ORCID Profile
0000-0001-5519-981X
Current Organisations
Walter and Eliza Hall Institute of Medical Research
,
Melbourne Health
,
Melbourne Neuropsychiatry Centre
,
Epworth Richmond
,
Bionics Institute
,
Royal Australasian College of Physicians
,
University of Melbourne
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Publisher: Elsevier BV
Date: 08-2022
DOI: 10.1111/NER.13407
Publisher: Cambridge University Press (CUP)
Date: 28-04-2023
DOI: 10.1017/NEU.2023.25
Abstract: People with neuropsychiatric symptoms often experience delay in accurate diagnosis. Although cerebrospinal fluid neurofilament light (CSF NfL) shows promise in distinguishing neurodegenerative disorders (ND) from psychiatric disorders (PSY), its accuracy in a diagnostically challenging cohort longitudinally is unknown. We collected longitudinal diagnostic information (mean = 36 months) from patients assessed at a neuropsychiatry service, categorising diagnoses as ND/mild cognitive impairment/other neurological disorders (ND/MCI/other) and PSY. We pre-specified NfL 582 pg/mL as indicative of ND/MCI/other. Diagnostic category changed from initial to final diagnosis for 23% (49/212) of patients. NfL predicted the final diagnostic category for 92% (22/24) of these and predicted final diagnostic category overall (ND/MCI/other vs. PSY) in 88% (187/212), compared to 77% (163/212) with clinical assessment alone. CSF NfL improved diagnostic accuracy, with potential to have led to earlier, accurate diagnosis in a real-world setting using a pre-specified cut-off, adding weight to translation of NfL into clinical practice.
Publisher: Hindawi Limited
Date: 24-07-2019
DOI: 10.1155/2019/8143868
Abstract: Background . While numerous validated questionnaires measuring psychiatric symptoms in Parkinson’s disease (PD) are available, a quick multifaceted screening tool is lacking. Objective . To generate the Brief Psychiatric Questionnaire (BPQ) that quickly screens for depression, anxiety, and apathy and to evaluate its content validity against three reference scales. Methods . Forty-seven questions were drafted and measured against the Geriatric Depression Scale (GDS), State Trait Anxiety Inventory (Form Y2) (STAI-Y2), and Apathy Evaluation Scale (AES). Data were reduced by principal component analysis and linear regression. Content validity and repeatability were assessed in a second cohort. Results . Data from ninety-five patients were used for BPQ development. Variation explained by the final linear regression models was 52% for GDS ( R 2 = 0.521, F (2,94) = 49.97, p 0.0001 ), 65% for STAI-Y2 ( R 2 = 0.652, F (4,94) = 42.08, p 0.0001 ), and 14% for AES ( R 2 = 0.135, F (1,94) = 14.51, p 0.0001 ). From the initial pool, only five questions remained for further testing. BPQ questions correctly identified 88% in the second cohort of 33 patients scoring more than five on GDS and 91% who scored in the highest decile of STAI-Y2, but only 51% who scored in the highest decile of AES. Moderate to strong correlation ( r = 0.464 − 0.733, p 0.004 ) between predicted scores based on BPQ questions and actual scores of three validated questionnaires was demonstrated. Good repeatability of BPQ questions was demonstrated by moderate to high intraclass correlation coefficients (0.47–0.772, p 0.01 ). Conclusions . BPQ questions were able to accurately identify patients at risk of depression and anxiety but not apathy. It is brief and multifaceted and can act as a preconsultation tool to prompt further psychiatric assessment.
Publisher: Wiley
Date: 11-2021
DOI: 10.1111/IMJ.15569
Abstract: Chronic graft‐versus‐host disease (cGVHD) complicating allogeneic haemopoietic stem cell transplantation rarely involves the nervous system oromandibular parafunction has not been previously reported. We describe five patients with cGVHD, presenting with bruxism, limitation of mouth opening, jaw locking, pain and masseter hypertrophy. Pathophysiological mechanisms are discussed. Targeted botulinum toxin injections were an effective treatment with minimal side‐effects.
Publisher: Wiley
Date: 28-05-2019
DOI: 10.1002/MDS.27689
Abstract: Impulse control disorders (ICDs) and related impulsive and compulsive behaviors (together called ICBs) have been increasingly recognized in the context of Parkinson's disease (PD) and treatment. The International Parkinson's and Movement Disorder Society commissioned a task force to assess available clinical screening instruments and rating scales, including their clinimetric properties, make recommendations regarding their utility, and suggest future directions in scale development and validation. The literature was systematically searched for scales measuring a range of reported ICBs in PD. A scale was designated "recommended" if the scale had been employed in PD studies, been used beyond the group that developed it, and had adequate clinimetric data published for PD. Numerous diagnostic screening tools and severity rating scales were identified for a range of ICBs, including compulsive medication use, punding/hobbyism, walkabout, pathological gambling, hypersexuality, compulsive or binge eating, compulsive buying, reckless driving, compulsive exercise, pyromania, trichotillomania, hoarding, kleptomania, intermittent explosive disorder, and internet addiction. For screening across the range of ICBs (except compulsive medication use), the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease (QUIP) and QUIP-Rating Scale (QUIP-RS) are recommended, and for severity rating across the range of ICBs the QUIP-RS and the Ardouin Scale of Behavior in Parkinson's Disease are recommended. The Scale for Outcomes in Parkinson's Disease-Psychiatric Complications is recommended for rating of hypersexuality and the compulsive behaviors gambling/shopping. Further testing of established scales against gold standard diagnostic criteria is urgently required for all other in idual ICBs in PD. © 2019 International Parkinson and Movement Disorder Society © 2019 International Parkinson and Movement Disorder Society.
Publisher: MDPI AG
Date: 18-05-2023
Abstract: Parkinson’s disease (PD) is a chronic and progressive age-related neurodegenerative disease affecting up to 3% of the global population over 65 years of age. Currently, the underlying physiological aetiology of PD is unknown. However, the diagnosed disorder shares many common non-motor symptoms associated with ageing-related neurodegenerative disease progression, such as neuroinflammation, microglial activation, neuronal mitochondrial impairment, and chronic autonomic nervous system dysfunction. Clinical PD has been linked to many interrelated biological and molecular processes, such as escalating proinflammatory immune responses, mitochondrial impairment, lower adenosine triphosphate (ATP) availability, increasing release of neurotoxic reactive oxygen species (ROS), impaired blood brain barrier integrity, chronic activation of microglia, and damage to dopaminergic neurons consistently associated with motor and cognitive decline. Prodromal PD has also been associated with orthostatic hypotension and many other age-related impairments, such as sleep disruption, impaired gut microbiome, and constipation. Thus, this review aimed to present evidence linking mitochondrial dysfunction, including elevated oxidative stress, ROS, and impaired cellular energy production, with the overactivation and escalation of a microglial-mediated proinflammatory immune response as naturally occurring and damaging interlinked bidirectional and self-perpetuating cycles that share common pathological processes in ageing and PD. We propose that both chronic inflammation, microglial activation, and neuronal mitochondrial impairment should be considered as concurrently influencing each other along a continuum rather than as separate and isolated linear metabolic events that affect specific aspects of neural processing and brain function.
Location: Australia
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Andrew Evans.