Carl Gold

All Publications

• Administration of Dexamethasone for Bacterial Meningitis: An Unreliable Quality Measure. The Neurohospitalist Dujari, S. n., Gummidipundi, S. n., He, Z. n., Gold, C. A. 2021; 11 (2): 101–6

  Abstract

  To validate the use of administrative data to identify patients with bacterial meningitis and quantify the rate of dexamethasone administration as defined in the American Academy of Neurology Inpatient and Emergency Care Quality Measurement Set.The Vizient Clinical Data Base and Resource Manager was used to identify patients with International Classification of Diseases, Tenth Revision (ICD-10) codes for bacterial meningitis from October 2015 to June 2019. Chart review was performed on patients identified at a single quaternary-care hospital. The positive predictive value (PPV) of Vizient was determined. Demographic, clinical, and laboratory data were assessed using descriptive statistics.Of all hospitals that submitted complete data to Vizient during the study period, a median of 19 patients per hospital had ICD-10 codes for bacterial meningitis in the 45-month period. We identified 79 patients using Vizient at our institution of whom 69 had a diagnosis of bacterial meningitis confirmed by chart review (PPV = 87%). 15 patients were eligible to receive dexamethasone per the quality measurement set. Six of these patients (40%) received dexamethasone.It is feasible to use the Vizient Clinical Data Base and Resource Manager to identify patients with bacterial meningitis. Due to low prevalence across multiple institutions and high rate of exclusion criteria at our institution, this study suggests that the rate of dexamethasone administration in bacterial meningitis may be an unreliable indicator of quality of care provided by inpatient neurologists. The creation of a registry for hospitalized neurology patients could enhance development of future quality measures.

  View details for DOI 10.1177/1941874420969556

  View details for PubMedID 33791051

  View details for PubMedCentralID PMC7958681

• Administration of Dexamethasone for Bacterial Meningitis: An Unreliable Quality Measure NEUROHOSPITALIST Dujari, S., Gummidipundi, S., He, Z., Gold, C. A. 2020

  View details for DOI 10.1177/1941874420969556

  View details for Web of Science ID 000600210200001

• Opinion and Special Articles: Competency in serious illness communication for neurology residents. Neurology Goyal, T., Robinson, M. T., Gold, C. A. 2020

  View details for DOI 10.1212/WNL.0000000000011048

  View details for PubMedID 33055275

• Accelerated launch of video visits in ambulatory neurology during COVID-19: Key lessons from the Stanford experience. Neurology Yang, L., Brown-Johnson, C. G., Miller-Kuhlmann, R., Kling, S. M., Saliba-Gustafsson, E. A., Shaw, J. G., Gold, C. A., Winget, M. 2020

  Abstract

  The COVID-19 pandemic has rapidly moved telemedicine from discretionary to necessary. Here we describe how the Stanford Neurology Department: 1) rapidly adapted to the COVID-19 pandemic, resulting in over 1000 video visits within four weeks and 2) accelerated an existing quality improvement plan of a tiered roll out of video visits for ambulatory neurology to a full-scale roll out. Key issues we encountered and addressed were related to: equipment/software, provider engagement, workflow/triage, and training. Upon reflection, the key drivers of our success were provider engagement and a supportive physician champion. The physician champion played a critical role understanding stakeholder needs, including staff and physicians' needs, and creating workflows to coordinate both stakeholder groups. Prior to COVID-19, physician interest in telemedicine was mixed. However, in response to county and state stay-at-home orders related to COVID-19, physician engagement changed completely; all providers wanted to convert a majority of visits to video visits as quickly as possible. Rapid deployment of neurology video visits across all its subspecialties is feasible. Our experience and lessons learned can facilitate broader utilization, acceptance, and normalization of video visits for neurology patients in the present as well as the much anticipated post-pandemic era.

