but we have many new treatments, some that are truly breakthroughs," Dr. Griggs said. "However, lots of tough questions remain. The big one is dealing with those which we can afford and which we can’t afford, and ultimately who should receive the expensive new treatments."

He described T3 as practice-based research focused on disseminating and implementing research advances, and changing physician and patient behavior through quality and safety measures, checklists, and being mindful of economic and health policy considerations. T3 may be "less familiar territory to neurologists" than T1 or T2 research, he added, but he recommended that it become a priority.

"In preparing this talk over the past 2 years I realized over a year ago that I had not been sufficiently aware of [this] key aspect of treating patients," said Dr. Griggs. "I knew but hadn’t realized how important it is to teach in the context of what has been termed by oncologists as ‘the teachable moment,’ or riding the crest of the teachable moment, taking advantage of the time when a patient is first diagnosed, to get your messages across to the patient and to their family and friends. How do we get our patients to do what they should, take what they should, prevent what they should? How do we change neurologist behavior so that they set a high priority on changing the behaviors of patients?"

One easy way to implement T3 research into your clinical practice, he said, is to advise your patients to follow the American Heart Association’s "Life’s Simple 7" ways to prevent stroke. Those seven steps are get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, and stop smoking.

"We see hundreds of patients who are worried about having a stroke, and hundreds of patients who have had a stroke," Dr. Griggs said. Imparting this recommendation is a "teachable moment."

Dr. Griggs said that he had no relevant financial disclosures.

HONOLULU – The way Dr. Robert C. Griggs sees it, neurology lags behind other medical specialties when it comes to practice-based research that emphasizes changing physician and patient behavior to optimize outcomes.

During his presidential address at the annual meeting of the American Academy of Neurology, he said that while surgeons, cardiologists, and other nonneurology specialists have implemented checklists, patient safety measures, system engineering, and outcome reporting, neurologists have been slow to adapt standardized care algorithms.

"I sometimes worry that when our academy practice guidelines state that there’s a lack of evidence [for a certain treatment], we say to ourselves, ‘Great. I can continue to do it my way,’ " said Dr. Griggs, professor of neurology, medicine, pathology, laboratory medicine, and pediatrics at the University of Rochester (N.Y.). "Changing physician and patient behavior has to move to the top of our agenda in order for us to bring the benefits of what we’ve worked hard to do for all of our patients."

He made his remarks while giving a progress report on the categories of T1, T2, and T3 translational science research in the neurology field. He defined T1 as laboratory work that translates the understanding of disease into new diagnostic tests, new treatments, and disease prevention, from mice up to the first work in humans.

"For T1 we’re brilliant" as a field, said Dr. Griggs, who also is a professor in the center for human experimental therapeutics at the university. "We’ve defined hundreds of mutated genes, we can make animal models, and we can find possible treatments off of small molecules that improve a mouse model. We’re not as good yet on gene-modified treatments, but on the whole, we’re confident that we will be able to do it soon."

He defined T2 as translating basic research into clinical trials for a diagnostic test, prevention strategy, or new treatment. This consists of phase 2, 3, and 4 clinical trials and includes cost/benefit analyses, as well as research on disparities and outcomes.

"We’re not quite as good at T2 research as we are in T1 research, but we have many new treatments, some that are truly breakthroughs," Dr. Griggs said. "However, lots of tough questions remain. The big one is dealing with those which we can afford and which we can’t afford, and ultimately who should receive the expensive new treatments."

He described T3 as practice-based research focused on disseminating and implementing research advances, and changing physician and patient behavior through quality and safety measures, checklists, and being mindful of economic and health policy considerations. T3 may be "less familiar territory to neurologists" than T1 or T2 research, he added, but he recommended that it become a priority.

"In preparing this talk over the past 2 years I realized over a year ago that I had not been sufficiently aware of [this] key aspect of treating patients," said Dr. Griggs. "I knew but hadn’t realized how important it is to teach in the context of what has been termed by oncologists as ‘the teachable moment,’ or riding the crest of the teachable moment, taking advantage of the time when a patient is first diagnosed, to get your messages across to the patient and to their family and friends. How do we get our patients to do what they should, take what they should, prevent what they should? How do we change neurologist behavior so that they set a high priority on changing the behaviors of patients?"

One easy way to implement T3 research into your clinical practice, he said, is to advise your patients to follow the American Heart Association’s "Life’s Simple 7" ways to prevent stroke. Those seven steps are get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, and stop smoking.

"We see hundreds of patients who are worried about having a stroke, and hundreds of patients who have had a stroke," Dr. Griggs said. Imparting this recommendation is a "teachable moment."

Dr. Griggs said that he had no relevant financial disclosures.

HONOLULU – The way Dr. Robert C. Griggs sees it, neurology lags behind other medical specialties when it comes to practice-based research that emphasizes changing physician and patient behavior to optimize outcomes.

During his presidential address at the annual meeting of the American Academy of Neurology, he said that while surgeons, cardiologists, and other nonneurology specialists have implemented checklists, patient safety measures, system engineering, and outcome reporting, neurologists have been slow to adapt standardized care algorithms.

"I sometimes worry that when our academy practice guidelines state that there’s a lack of evidence [for a certain treatment], we say to ourselves, ‘Great. I can continue to do it my way,’ " said Dr. Griggs, professor of neurology, medicine, pathology, laboratory medicine, and pediatrics at the University of Rochester (N.Y.). "Changing physician and patient behavior has to move to the top of our agenda in order for us to bring the benefits of what we’ve worked hard to do for all of our patients."

He made his remarks while giving a progress report on the categories of T1, T2, and T3 translational science research in the neurology field. He defined T1 as laboratory work that translates the understanding of disease into new diagnostic tests, new treatments, and disease prevention, from mice up to the first work in humans.

"For T1 we’re brilliant" as a field, said Dr. Griggs, who also is a professor in the center for human experimental therapeutics at the university. "We’ve defined hundreds of mutated genes, we can make animal models, and we can find possible treatments off of small molecules that improve a mouse model. We’re not as good yet on gene-modified treatments, but on the whole, we’re confident that we will be able to do it soon."

He defined T2 as translating basic research into clinical trials for a diagnostic test, prevention strategy, or new treatment. This consists of phase 2, 3, and 4 clinical trials and includes cost/benefit analyses, as well as research on disparities and outcomes.

"We’re not quite as good at T2 research as we are in T1 research, but we have many new treatments, some that are truly breakthroughs," Dr. Griggs said. "However, lots of tough questions remain. The big one is dealing with those which we can afford and which we can’t afford, and ultimately who should receive the expensive new treatments."

He described T3 as practice-based research focused on disseminating and implementing research advances, and changing physician and patient behavior through quality and safety measures, checklists, and being mindful of economic and health policy considerations. T3 may be "less familiar territory to neurologists" than T1 or T2 research, he added, but he recommended that it become a priority.

"In preparing this talk over the past 2 years I realized over a year ago that I had not been sufficiently aware of [this] key aspect of treating patients," said Dr. Griggs. "I knew but hadn’t realized how important it is to teach in the context of what has been termed by oncologists as ‘the teachable moment,’ or riding the crest of the teachable moment, taking advantage of the time when a patient is first diagnosed, to get your messages across to the patient and to their family and friends. How do we get our patients to do what they should, take what they should, prevent what they should? How do we change neurologist behavior so that they set a high priority on changing the behaviors of patients?"

One easy way to implement T3 research into your clinical practice, he said, is to advise your patients to follow the American Heart Association’s "Life’s Simple 7" ways to prevent stroke. Those seven steps are get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, and stop smoking.

"We see hundreds of patients who are worried about having a stroke, and hundreds of patients who have had a stroke," Dr. Griggs said. Imparting this recommendation is a "teachable moment."

Dr. Griggs said that he had no relevant financial disclosures.

HONOLULU – The way Dr. Robert C. Griggs sees it, neurology lags behind other medical specialties when it comes to practice-based research that emphasizes changing physician and patient behavior to optimize outcomes.

During his presidential address at the annual meeting of the American Academy of Neurology, he said that while surgeons, cardiologists, and other nonneurology specialists have implemented checklists, patient safety measures, system engineering, and outcome reporting, neurologists have been slow to adapt standardized care algorithms.

"I sometimes worry that when our academy practice guidelines state that there’s a lack of evidence [for a certain treatment], we say to ourselves, ‘Great. I can continue to do it my way,’ " said Dr. Griggs, professor of neurology, medicine, pathology, laboratory medicine, and pediatrics at the University of Rochester (N.Y.). "Changing physician and patient behavior has to move to the top of our agenda in order for us to bring the benefits of what we’ve worked hard to do for all of our patients."

He made his remarks while giving a progress report on the categories of T1, T2, and T3 translational science research in the neurology field. He defined T1 as laboratory work that translates the understanding of disease into new diagnostic tests, new treatments, and disease prevention, from mice up to the first work in humans.

"For T1 we’re brilliant" as a field, said Dr. Griggs, who also is a professor in the center for human experimental therapeutics at the university. "We’ve defined hundreds of mutated genes, we can make animal models, and we can find possible treatments off of small molecules that improve a mouse model. We’re not as good yet on gene-modified treatments, but on the whole, we’re confident that we will be able to do it soon."

He defined T2 as translating basic research into clinical trials for a diagnostic test, prevention strategy, or new treatment. This consists of phase 2, 3, and 4 clinical trials and includes cost/benefit analyses, as well as research on disparities and outcomes.

"We’re not quite as good at T2 research as we are in T1 research, but we have many new treatments, some that are truly breakthroughs," Dr. Griggs said. "However, lots of tough questions remain. The big one is dealing with those which we can afford and which we can’t afford, and ultimately who should receive the expensive new treatments."

He described T3 as practice-based research focused on disseminating and implementing research advances, and changing physician and patient behavior through quality and safety measures, checklists, and being mindful of economic and health policy considerations. T3 may be "less familiar territory to neurologists" than T1 or T2 research, he added, but he recommended that it become a priority.

"In preparing this talk over the past 2 years I realized over a year ago that I had not been sufficiently aware of [this] key aspect of treating patients," said Dr. Griggs. "I knew but hadn’t realized how important it is to teach in the context of what has been termed by oncologists as ‘the teachable moment,’ or riding the crest of the teachable moment, taking advantage of the time when a patient is first diagnosed, to get your messages across to the patient and to their family and friends. How do we get our patients to do what they should, take what they should, prevent what they should? How do we change neurologist behavior so that they set a high priority on changing the behaviors of patients?"

One easy way to implement T3 research into your clinical practice, he said, is to advise your patients to follow the American Heart Association’s "Life’s Simple 7" ways to prevent stroke. Those seven steps are get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, and stop smoking.

"We see hundreds of patients who are worried about having a stroke, and hundreds of patients who have had a stroke," Dr. Griggs said. Imparting this recommendation is a "teachable moment."

Dr. Griggs said that he had no relevant financial disclosures.

HONOLULU – The way Dr. Robert C. Griggs sees it, neurology lags behind other medical specialties when it comes to practice-based research that emphasizes changing physician and patient behavior to optimize outcomes.

During his presidential address at the annual meeting of the American Academy of Neurology, he said that while surgeons, cardiologists, and other nonneurology specialists have implemented checklists, patient safety measures, system engineering, and outcome reporting, neurologists have been slow to adapt standardized care algorithms.

"I sometimes worry that when our academy practice guidelines state that there’s a lack of evidence [for a certain treatment], we say to ourselves, ‘Great. I can continue to do it my way,’ " said Dr. Griggs, professor of neurology, medicine, pathology, laboratory medicine, and pediatrics at the University of Rochester (N.Y.). "Changing physician and patient behavior has to move to the top of our agenda in order for us to bring the benefits of what we’ve worked hard to do for all of our patients."

He made his remarks while giving a progress report on the categories of T1, T2, and T3 translational science research in the neurology field. He defined T1 as laboratory work that translates the understanding of disease into new diagnostic tests, new treatments, and disease prevention, from mice up to the first work in humans.

"For T1 we’re brilliant" as a field, said Dr. Griggs, who also is a professor in the center for human experimental therapeutics at the university. "We’ve defined hundreds of mutated genes, we can make animal models, and we can find possible treatments off of small molecules that improve a mouse model. We’re not as good yet on gene-modified treatments, but on the whole, we’re confident that we will be able to do it soon."

He defined T2 as translating basic research into clinical trials for a diagnostic test, prevention strategy, or new treatment. This consists of phase 2, 3, and 4 clinical trials and includes cost/benefit analyses, as well as research on disparities and outcomes.

