A research participant was monitored over nearly two decades at Mayo Clinic, undergoing annual neurologic assessments, neuropsychological tests, and multimodal imaging. Initially, he was cognitively normal but developed symptoms consistent with Posterior Cortical Atrophy (PCA) during the study. Early tests indicated mild, yet normal-range declines in language and visuospatial skills. FDG-PET scans revealed increased metabolism in posterior brain regions long before symptoms appeared. Advanced analysis using a novel in-house machine-learning tool predicted concurrent Alzheimer\'s disease and dementia with Lewy bodies. Autopsy confirmed a mixed neurodegenerative condition with significant Alzheimer\'s pathology and dense neocortical Lewy bodies. This case underscores the value of longitudinal imaging in predicting complex neurodegenerative diseases, offering vital insights into the early neurocognitive changes associated with PCA and dementia with Lewy bodies.

BACKGROUND: Bipolar disorders are serious mental illnesses, yet evidence suggests that the diagnosis and treatment of bipolar disorder can be delayed by around 6 years.
OBJECTIVE: To identify signals of undiagnosed bipolar disorder using routinely collected electronic health records.
METHODS: A nested case-control study conducted using the UK Clinical Practice Research Datalink (CPRD) GOLD dataset, an anonymised electronic primary care patient database linked with hospital records. \'Cases\' were adult patients with incident bipolar disorder diagnoses between 1 January 2010 and 31 July 2017.
METHODS: The patients with bipolar disorder (the bipolar disorder group) were matched by age, sex, and registered general practice to 20 \'controls\' without recorded bipolar disorder (the control group). Annual episode incidence rates were estimated and odds ratios from conditional logistic regression models were reported for recorded health events before the index (diagnosis) date.
RESULTS: There were 2366 patients with incident bipolar disorder diagnoses and 47 138 matched control patients (median age 40 years and 60.4% female: n = 1430/2366 with bipolar disorder and n = 28 471/47 138 without). Compared with the control group, the bipolar disorder group had a higher incidence of diagnosed depressive, psychotic, anxiety, and personality disorders and escalating self-harm up to 10 years before a bipolar disorder diagnosis. Sleep disturbance, substance misuse, and mood swings were more frequent among the bipolar disorder group than the control group. The bipolar disorder group had more frequent face-to-face consultations, and were more likely to miss multiple scheduled appointments and to be prescribed ≥3 different psychotropic medication classes in a given year.
CONCLUSIONS: Psychiatric diagnoses, psychotropic prescriptions, and health service use patterns might be signals of unreported bipolar disorder. Recognising these signals could prompt further investigation for undiagnosed significant psychopathology, leading to timely referral, assessment, and initiation of appropriate treatments.

OBJECTIVE: We present the neuropsychological profile of a 33-year-old female with a history of transient amnestic events preceding frontal intraparenchymal/intraventricular hemorrhage, bilateral frontal cerebral edema and subarachnoid hemorrhage following a rupture of an anterior communicating artery aneurysm (ACoA).
METHODS: Comprehensive neuropsychological evaluation referral by neurology to assist with treatment planning given cognitive and behavioral changes since rupture of ACoA aneurysm. Prior to hospitalization, transient episodes of feeling as if she had been \"drugged at a party,\" followed by behavior changes (e.g., irritability/agitation, \"not herself\") were notable, while the patient was amnestic to the events; spanning days at a time.
RESULTS: Intellectual functioning was well-preserved. Neuropsychological testing revealed weaknesses in visuospatial organization, word retrieval, and aspects of executive functioning. Most salient were deficiencies in memory; patient was amnestic to tests shortly after administration. Striking emotional lability/frequent bouts of laughing disproportionate to the conversation and social comportment inappropriate to the setting were present.
CONCLUSIONS: To our knowledge, amnestic events preceding ACoA aneurysm rupture have not been reported, and perhaps the symptoms this patient experienced prior to the event were indeed prodromal in nature. Therefore, the potentially rare phenomena in the form of transient amnesia should be further investigated. While these symptoms of memory lapses may be nonspecific and unique to the patient, we also cannot rule out possible \"sentinel seizure\" as a potential warning sign.

The first episode of psychotic disorders often occurs in adolescence. Depressive symptoms are the most common symptoms in the prodromal period and the symptoms in this period are not specific to psychosis. Adolescence is a risky period in terms of suicidal behaviors. The risk of self-harm is further increased in the prodromal period and in the psychotic episode. Homicides in psychosis constitute a small part of all homicidal cases and homicidal thoughts have been associated with command hallucinations and delusions. In this article, an adolescent girl with psychosis who had intense homicidal and suicidal thoughts and self-harming behaviors will be presented, and homicidal thoughts in psychosis will be discussed. The symptoms of the case decreased with risperidone, and she started to socialize with the support of her teacher, who visited her house for lectures. The medical, legal, and social aspects of suicides and homicides in psychosis are discussed. Keywords: Adolescent, psychosis, homicidal, suicidal.

