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Dive into the research topics where Kevin M. Biglan is active.

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Featured researches published by Kevin M. Biglan.


Neurology | 2007

Projected number of people with Parkinson disease in the most populous nations, 2005 through 2030

E. R. Dorsey; Radu Constantinescu; Joel P. Thompson; Kevin M. Biglan; Robert G. Holloway; Karl Kieburtz; Frederick Marshall; Bernard Ravina; Giovanni Schifitto; Andrew Siderowf; Caroline M. Tanner

Based on published prevalence studies, we used two different methodologies to project the number of individuals with Parkinson disease (PD) in Western Europe’s 5 most and the world’s 10 most populous nations. The number of individuals with PD over age 50 in these countries was between 4.1 and 4.6 million in 2005 and will double to between 8.7 and 9.3 million by 2030.


Journal of Neurology, Neurosurgery, and Psychiatry | 2008

Detection of Huntington’s disease decades before diagnosis: the Predict-HD study

Jane S. Paulsen; Douglas R. Langbehn; Julie C. Stout; Elizabeth H. Aylward; Christopher A. Ross; Martha Nance; Mark Guttman; Shannon A. Johnson; Marcy E. MacDonald; Leigh J. Beglinger; Kevin Duff; Elise Kayson; Kevin M. Biglan; Ira Shoulson; David Oakes; Michael R. Hayden

Objective: The objective of the Predict-HD study is to use genetic, neurobiological and refined clinical markers to understand the early progression of Huntington’s disease (HD), prior to the point of traditional diagnosis, in persons with a known gene mutation. Here we estimate the approximate onset and initial course of various measurable aspects of HD relative to the time of eventual diagnosis. Methods: We studied 438 participants who were positive for the HD gene mutation, but did not yet meet the diagnostic criteria for HD and had no functional decline. Predictability of baseline cognitive, motor, psychiatric and imaging measures was modelled non-linearly using estimated time until diagnosis (based on CAG repeat length and current age) as the predictor. Results: Estimated time to diagnosis was related to most clinical and neuroimaging markers. The patterns of association suggested the commencement of detectable changes one to two decades prior to the predicted time of clinical diagnosis. The patterns were highly robust and consistent, despite the varied types of markers and diverse measurement methodologies. Conclusions: These findings from the Predict-HD study suggest the approximate time scale of measurable disease development, and suggest candidate disease markers for use in preventive HD trials.


Neuropsychology (journal) | 2011

Neurocognitive Signs in Prodromal Huntington Disease

Julie C. Stout; Jane S. Paulsen; Sarah Queller; Andrea C. Solomon; Kathryn B. Whitlock; J. Colin Campbell; Noelle E. Carlozzi; Kevin Duff; Leigh J. Beglinger; Douglas R. Langbehn; Shannon A. Johnson; Kevin M. Biglan; Elizabeth H. Aylward

OBJECTIVE PREDICT-HD is a large-scale international study of people with the Huntington disease (HD) CAG-repeat expansion who are not yet diagnosed with HD. The objective of this study was to determine the stage in the HD prodrome at which cognitive differences from CAG-normal controls can be reliably detected. METHOD For each of 738 HD CAG-expanded participants, we computed estimated years to clinical diagnosis and probability of diagnosis in 5 years based on age and CAG-repeat expansion number (Langbehn, Brinkman, Falush, Paulsen, & Hayden, 2004). We then stratified the sample into groups: NEAR, estimated to be ≤9 years; MID, between 9 and 15 years; and FAR, ≥15 years. The control sample included 168 CAG-normal participants. Nineteen cognitive tasks were used to assess attention, working memory, psychomotor functions, episodic memory, language, recognition of facial emotion, sensory-perceptual functions, and executive functions. RESULTS Compared with the controls, the NEAR group showed significantly poorer performance on nearly all of the cognitive tests and the MID group on about half of the cognitive tests (p = .05, Cohens d NEAR as large as -1.17, MID as large as -0.61). One test even revealed significantly poorer performance in the FAR group (Cohens d = -0.26). Individual tasks accounted for 0.2% to 9.7% of the variance in estimated proximity to diagnosis. Overall, the cognitive battery accounted for 34% of the variance; in comparison, the Unified Huntingtons Disease Rating Scale motor score accounted for 11.7%. CONCLUSIONS Neurocognitive tests are robust clinical indicators of the disease process prior to reaching criteria for motor diagnosis of HD.