  View details for DOI 10.1212/WNL.0000000000010015

  View details for PubMedID 32611634

• A Novel Goals of Care Communication Curriculum for Neurology Residents Improves Confidence and Skills Goyal, T., Merrell, S., Weimer-Elder, B., Kline, M., Gold, C. LIPPINCOTT WILLIAMS & WILKINS. 2020

  View details for Web of Science ID 000536058006035

• Benchmarking Performance on Administration of Dexamethasone for Bacterial Meningitis Dujari, S., Gummidipundi, S., He, Z., Gold, C. LIPPINCOTT WILLIAMS & WILKINS. 2020

  View details for Web of Science ID 000536058003112

• A Standardized Checklist Improves the Transfer of Stroke Patients from the Neurocritical Care Unit to Hospital Ward NEUROHOSPITALIST Murray, N. M., Joshi, A. N., Kronfeld, K., Hobbs, K., Bernier, E., Hirsch, K. G., Gold, C. A. 2020; 10 (2): 100–108

  View details for DOI 10.1177/1941874419873810

  View details for Web of Science ID 000524171000005

• Education Research: A novel resident-driven neurology quality improvement curriculum. Neurology Miller-Kuhlmann, R., Kraler, L., Bozinov, N., Frolov, A., Mlynash, M., Gold, C. A., Kvam, K. A. 2020; 94 (3): 137–42

  Abstract

  OBJECTIVE: To describe and assess the effectiveness of a neurology resident quality improvement curriculum focused on development of practical skills and project experience.METHODS: We designed and implemented a quality improvement curriculum composed of (1) a workshop series and (2) monthly resident-led Morbidity, Mortality, & Improvement conferences focused on case analysis and project development. Surveys were administered precurriculum and 18 months postcurriculum to assess the effect on self-assessed confidence with quality improvement skills, attitudes, and project participation. Scholarship in the form of posters, presentations, and manuscripts was tracked during the course of the study.RESULTS: Precurriculum, 83% of neurology residents felt that instruction in quality improvement was important, but most rated their confidence level with various skills as low. Following implementation of the curriculum, residents were significantly more confident in analyzing a patient case (odds ratio, 95% confidence interval) (2.4, 1.9-3.1), proposing system changes (3.1, 2.3-3.9), writing a problem statement (9.9, 6.2-13.5), studying a process (3.1, 2.3-3.8), identifying resources (3.1, 2.3-3.8), identifying appropriate measures (2.5, 1.9-3.0), collaborating with other providers to make improvements (4.9, 3.5-6.4), and making changes in a system (3.1, 2.3-3.8). Project participation increased from the precurriculum baseline (7/18, 39%) to the postcurriculum period (17/22, 77%; p = 0.023). One hundred percent of residents surveyed rated the curriculum positively.CONCLUSIONS: Our multifaceted curriculum was associated with increased resident confidence with quality improvement skills and increased participation in improvement projects. With adequate faculty mentorship, this curriculum represents a novel template for preparing neurology residents for meeting the expectations of improvement in practice and offers scholarship opportunities.

  View details for DOI 10.1212/WNL.0000000000008752

  View details for PubMedID 31959682

• Eponyms are here to stay: Usage in the literature and among current neurology trainees. Neurology Zheng, J. n., Gold, C. A. 2020

  Abstract

  To assess the historical trends of medical eponym use in neurology literature and knowledge and attitudes among current trainees related to eponyms.A comprehensive list of medical eponyms compiled from multiple online and print sources was queried against the titles and abstracts of PubMed articles authored by neurologists to assess historical prevalence in the literature from 1988 to 2013. We also surveyed current neurology trainees and trainees who have matched for residency in neurology, but not yet started neurology training, on their familiarity and attitudes toward eponyms.The yearly prevalence of eponyms among neurologist-authored publications ranged from 15% and 25%, with a mean of 21%. The total number of unique eponyms appearing in titles and abstracts increased from 693 in 1988 to 1,076 in 2013, representing 1.8% average annual growth. Our survey showed that residents with at least 1 year of neurology training reported familiarity with significantly more eponyms than those before neurology training (p < 0.001). For familiar eponyms, most residents were either unaware of an alternative descriptor or preferred using the eponym. Despite recognizing both the benefits and drawbacks of eponyms, the vast majority of trainees stated that historical precedent, pervasiveness, and ease of use would drive the continued use of eponyms in neurology.Eponyms will remain a cornerstone in medical education and communication moving forward. Educators in neurology should consider how best to integrate useful eponyms and alternative descriptors into residency training to enhance knowledge acquisition and retention.