"We’re not quite as good at T2 research as we are in T1 research, but we have many new treatments, some that are truly breakthroughs," Dr. Griggs said. "However, lots of tough questions remain. The big one is dealing with those which we can afford and which we can’t afford, and ultimately who should receive the expensive new treatments."

He described T3 as practice-based research focused on disseminating and implementing research advances, and changing physician and patient behavior through quality and safety measures, checklists, and being mindful of economic and health policy considerations. T3 may be "less familiar territory to neurologists" than T1 or T2 research, he added, but he recommended that it become a priority.

"In preparing this talk over the past 2 years I realized over a year ago that I had not been sufficiently aware of [this] key aspect of treating patients," said Dr. Griggs. "I knew but hadn’t realized how important it is to teach in the context of what has been termed by oncologists as ‘the teachable moment,’ or riding the crest of the teachable moment, taking advantage of the time when a patient is first diagnosed, to get your messages across to the patient and to their family and friends. How do we get our patients to do what they should, take what they should, prevent what they should? How do we change neurologist behavior so that they set a high priority on changing the behaviors of patients?"

One easy way to implement T3 research into your clinical practice, he said, is to advise your patients to follow the American Heart Association’s "Life’s Simple 7" ways to prevent stroke. Those seven steps are get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, and stop smoking.

"We see hundreds of patients who are worried about having a stroke, and hundreds of patients who have had a stroke," Dr. Griggs said. Imparting this recommendation is a "teachable moment."

Dr. Griggs said that he had no relevant financial disclosures.

HONOLULU – The way Dr. Robert C. Griggs sees it, neurology lags behind other medical specialties when it comes to practice-based research that emphasizes changing physician and patient behavior to optimize outcomes.

During his presidential address at the annual meeting of the American Academy of Neurology, he said that while surgeons, cardiologists, and other nonneurology specialists have implemented checklists, patient safety measures, system engineering, and outcome reporting, neurologists have been slow to adapt standardized care algorithms.

"I sometimes worry that when our academy practice guidelines state that there’s a lack of evidence [for a certain treatment], we say to ourselves, ‘Great. I can continue to do it my way,’ " said Dr. Griggs, professor of neurology, medicine, pathology, laboratory medicine, and pediatrics at the University of Rochester (N.Y.). "Changing physician and patient behavior has to move to the top of our agenda in order for us to bring the benefits of what we’ve worked hard to do for all of our patients."

He made his remarks while giving a progress report on the categories of T1, T2, and T3 translational science research in the neurology field. He defined T1 as laboratory work that translates the understanding of disease into new diagnostic tests, new treatments, and disease prevention, from mice up to the first work in humans.

"For T1 we’re brilliant" as a field, said Dr. Griggs, who also is a professor in the center for human experimental therapeutics at the university. "We’ve defined hundreds of mutated genes, we can make animal models, and we can find possible treatments off of small molecules that improve a mouse model. We’re not as good yet on gene-modified treatments, but on the whole, we’re confident that we will be able to do it soon."

He defined T2 as translating basic research into clinical trials for a diagnostic test, prevention strategy, or new treatment. This consists of phase 2, 3, and 4 clinical trials and includes cost/benefit analyses, as well as research on disparities and outcomes.

"We’re not quite as good at T2 research as we are in T1 research, but we have many new treatments, some that are truly breakthroughs," Dr. Griggs said. "However, lots of tough questions remain. The big one is dealing with those which we can afford and which we can’t afford, and ultimately who should receive the expensive new treatments."

He described T3 as practice-based research focused on disseminating and implementing research advances, and changing physician and patient behavior through quality and safety measures, checklists, and being mindful of economic and health policy considerations. T3 may be "less familiar territory to neurologists" than T1 or T2 research, he added, but he recommended that it become a priority.

"In preparing this talk over the past 2 years I realized over a year ago that I had not been sufficiently aware of [this] key aspect of treating patients," said Dr. Griggs. "I knew but hadn’t realized how important it is to teach in the context of what has been termed by oncologists as ‘the teachable moment,’ or riding the crest of the teachable moment, taking advantage of the time when a patient is first diagnosed, to get your messages across to the patient and to their family and friends. How do we get our patients to do what they should, take what they should, prevent what they should? How do we change neurologist behavior so that they set a high priority on changing the behaviors of patients?"

One easy way to implement T3 research into your clinical practice, he said, is to advise your patients to follow the American Heart Association’s "Life’s Simple 7" ways to prevent stroke. Those seven steps are get active, control cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar, and stop smoking.

"We see hundreds of patients who are worried about having a stroke, and hundreds of patients who have had a stroke," Dr. Griggs said. Imparting this recommendation is a "teachable moment."

Dr. Griggs said that he had no relevant financial disclosures.

HONOLULU – Certain maternal autoantibodies are associated with the development of autism spectrum disorders, results from a large ongoing analysis demonstrate.

The finding lays the groundwork for an eventual diagnostic test for autism, Judy Van de Water, Ph.D., said at the annual meeting of the American Academy of Neurology.

"Currently there is no biologic marker for autism," said Dr. Van de Water, an immunologist at the University of California, Davis. "It’s completely defined by behaviors."

The maternal immune response in autism is of interest to researchers because of its role in neurodevelopment. "Maternal IgG isotype antibodies readily cross the placenta and are known to persist for up to 6 months postnatally in the child," Dr. Van de Water said. "In addition, maternal antibodies have been shown to cause changes in fetal development in several known autoimmune disorders, such as SLE."

In 2002, Dr. Van de Water and her associates began to collect blood samples from families as part of the Childhood Autism Risk from Genetics and the Environment (CHARGE) study. They sampled the study population from three groups of children aged 2-5 years: children with autism (currently includes more than 800 families); typically developing children without autism or other developmental disabilities selected from the general population (currently 600 families enrolled); and children with developmental disabilities without autism (currently 220 families enrolled).

In the original experimental design, Western blots against human fetal brain protein were performed with 61 mothers of children with autism (36 regressive and 25 early onset), 40 mothers of children with developmental delay, and 62 mothers of typically developing children. The mothers were matched for age and parity (Neurotoxicology 2008;29:226-31). The investigators found that seven mothers of children with autism (12%) had IgG reactivity to fetal brain proteins at bands 37kDa and 73kDa. "We did not see this pattern in the typically developing controls or in the developmentally delayed population, so this seemed to be very specific for autism," Dr. Van de Water said.

Analysis of autoantibody profiles of an additional 458 mothers – 204 mothers of children diagnosed with autism, 71 mothers of children diagnosed with an autism spectrum disorder, and 183 mothers of typically developing children – continues to yield highly significant associations between the presence of IgG reactivity to fetal brain proteins at bands 37kDa and 73kDa and a diagnosis of full autism. Dr. Van de Water and her associates also discovered an association between the 39kDa and 73kDa bands and a diagnosis of the broader autism phenotype, "though this pattern is less frequent in the full autism group," she said. Some mothers had reactivity to fetal brain proteins at all three bands.

"We think we may have a very interesting biomarker, but is there a pathologic significance to these antibodies?" she asked. To find out, the researchers analyzed behavioral characteristics associated with maternal antibodies to fetal brain proteins. Children of mothers who demonstrated reactivity at bands 37kDa and 73kDa had less expressive language based on the Expressive Language Scale of the Mullen Scales of Early Learning. Similar results were seen in children of mothers who demonstrated reactivity at all three bands. In contrast, children of mothers who demonstrated reactivity at bands 39kDa and 73kDa had higher scores on the Aberrant Behavior Checklist irritability subscale, "so we can see that we’re starting to phenotypically separate these children."

A pilot study in monkeys conducted by Dr. Van de Water and her associates demonstrated behavioral changes in offspring following passive transfer of maternal IgG during the late first and early second trimesters (Brain Behav. Immun. 2008;22:806-16). Subsequent studies have confirmed that passive transfer of these antibodies into an animal model can recapitulate some behaviors characteristic of autism. More confirmatory studies are underway.

"We are currently verifying the identity of the protein antigens recognized by these autoantibodies," Dr. Van de Water said. "We intend to develop a preconception test to use for mothers at risk of having a second child with autism."

Dr. Van de Water disclosed that she has received personal compensation for activities with Pediatric Bioscience as a consultant, and holds stock and/or stock options in the company. She has also received royalty payments from the University of California, Davis.

HONOLULU – Certain maternal autoantibodies are associated with the development of autism spectrum disorders, results from a large ongoing analysis demonstrate.

The finding lays the groundwork for an eventual diagnostic test for autism, Judy Van de Water, Ph.D., said at the annual meeting of the American Academy of Neurology.

"Currently there is no biologic marker for autism," said Dr. Van de Water, an immunologist at the University of California, Davis. "It’s completely defined by behaviors."

The maternal immune response in autism is of interest to researchers because of its role in neurodevelopment. "Maternal IgG isotype antibodies readily cross the placenta and are known to persist for up to 6 months postnatally in the child," Dr. Van de Water said. "In addition, maternal antibodies have been shown to cause changes in fetal development in several known autoimmune disorders, such as SLE."

In 2002, Dr. Van de Water and her associates began to collect blood samples from families as part of the Childhood Autism Risk from Genetics and the Environment (CHARGE) study. They sampled the study population from three groups of children aged 2-5 years: children with autism (currently includes more than 800 families); typically developing children without autism or other developmental disabilities selected from the general population (currently 600 families enrolled); and children with developmental disabilities without autism (currently 220 families enrolled).

In the original experimental design, Western blots against human fetal brain protein were performed with 61 mothers of children with autism (36 regressive and 25 early onset), 40 mothers of children with developmental delay, and 62 mothers of typically developing children. The mothers were matched for age and parity (Neurotoxicology 2008;29:226-31). The investigators found that seven mothers of children with autism (12%) had IgG reactivity to fetal brain proteins at bands 37kDa and 73kDa. "We did not see this pattern in the typically developing controls or in the developmentally delayed population, so this seemed to be very specific for autism," Dr. Van de Water said.

Analysis of autoantibody profiles of an additional 458 mothers – 204 mothers of children diagnosed with autism, 71 mothers of children diagnosed with an autism spectrum disorder, and 183 mothers of typically developing children – continues to yield highly significant associations between the presence of IgG reactivity to fetal brain proteins at bands 37kDa and 73kDa and a diagnosis of full autism. Dr. Van de Water and her associates also discovered an association between the 39kDa and 73kDa bands and a diagnosis of the broader autism phenotype, "though this pattern is less frequent in the full autism group," she said. Some mothers had reactivity to fetal brain proteins at all three bands.

"We think we may have a very interesting biomarker, but is there a pathologic significance to these antibodies?" she asked. To find out, the researchers analyzed behavioral characteristics associated with maternal antibodies to fetal brain proteins. Children of mothers who demonstrated reactivity at bands 37kDa and 73kDa had less expressive language based on the Expressive Language Scale of the Mullen Scales of Early Learning. Similar results were seen in children of mothers who demonstrated reactivity at all three bands. In contrast, children of mothers who demonstrated reactivity at bands 39kDa and 73kDa had higher scores on the Aberrant Behavior Checklist irritability subscale, "so we can see that we’re starting to phenotypically separate these children."

A pilot study in monkeys conducted by Dr. Van de Water and her associates demonstrated behavioral changes in offspring following passive transfer of maternal IgG during the late first and early second trimesters (Brain Behav. Immun. 2008;22:806-16). Subsequent studies have confirmed that passive transfer of these antibodies into an animal model can recapitulate some behaviors characteristic of autism. More confirmatory studies are underway.

"We are currently verifying the identity of the protein antigens recognized by these autoantibodies," Dr. Van de Water said. "We intend to develop a preconception test to use for mothers at risk of having a second child with autism."

Dr. Van de Water disclosed that she has received personal compensation for activities with Pediatric Bioscience as a consultant, and holds stock and/or stock options in the company. She has also received royalty payments from the University of California, Davis.

HONOLULU – Certain maternal autoantibodies are associated with the development of autism spectrum disorders, results from a large ongoing analysis demonstrate.

The finding lays the groundwork for an eventual diagnostic test for autism, Judy Van de Water, Ph.D., said at the annual meeting of the American Academy of Neurology.

"Currently there is no biologic marker for autism," said Dr. Van de Water, an immunologist at the University of California, Davis. "It’s completely defined by behaviors."

The maternal immune response in autism is of interest to researchers because of its role in neurodevelopment. "Maternal IgG isotype antibodies readily cross the placenta and are known to persist for up to 6 months postnatally in the child," Dr. Van de Water said. "In addition, maternal antibodies have been shown to cause changes in fetal development in several known autoimmune disorders, such as SLE."