Movement Disorders | 2009

Motor abnormalities in premanifest persons with Huntington's disease: the PREDICT-HD study.

Kevin M. Biglan; Christopher A. Ross; Douglas R. Langbehn; Elizabeth H. Aylward; Julie C. Stout; Sarah Queller; Noelle E. Carlozzi; Kevin Duff; Leigh J. Beglinger; Jane S. Paulsen

The PREDICT‐HD study seeks to identify clinical and biological markers of Huntingtons disease in premanifest individuals who have undergone predictive genetic testing. We compared baseline motor data between gene‐expansion carriers (cases) and nongene‐expansion carriers (controls) using t‐tests and Chi‐square. Cases were categorized as near, mid, or far from diagnosis using a CAG‐based formula. Striatal volumes were calculated using volumetric magnetic resonance imaging measurements. Multiple linear regression associated total motor score, motor domains, and individual motor items with estimated diagnosis and striatal volumes. Elevated total motor scores at baseline were associated with higher genetic probability of disease diagnosis in the near future (partial R2 0.14, P < 0.0001) and smaller striatal volumes (partial R2 0.15, P < 0.0001). Nearly all motor domain scores showed greater abnormality with increasing proximity to diagnosis, although bradykinesia and chorea were most highly associated with diagnostic immediacy. Among individual motor items, worse scores on finger tapping, tandem gait, Luria, saccade initiation, and chorea show unique association with diagnosis probability. Even in this premanifest population, subtle motor abnormalities were associated with a higher probability of disease diagnosis and smaller striatal volumes. Longitudinal assessment will help inform whether motor items will be useful measures in preventive clinical trials.


Movement Disorders | 2009

Atomoxetine for the treatment of executive dysfunction in Parkinson's disease: A pilot open‐label study

Laura Marsh; Kevin M. Biglan; Melissa Gerstenhaber; James R. Williams

Executive dysfunction (ED) is a prominent and often disabling feature of cognitive impairment in Parkinsons disease (PD). Few studies have examined treatments. Given the role of noradrenergic pathology in ED, atomoxetine, a norepinephrine reuptake inhibitor indicated for attention deficit hyperactivity disorder (ADHD), may be a potential treatment for PD‐related ED. Twelve patients with PD and disabling ED completed an 8‐week pilot open‐label, flexible dose (25–100 mg/day) trial of atomoxetine. On primary outcome measures, atomoxetine was associated with improved ED based on the Clinical Global Impression‐Change Scale (75% positive response rate; 95% CI: 43–95%, P < 05) and behavioral measures of ED [Frontal Systems Behavior Scale (FrSBE) Executive Dysfunction and Connors Adult ADHD Rating Scale (CAARS) inattention/memory subscales]. Adverse effects included sleep and gastrointestinal disturbances and hypomania. Atomoxetine is tolerable in PD and may benefit clinical manifestations of ED, warranting further study in controlled trials.


Parkinsonism & Related Disorders | 2015

Detecting and monitoring the symptoms of Parkinson's disease using smartphones: A pilot study

Siddharth Arora; Vinayak Venkataraman; Andong Zhan; Sean R. Donohue; Kevin M. Biglan; E.R. Dorsey; Max A. Little

