Diagnostic Battery Research Articles

Auditory event-related potentials and function of the medial olivocochlear efferent system in children with auditory processing disorders

Objective: The objectives were to investigate the function of central auditory pathways and of the medial efferent olivocochlear system (MOCS).Design: Event-related potentials (ERP) were recorded following the delivery of the stimulus /da/ in quiet and in ipsilateral, contralateral, and binaural noise conditions and correlated to the results of the auditory processing disorders (APD) diagnostic test battery. MOCS function was investigated by adding ipsilateral, contralateral, and binaural noise to transient evoked otoacoustic emission recordings. Auditory brainstem responses and pure tone audiogram were also evaluated.Study Sample: Nineteen children (7 to 12 years old) with APD were compared with 24 age-matched controls.Results: Otoacoustic emissions and ABR characteristics did not differ between groups, whereas ERP latencies were significantly longer and of higher amplitudes in APD children than in controls, in both quiet and noise conditions. The MOCS suppression was higher in APD children.Conclusions: Findings indicate that children with APD present with neural deficiencies in both challenging and nonchallenging environments with an increase in the timing of several central auditory processes correlated to their behavioural performances. Meanwhile, their modulation of the auditory periphery under noisy conditions differs from control children with higher suppression.

Psychiatric Assessment in Patients with Mild Temporal Lobe Epilepsy.

Objectives The findings of previous studies focused on personality disorders in epileptic patients are difficult to interpret due to nonhomogeneous samples and noncomparable methods. Here, we aimed at studying the personality profile in patients with mild temporal lobe epilepsy (mTLE) with psychiatric comorbidity. Materials and Methods Thirty-five patients with mTLE (22 males, mean age 40.7 ± 12.1) underwent awake and sleep EEG, 3T brain MRI, and an extensive standardized diagnostic neuropsychiatric battery: Temperament and Character Inventory-Revised (TCI-R), Beck Depression Inventory-2, and State-Trait Anxiety Inventory. Drug history was collected in detail. Hierarchical Cluster Analysis was performed on TCI-R data, while all other clinical and psychological variables were compared across the resulting clusters. Results Scores of Harm Avoidance (HA), Reward Dependence (RD), Persistence (P), Cooperativeness (C), and Self-Transcendence (ST) allowed the identification of two clusters, describing different personality subtypes. Cluster 1 was characterized by an early onset, more severe anxiety traits, and combined drug therapy (antiepileptic drug and Benzodiazepine/Selective Serotonin Reuptake Inhibitors) compared to Cluster 2. Conclusions Our findings suggest that different personality traits may play a role in determining the clinical outcome in patients with mTLE. Specifically, lower scores of HA, RD, P, C, and ST were associated with worse clinical outcome. Thus, personality assessment could serve as an early indicator of greater disease severity, improving the management of mTLE.

Basic Neuro-Optometric Diagnostic Tests for Mild Traumatic Brain Injury/Concussion: A Narrative Review, Perspective, Proposed Techniques and Protocols

Vision problems are common in individuals with mild traumatic brain injury (mTBI)/concussion. However, a global conceptualization of the diagnostic process remains incomplete and practitioner dependent. Thus, a comprehensive diagnostic test battery is proposed to assist in the management of these patients. This battery includes a range of basic clinical tests of a sensory and motor nature, with all having a clinical and scientific rationale. These tests have been used by the authors for many years, with good success, and furthermore they have been found to be clinically useful and insightful.

