Higher Motor Scores Research Articles

Understanding the Relationship Between Perseveration, Comorbid Behavioral Symptoms, Motor Decline, Functional Decline, and Self-report Accuracy in Huntington Disease Can Help Inform Clinical Practice.

Perseveration is one of the most debilitating symptoms of Huntington disease (HD). To study perseveration and its relationship to comorbid behavioral symptoms, motor decline, functional decline, and subject self-report accuracy by analyzing cross-sectional data tracking individuals who have or are at risk for HD and healthy controls (HC). We studied 96 individuals from HD families and 35 HC who were either family controls or gene negative. We used χ2 tests to compare patient demographic and survey outcomes data and to analyze the presence of obsessions and compulsions (OC), depression, and apathy relative to the presence of perseveration. Individuals with HD and perseveration had a higher presence of OC, depression, and apathy compared with individuals with HD of the same stages without perseveration (19%, 47.6%, and 47.6% vs 15%, 40%, and 25%, respectively). In addition, individuals in HD Stages 1-3 with higher motor scores (showing a later stage of disease) displayed a significantly higher rate of perseveration than the HC (P = 0.0476; P = 0.0499, respectively). The presence of an informant resulted in a significantly higher rate of perseveration reporting for individuals in HD Stages 1 and 2 (41.2% and 53.8% with informant vs 23.5% and 11.1% without informant, respectively). Perseveration was seen across all motor and functional stages for the individuals with HD, without significant differences between the different stages. Additionally, informants were beneficial to obtaining accurate patient reports of perseveration. These findings should prove useful for physician evaluation and treatment considerations.

Updated Parkinson's disease motor subtypes classification and correlation to cerebrospinal homovanillic acid and 5-hydroxyindoleacetic acid levels

IntroductionMotor classifications of Parkinson's Disease (PD) have been widely used. This paper aims to update a subtype classification using the MDS-UPDRS-III and determine if cerebrospinal neurotransmitter profiles (HVA and 5-HIAA) differ between these subtypes in a cohort from the Parkinson's Progression Marker Initiative (PPMI). MethodsUPDRS and MDS-UPDRS scores were collected for 20 PD patients. Akinetic-rigid (AR), Tremor-dominant (TD), and Mixed (MX) subtypes were calculated using a formula derived from UPDRS, and a new ratio was developed for subtyping patients with the MDS-UPDRS. This new formula was subsequently applied to 95 PD patients from the PPMI dataset, and subtyping was correlated to neurotransmitter levels.Data were analyzed using receiver operating characteristic models and ANOVA. ResultsCompared to previous UPDRS classifications, the new MDS-UPDRS TD/AR ratios produced significant areas under the curve (AUC) for each subtype. The optimal sensitivity and specificity cutoff scores were ≥0.82 for TD, ≤0.71 for AR, and >0.71 and <0.82 for Mixed. Analysis of variance showed that the AR group had significantly lower HVA and 5-HIAA levels than the TD and HC groups. A logistic model using neurotransmitter levels and MDS-UPDRS-III could predict the subtype classification. ConclusionsThis MDS-UPDRS motor classification system provides a method to transition from the original UPDRS to the new MDS-UPDRS. It is a reliable and quantifiable subtyping tool for monitoring disease progression. The TD subtype is associated with lower motor scores and higher HVA levels, while the AR subtype is associated with higher motor scores and lower 5-HIAA levels.

Effect of Specific Acupuncture Therapy Combined with Rehabilitation Training on Incomplete Spinal Cord Injury: A Randomized Clinical Trial.