In 2002, Dr. Van de Water and her associates began to collect blood samples from families as part of the Childhood Autism Risk from Genetics and the Environment (CHARGE) study. They sampled the study population from three groups of children aged 2-5 years: children with autism (currently includes more than 800 families); typically developing children without autism or other developmental disabilities selected from the general population (currently 600 families enrolled); and children with developmental disabilities without autism (currently 220 families enrolled).

In the original experimental design, Western blots against human fetal brain protein were performed with 61 mothers of children with autism (36 regressive and 25 early onset), 40 mothers of children with developmental delay, and 62 mothers of typically developing children. The mothers were matched for age and parity (Neurotoxicology 2008;29:226-31). The investigators found that seven mothers of children with autism (12%) had IgG reactivity to fetal brain proteins at bands 37kDa and 73kDa. "We did not see this pattern in the typically developing controls or in the developmentally delayed population, so this seemed to be very specific for autism," Dr. Van de Water said.

Analysis of autoantibody profiles of an additional 458 mothers – 204 mothers of children diagnosed with autism, 71 mothers of children diagnosed with an autism spectrum disorder, and 183 mothers of typically developing children – continues to yield highly significant associations between the presence of IgG reactivity to fetal brain proteins at bands 37kDa and 73kDa and a diagnosis of full autism. Dr. Van de Water and her associates also discovered an association between the 39kDa and 73kDa bands and a diagnosis of the broader autism phenotype, "though this pattern is less frequent in the full autism group," she said. Some mothers had reactivity to fetal brain proteins at all three bands.

"We think we may have a very interesting biomarker, but is there a pathologic significance to these antibodies?" she asked. To find out, the researchers analyzed behavioral characteristics associated with maternal antibodies to fetal brain proteins. Children of mothers who demonstrated reactivity at bands 37kDa and 73kDa had less expressive language based on the Expressive Language Scale of the Mullen Scales of Early Learning. Similar results were seen in children of mothers who demonstrated reactivity at all three bands. In contrast, children of mothers who demonstrated reactivity at bands 39kDa and 73kDa had higher scores on the Aberrant Behavior Checklist irritability subscale, "so we can see that we’re starting to phenotypically separate these children."

A pilot study in monkeys conducted by Dr. Van de Water and her associates demonstrated behavioral changes in offspring following passive transfer of maternal IgG during the late first and early second trimesters (Brain Behav. Immun. 2008;22:806-16). Subsequent studies have confirmed that passive transfer of these antibodies into an animal model can recapitulate some behaviors characteristic of autism. More confirmatory studies are underway.

"We are currently verifying the identity of the protein antigens recognized by these autoantibodies," Dr. Van de Water said. "We intend to develop a preconception test to use for mothers at risk of having a second child with autism."

Dr. Van de Water disclosed that she has received personal compensation for activities with Pediatric Bioscience as a consultant, and holds stock and/or stock options in the company. She has also received royalty payments from the University of California, Davis.

HONOLULU – Certain maternal autoantibodies are associated with the development of autism spectrum disorders, results from a large ongoing analysis demonstrate.

The finding lays the groundwork for an eventual diagnostic test for autism, Judy Van de Water, Ph.D., said at the annual meeting of the American Academy of Neurology.

"Currently there is no biologic marker for autism," said Dr. Van de Water, an immunologist at the University of California, Davis. "It’s completely defined by behaviors."

The maternal immune response in autism is of interest to researchers because of its role in neurodevelopment. "Maternal IgG isotype antibodies readily cross the placenta and are known to persist for up to 6 months postnatally in the child," Dr. Van de Water said. "In addition, maternal antibodies have been shown to cause changes in fetal development in several known autoimmune disorders, such as SLE."

In 2002, Dr. Van de Water and her associates began to collect blood samples from families as part of the Childhood Autism Risk from Genetics and the Environment (CHARGE) study. They sampled the study population from three groups of children aged 2-5 years: children with autism (currently includes more than 800 families); typically developing children without autism or other developmental disabilities selected from the general population (currently 600 families enrolled); and children with developmental disabilities without autism (currently 220 families enrolled).

In the original experimental design, Western blots against human fetal brain protein were performed with 61 mothers of children with autism (36 regressive and 25 early onset), 40 mothers of children with developmental delay, and 62 mothers of typically developing children. The mothers were matched for age and parity (Neurotoxicology 2008;29:226-31). The investigators found that seven mothers of children with autism (12%) had IgG reactivity to fetal brain proteins at bands 37kDa and 73kDa. "We did not see this pattern in the typically developing controls or in the developmentally delayed population, so this seemed to be very specific for autism," Dr. Van de Water said.

Analysis of autoantibody profiles of an additional 458 mothers – 204 mothers of children diagnosed with autism, 71 mothers of children diagnosed with an autism spectrum disorder, and 183 mothers of typically developing children – continues to yield highly significant associations between the presence of IgG reactivity to fetal brain proteins at bands 37kDa and 73kDa and a diagnosis of full autism. Dr. Van de Water and her associates also discovered an association between the 39kDa and 73kDa bands and a diagnosis of the broader autism phenotype, "though this pattern is less frequent in the full autism group," she said. Some mothers had reactivity to fetal brain proteins at all three bands.

"We think we may have a very interesting biomarker, but is there a pathologic significance to these antibodies?" she asked. To find out, the researchers analyzed behavioral characteristics associated with maternal antibodies to fetal brain proteins. Children of mothers who demonstrated reactivity at bands 37kDa and 73kDa had less expressive language based on the Expressive Language Scale of the Mullen Scales of Early Learning. Similar results were seen in children of mothers who demonstrated reactivity at all three bands. In contrast, children of mothers who demonstrated reactivity at bands 39kDa and 73kDa had higher scores on the Aberrant Behavior Checklist irritability subscale, "so we can see that we’re starting to phenotypically separate these children."

A pilot study in monkeys conducted by Dr. Van de Water and her associates demonstrated behavioral changes in offspring following passive transfer of maternal IgG during the late first and early second trimesters (Brain Behav. Immun. 2008;22:806-16). Subsequent studies have confirmed that passive transfer of these antibodies into an animal model can recapitulate some behaviors characteristic of autism. More confirmatory studies are underway.

"We are currently verifying the identity of the protein antigens recognized by these autoantibodies," Dr. Van de Water said. "We intend to develop a preconception test to use for mothers at risk of having a second child with autism."

Dr. Van de Water disclosed that she has received personal compensation for activities with Pediatric Bioscience as a consultant, and holds stock and/or stock options in the company. She has also received royalty payments from the University of California, Davis.

HONOLULU – Certain maternal autoantibodies are associated with the development of autism spectrum disorders, results from a large ongoing analysis demonstrate.

The finding lays the groundwork for an eventual diagnostic test for autism, Judy Van de Water, Ph.D., said at the annual meeting of the American Academy of Neurology.

"Currently there is no biologic marker for autism," said Dr. Van de Water, an immunologist at the University of California, Davis. "It’s completely defined by behaviors."

The maternal immune response in autism is of interest to researchers because of its role in neurodevelopment. "Maternal IgG isotype antibodies readily cross the placenta and are known to persist for up to 6 months postnatally in the child," Dr. Van de Water said. "In addition, maternal antibodies have been shown to cause changes in fetal development in several known autoimmune disorders, such as SLE."

In 2002, Dr. Van de Water and her associates began to collect blood samples from families as part of the Childhood Autism Risk from Genetics and the Environment (CHARGE) study. They sampled the study population from three groups of children aged 2-5 years: children with autism (currently includes more than 800 families); typically developing children without autism or other developmental disabilities selected from the general population (currently 600 families enrolled); and children with developmental disabilities without autism (currently 220 families enrolled).

In the original experimental design, Western blots against human fetal brain protein were performed with 61 mothers of children with autism (36 regressive and 25 early onset), 40 mothers of children with developmental delay, and 62 mothers of typically developing children. The mothers were matched for age and parity (Neurotoxicology 2008;29:226-31). The investigators found that seven mothers of children with autism (12%) had IgG reactivity to fetal brain proteins at bands 37kDa and 73kDa. "We did not see this pattern in the typically developing controls or in the developmentally delayed population, so this seemed to be very specific for autism," Dr. Van de Water said.

Analysis of autoantibody profiles of an additional 458 mothers – 204 mothers of children diagnosed with autism, 71 mothers of children diagnosed with an autism spectrum disorder, and 183 mothers of typically developing children – continues to yield highly significant associations between the presence of IgG reactivity to fetal brain proteins at bands 37kDa and 73kDa and a diagnosis of full autism. Dr. Van de Water and her associates also discovered an association between the 39kDa and 73kDa bands and a diagnosis of the broader autism phenotype, "though this pattern is less frequent in the full autism group," she said. Some mothers had reactivity to fetal brain proteins at all three bands.

"We think we may have a very interesting biomarker, but is there a pathologic significance to these antibodies?" she asked. To find out, the researchers analyzed behavioral characteristics associated with maternal antibodies to fetal brain proteins. Children of mothers who demonstrated reactivity at bands 37kDa and 73kDa had less expressive language based on the Expressive Language Scale of the Mullen Scales of Early Learning. Similar results were seen in children of mothers who demonstrated reactivity at all three bands. In contrast, children of mothers who demonstrated reactivity at bands 39kDa and 73kDa had higher scores on the Aberrant Behavior Checklist irritability subscale, "so we can see that we’re starting to phenotypically separate these children."

A pilot study in monkeys conducted by Dr. Van de Water and her associates demonstrated behavioral changes in offspring following passive transfer of maternal IgG during the late first and early second trimesters (Brain Behav. Immun. 2008;22:806-16). Subsequent studies have confirmed that passive transfer of these antibodies into an animal model can recapitulate some behaviors characteristic of autism. More confirmatory studies are underway.

"We are currently verifying the identity of the protein antigens recognized by these autoantibodies," Dr. Van de Water said. "We intend to develop a preconception test to use for mothers at risk of having a second child with autism."

Dr. Van de Water disclosed that she has received personal compensation for activities with Pediatric Bioscience as a consultant, and holds stock and/or stock options in the company. She has also received royalty payments from the University of California, Davis.

HONOLULU – Certain maternal autoantibodies are associated with the development of autism spectrum disorders, results from a large ongoing analysis demonstrate.

The finding lays the groundwork for an eventual diagnostic test for autism, Judy Van de Water, Ph.D., said at the annual meeting of the American Academy of Neurology.

"Currently there is no biologic marker for autism," said Dr. Van de Water, an immunologist at the University of California, Davis. "It’s completely defined by behaviors."

The maternal immune response in autism is of interest to researchers because of its role in neurodevelopment. "Maternal IgG isotype antibodies readily cross the placenta and are known to persist for up to 6 months postnatally in the child," Dr. Van de Water said. "In addition, maternal antibodies have been shown to cause changes in fetal development in several known autoimmune disorders, such as SLE."

In 2002, Dr. Van de Water and her associates began to collect blood samples from families as part of the Childhood Autism Risk from Genetics and the Environment (CHARGE) study. They sampled the study population from three groups of children aged 2-5 years: children with autism (currently includes more than 800 families); typically developing children without autism or other developmental disabilities selected from the general population (currently 600 families enrolled); and children with developmental disabilities without autism (currently 220 families enrolled).

In the original experimental design, Western blots against human fetal brain protein were performed with 61 mothers of children with autism (36 regressive and 25 early onset), 40 mothers of children with developmental delay, and 62 mothers of typically developing children. The mothers were matched for age and parity (Neurotoxicology 2008;29:226-31). The investigators found that seven mothers of children with autism (12%) had IgG reactivity to fetal brain proteins at bands 37kDa and 73kDa. "We did not see this pattern in the typically developing controls or in the developmentally delayed population, so this seemed to be very specific for autism," Dr. Van de Water said.

Analysis of autoantibody profiles of an additional 458 mothers – 204 mothers of children diagnosed with autism, 71 mothers of children diagnosed with an autism spectrum disorder, and 183 mothers of typically developing children – continues to yield highly significant associations between the presence of IgG reactivity to fetal brain proteins at bands 37kDa and 73kDa and a diagnosis of full autism. Dr. Van de Water and her associates also discovered an association between the 39kDa and 73kDa bands and a diagnosis of the broader autism phenotype, "though this pattern is less frequent in the full autism group," she said. Some mothers had reactivity to fetal brain proteins at all three bands.

