Background and Objectives: Diagnostic performance of the cerebrospinal fluid (CSF) biomarkers -a... more Background and Objectives: Diagnostic performance of the cerebrospinal fluid (CSF) biomarkers -amyloid peptide (A 1-42), total tau protein (tau) and tau phosphorylated at threonine 181 (P-tau 181P) remains to be established compared to clinical diagnosis in autopsyconfirmed dementia subjects. Methods: A total of 100 CSF samples from demented patients with autopsy-confirmed pathological diagnoses were included. CSF levels of A 1-42 , tau and P-tau 181P were determined with commercially available single parameter ELISA kits (INNOTEST®). Results: Diagnostic accuracy of a biomarker model (using age-corrected CSF levels of A 1-42 and P-tau 181P) differentiating Alzheimer's disease (AD) from other dementias was 82.7% compared to 81.6% for clinical diagnosis, showing that this biomarker model gives the same information as a whole clinical work-up (including imaging). Using the biomarker-based model in cases with clinically doubtful diagnoses, a correct diagnosis would have been established in 4 of the 6 autopsy-confirmed AD cases and 3 of the 3 autopsy-confirmed cases with other dementias. Conclusions: This study showed the value of biomarkers in differential dementia diagnosis, using the gold standard (pathological diagnosis) as a reference. Diagnostic accuracy of a biomarker-based model is comparable to clinical diagnostic accuracy, and can help in establishing a correct diagnosis in case of doubtful clinical diagnoses.
Journal of the American College of Emergency Physicians Open
Background: The COVID-19 pandemic has resulted in over 6 million deaths worldwide as of March 202... more Background: The COVID-19 pandemic has resulted in over 6 million deaths worldwide as of March 2022. Adverse psychological effects on patients and the general public linked to the pandemic have been well documented. Methods: We conducted a retrospective analysis of adult emergency department (ED) encounters with diagnoses of anxiety, depression, and suicidal ideation using International Classification of Diseases, Tenth Revision (ICD-10) codes at a tertiary care hospital in New York City from March 15 through July 31, 2020 and compared it with ED encounters during the same time period in the previous 3 years (2017-2019). The relative risk (RR) of these diagnoses was calculated comparing a prepandemic sample to a pandemic sample, accounting for total volume of ED visits. Results: A total of 2816 patient encounters met the inclusion criteria. The study period in 2020 had 31.5% lower overall ED volume seen during the same time period in the previous 3 years (27,874 vs average 40,716 ED encounters). The risk of presenting with anxiety during the study period in 2020 compared to prior 3 years was 1.40 (95% confidence interval [CI] 1.21-1.63), for depression was 1.47 (95% CI 1.28-1.69), and for suicidal ideation was 1.05 (95% CI 0.90-1.23). There was an increase in admissions for depression during the pandemic period (15.2% increase, 95% CI 4.6%-25.7%). Conclusion: There was a relative increase in patients presenting to the ED with complaints of anxiety and depression during the height of the COVID-19 pandemic, while absolute numbers remained stable. Our results highlight the importance of acute care-based mental health resources and interventions to support patients during this pandemic.
Background and Objectives: Diagnostic performance of the cerebrospinal fluid (CSF) biomarkers -a... more Background and Objectives: Diagnostic performance of the cerebrospinal fluid (CSF) biomarkers -amyloid peptide (A 1-42 ), total tau protein (tau) and tau phosphorylated at threonine 181 (P-tau 181P ) remains to be established compared to clinical diagnosis in autopsyconfirmed dementia subjects. Methods: A total of 100 CSF samples from demented patients with autopsy-confirmed pathological diagnoses were included. CSF levels of A 1-42 , tau and P-tau 181P were determined with commercially available single parameter ELISA kits (INNOTEST®). Results: Diagnostic accuracy of a biomarker model (using age-corrected CSF levels of A 1-42 and P-tau 181P ) differentiating Alzheimer's disease (AD) from other dementias was 82.7% compared to 81.6% for clinical diagnosis, showing that this biomarker model gives the same information as a whole clinical work-up (including imaging). Using the biomarker-based model in cases with clinically doubtful diagnoses, a correct diagnosis would have been established in 4 of the 6 autopsy-confirmed AD cases and 3 of the 3 autopsy-confirmed cases with other dementias. Conclusions: This study showed the value of biomarkers in differential dementia diagnosis, using the gold standard (pathological diagnosis) as a reference. Diagnostic accuracy of a biomarker-based model is comparable to clinical diagnostic accuracy, and can help in establishing a correct diagnosis in case of doubtful clinical diagnoses.