Screening utility of a rapid non-invasive dry eye assessment algorithm

PurposeTo evaluate the discriminative ability of a rapid non-invasive dry eye assessment algorithm (global evaluation component: SANDE questionnaire, and non-invasive tear film breakup time; subtype classification testing component: tear film lipid layer grade, and tear meniscus height) in detecting dry eye disease, as defined by the TFOS DEWS II diagnostic criteria. MethodsTwo hundred and thirty-five participants (77 male, 158 female), with a mean ± SD age of 43 ± 17 years, were recruited into a prospective diagnostic accuracy study. OSDI, DEQ-5, and SANDE dry eye symptomology scores; non-invasive tear film breakup time; absolute and inter-ocular differences in tear osmolarity; corneal, conjunctival, and lid margin staining scores; tear film lipid layer, meibum expressibility, meibomian gland orifice plugging, and eyelid margin telangiectasia grades; and tear meniscus height were evaluated in a single clinical session. ResultsThe areas under the ROC curves exceeded 0.80 for all individual components of the rapid non-invasive dry eye assessment algorithm, and the discriminative abilities were significantly greater than chance (all p < 0.001). At the Youden optimal diagnostic thresholds for the global evaluation component of the rapid non-invasive assessment algorithm (SANDE score ≥30, non-invasive tear film break-up time <10 s), the overall sensitivity was 86%, specificity 94%, positive likelihood ratio 15.0, and negative likelihood ratio 0.15. ConclusionsThe abridged non-invasive dry eye assessment algorithm may be a useful rapid screening instrument for the full TFOS DEWS II diagnostic test battery, of particular benefit in resource or time-constrained settings.

Selective impairment of attentional set shifting in adults with ADHD

BackgroundTask switch protocols are frequently used in the assessment of cognitive control, both in clinical and non-clinical populations. These protocols frequently confound task switch and attentional set shift. The current study investigated the ability of adult ADHD patients to shift attentional set in the context of switching tasks.MethodWe tested 38 adults with ADHD and 39 control adults with an extensive diagnostic battery and a task switch protocol without proactive interference. The experiment combined orthogonally task-switch vs. repetition, and attentional set shift vs. no shift. Each experimental stimulus had global and local features (Hierarchical/“Navon” stimuli), associated with corresponding attentional sets.ResultsADHD patients were slower than controls in task switch trials with a simultaneous shift of attention between global/local attentional sets. This also correlated significantly with diagnostic scales for ADHD symptoms. The patients had more variable reaction times, but when the attentional set was kept constant neither were they significantly slower nor showed higher task switch costs.ConclusionADHD is associated with a deficit in flexible deployment of attention to varying sources of stimulus information.

POTT'S DISEASE: A RARE BUT CRITICAL DIAGNOSIS

SESSION TITLE: Chest Infections 1 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Pott’s disease is the most common form of skeletal tuberculosis (TB) which often affects the thoracic and lumbar spines. In 2013, it represented only 2.3% of all United States TB cases. However, it is important for clinicians to include this differential diagnosis to prevent delays of diagnosis and treatment. CASE PRESENTATION: An 82-year-old male with a history of non-compliance to Mycobacterium Avium-Intracellulare (MAI) treatment and atrial fibrillation presented after notification of “bone biopsy positive for TB”. Previously, he presented to another hospital for worsening lower back and bilateral hip pain for the past three months associated with unintentional twenty-pound weight loss within the last six months and night sweats for the past two to three years. Chest X-Ray showed a right lower lobe opacity. Magnetic Resonance Imaging (MRI) revealed abnormal signal intensities/ enhancements and discitis/ osteomyelitis at the thoracic and lumbar vertebrae. It also showed a small epidural abscess/ phelgmon causing moderate to severe spinal canal stenosis at the L2/L3 level and bilateral psoas muscle abscesses. Following a Computed Tomography (CT) guided biopsy of the paraspinal collection and L2- L3 disc space, he received empiric osteomyelitis treatment with Vancomycin and Meropenem. Despite being Quantiferon positive, he was deemed as having latent TB after three negative Acid-Fast Bacillus (AFB) by sputum. Three weeks later, he presented to our hospital after notification of the biopsy results. AFB smear was negative, but culture revealed growth of AFB detected in broth and Mycobacterium tuberculosis complex by DNA probe. Further history revealed he had emigrated from China ten years ago and recently visited China for one month a year ago. Subsequently, Pott’s disease treatment was initiated with Isoniazid, Rifampin, Pyrazinamide, Ethambutol and Pyridoxine. DISCUSSION: Pott’s disease presents as back pain with muscle spasms and rigidity, but rarely constitutional symptoms. Diagnosing skeletal TB presents with challenges such as not including it as a differential diagnosis due to the subtle presentation, lack of active pulmonary disease, and slow disease progression. It is diagnosed by clinical presentation, radiologic imaging with MRI as the most sensitive diagnostic modality, and biopsy. Biopsy limitations include slow culture growth of 6 to 8 weeks, needing 10 – 100 bacilli for culture recovery, and sometimes inconclusive histopathology. Delays in diagnosis lead to complications including vertebral collapse, cord compression, and paraplegia. CONCLUSIONS: It raises the importance of a proper and thorough history in order to include an appropriate differential diagnosis. Since extra-pulmonary tuberculosis is more common in immigrants from endemic areas, our patient who was from China with complaints of back pain should have elicited a higher suspicion of Pott’s disease. Reference #1: McDonald M and Sexton D. Skeletal tuberculosis. UpToDate. July 2017. Available at https://www.uptodate.com/contents/skeletal-tuberculosis?source=search_result&search=potts%20disease&selectedTitle=1∼13#H6 . Accessed August 15, 2017 Reference #2: Ansari S, Amanullah F, Ahmad K, Rauniyar R. Pott’s Spine: Diagnostic Imaging Modalities and Technology Advancements. N Am J Med Sci. 2013 Jul; 5 (7): 404-411. Reference #3: Kumar M, Kumar R, Srivastva AK, et al. The efficiency of diagnostic battery in Pott’s disease: A prospective study. Indian Journal of Orthopedics. 2014; 48 (1) : 60-66 DISCLOSURES: No relevant relationships by Adam Hines, source=Web Response No relevant relationships by Roxana Lazarescu, source=Web Response No relevant relationships by Jennifer Tom, source=Web Response