Acupuncture therapies were used to treat spinal cord injury (SCI) and its complications. To assess the effect of a specific acupuncture therapy combined with rehabilitation training for inpatients with incomplete SCI, we conducted an assessor-blinded, randomized controlled clinical trial in the Department of Rehabilitation Medicine Center in West China Hospital, Sichuan University. Seventy-two participants diagnosed with incomplete SCI were randomly assigned into 3 groups of 24 patients each, with data collection completed in December, 2019. Participants were randomly assigned (1 : 1 : 1) to 3 groups to receive treatment for 4 weeks, 5 times/week of acupuncture for Continuous Acupuncture Treatment (CAT) group, 3 times/week for Intermittent Acupuncture Treatment (IAT) group, and no acupuncture for Control group; all 3 groups received routine rehabilitation training. The primary outcome was the change of American Spinal Injury Association (ASIA) motor score from baseline to week 4. Secondary outcomes included sensory score, Modified Barthel Index (MBI). At week 4, CAT group had a higher motor score and MBI score increase than the control group (mean difference 10.52, 17.36; p < 0.001, p < 0.01, respectively). CAT group had more increase in motor score and MBI than IAT group (mean difference 5.55, 14.77; p < 0.05, p < 0.05, respectively). But the difference among groups in the increase of sensory score was not statistically significant. Acupuncture resulted in a higher motor score and MBI after 4 weeks. And the dosage of 5/week led to more improvement in motor score and MBI than that of 3/week. The results suggested that a dosage of 5/week of acupuncture is safe and more effective for SCI than 3/week. But further research is needed to determine the best intervention dosage, long-term efficacy, and underlying mechanism. This trial is registered with ChiCTR1900021530.

Excessive daytime sleepiness in idiopathic blepharospasm

ObjectiveTo explore the frequency of excessive daytime sleepiness (EDS), and its impact on quality of life and its associated clinical factors in idiopathic blepharospasm. MethodsThis cross-sectional study was carried out in 425 idiopathic blepharospasm patients and a group of 424 age-matched and sex-matched healthy subjects. EDS was assessed with the Epworth Sleepiness Scale (ESS) in all subjects. Other clinical characteristics of patients with idiopathic blepharospasm including motor symptoms, sleep quality, depression, anxiety, cognition, and quality of life were also assessed. ResultsEDS was significantly more frequent in patients with idiopathic blepharospasm than in controls (22.1% vs 12.3%; p < 0.05). Blepharospasm patients with EDS scored significantly higher in Jankovic Rating scale, Hamilton Rating Scale for Depression (HDRS), Hamilton Rating Scale for Anxiety (HARS), and significantly lower in Montreal Cognitive Assessment (MoCA) and 36-Item Short Form Health Survey (SF-36) than those without EDS (p < 0.05). The binary logistic regression model indicated that male, younger age of onset of blepharospasm, higher motor scores, higher HDRS scores, and lower MoCA scores were associated with the presence of EDS in patients with blepharospasm (p < 0.05). ConclusionsRecognition and management of EDS in idiopathic blepharospasm patients is necessary as the occurrence of EDS was associated with higher motor burden, more serious mood and cognitive disturbances, and poorer quality of life. Our results suggest that blepharospasm may exhibit abnormal sleep-wake patterns and further support the clinical heterogeneity of the disease.

Brain tissue volumes at term-equivalent age are associated with early motor behavior in very preterm infants.

Preterm birth is associated with a wide range of adverse developmental outcomes, including sensory, motor, cognitive and language impairments, and behavioral or attention problems. Subtle motor deficits that might emerge in premature infants with no evident or with mild brain injury encompass qualitative and quantitative aspects of motor behavior. This prospective cohort study provided an evaluation of the relationship between brain tissue volumes revealed by magnetic resonance imaging (MRI) at term-equivalent age and motor behavior in infancy in very preterm infants (total number=40; mean gestational age=28weeks+4days; mean birth weight=1190g) without evident or with mild brain injury. Infants were recruited at birth and assessed at 12months corrected age using the tool for qualitative and quantitative assessment of motor behavior, infant motor profile. The brain tissue was segmented first using advanced segmentation techniques and the volumes were measured by summing the volumes of all voxels belonging to a particular tissue class. The associations between volumetric brain MRI measures with motor behavior were explored using linear regression analyses. Results showed that larger total brain volumes were associated with higher motor score. Similar relationships were documented for parietal lobe, deep gray matter, and cerebellum volumes. Volumetric quantitative data of brain structures may serve as biomarkers for subtle motor deficits described in very preterm born infants without or with mild brain lesions apparent on MRI.

