Bioinformatics and system biology approaches to identify pathophysiological impact of COVID-19 to the progression and severity of neurological diseases.

The Coronavirus Disease 2019 (COVID-19) still tends to propagate and increase the occurrence of COVID-19 across the globe. The clinical and epidemiological analyses indicate the link between COVID-19 and Neurological Diseases (NDs) that drive the progression and severity of NDs. Elucidating why some patients with COVID-19 influence the progression of NDs and patients with NDs who are diagnosed with COVID-19 are becoming increasingly sick, although others are not is unclear. In this research, we investigated how COVID-19 and ND interact and the impact of COVID-19 on the severity of NDs by performing transcriptomic analyses of COVID-19 and NDs samples by developing the pipeline of bioinformatics and network-based approaches. The transcriptomic study identified the contributing genes which are then filtered with cell signaling pathway, gene ontology, protein-protein interactions, transcription factor, and microRNA analysis. Identifying hub-proteins using protein-protein interactions leads to the identification of a therapeutic strategy. Additionally, the incorporation of comorbidity interactions score enhances the identification beyond simply detecting novel biological mechanisms involved in the pathophysiology of COVID-19 and its NDs comorbidities. By computing the semantic similarity between COVID-19 and each of the ND, we have found gene-based maximum semantic score between COVID-19 and Parkinson's disease, the minimum semantic score between COVID-19 and Multiple sclerosis. Similarly, we have found gene ontology-based maximum semantic score between COVID-19 and Huntington disease, minimum semantic score between COVID-19 and Epilepsy disease. Finally, we validated our findings using gold-standard databases and literature searches to determine which genes and pathways had previously been associated with COVID-19 and NDs.

Bioinformatics and system biology approaches to identify pathophysiological impact of COVID-19 to the progression and severity of neurological diseases

BACKGROUND: The COVID-19 pandemic has increased the need for remote healthcare options among patients with Huntington's disease (HD). However, since not every HD patient is suitable for telehealth, it is important to differentiate who can be seen virtually from who should remain as in-person. Unfortunately, there are no clinical guidelines on how to evaluate HD patients for telehealth eligibility. OBJECTIVE: To standardize the teleneurology selection process in HD by implementing a screening tool that accounts for patient-specific factors. METHODS: We organized various indications and contraindications to teleneurology into a flowchart. If any indications or contraindications were met, patients were assigned to telehealth or maintained as in-person, respectively. If no indications or contraindications were met, patients were given the option of telehealth or in-person for their upcoming appointments. In two implementation cycles, we tested this screening tool among all HD patients scheduled for clinic visits, aided by chart review and phone interview. RESULTS: In a cohort of 81 patients, telehealth acceptance among eligible patients increased from 45.0%to 83.3%. Frequency of telehealth visits increased from a pre-intervention baseline of 12.8%to 28.2%. CONCLUSION: Teleneurology utilization among HD patients more than doubled across our study. Our intervention promotes consistency and patient-centeredness in HD clinical care and streamlines the overall telehealth selection process. Future studies can seek to reduce telehealth no-shows and also evaluate the utility of the motor and psychiatric criteria included in our screening tool.

Improving Patient Outreach by Defining Telehealth Suitability in a Tertiary Huntington's Disease Clinic.