BACKGROUND Remote, non-invasive and objective tests that can be used to support expert diagnosis for Parkinsons disease (PD) are lacking. METHODS Participants underwent baseline in-clinic assessments, including the Unified Parkinsons Disease Rating Scale (UPDRS), and were provided smartphones with an Android operating system that contained a smartphone application that assessed voice, posture, gait, finger tapping, and response time. Participants then took the smart phones home to perform the five tasks four times a day for a month. Once a week participants had a remote (telemedicine) visit with a Parkinson disease specialist in which a modified (excluding assessments of rigidity and balance) UPDRS performed. Using statistical analyses of the five tasks recorded using the smartphone from 10 individuals with PD and 10 controls, we sought to: (1) discriminate whether the participant had PD and (2) predict the modified motor portion of the UPDRS. RESULTS Twenty participants performed an average of 2.7 tests per day (68.9% adherence) for the study duration (average of 34.4 days) in a home and community setting. The analyses of the five tasks differed between those with Parkinson disease and those without. In discriminating participants with PD from controls, the mean sensitivity was 96.2% (SD 2%) and mean specificity was 96.9% (SD 1.9%). The mean error in predicting the modified motor component of the UPDRS (range 11-34) was 1.26 UPDRS points (SD 0.16). CONCLUSION Measuring PD symptoms via a smartphone is feasible and has potential value as a diagnostic support tool.


Neurology | 2007

Risk factors for somnolence, edema, and hallucinations in early Parkinson disease

Kevin M. Biglan; Robert G. Holloway; Michael P. McDermott; Irene Hegeman Richard

Background: The CALM-PD trial evaluated the development of motor complications in subjects with early Parkinson disease (PD) randomized to initial treatment with either pramipexole or levodopa. A secondary finding of the trial was a higher than anticipated development or worsening of somnolence and edema and development of hallucinations. Objectives: To investigate risk factors for somnolence, edema, and hallucinations in patients with early PD initiating dopaminergic therapy. Methods: This was a secondary analysis of data from the CALM-PD trial. Baseline patient characteristics were evaluated for their associations with the development or worsening of somnolence and edema and the development of hallucinations using Cox proportional hazards regression models. Results: Kaplan-Meier estimates of the 4-year incidence of the development or worsening of somnolence and edema and the development of hallucinations were 35%, 45%, and 17%. Initial pramipexole treatment (hazard ratio [HR] 2.22, 95% CI 1.41, 3.50, p < 0.001), male gender (HR 1.79, 95% CI 1.09, 2.93, p = 0.02), and >5 systems with a comorbid illness (HR 1.62, 95% CI 1.04, 2.51, p = 0.03) were associated with somnolence. Initial pramipexole treatment (HR 3.18, 95% CI 1.95, 5.18, p < 0.0001), female gender (HR 1.46, 95% CI 0.94, 2.27, p = 0.09), and comorbid cardiac disease (HR 1.59, 95% CI 1.02, 2.47, p = 0.04) were associated with edema. Age ≥65 (HR 2.06, 95% CI 0.98, 4.32, p = 0.06), Mini-Mental State Examination score >28 (HR 0.42, 95% CI 0.19, 0.91, p = 0.03), and >5 systems with a comorbid illness (HR 3.42, 95% CI 1.59, 7.38, p = 0.002) were associated with hallucinations. Conclusions: Comorbid illnesses are important and overlooked risk factors for the development of somnolence, edema, and hallucinations. When initiating therapy with pramipexole, patients should be counseled about and monitored for somnolence and edema. Slight decrements in cognitive function and older age are associated with an increased risk of hallucinations.


Movement Disorders | 2008

The relationship between CAG repeat length and clinical progression in Huntington's disease†‡

Bernard Ravina; Megan Romer; Radu Constantinescu; Kevin M. Biglan; Alicia Brocht; Karl Kieburtz; Ira Shoulson; Michael P. McDermott

The objective of this study was to examine the relationship between CAG repeat length (CAGn) and clinical progression in patients with Huntingtons disease (HD). There are conflicting reports about the relationship between CAGn and clinical progression of HD. We conducted an analysis of data from the Coenzyme Q10 and Remacemide Evaluation in Huntingtons Disease (CARE‐HD) clinical trial. We modeled progression over 30 months on the Unified Huntingtons Disease Rating Scale (UHDRS) and supplemental neuropsychological and behavioral tests using multiple linear regression. Mean subject age was 47.9 ± 10.5 years and mean CAGn was 45.0 ± 4.1. Multiple linear regression revealed statistically significant associations between CAGn and worsening on several motor, cognitive, and functional outcomes, but not behavioral outcomes. Many effects were clinically important; 10 additional CAG repeats were associated with an 81% increase in progression on the Independence Scale. These associations were not observed in the absence of age adjustment. Age at the time of assessment confounds the association between CAGn and progression. Adjusting for age shows that longer CAGn is associated with greater clinical progression of HD. This finding may account for the variable results from previous studies examining CAGn and progression. Adjusting for CAGn may be important for clinical trials.