Applying the bioecological theory to the study of fundamental motor skills

ABSTRACTBackground: This study applied the Person-Process-Context-Time model based on Bioecological theory to investigate the sociocultural influences on motor skill development.Purpose: The objectives of the present study were: (a) to assess the personal resources associated with the development of motor skills of children from three different geographic regions located in Northeastern Brazil; and, (b) to identify the factors in the microsystems (i.e. schools and in the state-funded sports programs) and mesosystems (i.e. interrelations between contexts) that contribute to the development of motor skills in children, and how more distal systems, the exosystems (i.e. department of education and sports) and macrosystem (i.e. school funding; public educational policy; legislation; regional culture) influence this process in each geographic region.Research design: The Test of Gross Motor Development-2 was used to assess the motor performance of 274 economically underprivileged children from three different geographic regions, semiarid (n = 66), mountainous (n = 104), and coastal (n = 104) regions of Brazil. The principal investigator of this study conducted non-participant observations, the interviews with the physical education (n = 15) and classroom (n = 17) teachers, and the children's assessments. The Collective Subject Speech method was used to analyze the teachers’ interviews.Data collection and analysis: Teachers and children were interviewed and assessed, respectively, at the schools. Researcher ecological insertion was adopted to understand contextual factors further. Qualitative data was obtained through observation and interviews. Data reduction for the interviews was obtained using the Key Expression, Central Ideas, and Anchorages. Children's motor scores were analyzed using a three-way ANOVA (sex (boys and girls) x geographic regions (semiarid, mountainous, and coastal) × microsystem) for locomotor and object control skills. To follow up the significant interactions, post hoc tests using simple effects (One-Way ANOVA and Tukey post hoc) followed by appropriate cell-to-cell comparisons (Independent T-Test) were conducted.Results: The results indicate a prevalence of delays in the total sample (percentile < 5 at the TGMD-2). Higher motor scores were observed for children enrolled in sports compared to physical education programs. Girls had limited opportunities to learn sports skills and consequently, demonstrated poorer motor scores within the microsystems from the three regions. The interviews revealed that teachers did not feel adequately trained, had limited resources and facilities, and scarcely met the children's developmental needs.Conclusions: These findings suggest that the educational policies and the teachers’ lack of training were the primary restrictions related to promoting opportunities for children to learn motor skills within the investigated regions.

Early Neurodevelopmental Outcomes in Children with Hypoplastic Left Heart Syndrome and Related Anomalies After Hybrid Procedure.

The hybrid strategy is one approach to single ventricle palliation. In this study, we reported neurodevelopment at 12months for two cohorts of children managed with the hybrid and clinical factors associated with neurodevelopment in the entire sample. We performed a retrospective study of children with single ventricle who had undergone a neonatal hybrid procedure. One group included infants with hypoplastic left heart syndrome (HLHS); another group included infants with non-HLHS single ventricle. Neurodevelopment was assessed with 12-month Bayley III. Parametric and non-parametric statistics were used for analysis. Nine infants with HLHS and 15 with non-HLHS were identified. Abnormal neurodevelopment was identified in 11 of 24 (46%), primarily motor (46%). Development did not differ between groups. In the whole sample, higher lactate levels were associated with lower cognitive scores (p = 0.04). Fewer mechanical ventilation days were associated with higher cognitive scores (p = 0.05) after Stage 1 and higher motor scores after Stage 2. Shorter ICU length of stay (p = 0.01), shorter hospital length of stay (p = 0.01), and fewer complications (p = 0.01) after stage 2 were associated with higher motor scores. Higher cognitive (p = 0.02) and language (p = 0.002) scores were associated with higher weight at 12months. In the largest cohort of single ventricle children treated with neonatal hybrid palliation yet reported, significant neurodevelopmental impairment was identified. No differences in neurodevelopment were found between children with HLHS and those with non-HLHS variants. A multicenter trial is needed to test differences in neurodevelopment between hybrid and Norwood approaches.