  View details for DOI 10.1212/WNL.0000000000008912

  View details for PubMedID 31896619

• Rapid implementation of video visits in neurology during COVID-19: a mixed methods evaluation. Journal of medical Internet research Saliba-Gustafsson, E. A., Miller-Kuhlmann, R. n., Kling, S. M., Garvert, D. W., Brown-Johnson, C. G., Lestoquoy, A. S., Verano, M. R., Yang, L. n., Falco-Walter, J. n., Shaw, J. G., Asch, S. M., Gold, C. A., Winget, M. n. 2020

  Abstract

  Telemedicine has been used for decades; yet, despite its many advantages, its uptake and rigorous evaluation of feasibility across neurology's ambulatory subspecialties has been sparse. The SARS-CoV-2 (COVID-19) pandemic however, prompted healthcare systems worldwide to reconsider traditional healthcare delivery. To safeguard healthcare workers and patients many healthcare systems quickly transitioned to telemedicine, including across neurology subspecialties, providing a new opportunity to evaluate this modality of care.To evaluate the accelerated implementation of video visits in ambulatory neurology during the COVID-19 pandemic, we used mixed methods to assess the adoption, acceptability, appropriateness, and perceptions of potential sustainability.Video visits were launched rapidly in ambulatory neurology clinics of a large academic medical center. To assess adoption, we analyzed clinician-level scheduling data collected between March 22 and May 16, 2020. We assessed acceptability, appropriateness, and sustainability via a clinician survey (n=48) and semi-structured interviews with providers (n=30) completed between March and May 2020.Video visits were adopted rapidly; 65 (98%) clinicians integrated video visits into their workflow within the first 6 implementation weeks and 92% of all visits were conducted via video. Video visits were largely considered acceptable by clinicians, although various technological issues impacted satisfaction. Video visits were reported to be more convenient for patients, families, and/or caregivers than in-person visits; however, access to technology, the patient's technological capacity, and language difficulties were considered barriers. Many clinicians expressed optimism about future utilization of video visits in neurology. They believed that video visits promote continuity of care and can be incorporated into their practice long-term, although several insisted that they can never replace the in-person examination.Video visits are an important addition to clinical care in ambulatory neurology and are anticipated to remain a permanent supplement to in-person visits, promoting patient care continuity, and flexibility for patients and clinicians alike.

  View details for DOI 10.2196/24328

  View details for PubMedID 33245699

• Utilization, yield, and accuracy of the FilmArray Meningitis/Encephalitis panel with diagnostic stewardship and testing algorithm. Journal of clinical microbiology Broadhurst, M. J., Dujari, S. n., Budvytiene, I. n., Pinsky, B. A., Gold, C. A., Banaei, N. n. 2020

  Abstract

  Background: The impact of diagnostic stewardship and testing algorithms on utilization and performance of the FilmArray® Meningitis/Encephalitis (ME) Panel has received limited investigation.Methods: We performed a retrospective single-center cohort study assessing all individuals with suspected ME between February 2017 and April 2019 for whom the ME Panel was ordered. Testing was restricted to patients with cerebrospinal fluid (CSF) pleocytosis. Positive ME Panel results were confirmed before reporting through correlation with direct stain (Gram and Calcofluor white) and CSF Cryptococcal antigen or by repeat ME Panel testing. Outcomes included ME Panel test utilization rate, negative predictive value of non-pleocytic CSF samples, test yield and false-positivity rate, and time to appropriate de-escalation of acyclovir.Results: Restricting testing to pleocytic CSF samples reduced ME Panel utilization by 42.7% (263 vs 459 tests performed) and increased test yield by 61.8% (18.6% vs 11.5% positivity rate; P < 0.01) with application of criteria. The negative predictive value of normal CSF WBC for ME Panel targets was 100% (195/195) for non-viral targets and 98.0% (192/196) overall. All pathogens detected in non-pleocytic CSF samples were herpesviruses. Application of a selective testing algorithm based on repeat testing of non-viral targets avoided 75% (3/4) of false-positive results without generating false-negative results. Introduction of the ME panel reduced the duration of acyclovir treatment from an average of 66 hours (SD, 43) to 46 hours (SD, 36) (P = 0.03).Conclusions: Implementation of the ME Panel with restriction criteria and a selective testing algorithm for non-viral targets optimizes its utilization, yield and accuracy.

