Faculty Bibliography

BACKGROUND:Cannabis use among older adults has increased in recent years. Age-related physiological changes, socio-ecological factors, and medications may exacerbate potential adverse effects of cannabis and complicate the detection of cannabis use disorder (CUD) in older adults. However, current estimates of cannabis use are largely limited to national surveys, which may have age-related surveying challenges. METHODS:We conducted an intercept survey of 315 adults aged ≥ 65 in New York City, primarily in public parks and immediately outside older adult centers. The survey asked primarily about drug use with a focus on past-year cannabis use, reasons for use, adverse effects, and CUD. We examined reported cannabis use and delineated correlates of use and of having CUD. RESULTS:22.2% of participants (n = 70) reported past-year cannabis use, and among them, 11.1% (n = 35) reported past 24-h use. Older [adjusted odds ratio (aOR) = 0.90, 95% CI: 0.84-0.95] and female participants were at lower odds for use (aOR = 0.35, 95% CI: 0.17-0.73), and those who smoked cigarettes were at higher odds (aOR = 3.73, 95% CI: 1.65-8.48). Cannabis was most often used to get high (60.0%), relieve tension (55.7%), sleep (52.9%), or relieve chronic pain (30.0%). Dry mouth (41.4%) and drowsiness (18.6%) were the most reported adverse effects. Nearly a third (32.9%) who used cannabis had CUD, with 5.7% having severe CUD. CONCLUSIONS:Findings suggest that cannabis use among older adults may be more common and clinically significant than suggested by prior evidence. Improved screening, clinician education, and harm reduction strategies are needed to confront emerging risks in this population.

Kaplan-Meier analysis of time to first all-cause readmission over 12 months among older adults with ischemic heart disease randomized to 3 months of mobile health cardiac rehabilitation (mHealth-CR) or usual care. There was no significant difference in time to first readmission between groups (log-rank P = 0.26).

BACKGROUND:Inorganic arsenic (As) is a carcinogen and >200 million people worldwide are exposed to As through drinking water. Long-term As exposure increases the risk of chronic diseases including cancer and cardiovascular disease. While prior work has identified several genomic regions where DNA methylation (DNAm) is associated with As exposure, our knowledge remains limited. METHODS:We first evaluated the association of As exposure (measured in urine and drinking water) with DNAm (measured genome-wide in blood cells at >720 000 cytosine-phosphate-guanine (CpG) sites) among 1186 Bangladeshi adults from the Health Effects of Arsenic Longitudinal Study-a population with a wide range of As exposure levels. We then utilized elastic net regression to build a DNAm-based biomarker of As exposure. RESULTS:We identified 1177 CpGs associated with urinary As (false discovery rate < 0.05) and further demonstrated that these associations are likely causal by using genetic determinants of As metabolism as instrumental variables. Arsenic-associated CpGs showed strong enrichment for genomic context and CpG sets related to disease states previously linked to As exposure. We developed a 255-CpG DNAm-based biomarker of As exposure that was highly predictive of urinary As levels (r2 = 0.46) and arsenical skin-lesion status (area under the receiver-operating characteristic curve = 0.69)-a common sign of As toxicity. This biomarker was also highly associated with measured urinary As levels in an independent Bangladeshi cohort (P = 1.3 × 10-19) and further validated in the Strong Heart Study (P = 6.7 × 10-6), in which the DNAm-predicted As was also associated with overall mortality (P = 4.6 × 10-4). CONCLUSION:We demonstrate the utility of a DNAm-based biomarker of As exposure that can predict the risk of toxicity and present guidelines for developing epigenetic biomarkers to track environmental chemical exposures.