P117 Predictive factors of outcome in poor grade subarachnoid haemorrhage (SAH)

ObjectivesTo study the factors associated with outcome in poor grade SAH in a busy tertiary centre.DesignRetrospective records review.SubjectsAll Patients with SAH WFNS grades IV and V admitted Jan 2016-Dec 2017.MethodsWe admitted 379 SAH patients, 84 (22%) were poor grade (n=84, 33M/51F mean age 60.7±1.4 y). Outcome was assessed by Modified Rankin Scale (mRS) scores before surgery and at latest follow up (3–6 months). mRS was dichotomised as good (0–3) and poor (4–6).Spearman’s rank-order test evaluated correlation between latest mRS and all other variables (WFNS grade, GCS, Motor score of GCS, age, sex, smoking, hypertension, intraventricular haemorrhage (IVH) and intracerebral haemorrhages (ICH)).Results63 patients (75%) had poor outcome, of which 46 (55%) died (44 with 30 days), versus 21 (25%) had good outcome. Spearman’s correlation analysis revealed that patients with smaller aneurysms (3.3±0.4 mm in good outcome patients vs 11.3±1.2 mm in poor outcome) (rs=0.37, p=0.009), who are younger (rs=0.24, p=0.03), have higher GCS (rs=−0.24, p=0.03), higher motor score (rs=0.25, p=0.02), lower WFNS grade (rs=0.3, p=0.007) and received coiling of aneurysms vs no treatment (rs=−0.39, p&lt;0.0001) had better outcome. There was no significant correlation in outcome with ICH, IVH, external ventricular drain insertion, location of aneurysms, smoking, hypertension, other co-morbidities or sex.ConclusionsIn poor grade SAH, younger patients with smaller aneurysms, higher GCS and higher motor score who received endovascular coiling had better outcome.

The prevalence of chronic low back pain and lumbar deformities in patients with Parkinson's disease: implications on spinal surgery.

This observational study was aimed at quantification of low back pain (LBP) in Parkinsonian patients and its morphological correlation. Parkinson's disease (PD) is a common disabling condition in the elderly population. Parkinsonian patients frequently are troubled by LBP. Causes for LBP in PD are muscular imbalances by the movement disorder itself and skeletal degeneration. Ninety-seven PD patients and 97 controls were inquired about low back pain through the Oswestry Low Back Pain Disability Questionnaire and visual analogue scales. Fifty-four patients with LBP underwent X-ray of the lumbar spine in two planes and flexion-extension views. Parkinson's disease was characterized by stage, disease duration, motor score, lateralization of symptoms and dosage of medication. LBP occurred significantly more frequent in PD (87.6%) compared to controls (62.6%) with longer duration and higher pain intensity. Pain intensity and disability scores were associated with higher PD stages and higher motor scores. Patients with the hypokinetic PD subtype experienced more pain intensity. X-ray of the lumbar spine revealed lumbar arthrosis in 79.6%, scoliosis in 38.8% and spondylolisthesis in 24.1% of PD patients with LBP. Lateralization of scoliosis and PD symptoms were significantly correlated. Only a small portion of PD patients with LBP received specialized orthopaedic treatment. LBP and lumbar degeneration are common in PD. Both are related to movement disorder symptoms. The knowledge about musculoskeletal conditions in Parkinson's disease is important for an interdisciplinary conservative or operative treatment decision of LBP. These slides can be retrieved under Electronic Supplementary Material.

Diabetes mellitus and Parkinson disease.