  View details for DOI 10.1128/JCM.00311-20

  View details for PubMedID 32493787

• A Standardized Checklist Improves the Transfer of Stroke Patients from the Neurocritical Care Unit to Hospital Ward. The Neurohospitalist Murray, N. M., Joshi, A. N., Kronfeld, K. n., Hobbs, K. n., Bernier, E. n., Hirsch, K. G., Gold, C. A. 2020; 10 (2): 100–108

  Abstract

  The transfer of patients with ischemic stroke from the intensive care unit (ICU) to noncritical care inpatient wards involves detailed information sharing between care teams. Our local transfer process was not standardized, leading to potential patient risk. We developed and evaluated an "ICU Transfer Checklist" to standardize communication between the neurocritical care team and the stroke ward team.Retrospective review of consecutive patients with ischemic stroke admitted to the neurocritical care unit who were transferred to the stroke ward was used to characterize transfer documentation. A multidisciplinary team developed and implemented an ICU Transfer Checklist that contained a synthesis of the patient's clinical course, immediate "to-do" action items, and a system-based review of active medical problems. Postintervention checklist utilization was recorded for 8 months, and quality metrics for the postintervention cohort were compared to the preintervention cohort. Providers were surveyed pre- and postintervention to characterize perceived workflow and quality of care.Patients before (n = 52) and after (n = 81) ICU Transfer Checklist implementation had similar demographic and clinical characteristics. In the postchecklist implementation period, the ICU Transfer Checklist was used in over 85% of patients and median hospital length of stay (LOS) decreased (8.6 days vs 5.4 days, P = .003), while ICU readmission rate remained low. The checklist was associated with improved perceptions of safety and decreased time needed to transfer patients.Use of the standardized ICU Transfer Checklist was associated with decreased hospital LOS and with improvements in providers' perceptions of patient safety.

  View details for DOI 10.1177/1941874419873810

  View details for PubMedID 32373272

  View details for PubMedCentralID PMC7191660

• National Variability in Prion Disease-Related Safety Policies for Neurologic Procedures. The Neurohospitalist Werbaneth, K., Tummalapalli, P., Gold, C. A. 2019; 9 (4): 222–25

  Abstract

  Prion diseases are fatal neurodegenerative disorders that can be transmitted via contact with infective tissue. Variability in hospital safety policies related to prion disease may place health-care workers at risk. We sought to assess variability of safety policies related to prion disease for neurosurgical procedures and lumbar punctures among neurological institutions in the United States. We e-mailed neurologists associated with 2016 US News and World Report "Top 50" Neurology & Neurosurgery Institutions to request hospital policies regarding safety precautions related to prion disease. For institutional surgical policies, the main outcome was concordance with each of the 8 specific precautions described in World Health Organization (WHO) guidelines published in 1999. No similar guidelines are available for lumbar puncture, so themes were identified and quantified among the lumbar puncture policies we collected. Of the 51 institutions contacted, there were 38 responses. Two institutions did not have relevant policies and 3 institutions declined to share their policies, yielding 33 institutional policies for review. Of these, 85% had a surgical policy and 54% had a lumbar puncture policy. Concordance with all 8 specific precautions described in the WHO guidelines was found in 14% of surgical policies. Lumbar puncture policies demonstrated variability in methods of waste disposal and decontamination procedures. There is significant variability in policies regarding safety precautions in patients with suspected prion disease. We advocate for the formation of national or international committees to examine this issue, set new guidelines, and foster implementation at the level of individual institutions.