Large prospective studies are essential for investigating the environmental causes of Parkinson\'s disease (PD), but PD diagnosis via clinical exams is often infeasible in such studies.
To present case ascertainment strategy and data collection in a US cohort of women.
In the Sister Study (n = 50,884, baseline ages 55.6±9.0), physician-made PD diagnoses were first reported by participants or their proxies. Cohort-wide follow-up surveys collected data on subsequent diagnoses, medication usage and PD-relevant motor and nonmotor symptoms. We contacted self-reported PD cases and their treating physicians to obtain relevant diagnostic and treatment history. Diagnostic adjudication was made via expert review of all available data, except nonmotor symptoms. We examined associations of nonmotor symptoms with incident PD, using multivariable logistic regression models and reported odds ratio (OR) and 95% confidence intervals (CI).
Of the 371 potential PD cases identified, 242 diagnoses were confirmed. Compared with unconfirmed cases, confirmed cases were more likely to report PD diagnosis from multiple sources, medication usage, and motor and nonmotor features consistently during the follow-up. PD polygenic risk score was associated with confirmed PD (ORinter-quartile range = 1.74, 95% CI: 1.45-2.10), but not with unconfirmed cases (corresponding OR = 1.05). Hyposmia, dream-enacting behaviors, constipation, depression, unexplained weight loss, dry eyes, dry mouth, and fatigue were significantly related to PD risk, with ORs from 1.71 to 4.88. Only one of the eight negative control symptoms was associated with incident PD.
Findings support our PD case ascertainment approach in this large cohort of women. PD prodromal presentation is likely beyond its well-documented profile.

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BACKGROUND: Most women experience prodromal myocardial infarction (MI) symptoms, but more information is needed about the perception, attribution, and care-seeking behaviors related to these prodromal symptoms.
OBJECTIVE: We aimed to describe women\'s perceptions, attributions, and care-seeking behaviors related to prodromal MI symptoms.
METHODS: We used a qualitative, multiple case study approach, recruiting participants during summer 2019 from a large hospital in the Midwestern United States. Data were collected from interviews with the women who experienced MI and some of their family members, journals, and electronic health records. An inductive, comparative analysis procedure was applied.
RESULTS: Ten women, ages 42 to 84, participated in the study. The women experienced a mixture of certainty and uncertainty related to their symptoms and engaged in several cognitive processes to conceptualize and act upon their symptoms. Although all the women retrospectively reported at least 4 prodromal symptoms, they lacked knowledge of prodromal MI symptoms and often responded to prodromal sensations that they experienced using emotion- and avoidance-based strategies. It was difficult for the women to establish a symptom pattern that was attributable to heart disease.
CONCLUSIONS: The findings of this study may be used as evidence to support interventions that would facilitate women\'s care seeking for and health care providers\' recognition of prodromal MI symptoms. Additional research is necessary to more fully characterize the cognitive processes at play for women of many different sociocultural backgrounds who experience prodromal MI symptoms.

Significant progress has been made in expanding our understanding of prodromal Parkinson disease (PD), particularly for recognition of early motor and nonmotor signs and symptoms. Although identification of these prodromal features may improve our understanding of the earliest stages of PD, they are individually insufficient for early disease detection and enrollment of participants in prevention trials in most cases because of low sensitivity, specificity, and positive predictive value. Composite cohorts, composed of individuals with multiple co-occurring prodromal features, are an important resource for conducting prodromal PD research and eventual prevention trials because they are more representative of the population at risk for PD, allow investigators to evaluate the efficacy of an intervention across individuals with varying prodromal feature patterns, are able to produce larger sample sizes, and capture individuals at different stages of prodromal PD. A key challenge in identifying individuals with prodromal disease for composite cohorts and prevention trial participation is that we know little about the natural history of prodromal PD. To move toward prevention trials, it is critical that we better understand common prodromal feature patterns and be able to predict the probability of progression and phenoconversion. Ongoing research in cohort studies and administrative databases is beginning to address these questions, but further longitudinal analyses in a large population-based sample are necessary to provide a convincing and definitive strategy for identifying individuals to be enrolled in a prevention trial.

Some physical illnesses are potentially associated with the development of schizophrenia. However, few studies have investigated these associations. Here, we examined physical illnesses and medical utilization patterns existing before patients received a diagnosis of schizophrenia. We enrolled a large representative cohort of the general population in Taiwan (N = 1 000 000) and identified 1969 young patients with a new diagnosis of schizophrenia from January 1, 2000 to December 31, 2013. We conducted a nested case-control study based on risk-set sampling. Each case was age-matched and sex-matched with 4 controls selected from the general population. The case and control groups were compared on the basis of various clinical characteristics. Conditional logistic regression was used to estimate the magnitude of risk associated with newly diagnosed schizophrenia. Within the 1 year before the schizophrenia diagnosis, the cases were most likely to visit the psychiatry department, followed by internal medicine and family medicine departments. According to multivariate analysis, compared with the controls, the cases had substantially higher risk of physical conditions in the prodromal phase, including hypertension (adjusted risk ratio [aRR] = 1.93, P = .001), other forms of heart disease (aRR = 2.07, P < .001), cerebrovascular diseases (aRR = 2.96, P = .001), chronic obstructive pulmonary disease (aRR = 1.50, P = .005), asthma (aRR = 1.76, P = .003), and irritable bowel syndrome (aRR = 2.00, P < .001). A wide range of psychiatric diseases and concomitant use of medications were significantly associated with schizophrenia development. In conclusion, several physical illnesses were identified to be associated with schizophrenia development, indicating that people with these illnesses could be vulnerable to schizophrenia.

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