Introduction A 41-year-old Cuban man with Down syndrome and mental retardation was brought to the... more Introduction A 41-year-old Cuban man with Down syndrome and mental retardation was brought to the Emergency Department for episodes of worsening shortness of breath over one day. Bedside color Doppler ultrasound subcostal and apical four-chamber examination of the heart revealed atrial and ventricular septal defects with left-toright shunting of blood. A right ventricular outflow tract view revealed a bicuspid aortic valve, and continuous wave Doppler ultrasound in the right ventricular inflow tract view revealed tricuspid regurgitation and pulmonary hypertension. Conclusion Bedside echocardiography with color Doppler and continuous wave Doppler imaging can assist the emergency physician and the critical care physician in the diagnosis of ASD, VSD, bicuspid aortic valve, and pulmonary hypertension in the Down syndrome patient who is short of breath.
Proceedings of the National Academy of Sciences, 2010
Amyloid-β (Aβ) plaque deposition can precede the clinical manifestations of dementia of the Alzhe... more Amyloid-β (Aβ) plaque deposition can precede the clinical manifestations of dementia of the Alzheimer type (DAT) by many years and can be associated with changes in brain metabolism. Both the Aβ plaque deposition and the changes in metabolism appear to be concentrated in the brain's default-mode network. In contrast to prior studies of brain metabolism which viewed brain metabolism from a unitary perspective that equated glucose utilization with oxygen consumption, we here report on regional glucose use apart from that entering oxidative phosphorylation (so-called "aerobic glycolysis"). Using PET, we found that the spatial distribution of aerobic glycolysis in normal young adults correlates spatially with Aβ deposition in individuals with DAT and cognitively normal participants with elevated Aβ, suggesting a possible link between regional aerobic glycolysis in young adulthood and later development of Alzheimer pathology.
Background and Objectives: Diagnostic performance of the cerebrospinal fluid (CSF) biomarkers -a... more Background and Objectives: Diagnostic performance of the cerebrospinal fluid (CSF) biomarkers -amyloid peptide (A 1-42), total tau protein (tau) and tau phosphorylated at threonine 181 (P-tau 181P) remains to be established compared to clinical diagnosis in autopsyconfirmed dementia subjects. Methods: A total of 100 CSF samples from demented patients with autopsy-confirmed pathological diagnoses were included. CSF levels of A 1-42 , tau and P-tau 181P were determined with commercially available single parameter ELISA kits (INNOTEST®). Results: Diagnostic accuracy of a biomarker model (using age-corrected CSF levels of A 1-42 and P-tau 181P) differentiating Alzheimer's disease (AD) from other dementias was 82.7% compared to 81.6% for clinical diagnosis, showing that this biomarker model gives the same information as a whole clinical work-up (including imaging). Using the biomarker-based model in cases with clinically doubtful diagnoses, a correct diagnosis would have been established in 4 of the 6 autopsy-confirmed AD cases and 3 of the 3 autopsy-confirmed cases with other dementias. Conclusions: This study showed the value of biomarkers in differential dementia diagnosis, using the gold standard (pathological diagnosis) as a reference. Diagnostic accuracy of a biomarker-based model is comparable to clinical diagnostic accuracy, and can help in establishing a correct diagnosis in case of doubtful clinical diagnoses.