  View details for DOI 10.1177/1941874419846338

  View details for PubMedID 31534612

• Infected Implantable Pulse Generator NEUROHOSPITALIST Dujari, S., Gold, C. A. 2019; 9 (3): 172–73

  View details for DOI 10.1177/1941874418809869

  View details for Web of Science ID 000471642900011

  View details for PubMedID 31244976

  View details for PubMedCentralID PMC6582390

• Plateau waves of intracranial pressure mimicking seizure in a patient with fungal meningitis Wu, T., Sadat-Hossieny, Z., Gold, C. LIPPINCOTT WILLIAMS & WILKINS. 2019

  View details for Web of Science ID 000475965901049

• Author response: Video NeuroImages: Paraneoplastic spinal myoclonus associated with Caspr2 antibodies. Neurology Hines, H., Murray, N. M., Ahmad, S., Jaradeh, S., Gold, C. A. 2019; 92 (6): 303

  View details for DOI 10.1212/WNL.0000000000006871

  View details for PubMedID 30718327

• Coexistence of Neuromyelitis Optica and Amyotrophic Lateral Sclerosis: A Case Report NEUROHOSPITALIST Li, A., McGranahan, T., Su, E., Kipp, L., Gold, C. A. 2019; 9 (1): 37–40

  View details for DOI 10.1177/1941874418783914

  View details for Web of Science ID 000454208800007

• Education Research: Understanding barriers to goals of care communication for neurology trainees. Neurology Goyal, T. n., Hasty, B. N., Bereknyei Merrell, S. n., Gold, C. A. 2019; 93 (8): 362–66

  Abstract

  To describe the perspectives of neurology residents regarding barriers to effective goals of care discussions and to identify residents' current and desired educational strategies to improve goals of care communication.All neurology residents at our institution were invited to voluntarily participate in focus groups. Residents were organized into 3 focus groups by year of training. Moderators asked residents open-ended questions about current goals of care communication practice and ideas for improving the frequency and effectiveness of goals of care discussions. All responses were audiorecorded, transcribed, and de-identified. Transcripts of the focus groups were independently read and coded by members of the research team. We performed thematic analysis to identify and systematize relationships across coded data.Twenty out of 29 neurology residents participated in the focus groups. We identified 3 overarching domains impeding goals of care communication: patient factors, resident factors, and systems factors. Residents proposed specific desired strategies to address these 3 domains with the goal of improving the frequency and efficacy of goals of care communication. The desired strategies included receiving feedback from patients and families, developing resident-focused educational opportunities through direct observation and coaching, and systems changes by documenting goals of care discussions.Neurology residents identify multiple barriers to effective goals of care communication and propose specific desired strategies for improvement. This detailed input from residents will be incorporated into future curricular interventions to improve confidence and skill in leading goals of care discussions.

  View details for DOI 10.1212/WNL.0000000000007975

  View details for PubMedID 31427487

• Expanding Access to Magnetic Resonance Imaging for Patients With Cardiac Rhythm Devices JAMA NEUROLOGY Culbertson, C. J., Gold, C. A. 2018; 75 (10): 1173–74

  View details for DOI 10.1001/jamaneurol.2018.1651

  View details for Web of Science ID 000446679000001

• Expanding Access to Magnetic Resonance Imaging for Patients With Cardiac Rhythm Devices. JAMA neurology Culbertson, C. J., Gold, C. A. 2018

  View details for PubMedID 29971323

• Variability of Safety Policies Related to Prion Disease Among Top Neurological Institutions Werbaneth, K., Tummalapalli, P., Kraler, L., Gold, C. LIPPINCOTT WILLIAMS & WILKINS. 2018

  View details for Web of Science ID 000453090805308

• A Quality Improvement Curriculum for Neurology Residents Miller-Kuhlmann, R., Kraler, L., Bozinov, N., Frolov, A., Mlynash, M., Gold, C., Kvam, K. LIPPINCOTT WILLIAMS & WILKINS. 2018

  View details for Web of Science ID 000453090805218

• Video NeuroImages: Paraneoplastic spinal myoclonus associated with Caspr2 antibodies. Neurology Hines, H., Murray, N. M., Ahmad, S., Jaradeh, S., Gold, C. A. 2018; 90 (14): 660–61