Background and Objectives Huntington disease (HD) is an inherited neurodegenerative condition associated with varying degrees of motor, cognitive, and behavioral abnormalities. Although aggression, irritability, lack of insight, and poor impulse are well-recognized nonmotor manifestations of the disease, very little is known about their association with criminality, which is broadly defined as acts that are punishable by law. Methods We explored the prevalence of criminality in patients with HD seen between January 1, 2017, and December 31, 2021, within a large academic medical center in the state of Illinois. To determine rates of criminality, we examined “criminal behavior” (defined as illegal actions that do not necessarily lead to criminal prosecution) through a retrospective medical record review of keywords or phrases related to criminality. We also examined “crime” (defined as the presence of a criminal record) in this same sample of patients through a search of official publicly available online databases from the state of Illinois and the federal government. Results Of the 210 patients included, 97 (46.2%) had criminal behavior documented in their medical records. Based on public database information, 89 patients (42.4%) had a criminal record and 26 patients (12.4%) had been arrested. Traffic violations were committed by 94.4% of the cohort and were the most common infractions. Most of these violations were petty offenses and only punishable by fines. Physical aggression toward caregivers was the most common criminal behavior identified in medical records. This tended to occur in advance stages of the disease and rarely led to criminal charges. Crime occurred at any point in the disease course of HD, including before and after the development of clinical signs and the formal diagnosis of HD. Discussion The presence of criminality was not infrequent in our cohort, but rarely did this result in criminal charges and rarely did these charges result in arrests or incarcerations. Discussions surrounding driving safety and management of physical aggression toward caregivers should be part of regular outpatient visits with patients with HD. Ultimately, it is unknown whether criminality is a common feature of HD, and assessments need to be developed to determine its true prevalence. 

Criminality in Huntington Disease

Forensic neurology: a distinct subspecialty at the intersection of neurology, neuroscience and law.

BACKGROUND: Safer-at-home orders during the COVID-19 pandemic altered the structure of clinical care for Huntington's disease (HD) patients. This shift provided an opportunity to identify limitations in the current healthcare infrastructure and how these may impact the health and well-being of persons with HD. OBJECTIVE: The study objectives were to assess the feasibility of remote healthcare delivery in HD patients, to identify socioeconomic factors which may explain differences in feasibility and to evaluate the impact of safer-at-home orders on HD patient stress levels. METHODS: This observational study of a clinical HD population during the 'safer-at-home' orders asked patients or caregivers about their current access to healthcare resources and patient stress levels. A chart review allowed for an assessment of socioeconomic status and characterization of HD severity. RESULTS: Two-hundred and twelve HD patients were contacted with 156 completing the survey. During safer-at-home orders, the majority of HD patients were able to obtain medications and see a physician; however, 25% of patients would not commit to regular telehealth visits, and less than 50% utilized an online healthcare platform. We found that 37% of participants were divorced/single, 39% had less than a high school diploma, and nearly 20% were uninsured or on low-income health insurance. Patient stress levels correlated with disease burden. CONCLUSION: A significant portion of HD participants were not willing to participate in telehealth services. Potential explanations for these limitations may include socioeconomic barriers and caregiving structure. These observations illustrate areas for clinical care improvement to address healthcare disparities in the HD community.

Healthcare Delivery and Huntington's Disease During the Time of COVID-19.

Unlawful behaviors have been reported in association with Huntington's disease (HD), although their overall prevalence and clinical significance remain unknown. Recognition of problematic behavior is limited by stigma and lack of routine clinical assessment, as well as the absence of validated screening measures. We performed a retrospective chart review of 289 patients treated for HD at Vanderbilt University Medical Center from 2006 to 2020 to assess the frequency of illegal activity in our HD population. We identified 31 patients with HD who have a documented history of unlawful behavior, comprising 11 percent of the charts reviewed. Physical violence was the most common behavior reported, followed by reckless driving, substance abuse, illegal financial activity, and inappropriate sexual behavior. Mean age at the time of the first offense was 37 years. Patients with criminal offenses were more likely to be male and in the early stages of disease with associated psychiatric symptoms. Our results emphasize that illegal activities are a significant clinical problem in individuals with HD, particularly young adult males with comorbid psychiatric symptoms. These findings highlight the need for improved screening measures to detect high-risk behaviors in individuals with HD, as well as evidence-based protocols to guide triage and management of patients engaging in potentially detrimental activities.

http://jaapl.org/content/jaapl/early/2021/08/02/JAAPL.210008-21.full.pdf

Medicolegal Aspects of Huntington Disease.

Effectiviteit en modererende factoren van een preventieve interventie met cognitieve gedragstherapie in gezinsgroepen voor kinderen van ouders met depressie

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Healthcare Delivery and Huntington's Disease During the Time of COVID-19.

Medicolegal Aspects of Huntington Disease.

Effectiviteit en modererende factoren van een preventieve interventie met cognitieve gedragstherapie in gezinsgroepen voor kinderen van ouders met depressie