"We think we may have a very interesting biomarker, but is there a pathologic significance to these antibodies?" she asked. To find out, the researchers analyzed behavioral characteristics associated with maternal antibodies to fetal brain proteins. Children of mothers who demonstrated reactivity at bands 37kDa and 73kDa had less expressive language based on the Expressive Language Scale of the Mullen Scales of Early Learning. Similar results were seen in children of mothers who demonstrated reactivity at all three bands. In contrast, children of mothers who demonstrated reactivity at bands 39kDa and 73kDa had higher scores on the Aberrant Behavior Checklist irritability subscale, "so we can see that we’re starting to phenotypically separate these children."

A pilot study in monkeys conducted by Dr. Van de Water and her associates demonstrated behavioral changes in offspring following passive transfer of maternal IgG during the late first and early second trimesters (Brain Behav. Immun. 2008;22:806-16). Subsequent studies have confirmed that passive transfer of these antibodies into an animal model can recapitulate some behaviors characteristic of autism. More confirmatory studies are underway.

"We are currently verifying the identity of the protein antigens recognized by these autoantibodies," Dr. Van de Water said. "We intend to develop a preconception test to use for mothers at risk of having a second child with autism."

Dr. Van de Water disclosed that she has received personal compensation for activities with Pediatric Bioscience as a consultant, and holds stock and/or stock options in the company. She has also received royalty payments from the University of California, Davis.

HONOLULU – Women and minorities with Parkinson’s disease obtained care from a neurologist less often than did white men, in a large national analysis of Medicare data.

In addition, Parkinson’s patients who received care from a neurologist had significant improvement in certain clinical outcomes as well as better overall survival compared with patients who received care from physicians in other specialties.

"Neurological disorders are common," Dr. Allison Wright Willis said at the annual meeting of the American Academy of Neurology. "However, medical students and new physicians report feeling least secure in their ability to diagnose and manage neurologic disease. Unfortunately, primary care training programs may not be able to provide sufficient training in the management of complicated neurodegenerative diseases such as Parkinson’s disease."

Dr. Willis of the department of neurology at Washington University in St. Louis and her associates set out to determine if treatment of Parkinson’s patients by a neurologist is associated with improved selected health outcomes, including hip fracture, skilled nursing facility placement, and survival. They evaluated more than 138,000 incident cases of Parkinson’s disease from Medicare beneficiaries with outpatient or carrier file claims for Parkinson’s disease in 2002.

For the period of 2002-2008, Dr. Willis and her colleagues used a Cox proportional hazards model to compare survival in patients with Parkinson’s disease who were treated by either a neurologist or primary care physician. They included the variables of race, age, sex, comorbidity index, socioeconomic deprivation score, and physician specialty.

Dr. Willis reported that only 57% of newly diagnosed Parkinson’s patients saw a neurologist at any time during the 48-month period in which neurologist encounter rates were calculated. Men and whites had the highest specialist treatment rates. Women and blacks both had 23% lower odds of receiving neurologist care than did men and whites, after adjustment for covariates.

Investigation of race and gender pairs revealed that white women, black men, black women, Hispanic women, and Asian women all had significantly lower odds, compared with white men, of receiving care from a neurologist after adjustment for age, comorbidity, and economic disparity. A sensitivity analysis performed using 469,000 prevalent cases of Parkinson’s disease yielded similar findings.

In a subgroup analysis of nearly 130,000 Parkinson’s patients without incident stroke or transient ischemic attack, patients cared for by a neurologist had 21% lower odds of being placed in a skilled nursing home, compared with patients treated by primary care physicians. Treatment by a neurologist also was associated with 14% lower odds of hip fracture than was treatment by primary care physicians.

The odds of survival over a 6-year period was 23% greater when patients received care from a neurologist rather than a primary care physician, with the greatest increase in survival seen in white men, white women, and black men.

"Should these results be confirmed using individual-level data, measures to lessen these disparities are vital," Dr. Willis commented. "Furthermore, by demonstrating that neurologist treatment improves Parkinson’s disease outcomes, our data highlight the need for health policy measures that support neurology practice and neurological education. However, the finding that fewer women and nonwhites received neurologist care may have broader implications for health care disparity and medical education."

She went on to point out that in addition to what she described as "the clear social and policy implications of our research, these data are important to Parkinson’s researchers. Parkinson’s disease epidemiological studies and clinical trials typically rely on speciality centers or neurologist practices for case identification and recruitment. Our data suggest that this may produce a significant referral bias, [which is] critical when attempting to perform gene or environmental risk studies, and may result in a distortion of the Parkinson’s disease risk literature or possibly confound clinical trial results. Additionally, the exclusive use of speciality center populations for recruitment may propagate a treatment bias resulting in fewer women and fewer minorities receiving state-of-the-art care."

Dr. Willis acknowledged certain limitations of the study, including the fact that the Medicare data set analyzed does not provide information on severity of Parkinson’s disease or physician diagnostic accuracy. "As with any epidemiological study, unknown medical, social, economic, or cultural factors may remain that have influenced the observed health care patterns," she noted. "Also, seeking neurologist care may be more likely in those who are health conscious and may correlate with other behaviors which would improve well-being, clinical course, or survival, such as medication use and exercise."

Dr. Willis said she had no relevant financial disclosures.

HONOLULU – Women and minorities with Parkinson’s disease obtained care from a neurologist less often than did white men, in a large national analysis of Medicare data.

In addition, Parkinson’s patients who received care from a neurologist had significant improvement in certain clinical outcomes as well as better overall survival compared with patients who received care from physicians in other specialties.

"Neurological disorders are common," Dr. Allison Wright Willis said at the annual meeting of the American Academy of Neurology. "However, medical students and new physicians report feeling least secure in their ability to diagnose and manage neurologic disease. Unfortunately, primary care training programs may not be able to provide sufficient training in the management of complicated neurodegenerative diseases such as Parkinson’s disease."

Dr. Willis of the department of neurology at Washington University in St. Louis and her associates set out to determine if treatment of Parkinson’s patients by a neurologist is associated with improved selected health outcomes, including hip fracture, skilled nursing facility placement, and survival. They evaluated more than 138,000 incident cases of Parkinson’s disease from Medicare beneficiaries with outpatient or carrier file claims for Parkinson’s disease in 2002.

For the period of 2002-2008, Dr. Willis and her colleagues used a Cox proportional hazards model to compare survival in patients with Parkinson’s disease who were treated by either a neurologist or primary care physician. They included the variables of race, age, sex, comorbidity index, socioeconomic deprivation score, and physician specialty.

Dr. Willis reported that only 57% of newly diagnosed Parkinson’s patients saw a neurologist at any time during the 48-month period in which neurologist encounter rates were calculated. Men and whites had the highest specialist treatment rates. Women and blacks both had 23% lower odds of receiving neurologist care than did men and whites, after adjustment for covariates.

Investigation of race and gender pairs revealed that white women, black men, black women, Hispanic women, and Asian women all had significantly lower odds, compared with white men, of receiving care from a neurologist after adjustment for age, comorbidity, and economic disparity. A sensitivity analysis performed using 469,000 prevalent cases of Parkinson’s disease yielded similar findings.

In a subgroup analysis of nearly 130,000 Parkinson’s patients without incident stroke or transient ischemic attack, patients cared for by a neurologist had 21% lower odds of being placed in a skilled nursing home, compared with patients treated by primary care physicians. Treatment by a neurologist also was associated with 14% lower odds of hip fracture than was treatment by primary care physicians.

The odds of survival over a 6-year period was 23% greater when patients received care from a neurologist rather than a primary care physician, with the greatest increase in survival seen in white men, white women, and black men.

"Should these results be confirmed using individual-level data, measures to lessen these disparities are vital," Dr. Willis commented. "Furthermore, by demonstrating that neurologist treatment improves Parkinson’s disease outcomes, our data highlight the need for health policy measures that support neurology practice and neurological education. However, the finding that fewer women and nonwhites received neurologist care may have broader implications for health care disparity and medical education."

She went on to point out that in addition to what she described as "the clear social and policy implications of our research, these data are important to Parkinson’s researchers. Parkinson’s disease epidemiological studies and clinical trials typically rely on speciality centers or neurologist practices for case identification and recruitment. Our data suggest that this may produce a significant referral bias, [which is] critical when attempting to perform gene or environmental risk studies, and may result in a distortion of the Parkinson’s disease risk literature or possibly confound clinical trial results. Additionally, the exclusive use of speciality center populations for recruitment may propagate a treatment bias resulting in fewer women and fewer minorities receiving state-of-the-art care."

Dr. Willis acknowledged certain limitations of the study, including the fact that the Medicare data set analyzed does not provide information on severity of Parkinson’s disease or physician diagnostic accuracy. "As with any epidemiological study, unknown medical, social, economic, or cultural factors may remain that have influenced the observed health care patterns," she noted. "Also, seeking neurologist care may be more likely in those who are health conscious and may correlate with other behaviors which would improve well-being, clinical course, or survival, such as medication use and exercise."

Dr. Willis said she had no relevant financial disclosures.

HONOLULU – Women and minorities with Parkinson’s disease obtained care from a neurologist less often than did white men, in a large national analysis of Medicare data.

In addition, Parkinson’s patients who received care from a neurologist had significant improvement in certain clinical outcomes as well as better overall survival compared with patients who received care from physicians in other specialties.

"Neurological disorders are common," Dr. Allison Wright Willis said at the annual meeting of the American Academy of Neurology. "However, medical students and new physicians report feeling least secure in their ability to diagnose and manage neurologic disease. Unfortunately, primary care training programs may not be able to provide sufficient training in the management of complicated neurodegenerative diseases such as Parkinson’s disease."

Dr. Willis of the department of neurology at Washington University in St. Louis and her associates set out to determine if treatment of Parkinson’s patients by a neurologist is associated with improved selected health outcomes, including hip fracture, skilled nursing facility placement, and survival. They evaluated more than 138,000 incident cases of Parkinson’s disease from Medicare beneficiaries with outpatient or carrier file claims for Parkinson’s disease in 2002.

For the period of 2002-2008, Dr. Willis and her colleagues used a Cox proportional hazards model to compare survival in patients with Parkinson’s disease who were treated by either a neurologist or primary care physician. They included the variables of race, age, sex, comorbidity index, socioeconomic deprivation score, and physician specialty.

Dr. Willis reported that only 57% of newly diagnosed Parkinson’s patients saw a neurologist at any time during the 48-month period in which neurologist encounter rates were calculated. Men and whites had the highest specialist treatment rates. Women and blacks both had 23% lower odds of receiving neurologist care than did men and whites, after adjustment for covariates.

Investigation of race and gender pairs revealed that white women, black men, black women, Hispanic women, and Asian women all had significantly lower odds, compared with white men, of receiving care from a neurologist after adjustment for age, comorbidity, and economic disparity. A sensitivity analysis performed using 469,000 prevalent cases of Parkinson’s disease yielded similar findings.

In a subgroup analysis of nearly 130,000 Parkinson’s patients without incident stroke or transient ischemic attack, patients cared for by a neurologist had 21% lower odds of being placed in a skilled nursing home, compared with patients treated by primary care physicians. Treatment by a neurologist also was associated with 14% lower odds of hip fracture than was treatment by primary care physicians.

The odds of survival over a 6-year period was 23% greater when patients received care from a neurologist rather than a primary care physician, with the greatest increase in survival seen in white men, white women, and black men.

"Should these results be confirmed using individual-level data, measures to lessen these disparities are vital," Dr. Willis commented. "Furthermore, by demonstrating that neurologist treatment improves Parkinson’s disease outcomes, our data highlight the need for health policy measures that support neurology practice and neurological education. However, the finding that fewer women and nonwhites received neurologist care may have broader implications for health care disparity and medical education."

She went on to point out that in addition to what she described as "the clear social and policy implications of our research, these data are important to Parkinson’s researchers. Parkinson’s disease epidemiological studies and clinical trials typically rely on speciality centers or neurologist practices for case identification and recruitment. Our data suggest that this may produce a significant referral bias, [which is] critical when attempting to perform gene or environmental risk studies, and may result in a distortion of the Parkinson’s disease risk literature or possibly confound clinical trial results. Additionally, the exclusive use of speciality center populations for recruitment may propagate a treatment bias resulting in fewer women and fewer minorities receiving state-of-the-art care."