  View details for PubMedID 29610228

• Video NeuroImages: Paraneoplastic spinal myoclonus associated with Caspr2 antibodies NEUROLOGY Hines, H., Murray, N. M., Ahmad, S., Jaradeh, S., Gold, C. A. 2018; 90 (14): 660–61

  View details for DOI 10.1212/WNL.0000000000005265

  View details for Web of Science ID 000439108700020

• Young Man With Paraparesis. Annals of emergency medicine Rider, E. n., Gold, C. A. 2018; 72 (3): e19–e20

  View details for PubMedID 30144875

• Teaching NeuroImages: Myeloperoxidase-anti-neutrophil cytoplasmic antibody-positive hypertrophic pachymeningitis. Neurology Culbertson, C. J., Lummus, S. C., Gold, C. A. 2017; 89 (21): e253

  View details for PubMedID 29158303

• Anticipating the Challenges of Zika Virus and the Incidence of Guillain-Barré Syndrome. JAMA neurology Gold, C. A., Josephson, S. A. 2016

  View details for DOI 10.1001/jamaneurol.2016.1268

  View details for PubMedID 27272118

• Electrographic Correlates of Plateau Waves in Patients With Leptomeningeal Metastases. The Neurohospitalist Gold, C. A., Odom, N. n., Srinivasan, S. n., Schaff, L. n., Haggiagi, A. n., Odia, Y. n. 2016; 6 (4): 161–66

  Abstract

  We describe video electroencephalography (video-EEG) correlates of transient neurological attacks due to plateau waves-paroxysmal elevations in intracranial pressure-in patients with leptomeningeal metastases. We identified 3 patients with leptomeningeal metastases, intracranial hypertension, and transient neurological attacks captured on video-EEG without evidence of seizures or epileptiform activity. We identified all clinical events on video and reviewed the corresponding EEG data for evidence of abnormalities. All 3 patients had mild to moderate slowing and 2 had frontal intermittent rhythmic delta activity during background EEG recording. There were 33 clinical events recorded and stereotyped for each patient. All 33 events were associated with an increase in delta range slowing of ≥30% compared to the background. This abnormality started ≤2 minutes before the onset of clinical symptoms and persisted for minutes after clinical resolution. This study is the first to carefully describe the electrographic correlates of transient neurological attacks due to plateau waves in patients with leptomeningeal metastasis. Clinical attacks were consistently associated with a possible EEG signature of diffuse delta range slowing. Future studies can validate the sensitivity and specificity of these EEG changes as a prognostic and/or response biomarker in patients with leptomeningeal metastases with or without intracranial hypertension.

  View details for DOI 10.1177/1941874416648194

  View details for PubMedID 27695598

• Unplanned Transfers from Hospital Wards to the Neurological Intensive Care Unit NEUROCRITICAL CARE Gold, C. A., Mayer, S. A., Lennihan, L., Claassen, J., Willey, J. Z. 2015; 23 (2): 159-165

  Abstract

  The aim of this study is to evaluate the characteristics of unplanned transfers of adult patients from hospital wards to a neurological intensive care unit (NICU).We retrospectively reviewed consecutive unplanned transfers from hospital wards to the NICU at our institution over a 3-year period. In-hospital mortality rates were compared between patients readmitted to the NICU ("bounce-back transfers") and patients admitted to hospital wards from sources other than the NICU who were then transferred to the NICU ("incident transfers"). We also measured clinical characteristics of transfers, including source of admission and indication for transfer.A total of 446 unplanned transfers from hospital wards to the NICU occurred, of which 39% were bounce-back transfers. The in-hospital mortality rate associated with all unplanned transfers to the NICU was 17% and did not differ significantly between bounce-back transfers and incident transfers. Transfers to the NICU within 24 h of admission to a floor service accounted for 32% of all transfers and were significantly more common for incident transfers than bounce-back transfers (39 vs. 21%, p = .0002). Of patients admitted via the emergency department who had subsequent incident transfers to the NICU, 50% were transferred within 24 h of admission.Unplanned transfers to an NICU were common and were associated with a high in-hospital mortality rate. Quality improvement projects should target the triage process and transitions of care to the hospital wards in order to decrease unplanned transfers of high-risk patients to the NICU.