INTRODUCTION/UNASSIGNED:Older adults with chronic kidney disease (CKD) likely face higher dementia risk because of vascular injury and chronic inflammation, potentially intensified among racially minoritized groups and those in rural or deprived neighborhoods. We quantified this association and examined variation by race and ethnicity, urbanicity, and neighborhood deprivation. METHODS/UNASSIGNED:We identified 211,321 older adults with CKD stages 3 to 5 from the Medicare 5% sample (2010-2022) using International Classification of Diseases (ICD)-9 and/or ICD-10 codes. Zone Improvement Plan (ZIP)-code level urbanicity was defined using Rural-Urban Commuting Area Codes, and neighborhood deprivation was derived from the American Community Survey. We used cause-specific hazard models with time-varying CKD stage (reference = stage 3) to quantify the adjusted hazard ratio (aHR) of dementia and included interaction terms to test the differential effect of these associations by race and/or ethnicity, urbanicity, and neighborhood deprivation. RESULTS/UNASSIGNED:= 0.04). Among older Black (stage 4 aHR: 1.38, 95% CI: 1.28-1.48; stage 5 aHR: 2.01, 95% CI: 1.88-2.15) and Hispanic adults (stage 4 aHR: 1.33, 95% CI: 1.10-1.62; stage 5 aHR: 1.98, 95% CI: 1.67-2.34), stages 4 and 5 were associated with a higher risk of dementia. Among older adults in high-deprivation neighborhoods, stage 5 was associated with a higher risk of dementia (aHR: 1.89, 95% CI: 1.80-1.99). CONCLUSION/UNASSIGNED:CKD stages 4 and 5 were associated with a higher dementia risk, particularly among older Black adults and those in high-deprivation neighborhoods. These findings may inform targeted interventions for early detection and management of cognitive decline in advanced CKD.

This practice guideline provides updated evidence-based recommendations regarding the use of pharmacologic migraine prevention in adults. A multidisciplinary panel conducted a systematic review and developed practice recommendations following the process outlined in the 2017 edition of the American Academy of Neurology Clinical Practice Guideline Process Manual. The systematic review includes studies published through June 6, 2024, and is available in a companion publication. Recommendations are supported by structured rationales that integrate evidence from the systematic review, related evidence, principles of care, and inferences from evidence. Recommendations are provided on how to decide when it is appropriate to start a pharmacologic migraine preventive medication and how to decide which migraine preventive medication to start. Recommendations address decision making on appropriate choices of migraine preventive medications in specific situations and populations, including patients with fibromyalgia, obesity, or hypertension; considerations for older adults; treatment during pregnancy and lactation; sex-related factors in choosing medications; and treatment for patients with medication overuse. Recommendations on assessment of treatment efficacy, adverse effects, and discontinuing migraine preventive medications are provided.

BACKGROUND/PURPOSE/UNASSIGNED:Downbeat nystagmus (DBN) is an uncommon finding in comatose patients, especially as a manifestation of epileptiform activity. We report a 59-year-old man who developed DBN in the context of myoclonic status epilepticus following anoxic brain injury secondary to cardiac arrest. The DBN was phase-locked with generalized periodic epileptiform discharges (GPDs) on electroencephalography (EEG) and resolved with pharmacologic burst suppression. CONCLUSION/UNASSIGNED:This case suggests a potential link between DBN and cortical epileptiform activity, which we hypothesize may be due to bilateral cortical hyperexcitability and cerebellar disinhibition. The presence of DBN in this setting may indicate a poor prognosis.

BACKGROUND:Public awareness of concussion has grown significantly over the past 2 decades, driven largely by media coverage of sports-related injuries. This has paralleled a rise in traumatic brain injury (TBI)-related emergency department visits, underscoring the need for specialized concussion care centers. Despite this, most existing programs focus on sports or pediatric populations, leaving critical care gaps. RECENT FINDINGS/RESULTS:The NYU Langone Concussion Center was established in 2013 to address these gaps by providing interdisciplinary care for both sports-related and non-sports-related concussions. Approximately 60% of cases seen at the center are not sports related. This article outlines the center's inception, operational model, patient demographics, and evolution over the past decade. IMPLICATIONS FOR PRACTICE/CONCLUSIONS:Lessons learned from the NYU Langone model offer valuable guidance for developing comprehensive concussion programs that can serve diverse urban populations. Key strategies include cross-specialty collaboration, flexible infrastructure, and systems-level integration to address heterogeneous mechanisms of injury and outcomes.