Dr. Willis acknowledged certain limitations of the study, including the fact that the Medicare data set analyzed does not provide information on severity of Parkinson’s disease or physician diagnostic accuracy. "As with any epidemiological study, unknown medical, social, economic, or cultural factors may remain that have influenced the observed health care patterns," she noted. "Also, seeking neurologist care may be more likely in those who are health conscious and may correlate with other behaviors which would improve well-being, clinical course, or survival, such as medication use and exercise."

Dr. Willis said she had no relevant financial disclosures.

HONOLULU – Women and minorities with Parkinson’s disease obtained care from a neurologist less often than did white men, in a large national analysis of Medicare data.

In addition, Parkinson’s patients who received care from a neurologist had significant improvement in certain clinical outcomes as well as better overall survival compared with patients who received care from physicians in other specialties.

"Neurological disorders are common," Dr. Allison Wright Willis said at the annual meeting of the American Academy of Neurology. "However, medical students and new physicians report feeling least secure in their ability to diagnose and manage neurologic disease. Unfortunately, primary care training programs may not be able to provide sufficient training in the management of complicated neurodegenerative diseases such as Parkinson’s disease."

Dr. Willis of the department of neurology at Washington University in St. Louis and her associates set out to determine if treatment of Parkinson’s patients by a neurologist is associated with improved selected health outcomes, including hip fracture, skilled nursing facility placement, and survival. They evaluated more than 138,000 incident cases of Parkinson’s disease from Medicare beneficiaries with outpatient or carrier file claims for Parkinson’s disease in 2002.

For the period of 2002-2008, Dr. Willis and her colleagues used a Cox proportional hazards model to compare survival in patients with Parkinson’s disease who were treated by either a neurologist or primary care physician. They included the variables of race, age, sex, comorbidity index, socioeconomic deprivation score, and physician specialty.

Dr. Willis reported that only 57% of newly diagnosed Parkinson’s patients saw a neurologist at any time during the 48-month period in which neurologist encounter rates were calculated. Men and whites had the highest specialist treatment rates. Women and blacks both had 23% lower odds of receiving neurologist care than did men and whites, after adjustment for covariates.

Investigation of race and gender pairs revealed that white women, black men, black women, Hispanic women, and Asian women all had significantly lower odds, compared with white men, of receiving care from a neurologist after adjustment for age, comorbidity, and economic disparity. A sensitivity analysis performed using 469,000 prevalent cases of Parkinson’s disease yielded similar findings.

In a subgroup analysis of nearly 130,000 Parkinson’s patients without incident stroke or transient ischemic attack, patients cared for by a neurologist had 21% lower odds of being placed in a skilled nursing home, compared with patients treated by primary care physicians. Treatment by a neurologist also was associated with 14% lower odds of hip fracture than was treatment by primary care physicians.

The odds of survival over a 6-year period was 23% greater when patients received care from a neurologist rather than a primary care physician, with the greatest increase in survival seen in white men, white women, and black men.

"Should these results be confirmed using individual-level data, measures to lessen these disparities are vital," Dr. Willis commented. "Furthermore, by demonstrating that neurologist treatment improves Parkinson’s disease outcomes, our data highlight the need for health policy measures that support neurology practice and neurological education. However, the finding that fewer women and nonwhites received neurologist care may have broader implications for health care disparity and medical education."

She went on to point out that in addition to what she described as "the clear social and policy implications of our research, these data are important to Parkinson’s researchers. Parkinson’s disease epidemiological studies and clinical trials typically rely on speciality centers or neurologist practices for case identification and recruitment. Our data suggest that this may produce a significant referral bias, [which is] critical when attempting to perform gene or environmental risk studies, and may result in a distortion of the Parkinson’s disease risk literature or possibly confound clinical trial results. Additionally, the exclusive use of speciality center populations for recruitment may propagate a treatment bias resulting in fewer women and fewer minorities receiving state-of-the-art care."

Dr. Willis acknowledged certain limitations of the study, including the fact that the Medicare data set analyzed does not provide information on severity of Parkinson’s disease or physician diagnostic accuracy. "As with any epidemiological study, unknown medical, social, economic, or cultural factors may remain that have influenced the observed health care patterns," she noted. "Also, seeking neurologist care may be more likely in those who are health conscious and may correlate with other behaviors which would improve well-being, clinical course, or survival, such as medication use and exercise."

Dr. Willis said she had no relevant financial disclosures.

HONOLULU – Women and minorities with Parkinson’s disease obtained care from a neurologist less often than did white men, in a large national analysis of Medicare data.

In addition, Parkinson’s patients who received care from a neurologist had significant improvement in certain clinical outcomes as well as better overall survival compared with patients who received care from physicians in other specialties.

"Neurological disorders are common," Dr. Allison Wright Willis said at the annual meeting of the American Academy of Neurology. "However, medical students and new physicians report feeling least secure in their ability to diagnose and manage neurologic disease. Unfortunately, primary care training programs may not be able to provide sufficient training in the management of complicated neurodegenerative diseases such as Parkinson’s disease."

Dr. Willis of the department of neurology at Washington University in St. Louis and her associates set out to determine if treatment of Parkinson’s patients by a neurologist is associated with improved selected health outcomes, including hip fracture, skilled nursing facility placement, and survival. They evaluated more than 138,000 incident cases of Parkinson’s disease from Medicare beneficiaries with outpatient or carrier file claims for Parkinson’s disease in 2002.

For the period of 2002-2008, Dr. Willis and her colleagues used a Cox proportional hazards model to compare survival in patients with Parkinson’s disease who were treated by either a neurologist or primary care physician. They included the variables of race, age, sex, comorbidity index, socioeconomic deprivation score, and physician specialty.

Dr. Willis reported that only 57% of newly diagnosed Parkinson’s patients saw a neurologist at any time during the 48-month period in which neurologist encounter rates were calculated. Men and whites had the highest specialist treatment rates. Women and blacks both had 23% lower odds of receiving neurologist care than did men and whites, after adjustment for covariates.

Investigation of race and gender pairs revealed that white women, black men, black women, Hispanic women, and Asian women all had significantly lower odds, compared with white men, of receiving care from a neurologist after adjustment for age, comorbidity, and economic disparity. A sensitivity analysis performed using 469,000 prevalent cases of Parkinson’s disease yielded similar findings.

In a subgroup analysis of nearly 130,000 Parkinson’s patients without incident stroke or transient ischemic attack, patients cared for by a neurologist had 21% lower odds of being placed in a skilled nursing home, compared with patients treated by primary care physicians. Treatment by a neurologist also was associated with 14% lower odds of hip fracture than was treatment by primary care physicians.

The odds of survival over a 6-year period was 23% greater when patients received care from a neurologist rather than a primary care physician, with the greatest increase in survival seen in white men, white women, and black men.

"Should these results be confirmed using individual-level data, measures to lessen these disparities are vital," Dr. Willis commented. "Furthermore, by demonstrating that neurologist treatment improves Parkinson’s disease outcomes, our data highlight the need for health policy measures that support neurology practice and neurological education. However, the finding that fewer women and nonwhites received neurologist care may have broader implications for health care disparity and medical education."

She went on to point out that in addition to what she described as "the clear social and policy implications of our research, these data are important to Parkinson’s researchers. Parkinson’s disease epidemiological studies and clinical trials typically rely on speciality centers or neurologist practices for case identification and recruitment. Our data suggest that this may produce a significant referral bias, [which is] critical when attempting to perform gene or environmental risk studies, and may result in a distortion of the Parkinson’s disease risk literature or possibly confound clinical trial results. Additionally, the exclusive use of speciality center populations for recruitment may propagate a treatment bias resulting in fewer women and fewer minorities receiving state-of-the-art care."

Dr. Willis acknowledged certain limitations of the study, including the fact that the Medicare data set analyzed does not provide information on severity of Parkinson’s disease or physician diagnostic accuracy. "As with any epidemiological study, unknown medical, social, economic, or cultural factors may remain that have influenced the observed health care patterns," she noted. "Also, seeking neurologist care may be more likely in those who are health conscious and may correlate with other behaviors which would improve well-being, clinical course, or survival, such as medication use and exercise."

Dr. Willis said she had no relevant financial disclosures.

HONOLULU – Women and minorities with Parkinson’s disease obtained care from a neurologist less often than did white men, in a large national analysis of Medicare data.

In addition, Parkinson’s patients who received care from a neurologist had significant improvement in certain clinical outcomes as well as better overall survival compared with patients who received care from physicians in other specialties.

"Neurological disorders are common," Dr. Allison Wright Willis said at the annual meeting of the American Academy of Neurology. "However, medical students and new physicians report feeling least secure in their ability to diagnose and manage neurologic disease. Unfortunately, primary care training programs may not be able to provide sufficient training in the management of complicated neurodegenerative diseases such as Parkinson’s disease."

Dr. Willis of the department of neurology at Washington University in St. Louis and her associates set out to determine if treatment of Parkinson’s patients by a neurologist is associated with improved selected health outcomes, including hip fracture, skilled nursing facility placement, and survival. They evaluated more than 138,000 incident cases of Parkinson’s disease from Medicare beneficiaries with outpatient or carrier file claims for Parkinson’s disease in 2002.

For the period of 2002-2008, Dr. Willis and her colleagues used a Cox proportional hazards model to compare survival in patients with Parkinson’s disease who were treated by either a neurologist or primary care physician. They included the variables of race, age, sex, comorbidity index, socioeconomic deprivation score, and physician specialty.

Dr. Willis reported that only 57% of newly diagnosed Parkinson’s patients saw a neurologist at any time during the 48-month period in which neurologist encounter rates were calculated. Men and whites had the highest specialist treatment rates. Women and blacks both had 23% lower odds of receiving neurologist care than did men and whites, after adjustment for covariates.

Investigation of race and gender pairs revealed that white women, black men, black women, Hispanic women, and Asian women all had significantly lower odds, compared with white men, of receiving care from a neurologist after adjustment for age, comorbidity, and economic disparity. A sensitivity analysis performed using 469,000 prevalent cases of Parkinson’s disease yielded similar findings.

In a subgroup analysis of nearly 130,000 Parkinson’s patients without incident stroke or transient ischemic attack, patients cared for by a neurologist had 21% lower odds of being placed in a skilled nursing home, compared with patients treated by primary care physicians. Treatment by a neurologist also was associated with 14% lower odds of hip fracture than was treatment by primary care physicians.

The odds of survival over a 6-year period was 23% greater when patients received care from a neurologist rather than a primary care physician, with the greatest increase in survival seen in white men, white women, and black men.

"Should these results be confirmed using individual-level data, measures to lessen these disparities are vital," Dr. Willis commented. "Furthermore, by demonstrating that neurologist treatment improves Parkinson’s disease outcomes, our data highlight the need for health policy measures that support neurology practice and neurological education. However, the finding that fewer women and nonwhites received neurologist care may have broader implications for health care disparity and medical education."

She went on to point out that in addition to what she described as "the clear social and policy implications of our research, these data are important to Parkinson’s researchers. Parkinson’s disease epidemiological studies and clinical trials typically rely on speciality centers or neurologist practices for case identification and recruitment. Our data suggest that this may produce a significant referral bias, [which is] critical when attempting to perform gene or environmental risk studies, and may result in a distortion of the Parkinson’s disease risk literature or possibly confound clinical trial results. Additionally, the exclusive use of speciality center populations for recruitment may propagate a treatment bias resulting in fewer women and fewer minorities receiving state-of-the-art care."

Dr. Willis acknowledged certain limitations of the study, including the fact that the Medicare data set analyzed does not provide information on severity of Parkinson’s disease or physician diagnostic accuracy. "As with any epidemiological study, unknown medical, social, economic, or cultural factors may remain that have influenced the observed health care patterns," she noted. "Also, seeking neurologist care may be more likely in those who are health conscious and may correlate with other behaviors which would improve well-being, clinical course, or survival, such as medication use and exercise."

Dr. Willis said she had no relevant financial disclosures.

HONOLULU – Women and minorities with Parkinson’s disease obtained care from a neurologist less often than did white men, in a large national analysis of Medicare data.

In addition, Parkinson’s patients who received care from a neurologist had significant improvement in certain clinical outcomes as well as better overall survival compared with patients who received care from physicians in other specialties.

"Neurological disorders are common," Dr. Allison Wright Willis said at the annual meeting of the American Academy of Neurology. "However, medical students and new physicians report feeling least secure in their ability to diagnose and manage neurologic disease. Unfortunately, primary care training programs may not be able to provide sufficient training in the management of complicated neurodegenerative diseases such as Parkinson’s disease."