  View details for DOI 10.1007/s12028-015-0123-z

  View details for Web of Science ID 000360700700003

  View details for PubMedID 25680399

• Opsoclonus-myoclonus syndrome in a patient with an anaplastic oligoastrocytoma JOURNAL OF NEURO-ONCOLOGY Gold, C. A., Lassman, A. B., Odia, Y. 2015; 123 (2): 315-316

  View details for DOI 10.1007/s11060-015-1783-4

  View details for Web of Science ID 000355632800015

  View details for PubMedID 25864100

• New-onset seizures in two adults with hemophagocytic lymphohistiocytosis JOURNAL OF NEUROLOGY Gold, C. A., Sheth, S. J., Agarwal, S., Claassen, J., Foreman, B. 2015; 262 (4): 1063-1065

  View details for DOI 10.1007/s00415-015-7669-8

  View details for Web of Science ID 000353295400034

  View details for PubMedID 25701009

• Patient page. Driving after a stroke. Neurology Karceski, S., Gold, C. A. 2011; 76 (8): e35-8

  View details for DOI 10.1212/WNL.0b013e3182104170

  View details for PubMedID 21339494

• Discrimination and reliance on conceptual fluency cues are inversely related in patients with mild Alzheimer's disease NEUROPSYCHOLOGIA Wolk, D. A., Gold, C. A., Signoff, E. D., Budson, A. E. 2009; 47 (8-9): 1865-1872

  Abstract

  Prior work suggests that patients with mild Alzheimer's disease (AD) often base their recognition memory decisions on familiarity. It has been argued that conceptual fluency may play an important role in the feeling of familiarity. In the present study we measured the effect of conceptual fluency manipulations on recognition judgments of patients with mild AD and older adult controls. "Easy" and "hard" test conditions were created by manipulating encoding depth and list length to yield high and low discrimination, respectively. When the two participant groups performed identical procedures, AD patients displayed lower discrimination and greater reliance on fluency cues than controls. However, when the discrimination of older adult controls was decreased to the level of AD patients by use of a shallow encoding task, we found that controls reliance on fluency did not statistically differ from AD patients. Furthermore, we found that increasing discrimination using shorter study lists resulted in AD patients decreasing their reliance on fluency cues to a similar extent as controls. These findings support the notion that patients with AD are able to attribute conceptual fluency to prior experience. In addition, these findings suggest that discrimination and reliance on fluency cues may be inversely related in both AD patients and older adult controls.

  View details for DOI 10.1016/j.neuropsychologia.2009.02.029

  View details for Web of Science ID 000266701600010

  View details for PubMedID 19428418

• An evaluation of recollection and familiarity in Alzheimer's disease and mild cognitive impairment using receiver operating characteristics BRAIN AND COGNITION Ally, B. A., Gold, C. A., Budson, A. E. 2009; 69 (3): 504-513

  Abstract

  There is a need to investigate exactly how memory breaks down in the course of Alzheimer's disease (AD). Examining what aspects of memorial processing remain relatively intact early in the disease process will allow us to develop behavioral interventions and possible drug therapies focused on these intact processes. Several recent studies have worked to understand the processes of recollection and familiarity in patients with mild cognitive impairment (MCI) and very mild AD. Although there is general agreement that these patient groups are relatively unable to use recollection to support veridical recognition decisions, there has been some question as to how well these patients can use familiarity. The current study used receiver operating characteristic (ROC) curves and a depth of processing manipulation to understand the effect of MCI and AD on the estimates of recollection and familiarity. Results showed that patients with MCI and AD were impaired in both recollection and familiarity, regardless of the depth of encoding. These results are discussed in relation to disease pathology and in the context of recent conflicting evidence as to whether familiarity remains intact in patients with MCI. The authors highlight differences in stimuli type and task difficulty as possibly modulating the ability of these patients to successfully use familiarity in support of memorial decisions.