To investigate whether diabetes mellitus is associated with Parkinson-like pathology in people without Parkinson disease and to evaluate the effect of diabetes mellitus on markers of Parkinson pathology and clinical progression in drug-naive patients with early-stage Parkinson disease. We compared 25 patients with Parkinson disease and diabetes mellitus to 25 without diabetes mellitus, and 14 patients with diabetes mellitus and no Parkinson disease to 14 healthy controls (people with no diabetes mellitus or Parkinson disease). The clinical diagnosis of diabetes mellitus was confirmed by 2 consecutive fasting measurements of serum glucose levels >126 mL/dL. Over a 36-month follow-up period, we then investigated in the population with Parkinson disease whether the presence of diabetes mellitus was associated with faster motor progression or cognitive decline. The presence of diabetes mellitus was associated with higher motor scores (p < 0.01), lower striatal dopamine transporter binding (p < 0.05), and higher tau CSF levels (p < 0.05) in patients with Parkinson disease. In patients with diabetes but without Parkinson disease, the presence of diabetes mellitus was associated with lower striatal dopamine transporter binding (p < 0.05) and higher tau (p < 0.05) and α-synuclein (p < 0.05) CSF levels compared to healthy controls. At the Cox survival analysis in the population of patients with Parkinson disease, the presence of diabetes mellitus was associated with faster motor progression (hazard ratio = 4.521, 95% confidence interval = 1.468-13.926; p < 0.01) and cognitive decline (hazard ratio = 9.314, 95% confidence interval = 1.164-74.519; p < 0.05). Diabetes mellitus may predispose toward a Parkinson-like pathology, and when present in patients with Parkinson disease, can induce a more aggressive phenotype.

The prodromal phase of leucine-rich repeat kinase 2-associated Parkinson disease: Clinical and imaging Studies.

Asymptomatic, nonmanifesting carriers of leucine-rich repeat kinase 2 mutations are at increased risk of developing PD. Clinical and neuroimaging features may be associated with gene carriage and/or may demarcate individuals at greater risk for phenoconversion to PD. To investigate clinical and dopamine transporter single-photon emission computed tomography imaging characteristics of leucine-rich repeat kinase 2 asymptomatic carriers. A total of 342 carriers' and 259 noncarriers' relatives of G2019S leucine-rich repeat kinase 2/PD patients and 39 carriers' and 31 noncarriers' relatives of R1441G leucine-rich repeat kinase 2/PD patients were evaluated. Motor and nonmotor symptoms were assessed using specific scales and questionnaires. Neuroimaging quantitative data were obtained in 81 carriers and compared with 41 noncarriers. G2019S carriers scored higher in motor scores and had lower radioligand uptake compared to noncarriers, but no differences in nonmotor symptoms scores were observed. R1441G carriers scored higher in motor scores, had lower radioligand uptake, and had higher scores in depression, dysautonomia, and Rapid Eye Movements Sleep Behavior Disorder Screening Questionnaire scores, but had better cognition scores than noncarriers. Among G2019S carriers, a group with "mild motor signs" was identified, and was significantly older, with worse olfaction and lower radioligand uptake. G2019S and R1441G carriers differ from their noncarriers' relatives in higher motor scores and slightly lower radioligand uptake. Nonmotor symptoms were mild, and different nonmotor profiles were observed in G2019S carriers compared to R1441G carriers. A group of G2019S carriers with known prodromal features was identified. Longitudinal studies are required to determine whether such individuals are at short-term risk of developing overt parkinsonism. © 2017 International Parkinson and Movement Disorder Society.

Variation in Recent Onset Parkinson's Disease: Implications for Prodromal Detection.

Background: The detection of prodromal Parkinson’s disease (PD) is desirable to test drugs with neuroprotective potential, but will be affected by known disease variations.Objective: To assess the prevalence of four key non-motor prodromal PD markers, and evaluate the sensitivity of case detection when non-motor screening tools for prodromal PD are implemented in an early clinical PD cohort.Methods: Hyposmia (University of Pennsylvania smell identification test ≤15th centile or Sniffin’ Sticks at or ≤10th centile corrected for age and sex), rapid-eye movement sleep behaviour disorder (RBD questionnaire >4), constipation (<1 daily spontaneous bowel motion) and depression (Leeds >6) were recorded in recent onset PD cases, and proposed non-motor screening criteria applied.Results: In 1,719 PD cases, mean age 68.6 years (SD 8.1), 65.5% male, mean disease duration 1.3 years (SD 0.9), 72.2% were hyposmic, 43.3% had RBD, 22.1% depression, and 21.5% constipation. 11.6% of cases had no key non-motor features, 38.8% one, 32.1% two, 15.5% three, and 2.0% all four. Increasing numbers of non-motor features were associated with younger age (p = 0.019), higher motor scores (p < 0.001), more postural instability gait difficulty (PIGD) (p < 0.001), greater cognitive impairment (p < 0.001) and higher total non-motor burden (p < 0.001). Cases with hyposmia alone were younger (p < 0.001), had less severe cognitive (p = 0.006) and other non-motor features (p < 0.001). All screening criteria selected younger patients (p = 0.001, p < 0.001), three of four greater overall non-motor burden (p = 0.005, p < 0.001), and inclusion of RBD more cognitive impairment (p = 0.003, p = 0.001) and PIGD (p = 0.004, p = 0.001).Conclusions: Varying sensitivity levels, and age and phenotype selectivity, are found when different non-motor screening methods to detect prodromal PD are applied to an early clinical PD cohort.