Dr. Willis of the department of neurology at Washington University in St. Louis and her associates set out to determine if treatment of Parkinson’s patients by a neurologist is associated with improved selected health outcomes, including hip fracture, skilled nursing facility placement, and survival. They evaluated more than 138,000 incident cases of Parkinson’s disease from Medicare beneficiaries with outpatient or carrier file claims for Parkinson’s disease in 2002.

For the period of 2002-2008, Dr. Willis and her colleagues used a Cox proportional hazards model to compare survival in patients with Parkinson’s disease who were treated by either a neurologist or primary care physician. They included the variables of race, age, sex, comorbidity index, socioeconomic deprivation score, and physician specialty.

Dr. Willis reported that only 57% of newly diagnosed Parkinson’s patients saw a neurologist at any time during the 48-month period in which neurologist encounter rates were calculated. Men and whites had the highest specialist treatment rates. Women and blacks both had 23% lower odds of receiving neurologist care than did men and whites, after adjustment for covariates.

Investigation of race and gender pairs revealed that white women, black men, black women, Hispanic women, and Asian women all had significantly lower odds, compared with white men, of receiving care from a neurologist after adjustment for age, comorbidity, and economic disparity. A sensitivity analysis performed using 469,000 prevalent cases of Parkinson’s disease yielded similar findings.

In a subgroup analysis of nearly 130,000 Parkinson’s patients without incident stroke or transient ischemic attack, patients cared for by a neurologist had 21% lower odds of being placed in a skilled nursing home, compared with patients treated by primary care physicians. Treatment by a neurologist also was associated with 14% lower odds of hip fracture than was treatment by primary care physicians.

The odds of survival over a 6-year period was 23% greater when patients received care from a neurologist rather than a primary care physician, with the greatest increase in survival seen in white men, white women, and black men.

"Should these results be confirmed using individual-level data, measures to lessen these disparities are vital," Dr. Willis commented. "Furthermore, by demonstrating that neurologist treatment improves Parkinson’s disease outcomes, our data highlight the need for health policy measures that support neurology practice and neurological education. However, the finding that fewer women and nonwhites received neurologist care may have broader implications for health care disparity and medical education."

She went on to point out that in addition to what she described as "the clear social and policy implications of our research, these data are important to Parkinson’s researchers. Parkinson’s disease epidemiological studies and clinical trials typically rely on speciality centers or neurologist practices for case identification and recruitment. Our data suggest that this may produce a significant referral bias, [which is] critical when attempting to perform gene or environmental risk studies, and may result in a distortion of the Parkinson’s disease risk literature or possibly confound clinical trial results. Additionally, the exclusive use of speciality center populations for recruitment may propagate a treatment bias resulting in fewer women and fewer minorities receiving state-of-the-art care."

Dr. Willis acknowledged certain limitations of the study, including the fact that the Medicare data set analyzed does not provide information on severity of Parkinson’s disease or physician diagnostic accuracy. "As with any epidemiological study, unknown medical, social, economic, or cultural factors may remain that have influenced the observed health care patterns," she noted. "Also, seeking neurologist care may be more likely in those who are health conscious and may correlate with other behaviors which would improve well-being, clinical course, or survival, such as medication use and exercise."

Dr. Willis said she had no relevant financial disclosures.

HONOLULU – Women and minorities with Parkinson’s disease obtained care from a neurologist less often than did white men, in a large national analysis of Medicare data.

In addition, Parkinson’s patients who received care from a neurologist had significant improvement in certain clinical outcomes as well as better overall survival compared with patients who received care from physicians in other specialties.

"Neurological disorders are common," Dr. Allison Wright Willis said at the annual meeting of the American Academy of Neurology. "However, medical students and new physicians report feeling least secure in their ability to diagnose and manage neurologic disease. Unfortunately, primary care training programs may not be able to provide sufficient training in the management of complicated neurodegenerative diseases such as Parkinson’s disease."

Dr. Willis of the department of neurology at Washington University in St. Louis and her associates set out to determine if treatment of Parkinson’s patients by a neurologist is associated with improved selected health outcomes, including hip fracture, skilled nursing facility placement, and survival. They evaluated more than 138,000 incident cases of Parkinson’s disease from Medicare beneficiaries with outpatient or carrier file claims for Parkinson’s disease in 2002.

For the period of 2002-2008, Dr. Willis and her colleagues used a Cox proportional hazards model to compare survival in patients with Parkinson’s disease who were treated by either a neurologist or primary care physician. They included the variables of race, age, sex, comorbidity index, socioeconomic deprivation score, and physician specialty.

Dr. Willis reported that only 57% of newly diagnosed Parkinson’s patients saw a neurologist at any time during the 48-month period in which neurologist encounter rates were calculated. Men and whites had the highest specialist treatment rates. Women and blacks both had 23% lower odds of receiving neurologist care than did men and whites, after adjustment for covariates.

Investigation of race and gender pairs revealed that white women, black men, black women, Hispanic women, and Asian women all had significantly lower odds, compared with white men, of receiving care from a neurologist after adjustment for age, comorbidity, and economic disparity. A sensitivity analysis performed using 469,000 prevalent cases of Parkinson’s disease yielded similar findings.

In a subgroup analysis of nearly 130,000 Parkinson’s patients without incident stroke or transient ischemic attack, patients cared for by a neurologist had 21% lower odds of being placed in a skilled nursing home, compared with patients treated by primary care physicians. Treatment by a neurologist also was associated with 14% lower odds of hip fracture than was treatment by primary care physicians.

The odds of survival over a 6-year period was 23% greater when patients received care from a neurologist rather than a primary care physician, with the greatest increase in survival seen in white men, white women, and black men.

"Should these results be confirmed using individual-level data, measures to lessen these disparities are vital," Dr. Willis commented. "Furthermore, by demonstrating that neurologist treatment improves Parkinson’s disease outcomes, our data highlight the need for health policy measures that support neurology practice and neurological education. However, the finding that fewer women and nonwhites received neurologist care may have broader implications for health care disparity and medical education."

She went on to point out that in addition to what she described as "the clear social and policy implications of our research, these data are important to Parkinson’s researchers. Parkinson’s disease epidemiological studies and clinical trials typically rely on speciality centers or neurologist practices for case identification and recruitment. Our data suggest that this may produce a significant referral bias, [which is] critical when attempting to perform gene or environmental risk studies, and may result in a distortion of the Parkinson’s disease risk literature or possibly confound clinical trial results. Additionally, the exclusive use of speciality center populations for recruitment may propagate a treatment bias resulting in fewer women and fewer minorities receiving state-of-the-art care."

Dr. Willis acknowledged certain limitations of the study, including the fact that the Medicare data set analyzed does not provide information on severity of Parkinson’s disease or physician diagnostic accuracy. "As with any epidemiological study, unknown medical, social, economic, or cultural factors may remain that have influenced the observed health care patterns," she noted. "Also, seeking neurologist care may be more likely in those who are health conscious and may correlate with other behaviors which would improve well-being, clinical course, or survival, such as medication use and exercise."

Dr. Willis said she had no relevant financial disclosures.

HONOLULU – Women and minorities with Parkinson’s disease obtained care from a neurologist less often than did white men, in a large national analysis of Medicare data.

In addition, Parkinson’s patients who received care from a neurologist had significant improvement in certain clinical outcomes as well as better overall survival compared with patients who received care from physicians in other specialties.

"Neurological disorders are common," Dr. Allison Wright Willis said at the annual meeting of the American Academy of Neurology. "However, medical students and new physicians report feeling least secure in their ability to diagnose and manage neurologic disease. Unfortunately, primary care training programs may not be able to provide sufficient training in the management of complicated neurodegenerative diseases such as Parkinson’s disease."

Dr. Willis of the department of neurology at Washington University in St. Louis and her associates set out to determine if treatment of Parkinson’s patients by a neurologist is associated with improved selected health outcomes, including hip fracture, skilled nursing facility placement, and survival. They evaluated more than 138,000 incident cases of Parkinson’s disease from Medicare beneficiaries with outpatient or carrier file claims for Parkinson’s disease in 2002.

For the period of 2002-2008, Dr. Willis and her colleagues used a Cox proportional hazards model to compare survival in patients with Parkinson’s disease who were treated by either a neurologist or primary care physician. They included the variables of race, age, sex, comorbidity index, socioeconomic deprivation score, and physician specialty.

Dr. Willis reported that only 57% of newly diagnosed Parkinson’s patients saw a neurologist at any time during the 48-month period in which neurologist encounter rates were calculated. Men and whites had the highest specialist treatment rates. Women and blacks both had 23% lower odds of receiving neurologist care than did men and whites, after adjustment for covariates.

Investigation of race and gender pairs revealed that white women, black men, black women, Hispanic women, and Asian women all had significantly lower odds, compared with white men, of receiving care from a neurologist after adjustment for age, comorbidity, and economic disparity. A sensitivity analysis performed using 469,000 prevalent cases of Parkinson’s disease yielded similar findings.

In a subgroup analysis of nearly 130,000 Parkinson’s patients without incident stroke or transient ischemic attack, patients cared for by a neurologist had 21% lower odds of being placed in a skilled nursing home, compared with patients treated by primary care physicians. Treatment by a neurologist also was associated with 14% lower odds of hip fracture than was treatment by primary care physicians.

The odds of survival over a 6-year period was 23% greater when patients received care from a neurologist rather than a primary care physician, with the greatest increase in survival seen in white men, white women, and black men.

"Should these results be confirmed using individual-level data, measures to lessen these disparities are vital," Dr. Willis commented. "Furthermore, by demonstrating that neurologist treatment improves Parkinson’s disease outcomes, our data highlight the need for health policy measures that support neurology practice and neurological education. However, the finding that fewer women and nonwhites received neurologist care may have broader implications for health care disparity and medical education."

She went on to point out that in addition to what she described as "the clear social and policy implications of our research, these data are important to Parkinson’s researchers. Parkinson’s disease epidemiological studies and clinical trials typically rely on speciality centers or neurologist practices for case identification and recruitment. Our data suggest that this may produce a significant referral bias, [which is] critical when attempting to perform gene or environmental risk studies, and may result in a distortion of the Parkinson’s disease risk literature or possibly confound clinical trial results. Additionally, the exclusive use of speciality center populations for recruitment may propagate a treatment bias resulting in fewer women and fewer minorities receiving state-of-the-art care."

Dr. Willis acknowledged certain limitations of the study, including the fact that the Medicare data set analyzed does not provide information on severity of Parkinson’s disease or physician diagnostic accuracy. "As with any epidemiological study, unknown medical, social, economic, or cultural factors may remain that have influenced the observed health care patterns," she noted. "Also, seeking neurologist care may be more likely in those who are health conscious and may correlate with other behaviors which would improve well-being, clinical course, or survival, such as medication use and exercise."

Dr. Willis said she had no relevant financial disclosures.

HONOLULU – Only a small correlation between the severity of early-morning motor symptoms and nocturnal sleep disturbances was observed in patients with Parkinson’s disease, results from a post hoc trial analysis demonstrated.

"Parkinson’s disease is defined by cardinal motor symptoms, but as we are discovering more and more, nonmotor symptoms are burdensome to patients with Parkinson’s disease," Dr. Todd Swick said at the annual meeting of the American Academy of Neurology.

The major motor symptoms are rest tremor, rigidity, bradykinesia, akinesia, and postural instability. Common nonmotor symptoms include sleep disorders, cognitive dysfunction, depression, and gastrointestinal disorders.

"Sleep disorders are recognized to be of considerable clinical importance," said Dr. Swick, medical director of the Houston Sleep Center. "These have been shown to precede the onset of motor symptoms by as long as 50 years."

In an effort to investigate the association between the severity of nocturnal sleep disturbances and early-morning motor symptoms in Parkinson’s disease, he and his associates conducted a post hoc analysis of 267 patients who participated in the RECOVER (Randomized Evaluation of the 24-Hour Coverage: Efficacy of Rotigotine) study.

Dr. Swick described RECOVER as the first large-scale, double-blind, randomized trial to investigate sleep outcomes and motor function in the early morning as coprimary outcome measures in this patient population.

Patients were randomized to placebo or to the rotigotine transdermal system (2-16 mg every 24 hours). The researchers titrated to the optimal dose over a period of 1-8 weeks and maintained the dose for an additional 4 weeks. Significant benefits in early-morning function and in the severity of nocturnal sleep disturbances were observed in patients treated with rotigotine but not in those treated with placebo (Mov. Disord. 2011;26:90-9).