Journal of the American College of Emergency Physicians Open
Background: The COVID-19 pandemic has resulted in over 6 million deaths worldwide as of March 202... more Background: The COVID-19 pandemic has resulted in over 6 million deaths worldwide as of March 2022. Adverse psychological effects on patients and the general public linked to the pandemic have been well documented. Methods: We conducted a retrospective analysis of adult emergency department (ED) encounters with diagnoses of anxiety, depression, and suicidal ideation using International Classification of Diseases, Tenth Revision (ICD-10) codes at a tertiary care hospital in New York City from March 15 through July 31, 2020 and compared it with ED encounters during the same time period in the previous 3 years (2017-2019). The relative risk (RR) of these diagnoses was calculated comparing a prepandemic sample to a pandemic sample, accounting for total volume of ED visits. Results: A total of 2816 patient encounters met the inclusion criteria. The study period in 2020 had 31.5% lower overall ED volume seen during the same time period in the previous 3 years (27,874 vs average 40,716 ED encounters). The risk of presenting with anxiety during the study period in 2020 compared to prior 3 years was 1.40 (95% confidence interval [CI] 1.21-1.63), for depression was 1.47 (95% CI 1.28-1.69), and for suicidal ideation was 1.05 (95% CI 0.90-1.23). There was an increase in admissions for depression during the pandemic period (15.2% increase, 95% CI 4.6%-25.7%). Conclusion: There was a relative increase in patients presenting to the ED with complaints of anxiety and depression during the height of the COVID-19 pandemic, while absolute numbers remained stable. Our results highlight the importance of acute care-based mental health resources and interventions to support patients during this pandemic.
Background and Objectives: Diagnostic performance of the cerebrospinal fluid (CSF) biomarkers -a... more Background and Objectives: Diagnostic performance of the cerebrospinal fluid (CSF) biomarkers -amyloid peptide (A 1-42 ), total tau protein (tau) and tau phosphorylated at threonine 181 (P-tau 181P ) remains to be established compared to clinical diagnosis in autopsyconfirmed dementia subjects. Methods: A total of 100 CSF samples from demented patients with autopsy-confirmed pathological diagnoses were included. CSF levels of A 1-42 , tau and P-tau 181P were determined with commercially available single parameter ELISA kits (INNOTEST®). Results: Diagnostic accuracy of a biomarker model (using age-corrected CSF levels of A 1-42 and P-tau 181P ) differentiating Alzheimer's disease (AD) from other dementias was 82.7% compared to 81.6% for clinical diagnosis, showing that this biomarker model gives the same information as a whole clinical work-up (including imaging). Using the biomarker-based model in cases with clinically doubtful diagnoses, a correct diagnosis would have been established in 4 of the 6 autopsy-confirmed AD cases and 3 of the 3 autopsy-confirmed cases with other dementias. Conclusions: This study showed the value of biomarkers in differential dementia diagnosis, using the gold standard (pathological diagnosis) as a reference. Diagnostic accuracy of a biomarker-based model is comparable to clinical diagnostic accuracy, and can help in establishing a correct diagnosis in case of doubtful clinical diagnoses.
Introduction A 41-year-old Cuban man with Down syndrome and mental retardation was brought to the... more Introduction A 41-year-old Cuban man with Down syndrome and mental retardation was brought to the Emergency Department for episodes of worsening shortness of breath over one day. Bedside color Doppler ultrasound subcostal and apical four-chamber examination of the heart revealed atrial and ventricular septal defects with left-toright shunting of blood. A right ventricular outflow tract view revealed a bicuspid aortic valve, and continuous wave Doppler ultrasound in the right ventricular inflow tract view revealed tricuspid regurgitation and pulmonary hypertension. Conclusion Bedside echocardiography with color Doppler and continuous wave Doppler imaging can assist the emergency physician and the critical care physician in the diagnosis of ASD, VSD, bicuspid aortic valve, and pulmonary hypertension in the Down syndrome patient who is short of breath.
Proceedings of the National Academy of Sciences, 2010
Amyloid-β (Aβ) plaque deposition can precede the clinical manifestations of dementia of the Alzhe... more Amyloid-β (Aβ) plaque deposition can precede the clinical manifestations of dementia of the Alzheimer type (DAT) by many years and can be associated with changes in brain metabolism. Both the Aβ plaque deposition and the changes in metabolism appear to be concentrated in the brain's default-mode network. In contrast to prior studies of brain metabolism which viewed brain metabolism from a unitary perspective that equated glucose utilization with oxygen consumption, we here report on regional glucose use apart from that entering oxidative phosphorylation (so-called "aerobic glycolysis"). Using PET, we found that the spatial distribution of aerobic glycolysis in normal young adults correlates spatially with Aβ deposition in individuals with DAT and cognitively normal participants with elevated Aβ, suggesting a possible link between regional aerobic glycolysis in young adulthood and later development of Alzheimer pathology.
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