Showing papers by "Claudia S. Moy published in 2016"
TL;DR: The treatment of participants with intracerebral hemorrhage to achieve a target systolic blood pressure of 110 to 139mm Hg did not result in a lower rate of death or disability than standard reduction to a target of 140 to 179 mm Hg.
Abstract: BackgroundLimited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intracerebral hemorrhage. MethodsWe randomly assigned eligible participants with intracerebral hemorrhage (volume, <60 cm3) and a Glasgow Coma Scale (GCS) score of 5 or more (on a scale from 3 to 15, with lower scores indicating worse condition) to a systolic blood-pressure target of 110 to 139 mm Hg (intensive treatment) or a target of 140 to 179 mm Hg (standard treatment) in order to test the superiority of intensive reduction of systolic blood pressure to standard reduction; intravenous nicardipine to lower blood pressure was administered within 4.5 hours after symptom onset. The primary outcome was death or disability (modified Rankin scale score of 4 to 6, on a scale ranging from 0 [no symptoms] to 6 [death]) at 3 months after randomization, as ascertained by an investigator who was unaware of the treatment assignments. ResultsAmong 1000...
672 citations
TL;DR: It is proposed that understanding and targeting the biological mechanisms of VCID can have a similarly positive impact on public health.
Abstract: The World Health Organization reports that 47.5 million people are affected by dementia worldwide. With aging populations and 7.7 million new cases each year, the burden of illness due to dementia approaches crisis proportions. Despite significant advances in our understanding of the biology of Alzheimer's disease (AD), the leading dementia diagnosis, the actual causes of dementia in affected individuals are unknown except for rare fully penetrant genetic forms. Evidence from epidemiology and pathology studies indicates that damage to the vascular system is associated with an increased risk of many types of dementia. Both Alzheimer's pathology and cerebrovascular disease increase with age. How AD affects small blood vessel function and how vascular dysfunction contributes to the molecular pathology of Alzheimer's are areas of intense research. The science of vascular contributions to cognitive impairment and dementia (VCID) integrates diverse aspects of biology and incorporates the roles of multiple cell types that support the function of neural tissue. Because of the proven ability to prevent and treat cardiovascular disease and hypertension with population benefits for heart and stroke outcomes, it is proposed that understanding and targeting the biological mechanisms of VCID can have a similarly positive impact on public health.
143 citations
TL;DR: Findings show that the black–white Differences in stroke mortality are largely driven by differences in stroke incidence, with case fatality playing at most a minor role, and interventions need to focus on prevention of stroke in blacks.
Abstract: Background and Purpose—At age 45 years, blacks have a stroke mortality ≈3× greater than their white counterparts, with a declining disparity at older ages. We assess whether this black–white disparity in stroke mortality is attributable to a black–white disparity in stroke incidence versus a disparity in case fatality. Methods—We first assess if black–white differences in stroke mortality within 29 681 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort reflect national black–white differences in stroke mortality and then assess the degree to which black–white differences in stroke incidence or 30-day case fatality after stroke contribute to the disparities in stroke mortality. Results—The pattern of stroke mortality within the study mirrors the national pattern, with the black-to-white hazard ratio of ≈4.0 at age 45 years decreasing to ≈1.0 at age 85 years. The pattern of black-to-white disparities in stroke incidence shows a similar pattern but no evidence of a c...
70 citations
TL;DR: The Neuro-QOL SFs demonstrate good internal consistency, test-re-test reliability, and concurrent and known groups validity in this MS population, supporting the validity of Neuro- QOL in adults with MS.
Abstract: Background:Multiple sclerosis (MS) is a chronic, progressive, and disabling disease of the central nervous system with dramatic variations in the combination and severity of symptoms it can produce...
66 citations
TL;DR: The association of age and black race differs substantially on first vs recurrent stroke risk, with risk factors playing a similar role.