Movement Disorders | 2010

Increasing access to specialty care: A pilot, randomized controlled trial of telemedicine for Parkinson's disease†

E. Ray Dorsey; Lisa M. Deuel; Tiffini S. Voss; Kara S. Finnigan; Benjamin P. George; Sheelah Eason; David Miller; Jason I. Reminick; Anna Appler; Joyce Polanowicz; Lucy Viti; Sandy Smith; Anthony Joseph; Kevin M. Biglan

We conducted a randomized, controlled pilot trial to evaluate the feasibility of providing subspecialty care via telemedicine for patients with Parkinsons disease residing in a remote community located ∼130 miles from an academic movement disorders clinic. Study participants were randomized to receive telemedicine care with a movement disorder specialist at the University of Rochester or to receive their usual care. Participants in the telemedicine group received three telemedicine visits over six months. Feasibility, as measured by the completion of telemedicine visits, was the primary outcome measure. Secondary measures were quality of life, patient satisfaction, and clinical outcomes. Ten participants residing in the community were randomized to receive telemedicine care (n = 6) or their usual care (n = 4). Four nursing home patients were assigned to telemedicine. Those receiving telemedicine completed 97% (29 of 30) of their telemedicine visits as scheduled. At the studys conclusion, 13 of 14 study participants opted to receive specialty care via telemedicine. Compared with usual care, those randomized to telemedicine had significant improvements in quality of life (3.4 point improvement vs. 10.3 point worsening on the Parkinsons Disease Questionnaire 39; P = 0.04) and motor performance (0.3 point improvement vs. 6.5 point worsening on the Unified Parkinsons Disease Rating Scale, motor subscale; P = 0.03). Relative to baseline, nursing home patients experienced trends toward improvement in quality of life and patient satisfaction. Providing subspecialty care via telemedicine for individuals with Parkinsons disease living remotely is feasible.


Movement Disorders | 2014

The past, present, and future of telemedicine for Parkinson's disease

Meredith Achey; Jason Aldred; Noha Aljehani; Bastiaan R. Bloem; Kevin M. Biglan; Piu Chan; Esther Cubo; E. Ray Dorsey; Christopher G. Goetz; Mark Guttman; Anhar Hassan; Suketu M. Khandhar; Zoltan Mari; Meredith Spindler; Caroline M. Tanner; Pieter van den Haak; Richard Walker; Jayne R. Wilkinson

Travel distance, growing disability, and uneven distribution of doctors limit access to care for most Parkinsons disease (PD) patients worldwide. Telemedicine, the use of telecommunications technology to deliver care at a distance, can help overcome these barriers. In this report, we describe the past, present, and likely future applications of telemedicine to PD. Historically, telemedicine has relied on expensive equipment to connect single patients to a specialist in pilot programs in wealthy nations. As the cost of video conferencing has plummeted, these efforts have expanded in scale and scope, now reaching larger parts of the world and extending the focus from care to training of remote providers. Policy, especially limited reimbursement, currently hinders the growth and adoption of these new care models. As these policies change and technology advances and spreads, the following will likely develop: integrated care networks that connect patients to a wide range of providers; education programs that support patients and health care providers; and new research applications that include remote monitoring and remote visits. Together, these developments will enable more individuals with PD to connect to care, increase access to expertise for patients and providers, and allow more‐extensive, less‐expensive participation in research.

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E. Ray Dorsey

University of Rochester Medical Center

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Ira Shoulson

University of Rochester

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Christopher A. Beck

University of Rochester Medical Center

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Christopher A. Ross

Johns Hopkins University School of Medicine

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David Oakes

University of Rochester

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