The elusive and heterogeneous pattern of type 2M von Willebrand disease: A diagnostic challenge.

To investigate type 2M heterogeneity and to establish the most appropriate diagnostic flowchart. Hemostatic and genetic VWF analyses were performed in 14 type 2M VWD patients carrying the p.G1324S, p.R1374H, p.R1374C, p.A1344_A1350del, or p.F1293L mutations. PFA-100 was always significantly prolonged, and ristocetin-induced platelet aggregation (RIPA) and VWF ristocetin cofactor (VWF:RCo) greatly reduced or absent. Plasma VWF antigen (VWF:Ag) was reduced except in the p.G1324S patient, while platelet VWF:Ag was normal or near normal except in the p.R1374C patients. The ratio of collagen binding (VWF:CB) to VWF:Ag was normal or near normal except in patients carrying the p.R1374H and p.A1344_A1350del mutations, whose large VWF multimers were slightly reduced. Multimer patterns were normal or lacking in large oligomers, or with larger than normal VWF components. Only PFA100, RIPA and VWF:RCo were always abnormal. We thus propose a minimal diagnostic test battery: RIPA (demonstrating the defective VWF-platelet interaction), VWF:Ag (exploring VWF synthesis), and VWF:CB and its ratio (to explore multimer patterns). Other tests would only serve for confirmation, if necessary.

Enhancement of face-sensitive ERPs in older adults induced by face recognition training

A common cognitive problem reported by older people is compromised face recognition, which is often paralleled by age-related changes in face-sensitive and memory-related components in event-related brain potentials (ERPs). We developed a new training using photorealistic caricatures based on evidence that caricatures are beneficial for people with compromised face processing. Twenty-four older participants (62–75 yrs, 13 female) completed 12 training sessions (3 per week, 60 min each) and 24 older participants (61–76 yrs, 12 female) acted as controls. Before and after training (or waiting), participants took part in a diagnostic test battery for face processing abilities, and in ERP experiments on face learning and recognition. Although performance improvements during the training provided little evidence for generalization to other face processing tasks, ERPs showed substantial training-related enhancements of face-sensitive ERPs. Specifically, we observed marked increases of the N170, P200 and N250 components, which may indicate training-induced enhancement of face detection and activation of identity-specific representations. Thus, neuronal correlates of face processing are plastic in older age, and can be modulated by caricature training.