  View details for DOI 10.1016/j.bandc.2008.11.003

  View details for Web of Science ID 000264220800008

  View details for PubMedID 19101064

• The picture superiority effect in patients with Alzheimer's disease and mild cognitive impairment NEUROPSYCHOLOGIA Ally, B., Gold, C. A., Budson, A. E. 2009; 47 (2): 595-598

  Abstract

  The fact that pictures are better remembered than words has been reported in the literature for over 30 years. While this picture superiority effect has been consistently found in healthy young and older adults, no study has directly evaluated the presence of the effect in patients with Alzheimer's disease (AD) or mild cognitive impairment (MCI). Clinical observations have indicated that pictures enhance memory in these patients, suggesting that the picture superiority effect may be intact. However, several studies have reported visual processing impairments in AD and MCI patients which might diminish the picture superiority effect. Using a recognition memory paradigm, we tested memory for pictures versus words in these patients. The results showed that the picture superiority effect is intact, and that these patients showed a similar benefit to healthy controls from studying pictures compared to words. The findings are discussed in terms of visual processing and possible clinical importance.

  View details for DOI 10.1016/j.neuropsychologia.2008.10.010

  View details for Web of Science ID 000263815300034

  View details for PubMedID 18992266

• Memory loss in Alzheimer's disease: implications for development of therapeutics. Expert review of neurotherapeutics Gold, C. A., Budson, A. E. 2008; 8 (12): 1879-1891

  Abstract

  Alzheimer's disease (AD) is a progressive neurodegenerative disease marked by a constellation of cognitive disturbances, the earliest and most prominent being impaired episodic memory. Episodic memory refers to the memory system that allows an individual to consciously retrieve a previously experienced item or episode of life. Many recent studies have focused on characterizing how AD pathology impacts particular aspects of episodic memory and underlying mental and neural processes. This review summarizes the findings of those studies and discusses the effects of current and promising treatments for AD on episodic memory. The goal of this review is to raise awareness of the strides that cognitive neuroscientists have made in understanding intact and dysfunctional memory. Knowledge of the specific memorial processes that are impaired in AD may be of great value to basic scientists developing novel therapies and to clinical researchers assessing the efficacy of those therapies.

  View details for DOI 10.1586/14737175.8.12.1879

  View details for PubMedID 19086882

• Conceptual fluency at test shifts recognition response bias in Alzheimer's disease: Implications for increased false recognition NEUROPSYCHOLOGIA Gold, C. A., Marchant, N. L., Koutstaal, W., Schacter, D. L., Budson, A. E. 2007; 45 (12): 2791-2801

  Abstract

  The presence or absence of conceptual information in pictorial stimuli may explain the mixed findings of previous studies of false recognition in patients with mild Alzheimer's disease (AD). To test this hypothesis, 48 patients with AD were compared to 48 healthy older adults on a recognition task first described by Koutstaal et al. [Koutstaal, W., Reddy, C., Jackson, E. M., Prince, S., Cendan, D. L., & Schacter D. L. (2003). False recognition of abstract versus common objects in older and younger adults: Testing the semantic categorization account. Journal of Experimental Psychology: Learning, Memory, and Cognition, 29, 499-510]. Participants studied and were tested on their memory for categorized ambiguous pictures of common objects. The presence of conceptual information at study and/or test was manipulated by providing or withholding disambiguating semantic labels. Analyses focused on testing two competing theories. The semantic encoding hypothesis, which posits that the inter-item perceptual details are not encoded by AD patients when conceptual information is present in the stimuli, was not supported by the findings. In contrast, the conceptual fluency hypothesis was supported. Enhanced conceptual fluency at test dramatically shifted AD patients to a more liberal response bias, raising their false recognition. These results suggest that patients with AD rely on the fluency of test items in making recognition memory decisions. We speculate that AD patients' over reliance upon fluency may be attributable to (1) dysfunction of the hippocampus, disrupting recollection, and/or (2) dysfunction of prefrontal cortex, disrupting post-retrieval processes.

  View details for DOI 10.1016/j.neuropsychologia.2007.04.021

  View details for Web of Science ID 000249145800015

  View details for PubMedID 17573074