Park Nicollet Clinic

BackgroundEarly diagnosis of Lewy body dementia (LBD) is challenging, largely due to clinical heterogeneity and features overlapping with Alzheimer's disease (AD). Clinical differentiation is particularly challenging in females, who are more likely to have a mis- and delayed diagnosis than males with LBD.ObjectiveTo investigate whether there are sex differences in the prodromal symptoms and rate of change preceding dementia in people with Lewy body (LB) and pure AD pathologies.MethodsWe used data from National Alzheimer's Coordinating Center for people with dementia and LB (n = 196; 89 females, 107 males; including mostly people with AD co-pathology) or pure AD pathology (n = 308, 167 females, 141 males, without LB co-pathology). Prevalence of cognitive, behavioral, and parkinsonism symptoms were assessed annually starting with two-years prior to dementia. Changes over time for prevalences were compared between pathology groups and sexes.ResultsCognitive fluctuation prevalence was higher for males with LB than other groups. Compared to males with LB, females with LB had faster increase in judgment, language, visuospatial deficit prevalence and dementia severity. Relative to females with AD, affective symptom prevalence increased slower for females with LB. Relative to males with AD, males with LB had higher prevalence of parkinsonism and attention deficit, with slower increase in attention deficit prevalence.ConclusionsCognition can decline faster for females than males during prodromal LBD. Presence of parkinsonism and cognitive fluctuation can help differentiate LB from AD pathology for males. Such prominent differences may not occur for females, suggesting the need for sex-specific diagnostic approaches.

Fracture risk is strongly dependent on the presence of previous fractures, especially vertebral. In this paper, we focus on the use of vertebral fracture assessment (VFA) with dual-energy x-ray absorptiometry (DXA), as vertebral fractures can be clinically silent, and their identification is critical for optimal bone health management. Our tool was to inform health care professionals about the clinical utility of accurate recognition and classification of vertebral fractures. A comprehensive narrative review was conducted on the clinical relevance of diagnosing vertebral fractures, the technical aspects of optimal methodology for VFA, image interpretation and scoring methods, and pitfalls in evaluating VFA. Proposals for standardization on methodology and indications for VFA were discussed and iterated after comments from 15 international societies to achieve consensus recommendations. Vertebral fracture assessment should ideally be performed in all patients in whom a DXA-bone mineral density measurement is indicated. However, when there are limitations to DXA access or reimbursement, VFA should be obtained in patients at high risk for fractures, such as those with a low bone mineral density T-score (<-1.0) and one or more of the following: oral glucocorticoid use, prior vertebral fracture, loss of height, and advanced age (International Society for Clinical Densitometry criteria). If VFA is not available on the DXA system software, conventional lateral spine radiographs can also be used as an alternative option to identify vertebral fractures. Although several scoring systems exist, the semiquantitative Genant score and the algorithm-based qualitative scoring system seem to be among the best, with the Genant score being the easiest to apply in clinical practice.

This Viewpoint advocates for the use of federally qualified health centers in providing pediatric eye care in the US.

Provide clinical whole genome sequencing (WGS) and genetic counseling to a diverse and international population of people living with Parkinson’s disease (PD).