BASIC EMOTIONS, EXECUTIVE FUNCTIONS AND SOCIAL COGNITION IN PATIENTS AFTER STROKE

Alterations in executive functions (EF) constitute a common cognitive sequel, affecting up to 75% of patients with stroke. Previous investigations have found alterations in tasks of Theory of Mind (ToM) and empathy. Numerous studies have described alterations in the facial recognition of basic emotions (FRBE). However, there is little evidence on the presence of alterations in FRBE and social cognition, and their relationship with EF in this type of patients. We included 24 patients from Santa Catalina Neurorehabilitación Clínica with diagnosis of lobar ischemic stroke with an evolution time of 3 - 12 months. Patients with aphasia, visual perception deficit, fluctuations in the state of consciousness, or psychiatric antecedents were excluded. 17 patients completed these requirements and were able to complete the neurocognitive assessments and social cognition tasks. Control group: For the FRBE tests, 23 subjects were included, without neurological diseases. Instruments: General Diagnostic Battery: California Verbal Learning Test, Semantic Verbal Fluency, Boston Vocabulary, Complex King Figure, Symbols and Digits Test, Analogies, Matrices, Vocabulary, Digits and Adult Intelligence Scale Cubes Design WAIS III. Executive Function Tests: Wisconsin Card Sorting Test, Trail Making Test, FCR Copy Strategy, Reverse digits, phonological fluency. Tests of Social Cognition: Theory of the Mind (TOM): Reading of the Mind in the Eyes (RME), Faux Pas (FP), False belief (FB) of first and second order. Making of social decisions: Game of Dice Task (GDT). FRBE Battery: 60 photographs were selected based on the work of Calder et al. Three tasks were assembled, of 60 sheets each for basic emotion: joy, sadness, anger, disgust, fear and surprise. 92% of the patients presented alterations in at least two of the three tasks of FRBE. 75% showed alterations in TOM tasks. 42% showed alterations in GDT. 85% of the patients showed alterations in at least two EF tasks. Although the heterogeneity locations of the ischemias, most of the patients presented alterations in FRBE, TOM and EF. Disturbance for both the comprehension and expression of emotional and affective states are very frequent in this population, causing socially inadequate responses, deteriorating their rehabilitation process and quality of life.

The role of distress tolerance, anxiety sensitivity, and intolerance of uncertainty in predicting hoarding symptoms in a clinical sample

Hoarding disorder (HD) is characterized primarily by difficulty discarding possessions, leading to severe clutter and significant distress and impairment. Although promising psychological treatments have emerged, treating HD remains a clinical challenge. A greater understanding of the role of psychological vulnerability factors in predicting hoarding symptoms in a clinical HD sample could further enhance treatments. To investigate the role of proposed individual difference factors (i.e., distress tolerance, anxiety sensitivity, intolerance of uncertainty), we administered a diagnostic and self-report battery to 73 individuals diagnosed with HD who were seeking treatment for hoarding at a community clinic. Results indicated that when controlling for depression and anxiety symptoms, only distress tolerance predicted the severity of hoarding symptoms. Furthermore, meditation analyses revealed that the impact of distress tolerance on hoarding severity was partially mediated by hoarding beliefs. These results have important theoretical and clinical implications for HD.

Perception of freedom in leisure among substance users and nonusers

Abstract The aim of this study was to verify that substance use among adolescents would be linked to perceptions of freedom in leisure. It was selected for convenience sampling 186 adolescents at Projeto Quixote in a public school in Guarulhos. It used as questionnaire Data Sociodemographic and Leisure, The Leisure Diagnostic Battery, version B (PLL) to measure Perceived Freedom in Leisure and Drug Use Screening Inventory for classification of substance use, all self-administered. Based on 165 reviews analyzed, the frequency of use of ecstasy and marijuana in the last month were related to higher rates of PLL. The number of substances used in the last month had no significant effect. These data suggest specific components of leisure related to the frequency of substance use, such as perceived control and need at leisure.

The Relationship between Types of Attention and Auditory Processing Skills: Reconsidering Auditory Processing Disorder Diagnosis.