Gender and non motor fluctuations in Parkinson's disease: A prospective study

IntroductionIn Parkinson's disease (PD), non motor symptoms can fluctuate either along or irrespective to motor on/off phenomena. Prospective studies suggest that higher motor scores and levodopa dosage, younger age at onset and female gender represent risk factors for motor fluctuations' development. Yet, the predictors of development of non motor fluctuations (NMF) are less clear.In this prospective study, we aimed to assess the relationship between NMF and gender along with other potential risk factors. MethodsForty-seven (16 women/31 men) de novo, drug-naïve PD patients have been followed for 4 years since diagnosis. Motor and non motor fluctuations were evaluated with the 19-item Wearing off Questionnaire (WOQ-19). The association between gender and NMF was explored with multivariable regression models adjusted for age at onset, motor and non motor symptoms at diagnosis and levodopa intake at follow up. ResultsFemale gender was more likely associated with a diagnosis of NMF (adjusted odds ratio, AOR = 5.33,95%CI = 1.21–23.4, p = 0.027), but not with a diagnosis of generic wearing off at follow up (OR = 3.66, 95%CI = 0.8–16.8, p = 0.097). Women had greater likelihood of developing higher WOQ-19 Non motor scores (AOR = 4.58, 95%CI = 1.23–17.03, p = 0.023), but not higher WOQ-19 Total scores (AOR = 2.88, 95%CI = 0.86–9.71, p = 0.087) compared to men. Notwithstanding, no gender differences were detected in medication intake. ConclusionsWe showed that female gender represents a major risk factor for the development of NMF. There were no gender differences in medication intake, thus NMF in women remain mostly underestimated and not properly treated. From a practical standpoint, clinicians should take into account the role of gender in the management of NMF in PD.

Frequency and clinical correlates of postural and striatal deformities in Parkinson’s disease

ObjectiveTo assess the frequency of postural and striatal deformities in patients with Parkinson’s disease. Patients and methodsA total of 416 consecutive patients with Parkinson’s disease were evaluated for musculoskeletal deformities using a standardized criteria. Data including disease history, motor complications and antiparkinsonic treatment were collected. ResultsThe overall frequency of musculoskeletal deformities was 19.7%. Striatal deformities were the most frequent deformities (9.9%). Scoliosis was the deformity most frequently found. No cases with Pisa syndrome or antecollis were found. Striatal deformities were associated with a younger age at onset, more frequent use of levodopa, as well as higher levodopa equivalent daily dose. Postural deformities were associated with higher motor scores. ConclusionPostural and striatal deformities are common in Parkinson’s disease. Striatal deformities appear to be more related to dopaminergic treatment, while postural deformities are associated with the motor state.

Current pregnancy among women with spinal cord injury: findings from the US national spinal cord injury database.