For the current study, Dr. Swick and his associates conducted categorical and continuous value association analyses to determine United Parkinson’s Disease Rating Scale III (UPDRS III) total score (0-9, 10-19, 20-29, 30-39, and 40 or more, defined as categories 1, 2, 3, 4, and 5, respectively), as well as modified Parkinson’s Disease Sleep Scale (PDSS-2) total score in the study participants.

The mean age of the patients was 65 years, 66% were male, and 91% were white. Their mean UPDRS III and PDSS-2 total scores were 30.4 and 19.7.

Dr. Swick reported that the analyses showed only a modest correlation between severity of nocturnal sleep disturbances and early-morning motor symptoms in patients with Parkinson’s disease. "This is in line with previously published data," he said. "The data suggest that possibly nonmotor dysfunctions may influence the extent of sleep disorders. This may be due to changes within the central nervous system as evidenced by a significant deterioration in CNS functioning."

The data also suggest that, in the RECOVER study, "changes in PDSS-2 total score were unlikely to be entirely attributed to changes in UPDRS III scores," Dr. Swick said.

The study was supported by Schwarz Pharma, distributor of rotigotine. Dr. Swick disclosed that he has received personal compensation for speaking from Jazz Pharmaceuticals and research stipends from Jazz, Cephalon, Pfizer, Sanofi-Aventis, and Merck.

HONOLULU – Only a small correlation between the severity of early-morning motor symptoms and nocturnal sleep disturbances was observed in patients with Parkinson’s disease, results from a post hoc trial analysis demonstrated.

"Parkinson’s disease is defined by cardinal motor symptoms, but as we are discovering more and more, nonmotor symptoms are burdensome to patients with Parkinson’s disease," Dr. Todd Swick said at the annual meeting of the American Academy of Neurology.

The major motor symptoms are rest tremor, rigidity, bradykinesia, akinesia, and postural instability. Common nonmotor symptoms include sleep disorders, cognitive dysfunction, depression, and gastrointestinal disorders.

"Sleep disorders are recognized to be of considerable clinical importance," said Dr. Swick, medical director of the Houston Sleep Center. "These have been shown to precede the onset of motor symptoms by as long as 50 years."

In an effort to investigate the association between the severity of nocturnal sleep disturbances and early-morning motor symptoms in Parkinson’s disease, he and his associates conducted a post hoc analysis of 267 patients who participated in the RECOVER (Randomized Evaluation of the 24-Hour Coverage: Efficacy of Rotigotine) study.

Dr. Swick described RECOVER as the first large-scale, double-blind, randomized trial to investigate sleep outcomes and motor function in the early morning as coprimary outcome measures in this patient population.

Patients were randomized to placebo or to the rotigotine transdermal system (2-16 mg every 24 hours). The researchers titrated to the optimal dose over a period of 1-8 weeks and maintained the dose for an additional 4 weeks. Significant benefits in early-morning function and in the severity of nocturnal sleep disturbances were observed in patients treated with rotigotine but not in those treated with placebo (Mov. Disord. 2011;26:90-9).

For the current study, Dr. Swick and his associates conducted categorical and continuous value association analyses to determine United Parkinson’s Disease Rating Scale III (UPDRS III) total score (0-9, 10-19, 20-29, 30-39, and 40 or more, defined as categories 1, 2, 3, 4, and 5, respectively), as well as modified Parkinson’s Disease Sleep Scale (PDSS-2) total score in the study participants.

The mean age of the patients was 65 years, 66% were male, and 91% were white. Their mean UPDRS III and PDSS-2 total scores were 30.4 and 19.7.

Dr. Swick reported that the analyses showed only a modest correlation between severity of nocturnal sleep disturbances and early-morning motor symptoms in patients with Parkinson’s disease. "This is in line with previously published data," he said. "The data suggest that possibly nonmotor dysfunctions may influence the extent of sleep disorders. This may be due to changes within the central nervous system as evidenced by a significant deterioration in CNS functioning."

The data also suggest that, in the RECOVER study, "changes in PDSS-2 total score were unlikely to be entirely attributed to changes in UPDRS III scores," Dr. Swick said.

The study was supported by Schwarz Pharma, distributor of rotigotine. Dr. Swick disclosed that he has received personal compensation for speaking from Jazz Pharmaceuticals and research stipends from Jazz, Cephalon, Pfizer, Sanofi-Aventis, and Merck.

HONOLULU – Only a small correlation between the severity of early-morning motor symptoms and nocturnal sleep disturbances was observed in patients with Parkinson’s disease, results from a post hoc trial analysis demonstrated.

"Parkinson’s disease is defined by cardinal motor symptoms, but as we are discovering more and more, nonmotor symptoms are burdensome to patients with Parkinson’s disease," Dr. Todd Swick said at the annual meeting of the American Academy of Neurology.

The major motor symptoms are rest tremor, rigidity, bradykinesia, akinesia, and postural instability. Common nonmotor symptoms include sleep disorders, cognitive dysfunction, depression, and gastrointestinal disorders.

"Sleep disorders are recognized to be of considerable clinical importance," said Dr. Swick, medical director of the Houston Sleep Center. "These have been shown to precede the onset of motor symptoms by as long as 50 years."

In an effort to investigate the association between the severity of nocturnal sleep disturbances and early-morning motor symptoms in Parkinson’s disease, he and his associates conducted a post hoc analysis of 267 patients who participated in the RECOVER (Randomized Evaluation of the 24-Hour Coverage: Efficacy of Rotigotine) study.

Dr. Swick described RECOVER as the first large-scale, double-blind, randomized trial to investigate sleep outcomes and motor function in the early morning as coprimary outcome measures in this patient population.

Patients were randomized to placebo or to the rotigotine transdermal system (2-16 mg every 24 hours). The researchers titrated to the optimal dose over a period of 1-8 weeks and maintained the dose for an additional 4 weeks. Significant benefits in early-morning function and in the severity of nocturnal sleep disturbances were observed in patients treated with rotigotine but not in those treated with placebo (Mov. Disord. 2011;26:90-9).

For the current study, Dr. Swick and his associates conducted categorical and continuous value association analyses to determine United Parkinson’s Disease Rating Scale III (UPDRS III) total score (0-9, 10-19, 20-29, 30-39, and 40 or more, defined as categories 1, 2, 3, 4, and 5, respectively), as well as modified Parkinson’s Disease Sleep Scale (PDSS-2) total score in the study participants.

The mean age of the patients was 65 years, 66% were male, and 91% were white. Their mean UPDRS III and PDSS-2 total scores were 30.4 and 19.7.

Dr. Swick reported that the analyses showed only a modest correlation between severity of nocturnal sleep disturbances and early-morning motor symptoms in patients with Parkinson’s disease. "This is in line with previously published data," he said. "The data suggest that possibly nonmotor dysfunctions may influence the extent of sleep disorders. This may be due to changes within the central nervous system as evidenced by a significant deterioration in CNS functioning."

The data also suggest that, in the RECOVER study, "changes in PDSS-2 total score were unlikely to be entirely attributed to changes in UPDRS III scores," Dr. Swick said.

The study was supported by Schwarz Pharma, distributor of rotigotine. Dr. Swick disclosed that he has received personal compensation for speaking from Jazz Pharmaceuticals and research stipends from Jazz, Cephalon, Pfizer, Sanofi-Aventis, and Merck.

HONOLULU – Only a small correlation between the severity of early-morning motor symptoms and nocturnal sleep disturbances was observed in patients with Parkinson’s disease, results from a post hoc trial analysis demonstrated.

"Parkinson’s disease is defined by cardinal motor symptoms, but as we are discovering more and more, nonmotor symptoms are burdensome to patients with Parkinson’s disease," Dr. Todd Swick said at the annual meeting of the American Academy of Neurology.

The major motor symptoms are rest tremor, rigidity, bradykinesia, akinesia, and postural instability. Common nonmotor symptoms include sleep disorders, cognitive dysfunction, depression, and gastrointestinal disorders.

"Sleep disorders are recognized to be of considerable clinical importance," said Dr. Swick, medical director of the Houston Sleep Center. "These have been shown to precede the onset of motor symptoms by as long as 50 years."

In an effort to investigate the association between the severity of nocturnal sleep disturbances and early-morning motor symptoms in Parkinson’s disease, he and his associates conducted a post hoc analysis of 267 patients who participated in the RECOVER (Randomized Evaluation of the 24-Hour Coverage: Efficacy of Rotigotine) study.

Dr. Swick described RECOVER as the first large-scale, double-blind, randomized trial to investigate sleep outcomes and motor function in the early morning as coprimary outcome measures in this patient population.

Patients were randomized to placebo or to the rotigotine transdermal system (2-16 mg every 24 hours). The researchers titrated to the optimal dose over a period of 1-8 weeks and maintained the dose for an additional 4 weeks. Significant benefits in early-morning function and in the severity of nocturnal sleep disturbances were observed in patients treated with rotigotine but not in those treated with placebo (Mov. Disord. 2011;26:90-9).

For the current study, Dr. Swick and his associates conducted categorical and continuous value association analyses to determine United Parkinson’s Disease Rating Scale III (UPDRS III) total score (0-9, 10-19, 20-29, 30-39, and 40 or more, defined as categories 1, 2, 3, 4, and 5, respectively), as well as modified Parkinson’s Disease Sleep Scale (PDSS-2) total score in the study participants.

The mean age of the patients was 65 years, 66% were male, and 91% were white. Their mean UPDRS III and PDSS-2 total scores were 30.4 and 19.7.

Dr. Swick reported that the analyses showed only a modest correlation between severity of nocturnal sleep disturbances and early-morning motor symptoms in patients with Parkinson’s disease. "This is in line with previously published data," he said. "The data suggest that possibly nonmotor dysfunctions may influence the extent of sleep disorders. This may be due to changes within the central nervous system as evidenced by a significant deterioration in CNS functioning."

The data also suggest that, in the RECOVER study, "changes in PDSS-2 total score were unlikely to be entirely attributed to changes in UPDRS III scores," Dr. Swick said.

The study was supported by Schwarz Pharma, distributor of rotigotine. Dr. Swick disclosed that he has received personal compensation for speaking from Jazz Pharmaceuticals and research stipends from Jazz, Cephalon, Pfizer, Sanofi-Aventis, and Merck.

HONOLULU – Only a small correlation between the severity of early-morning motor symptoms and nocturnal sleep disturbances was observed in patients with Parkinson’s disease, results from a post hoc trial analysis demonstrated.

"Parkinson’s disease is defined by cardinal motor symptoms, but as we are discovering more and more, nonmotor symptoms are burdensome to patients with Parkinson’s disease," Dr. Todd Swick said at the annual meeting of the American Academy of Neurology.

The major motor symptoms are rest tremor, rigidity, bradykinesia, akinesia, and postural instability. Common nonmotor symptoms include sleep disorders, cognitive dysfunction, depression, and gastrointestinal disorders.

"Sleep disorders are recognized to be of considerable clinical importance," said Dr. Swick, medical director of the Houston Sleep Center. "These have been shown to precede the onset of motor symptoms by as long as 50 years."

In an effort to investigate the association between the severity of nocturnal sleep disturbances and early-morning motor symptoms in Parkinson’s disease, he and his associates conducted a post hoc analysis of 267 patients who participated in the RECOVER (Randomized Evaluation of the 24-Hour Coverage: Efficacy of Rotigotine) study.

Dr. Swick described RECOVER as the first large-scale, double-blind, randomized trial to investigate sleep outcomes and motor function in the early morning as coprimary outcome measures in this patient population.

Patients were randomized to placebo or to the rotigotine transdermal system (2-16 mg every 24 hours). The researchers titrated to the optimal dose over a period of 1-8 weeks and maintained the dose for an additional 4 weeks. Significant benefits in early-morning function and in the severity of nocturnal sleep disturbances were observed in patients treated with rotigotine but not in those treated with placebo (Mov. Disord. 2011;26:90-9).

For the current study, Dr. Swick and his associates conducted categorical and continuous value association analyses to determine United Parkinson’s Disease Rating Scale III (UPDRS III) total score (0-9, 10-19, 20-29, 30-39, and 40 or more, defined as categories 1, 2, 3, 4, and 5, respectively), as well as modified Parkinson’s Disease Sleep Scale (PDSS-2) total score in the study participants.

The mean age of the patients was 65 years, 66% were male, and 91% were white. Their mean UPDRS III and PDSS-2 total scores were 30.4 and 19.7.

Dr. Swick reported that the analyses showed only a modest correlation between severity of nocturnal sleep disturbances and early-morning motor symptoms in patients with Parkinson’s disease. "This is in line with previously published data," he said. "The data suggest that possibly nonmotor dysfunctions may influence the extent of sleep disorders. This may be due to changes within the central nervous system as evidenced by a significant deterioration in CNS functioning."