Measures of attention have been found to correlate with specific auditory processing tests in samples of children suspected of Auditory Processing Disorder (APD), but these relationships have not been adequately investigated. Despite evidence linking auditory attention and deficits/symptoms of APD, measures of attention are not routinely used in APD diagnostic protocols. The aim of the study was to examine the relationship between auditory and visual attention tests and auditory processing tests in children with APD and to assess whether a proposed diagnostic protocol for APD, including measures of attention, could provide useful information for APD management. A pilot study including 27 children, aged 7–11 years, referred for APD assessment was conducted. The validated test of everyday attention for children, with visual and auditory attention tasks, the listening in spatialized noise sentences test, the children's communication checklist questionnaire and tests from a standard APD diagnostic test battery were administered. Pearson's partial correlation analysis examining the relationship between these tests and Cochrane's Q test analysis comparing proportions of diagnosis under each proposed battery were conducted. Divided auditory and divided auditory-visual attention strongly correlated with the dichotic digits test, r = 0.68, p < 0.05, and r = 0.76, p = 0.01, respectively, in a sample of 20 children with APD diagnosis. The standard APD battery identified a larger proportion of participants as having APD, than an attention battery identified as having Attention Deficits (ADs). The proposed APD battery excluding AD cases did not have a significantly different diagnosis proportion than the standard APD battery. Finally, the newly proposed diagnostic battery, identifying an inattentive subtype of APD, identified five children who would have otherwise been considered not having ADs. The findings show that a subgroup of children with APD demonstrates underlying sustained and divided attention deficits. Attention deficits in children with APD appear to be centred around the auditory modality but further examination of types of attention in both modalities is required. Revising diagnostic criteria to incorporate attention tests and the inattentive type of APD in the test battery, provides additional useful data to clinicians to ensure careful interpretation of APD assessments.

Relationship between metacognitive beliefs and psychosocial performance in at-risk states of psychosis and patients with first psychotic episodes.

Improving diagnostic batteries to identify individuals at-risk for developing psychotic disorders as early as possible is an ongoing challenge in schizophrenia research. Here, we sought to explore whether metacognition in at-risk of developing psychosis would differ from that of first episode psychosis and unaffected controls and whether dysfunctional metacognitive beliefs would be associated with psychosocial functioning in the clinical groups. Twenty-three subjects at-risk of psychosis were compared with a group of 15 first psychotic episode patients and 21 healthy controls with regard to their metacognitive beliefs and psychosocial functioning. Metacognition was assessed using the Metacognition Questionnaire (MCQ), psychosocial functioning was rated using the Personal and Social Performance Scale (PSP). Depression and anxiety were also evaluated. The clinical groups differed significantly from controls in several MCQ scores, particularly the subscales "negative beliefs" and "need for control," as well as on all PSP scales. Furthermore, significant correlations emerged between the metacognition and psychosocial functioning. A mediation analysis revealed that dysfunctional metacognitive beliefs had no direct effect on psychosocial functioning, but was mediated by depressive symptoms. These results corroborate findings assigning depressive symptoms an important role in early recognition of psychosis.

Findings of Acoustic Stapedial Reflex Test in Newborns with and without Risk Factor

Objectives: The aim of this study was to determine the rates of acoustic stapedial reflexes (ASR) presence and to assess the test­­-retest reliability of ASR at a 1000 Hz probe tone in newborns with and without risk factor. Materials and Methods: Screening Transient Evoked Otoacoustic Emission (TEOAE), Automated Auditory Brainstem Response (AABR), tympanometry and ASR tests were performed on 59 ears with risk factor (research group) and 44 ears without risk factor (control group) within 0 ‒ 2 weeks following birth. Afterwards, tympanometry and ASRs were repeated one month later. Results: In terms of ASR thresholds, there is no significant difference between the two groups (p>0.05). Detection rates of ipsilateral ASRs were higher than those of contralateral ASRs in the first assessment for both group. Conclusion: Ipsilateral ASRs in neonates can be obtained in the early postnatal period, but contralateral ASRs can be detected late, especially one month after birth. ASR is an essential diagnostic test battery in newborns because it gives clinicians more information about the entire hearing system.