Study designCross-sectional studyObjectiveTo examine prevalence of pregnancy and associations with sociodemographic and clinical factors among women with spinal cord injury (SCI)SettingU.S. National Spinal Cord Injury Database, an SCI registry that interviews participants 1, 5, and then every 5 years post-injury. Data include SCI clinical details, functional impairments, participation measures, depressive symptoms, and life satisfaction. Women ages 18-49 are asked about hospitalizations in the last year relating to pregnancy or its complications. Data represent 1,907 women, who completed 3,054 interviews.MethodsWe used generalized estimating equations to examine bivariable associations between pregnancy and clinical and psychosocial variables and to perform multivariable regressions predicting pregnancy.ResultsAcross all women, 2.0% reported pregnancy during the prior 12 months. This annual prevalence differed significantly by years elapsed since injury; the highest rate occurred 15 years post-injury (3.7%). Bivariable analyses found that younger age at injury was significantly associated with current pregnancy (P < 0.0001). Compared with nonpregnant women, those reporting current pregancy were significantly more likely to be married or partnered, have sport-related SCI, have higher motor scores, and have more positive psychosocial status scores. Multivariable analyses found significant associations between current pregnancy and age, marital status, motor score, and mobility and occupation scale scores.ConclusionsCurrent pregnancy rates among reproductive-aged women with SCI are similar to rates of other U.S. women with chronic mobility impairments. More information is needed about pregnancy experiences and outcomes to inform both women with SCI seeking childbearing and clinicians providing their care.

Abstract T P186: The Effectiveness of the Motor Component of the National Institute of Health Stroke Scale at Predicting the Functional Outcome at Discharge in Patient Receiving Endovascular Therapy

Background and Purpose: The National Institute of Health (NIH) developed a standardized scale to evaluate the severity of a stroke at presentation. Predicting patient outcome after a vascular event can be very challenging. The objective of this analysis was to study the effect of the motor component of the NIH Stroke Scale (NIHSS) on a patient’s functional outcome at discharge looking at a multicenter group to further validate our observation. Methods: This is a retrospective analysis of all patients (n= 161) that presented to the hospitals with ischemic stroke and received mechanical thrombectomy between January 2009 and July 2014 and had all the components of NIHSS baseline documented at presentation. Statistical analysis was performed using GraphPad Prism to independently evaluate the relationship between the NIHSS components and patient functional outcome at discharge using modified rankin scale (mRS). mRS of 2 or less represented a good functional outcome. All variables were included in the analysis. Results: 112 patients that had all variables and their NIHSS breakdown components documented were included. Group analysis including gender, mean age, mean NIHSS, Afib%, DM%, Prior Stroke % and mortality at discharge were as follows: Female 52.7%, 72.1±16.3, 15.2±7.2, 34.8%, 27.7%, 25.9% and 12.5%. All Motor components of NIHSS in order left arm, left leg, right arm, right leg had a significant correlation with poor patient outcome at discharge (95%CI -3.932- -0.9607, P&lt;0.001); (95%CI, -3.843- -0.8714, P&lt;0.001); (95%CI, -3.584- -0.6125, P&lt;0.01); (95%CI, -3.539- -0.5678, P&lt;0.01). A higher motor score at presentation correlated with a worse outcome at discharge. NIHSS was significantly correlated with poor functional outcome (95% CI 9.881 -13.423 P&lt;0.001). Conclusion: Admission motor grade may serve as a good predictor of disability and mortality in patients undergoing mechanical thrombectomy with acute ischemic stroke. Further prospective study to validate such an observation is warranted.

Abstract 11740: Fetal and Neonatal Markers of Neurodevelopmental Outcome in Congenital Heart Disease