Reproductive health disparities disproportionately affect adolescents of color in the United States, particularly in contraceptive access, utilization, and knowledge. Because parents strongly shape adolescents' contraceptive behaviors, understanding their perspectives is essential for addressing inequities. This scoping review synthesized evidence on parental attitudes toward adolescent contraception in racially and ethnically diverse communities to inform culturally responsive interventions. Following PRISMA-ScR guidelines, seven databases were systematically searched for U.S.-based, peer reviewed studies (2008-2023) examining contraception-related perceptions among parents or guardians of adolescents of color. Twenty studies met inclusion criteria (cross-sectional surveys [n=4], focus groups [n=4], interviews [n=5], quasi-experimental controlled trial [n=1], mixed-methods [n=6]); most addressed contraception broadly rather than specific methods. Study quality, assessed using the Mixed Methods Appraisal Tool, was predominantly high (18/20). Key themes included limited parental contraceptive knowledge, reliance on schools or clinicians for sexual health education, gendered and indirect communication, and cultural or religious norms discouraging adolescent sexual activity. Mistrust of healthcare systems, safety concerns, fear of promoting sexual behavior, and the influence of structural inequities, stigma, and misinformation were common across communities. Addressing parental knowledge gaps, communication barriers, and systemic mistrust is critical to reducing contraceptive disparities through culturally tailored education and strengthened family-healthcare partnerships.

BACKGROUND AND OBJECTIVES/OBJECTIVE:This systematic review (SR) provides updated evidence-based conclusions regarding the use of pharmacologic migraine prevention in adults to inform a new joint American Academy of Neurology (AAN) and American Headache Society practice guideline. METHODS:A multidisciplinary panel conducted an SR following the 2017 AAN Clinical Practice Guideline Process Manual. Randomized controlled trials evaluating pharmacologic preventive treatments for adults with episodic or chronic migraine were included. Searches encompassed MEDLINE, Embase, and ClinicalTrials.gov from database inception through June 6, 2024. Studies were screened in duplicate, with dual independent risk-of-bias assessment. Outcomes included change in monthly headache days, ≥50% responder rate, and validated patient-reported quality of life (QOL) measures. Raw mean differences, standardized mean differences, and risk ratios were calculated. A modified Grading of Recommendations Assessment, Development, and Evaluation process was used to classify certainty of evidence. RESULTS:A total of 217 studies met inclusion criteria. For episodic migraine, high-confidence evidence showed that galcanezumab and erenumab are more effective than placebo in reducing headache frequency. Moderate-confidence evidence supported benefit from atogepant, eptinezumab, fremanezumab, propranolol, topiramate, and valproate. Several additional oral agents including amitriptyline, bisoprolol, flunarizine, fluoxetine, levetiracetam, metoprolol, nifedipine, pizotifen, and telmisartan had low-confidence evidence suggesting possible benefit. For chronic migraine, high-confidence evidence supported reductions in headache frequency with fremanezumab, galcanezumab, and onabotulinumtoxinA. Moderate-confidence evidence supported benefit from atogepant, eptinezumab, erenumab, topiramate and valproate. Across both episodic and chronic migraine populations, erenumab, fremanezumab, galcanezumab, eptinezumab, rimegepant, atogepant, topiramate and onabotulinumtoxinA demonstrated improvements in patient-reported QOL outcomes on validated instruments. Evidence comparing active treatments was limited and generally of low or very low confidence, restricting conclusions about comparative effectiveness. DISCUSSION/CONCLUSIONS:This SR provides a comprehensive synthesis of evidence on pharmacologic migraine prevention in adults. High- and moderate-confidence findings confirm the efficacy of several established and newer preventive therapies and demonstrate improvements in patient-reported outcomes across multiple validated measures. These conclusions informed the development of evidence-based recommendations, presented in a companion publication, to guide clinicians in selecting preventive medications for adults with episodic and chronic migraine.