El infradiagnóstico del trastorno mental en la población con discapacidad intelectual: estudio de prevalencia en población con diferentes grados de discapacidad intelectual

There are a few studies in the literature analyzing the prevalence of mental illness in people with intellectual disabilities (ID). This study explores the prevalence of mental disorders in adults without previous mental disorder and different degrees of ID. We assessed 142 individuals with varying degrees of ID and with unknown previous psychiatric disorder. We applied the diagnostic battery PAS-ADD based on criteria ICD-10 and DSM-IV TR to analyzed the prevalence of mental disorders in people with mild / moderate ID. We applied the Spanish version of the scale DASH-II to analyze the prevalence of mental disorders in people with severe and profound ID. We found a psychiatric disorder previously undiagnosed in 29.57% of our sample. In people with mild/ moderate ID the most common psychiatric disorder was depressive disorder (33.3%), but in people with severe and profound ID was the anxiety disorder. The most prevalent medical comorbidity was epilepsy (22.5% of the total sample and 39.2% in the population with severe / profound intellectual disabilities). Psychiatric disorders seem to be more common in the population with ID than in the general population, increasing their prevalence and medical comorbidity in severe and profound ID.

Adaptation of the Token Test in Standard Indonesian

Aphasia is a language disorder caused by focal brain injury. The Token Test is a tool to detect aphasic symptoms and measure aphasic severity in individuals who suffer brain damage causing language impairment. While Indonesia has a diagnostic test battery for aphasia (TADIR), it has yet to be able to quantify aphasic severity. In this study, we tested 49 individuals: 26 healthy adults, 7 non-aphasic post-stroke individuals, and 16 aphasic individuals. A series of tests were administered: the TADIR, Token Test, and the Verb and Sentence Test. The Token Test was sensitive enough to distinguish between the three groups and was also correlated with all other language tests including the TADIR.

Reliability and validity of bedside version of Arabic Diagnostic Aphasia Battery (A-DAB-1) for Lebanese individuals

ABSTRACTBackground: There are several clinical aphasia assessment tools for screening and rehabilitation purposes in different languages. They are used globally to determine important aspects of language functioning in brain damaged individuals. Despite this, a valid bedside operational assessment tool is not available in Arabic to determine the level and severity of aphasia in Lebanese brain damaged patients.Aims: The aim of the present study was to develop the bedside version of Arabic Diagnostic Aphasia Battery (A-DAB-1) to measure severity of aphasia for rehabilitation purposes in Lebanese Arabic-speaking people with aphasia (PWA).Methods & Procedures: This study followed the theoretical framework of the WAB-R as well as connected speech analysis framework of P-WAB-1 developed for Persian (Persian Western Aphasia Battery). An expert native speaking panel was employed to evaluate the faithful translation of A-DAB-1 for matching the sociolinguistic properties of Arabic spoken in Lebanon using the Delphi method. The content validity ratio (CVR) was determined, and the new version of the test was administered to 60 healthy native Arabic-speaking adults living in Lebanon to obtain norms. The final version was administered to 30 Lebanese Arabic-speaking cerebrovascular accident (CVA) PWA introduced by a neurologist. The internal consistency and the test-retest were determined by reassessing ten PWA within 2–4 weeks interval.Outcomes & Results: The results of this study indicated that A-DAB-1 is a valid and reliable bedside clinical assessment tool. It achieved CVR 0.75 and an acceptable internal consistency (alpha = 0.961) and test-retest reliability (ICC = 0.988 p. Also A-DAB-1 showed a good clinical utility to differentiate between normal individuals and the performance of PWA as an operational index of severity.Conclusions: Based on the result, A-DAB-1 can be used as a valid clinical assessment tool for screening aphasia in bedside and to determine the severity of aphasia and efficacy of language intervention in Lebanese Arabic-speaking PWA.