Objectives: Children with congenital heart disease (CHD) are at risk for abnormal neurodevelopment (ND). We evaluated associations between fetal Doppler and biometry measures, neonatal electroencephalogram (EEG) and 18-month ND. Methods: Fetuses with hypoplastic left heart syndrome (HLHS), transposition of the great arteries (TGA), and tetralogy of Fallot (TOF) had middle cerebral (MCA) and umbilical artery (UA) Doppler velocities, as well as biometry such as head (HC) and abdominal circumference (AC), prospectively recorded at 20-25 (F1), 26-32 (F2), and 33-39 (F3) wks gestational age (GA). Pulsatility indices (PI) with GA-derived z-scores and cerebral-to-placental resistance (CPR) ratios were calculated. Neonatal high-density EEG was preformed preoperatively and the Bayley Scales of Infant Development-III were assessed at 18-months. Factor analysis was used to reduce the number of EEG predictors used in regression analysis. Results: Among 56 CHD fetuses (N=19 HLHS, N=16 TGA, N=21 TOF) who underwent preoperative EEG, ND scores are available for 33 to date. Cardiac subtype was highly associated with EEG and was considered in all models. Cognition scores were predicted by CPR&lt; 1 ever (B=-15.7, P=0.002) and HC/AC at F2 (B=-130, P=0.013, R 2 =0.42). Language scores were predicted by UA PI z-score at F1 (B=-9.6, P=0.005, R 2 =0.27). Motor scores were predicted by UA PI z-score at F1 (B=-3.9, P=0.085), HLHS (B=-15, P&lt;0.001), EFW%ile (B=0.374, P=0.007), and delta band right parietal and right temporal log power in active sleep (B=3.9, P=0.045, R 2 =0.61). Conclusion: Lower umbilical artery pulsatility at 20-25 wks GA was associated with higher 18-month Language and Motor scores. A diagnosis of HLHS predicted poorer Motor scores. Increased EEG power in the parietal and temporal region of the right brain predicted higher Motor scores. A larger abdomen relative to head at 26-32 wks was associated with improved cognition while diminished cerebrovascular compared with placental resistance predicted poorer cognition, similar to what has been observed in the growth restricted fetus. Further investigation is needed to confirm these hypothesis-generating findings.

Abstract T P11: Motor Component of National Institute of Health Stroke Scale Effect on Functional Outcome and Mortality at Discharge in Patient Receiving Endovascular Therapy

Background and Purpose: Predicting the patient outcome after a vascular event can be very challenging. The National Institute of Health (NIH) developed a standardized scale to evaluate the severity of a stroke at presentation. The objective of this analysis was to study the effect of the motor component of the NIH Stroke Scale (NIHSS) on a patient’s functional outcome at discharge. Methods: This is a retrospective analysis of all patients (n= 97) that presented to our hospital with ischemic stroke and received mechanical thrombectomy between January 2009 and July 2012 and had all the components of NIHSS baseline documented at presentation. Statistical analysis was performed using the R statistical package and XLSTAT-Pro 2011. Spearman correlations (P value &lt;0.05) for non-normally distributed data were used to independently evaluate the correlation of each of the NIHSS components with patient functional outcome at discharge using modified rankin scale (mRS). mRS of 2 or less represented a good functional outcome. Results: Group analysis including gender, mean age, mean NIHSS and mortality at discharge was as follows: Female 49.5%, 72.9, 14.7 and 13.4%. All Motor components of NIHSS had a significant correlation (Rho=0.24, P value &lt;0.05) with poor patient outcome at discharge, meaning a higher motor score at presentation represented a worse outcome at discharge. A higher NIHSS had a significant correlation with poor functional outcome (Rho=0.41, P value &lt;0.05). Conclusion: In conclusion, admission motor grade may serve as a good predictor of disability and mortality in patients undergoing mechanical thrombectomy with acute ischemic stroke. Further validation by a prospective study with a larger sample size is warranted.

K06 Psychosis in HD: a data mining study from REGISTRY

BackgroundThere is little consensus in the literature surrounding the prevalence and incidence of psychotic symptoms in Huntington's Disease (HD) with prevalence rates varying from 5% to 64%. The differences may...

The Benefits of Breast Feeding across the Early Years of Childhood

There has been much scrutiny recently of the choice to breast-feed rather than formula-feed an infant, yet key identification issues remain to be resolved. This study uses the Early Childhood Longitudinal Survey—Birth Cohort to explore the causal effect of breast feeding on child development. Using simultaneous equations models and propensity score measures and adjusting for confounding factors, we examine health, physical, and cognitive outcomes and relate these to a set of breast feeding and formula feeding intensities measures. Our results indicate that breast feeding is protective against obesity and improves cognitive outcomes at 24 months and 54 months. Furthermore, not being formula-fed at birth is associated with higher motor scores.