The data also suggest that, in the RECOVER study, "changes in PDSS-2 total score were unlikely to be entirely attributed to changes in UPDRS III scores," Dr. Swick said.

The study was supported by Schwarz Pharma, distributor of rotigotine. Dr. Swick disclosed that he has received personal compensation for speaking from Jazz Pharmaceuticals and research stipends from Jazz, Cephalon, Pfizer, Sanofi-Aventis, and Merck.

HONOLULU – Only a small correlation between the severity of early-morning motor symptoms and nocturnal sleep disturbances was observed in patients with Parkinson’s disease, results from a post hoc trial analysis demonstrated.

"Parkinson’s disease is defined by cardinal motor symptoms, but as we are discovering more and more, nonmotor symptoms are burdensome to patients with Parkinson’s disease," Dr. Todd Swick said at the annual meeting of the American Academy of Neurology.

The major motor symptoms are rest tremor, rigidity, bradykinesia, akinesia, and postural instability. Common nonmotor symptoms include sleep disorders, cognitive dysfunction, depression, and gastrointestinal disorders.

"Sleep disorders are recognized to be of considerable clinical importance," said Dr. Swick, medical director of the Houston Sleep Center. "These have been shown to precede the onset of motor symptoms by as long as 50 years."

In an effort to investigate the association between the severity of nocturnal sleep disturbances and early-morning motor symptoms in Parkinson’s disease, he and his associates conducted a post hoc analysis of 267 patients who participated in the RECOVER (Randomized Evaluation of the 24-Hour Coverage: Efficacy of Rotigotine) study.

Dr. Swick described RECOVER as the first large-scale, double-blind, randomized trial to investigate sleep outcomes and motor function in the early morning as coprimary outcome measures in this patient population.

Patients were randomized to placebo or to the rotigotine transdermal system (2-16 mg every 24 hours). The researchers titrated to the optimal dose over a period of 1-8 weeks and maintained the dose for an additional 4 weeks. Significant benefits in early-morning function and in the severity of nocturnal sleep disturbances were observed in patients treated with rotigotine but not in those treated with placebo (Mov. Disord. 2011;26:90-9).

For the current study, Dr. Swick and his associates conducted categorical and continuous value association analyses to determine United Parkinson’s Disease Rating Scale III (UPDRS III) total score (0-9, 10-19, 20-29, 30-39, and 40 or more, defined as categories 1, 2, 3, 4, and 5, respectively), as well as modified Parkinson’s Disease Sleep Scale (PDSS-2) total score in the study participants.

The mean age of the patients was 65 years, 66% were male, and 91% were white. Their mean UPDRS III and PDSS-2 total scores were 30.4 and 19.7.

Dr. Swick reported that the analyses showed only a modest correlation between severity of nocturnal sleep disturbances and early-morning motor symptoms in patients with Parkinson’s disease. "This is in line with previously published data," he said. "The data suggest that possibly nonmotor dysfunctions may influence the extent of sleep disorders. This may be due to changes within the central nervous system as evidenced by a significant deterioration in CNS functioning."

The data also suggest that, in the RECOVER study, "changes in PDSS-2 total score were unlikely to be entirely attributed to changes in UPDRS III scores," Dr. Swick said.

The study was supported by Schwarz Pharma, distributor of rotigotine. Dr. Swick disclosed that he has received personal compensation for speaking from Jazz Pharmaceuticals and research stipends from Jazz, Cephalon, Pfizer, Sanofi-Aventis, and Merck.

HONOLULU – Only a small correlation between the severity of early-morning motor symptoms and nocturnal sleep disturbances was observed in patients with Parkinson’s disease, results from a post hoc trial analysis demonstrated.

"Parkinson’s disease is defined by cardinal motor symptoms, but as we are discovering more and more, nonmotor symptoms are burdensome to patients with Parkinson’s disease," Dr. Todd Swick said at the annual meeting of the American Academy of Neurology.

The major motor symptoms are rest tremor, rigidity, bradykinesia, akinesia, and postural instability. Common nonmotor symptoms include sleep disorders, cognitive dysfunction, depression, and gastrointestinal disorders.

"Sleep disorders are recognized to be of considerable clinical importance," said Dr. Swick, medical director of the Houston Sleep Center. "These have been shown to precede the onset of motor symptoms by as long as 50 years."

In an effort to investigate the association between the severity of nocturnal sleep disturbances and early-morning motor symptoms in Parkinson’s disease, he and his associates conducted a post hoc analysis of 267 patients who participated in the RECOVER (Randomized Evaluation of the 24-Hour Coverage: Efficacy of Rotigotine) study.

Dr. Swick described RECOVER as the first large-scale, double-blind, randomized trial to investigate sleep outcomes and motor function in the early morning as coprimary outcome measures in this patient population.

Patients were randomized to placebo or to the rotigotine transdermal system (2-16 mg every 24 hours). The researchers titrated to the optimal dose over a period of 1-8 weeks and maintained the dose for an additional 4 weeks. Significant benefits in early-morning function and in the severity of nocturnal sleep disturbances were observed in patients treated with rotigotine but not in those treated with placebo (Mov. Disord. 2011;26:90-9).

For the current study, Dr. Swick and his associates conducted categorical and continuous value association analyses to determine United Parkinson’s Disease Rating Scale III (UPDRS III) total score (0-9, 10-19, 20-29, 30-39, and 40 or more, defined as categories 1, 2, 3, 4, and 5, respectively), as well as modified Parkinson’s Disease Sleep Scale (PDSS-2) total score in the study participants.

The mean age of the patients was 65 years, 66% were male, and 91% were white. Their mean UPDRS III and PDSS-2 total scores were 30.4 and 19.7.

Dr. Swick reported that the analyses showed only a modest correlation between severity of nocturnal sleep disturbances and early-morning motor symptoms in patients with Parkinson’s disease. "This is in line with previously published data," he said. "The data suggest that possibly nonmotor dysfunctions may influence the extent of sleep disorders. This may be due to changes within the central nervous system as evidenced by a significant deterioration in CNS functioning."

The data also suggest that, in the RECOVER study, "changes in PDSS-2 total score were unlikely to be entirely attributed to changes in UPDRS III scores," Dr. Swick said.

The study was supported by Schwarz Pharma, distributor of rotigotine. Dr. Swick disclosed that he has received personal compensation for speaking from Jazz Pharmaceuticals and research stipends from Jazz, Cephalon, Pfizer, Sanofi-Aventis, and Merck.

HONOLULU – Only a small correlation between the severity of early-morning motor symptoms and nocturnal sleep disturbances was observed in patients with Parkinson’s disease, results from a post hoc trial analysis demonstrated.

"Parkinson’s disease is defined by cardinal motor symptoms, but as we are discovering more and more, nonmotor symptoms are burdensome to patients with Parkinson’s disease," Dr. Todd Swick said at the annual meeting of the American Academy of Neurology.

The major motor symptoms are rest tremor, rigidity, bradykinesia, akinesia, and postural instability. Common nonmotor symptoms include sleep disorders, cognitive dysfunction, depression, and gastrointestinal disorders.

"Sleep disorders are recognized to be of considerable clinical importance," said Dr. Swick, medical director of the Houston Sleep Center. "These have been shown to precede the onset of motor symptoms by as long as 50 years."

In an effort to investigate the association between the severity of nocturnal sleep disturbances and early-morning motor symptoms in Parkinson’s disease, he and his associates conducted a post hoc analysis of 267 patients who participated in the RECOVER (Randomized Evaluation of the 24-Hour Coverage: Efficacy of Rotigotine) study.

Dr. Swick described RECOVER as the first large-scale, double-blind, randomized trial to investigate sleep outcomes and motor function in the early morning as coprimary outcome measures in this patient population.

Patients were randomized to placebo or to the rotigotine transdermal system (2-16 mg every 24 hours). The researchers titrated to the optimal dose over a period of 1-8 weeks and maintained the dose for an additional 4 weeks. Significant benefits in early-morning function and in the severity of nocturnal sleep disturbances were observed in patients treated with rotigotine but not in those treated with placebo (Mov. Disord. 2011;26:90-9).

For the current study, Dr. Swick and his associates conducted categorical and continuous value association analyses to determine United Parkinson’s Disease Rating Scale III (UPDRS III) total score (0-9, 10-19, 20-29, 30-39, and 40 or more, defined as categories 1, 2, 3, 4, and 5, respectively), as well as modified Parkinson’s Disease Sleep Scale (PDSS-2) total score in the study participants.

The mean age of the patients was 65 years, 66% were male, and 91% were white. Their mean UPDRS III and PDSS-2 total scores were 30.4 and 19.7.

Dr. Swick reported that the analyses showed only a modest correlation between severity of nocturnal sleep disturbances and early-morning motor symptoms in patients with Parkinson’s disease. "This is in line with previously published data," he said. "The data suggest that possibly nonmotor dysfunctions may influence the extent of sleep disorders. This may be due to changes within the central nervous system as evidenced by a significant deterioration in CNS functioning."

The data also suggest that, in the RECOVER study, "changes in PDSS-2 total score were unlikely to be entirely attributed to changes in UPDRS III scores," Dr. Swick said.

The study was supported by Schwarz Pharma, distributor of rotigotine. Dr. Swick disclosed that he has received personal compensation for speaking from Jazz Pharmaceuticals and research stipends from Jazz, Cephalon, Pfizer, Sanofi-Aventis, and Merck.

HONOLULU – Only a small correlation between the severity of early-morning motor symptoms and nocturnal sleep disturbances was observed in patients with Parkinson’s disease, results from a post hoc trial analysis demonstrated.

"Parkinson’s disease is defined by cardinal motor symptoms, but as we are discovering more and more, nonmotor symptoms are burdensome to patients with Parkinson’s disease," Dr. Todd Swick said at the annual meeting of the American Academy of Neurology.

The major motor symptoms are rest tremor, rigidity, bradykinesia, akinesia, and postural instability. Common nonmotor symptoms include sleep disorders, cognitive dysfunction, depression, and gastrointestinal disorders.

"Sleep disorders are recognized to be of considerable clinical importance," said Dr. Swick, medical director of the Houston Sleep Center. "These have been shown to precede the onset of motor symptoms by as long as 50 years."

In an effort to investigate the association between the severity of nocturnal sleep disturbances and early-morning motor symptoms in Parkinson’s disease, he and his associates conducted a post hoc analysis of 267 patients who participated in the RECOVER (Randomized Evaluation of the 24-Hour Coverage: Efficacy of Rotigotine) study.

Dr. Swick described RECOVER as the first large-scale, double-blind, randomized trial to investigate sleep outcomes and motor function in the early morning as coprimary outcome measures in this patient population.

Patients were randomized to placebo or to the rotigotine transdermal system (2-16 mg every 24 hours). The researchers titrated to the optimal dose over a period of 1-8 weeks and maintained the dose for an additional 4 weeks. Significant benefits in early-morning function and in the severity of nocturnal sleep disturbances were observed in patients treated with rotigotine but not in those treated with placebo (Mov. Disord. 2011;26:90-9).

For the current study, Dr. Swick and his associates conducted categorical and continuous value association analyses to determine United Parkinson’s Disease Rating Scale III (UPDRS III) total score (0-9, 10-19, 20-29, 30-39, and 40 or more, defined as categories 1, 2, 3, 4, and 5, respectively), as well as modified Parkinson’s Disease Sleep Scale (PDSS-2) total score in the study participants.

The mean age of the patients was 65 years, 66% were male, and 91% were white. Their mean UPDRS III and PDSS-2 total scores were 30.4 and 19.7.

Dr. Swick reported that the analyses showed only a modest correlation between severity of nocturnal sleep disturbances and early-morning motor symptoms in patients with Parkinson’s disease. "This is in line with previously published data," he said. "The data suggest that possibly nonmotor dysfunctions may influence the extent of sleep disorders. This may be due to changes within the central nervous system as evidenced by a significant deterioration in CNS functioning."

The data also suggest that, in the RECOVER study, "changes in PDSS-2 total score were unlikely to be entirely attributed to changes in UPDRS III scores," Dr. Swick said.

The study was supported by Schwarz Pharma, distributor of rotigotine. Dr. Swick disclosed that he has received personal compensation for speaking from Jazz Pharmaceuticals and research stipends from Jazz, Cephalon, Pfizer, Sanofi-Aventis, and Merck.