Evaluación clínica y herramientas diagnósticas

The presence of cognitive impairment generates important changes in both affected individuals and their families and the health staff who must provide adequate care. Early identification of this alteration allows appropriate diagnosis and treatment and psychosocial and educational support, as well as the possibility of establishing care, life and financial plans. The interest of the scientific community in age-related cognitive alterations is demonstrated by the abundance of criteria and classifications. Obviously, there is a need to unify these criteria and implement longitudinal studies in order to reach reliable conclusions. Clinical assessment of the distinct cognitive domains should include careful history-taking and the use of diagnostic neuropsychological batteries. First, the ideal screening test would be one that could be administered in a few minutes, with a cut-off point that would identify patients requiring further assessment for correct diagnosis. The use of dynamic biomarkers is based on the hypothesis that they have a specific time-dependent model. These biomarkers include, firstly, markers of amyloidosis and, secondly, markers of neurodegeneration. Cognitive frailty is an emerging term inspired by a potential parallel with physical frailty syndrome. A subgroup of patients with cognitive impairment show a reduced capacity for recovery and functional decline that interact with physical frailty. The evidence suggests that cognitive status represents an important dimension of frailty syndrome.

Olfactory impairment in Parkinson's disease is a consequence of central nervous system decline.

Early diagnosis and timely treatment of Parkinson's disease are essential factors to provide these patients with a longer period of a better quality of life. Olfactory loss is among the first non-motor symptoms of the disease; however, in light of the many causes of smell loss, it is a very unspecific biomarker and should only be used as part of a diagnostic test battery. In this study, we investigated the olfactory response in 71 subjects, consisting of Parkinson's disease patients, hyposmic and anosmic patients of other causes, and normosmic individuals searching for sensitive, distinct biomarkers for which we used scalp event-related 64-channel electroencephalography and psychophysical tests. The analysis of the global field power indicated significant measurable differences between patients with Parkinson's disease and otherwise olfactory dysfunctional and normosmic individuals. The localization of brain sources, in particular, provides evidence for differences in mainly late EEG-components suggesting a decline of central brain networks as a causal factor for olfactory loss in Parkinson's disease. The findings indicate a different pattern of olfactory processing in patients with Parkinson's disease compared to olfactory dysfunctions of other origin, which provide further insights into the mechanisms behind olfactory dysfunction in Parkinson's.

Abstract WP235: Rates of Diagnostic Testing for Embolic Sources in a Nationally Representative Cohort of Patients With Ischemic Stroke

Introduction: Many strokes arise from a distant embolic source such as the heart or large arteries. It has recently been proposed that a minimum evaluation to identify such sources should include imaging of the intracranial and extracranial arteries, an echocardiogram, and continuous heart-rhythm monitoring for ≥24 hours. We sought to evaluate the utilization rates of these tests in a nationally representative cohort of U.S. patients with ischemic stroke. Methods: We analyzed inpatient and outpatient claims data from 2009-2014 in a 5% sample of Medicare beneficiaries ≥66 years of age. Using validated ICD-9-CM codes, we identified all patients with inpatient admission for ischemic stroke. Our outcomes were the following recommended diagnostic evaluations: intracranial arterial imaging (CTA, MRA, or TCD), extracranial imaging (CTA, MRA, or Doppler ultrasound), echocardiography (transthoracic or transesophageal), and heart-rhythm monitoring (Holter or loop recorder). We used CPT codes to identify whether these tests were performed within 3 months prior to and 6 months after the stroke. Results: We identified 23,475 patients with ischemic stroke. Extracranial vascular imaging was performed in 20,600 patients (87.8%; 95% confidence interval [CI], 87.3-88.2%), intracranial vascular imaging in 11,726 patients (50.0%; 95% CI, 49.3-50.6%), echocardiography in 19,278 patients (82.1%; 95% CI, 81.6-82.6%), and heart-rhythm monitoring in 2,063 patients (8.8%; 95% CI, 8.4-9.2%). Only 49 (0.2%) underwent the complete recommended diagnostic battery for the detection of embolic sources. These rates were not substantially different even after excluding patients with known atrial fibrillation, the most common source of embolic stroke. Limitations: We could not capture inpatient cardiac telemetry that was not formally interpreted by a physician. Conclusions: Among Medicare beneficiaries with acute ischemic stroke, the majority did not receive a full diagnostic evaluation for potential embolic sources of stroke. Promoting the widespread adoption of a more systematic interrogation of potential etiologies of stroke may allow for the implementation of more personalized secondary stroke prevention strategies.