Abstract: Objectives: To assess whether black race and other cerebrovascular risk factors have a differential effect on first vs recurrent stroke events. Methods: Estimate the differences in the magnitude of the association of demographic (age, back race, sex) or stroke risk factors (hypertension, diabetes, cigarette smoking, atrial fibrillation, left ventricular hypertrophy, or heart disease) for first vs recurrent stroke from a longitudinal cohort study of 29,682 black or white participants aged 45 years and older. Results: Over an average 6.8 years follow-up, 301 of 2,993 participants with a previous stroke at baseline had a recurrent stroke, while 818 of 26,689 participants who were stroke-free at baseline had a first stroke. Among those stroke-free at baseline, there was an age-by-race interaction ( p = 0.0002), with a first stroke risk 2.70 (95% confidence interval: 1.86–3.91) times greater for black than white participants at age 45, but no racial disparity at age 85 (hazard ratio = 0.91; 95% confidence interval: 0.70–1.18). In contrast, there was no evidence of a higher risk of recurrent stroke at any age for black participants ( p > 0.05). The association of traditional stroke risk factors was generally similar for first and recurrent stroke. Conclusion: The association of age and black race differs substantially on first vs recurrent stroke risk, with risk factors playing a similar role.
44 citations
TL;DR: Results of Neuro‐QoL clinical validation using a sample of PD patients are presented and neuro‐Qol enables brief, yet precise, assessment and the ability to conduct both PD‐specific and cross‐disease comparisons.
Abstract: Introduction
Neuro-QoL is a multidimensional patient-reported outcome measurement system assessing aspects of physical, mental, and social health identified by neurology patients and caregivers as important. One of the first neurology-specific patient-reported outcome measure systems created using modern test development methods, Neuro-Qol enables brief, yet precise, assessment and the ability to conduct both PD-specific and cross-disease comparisons. We present results of Neuro-QoL clinical validation using a sample of PD patients.
Methods
A total of 120 PD patients recruited from academic medical centers were assessed at baseline, 1 week, and 6 months. Assessments included Neuro-QoL and general and PD-specific validity measures.
Results
Participants were 62% male and 95% white (average age = 66); H & Y stages were 1 (16%), 2 (61%), 3 (18%), and 4 (5%). Internal consistency and test-retest reliability of Neuro-QoL ranged from Cronbach's alphas = 0.81 to 0.94 with intraclass correlation coefficients = 0.66 to 0.80. Pearson's correlations between Neuro-QoL and legacy measures were generally moderate and in expected directions. UPDRS Part 2 was moderately correlated with Neuro-QoL Upper Extremity and Mobility, respectively (r's = −0.44; −0.59). Parkinson's Disease Questionnaire-39 and Neuro-QoL measures of similar constructs showed strong-to-moderate correlations (r's = 0.70–0.44). Neuro-QoL measures of fatigue, mobility, positive emotion, and emotional/behavioral control showed responsiveness to self-reported change.
Conclusions
Neuro-QoL is valid for use in PD clinical research. Reliability for all but two measures is sufficient for group comparisons, with some evidence supporting responsiveness to change. Neuro-QoL possesses characteristics, such as brevity, flexibility in administration, and suitability, for cross-disease comparisons that may be advantageous to users in a variety of settings. © 2016 Movement Disorder Society
42 citations
TL;DR: Each measurement system described is described and considerations in the design and interpretation of studies that employ one or more of these systems are highlighted, and future directions for continued implementation ofThese systems in clinical practice, population-based research, observational studies, and clinical trials are summarized.
Abstract: There is rapidly growing interest in the capture of person-centered outcomes in clinical and population-based research and in healthcare delivery settings. Stakeholders (e.g., patients, clinicians, payers, regulators, researchers) increasingly agree that person-centered outcome measurement can accelerate the development of new knowledge, improve the efficiency and quality of care, and may also contribute to clinician or health system performance metrics and regulatory review of new therapies [1–3]. These outcomes may be incorporated into both observational studies and clinical trials, and provide salient endpoints in trials of preventive or disease-modifying treatments, as well as behavioral or psychosocial interventions. Over the past decade, the National Institutes of Health (NIH) has invested in the development and evaluation of several measurement systems that are now available for research and clinical use. These include the Patient Reported Outcomes Measurement Information System® (PROMIS®) [4], the NIH Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox®) [5], the Quality of Life Outcomes in Neurological Disorders (Neuro-QoL) [6], Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me) [7], and the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) [8]. In this paper, we (i) describe each system; (ii) highlight considerations in the design and interpretation of studies that employ one or more of these systems; and (iii) summarize future directions for continued implementation of these systems in clinical practice, population-based research, observational studies, and clinical trials.
22 citations