Podcasts about disorders

In episode 62 we discuss the article “Oral vs Extended-Release Injectable Naltrexone for Hospitalized Patients with Alcohol Use Disorder.” Magane KM, et al.Oral vs Extended-Release Injectable Naltrexone for Hospitalized Patients With Alcohol Use Disorder: A Randomized Clinical Trial. JAMA Intern Med. 2025 Jun 1;185(6):635-645. We also discuss reduced overdose deaths and changes in buprenorphine labelling to include higher doses. NPR:Drug deaths plummet among young Americans as fentanyl carnage eases Federal Register:Modifications to Labeling of Buprenorphine-Containing Transmucosal Products for the Treatment of Opioid Dependence --- This podcast offers category 1 and MATE-ACT CME credits through MI CARES and Michigan State University. To get credit for this episode and others, go tothis link to make your account, take a brief quiz, and claim your credit. To learn more about opportunities in addiction medicine, visitMI CARES. CME: https://micaresed.org/courses/podcast-addiction-medicine-journal-club/ --- Original theme music:composed and performed by Benjamin Kennedy Audio editing: Michael Bonanno Executive producer:Dr. Patrick Beeman A podcast fromArs Longa Media --- This is Addiction Medicine Journal Club with Dr. Sonya Del Tredici and Dr. John Keenan. We practice addiction medicine and primary care, and we believe that addiction is a disease that can be treated. This podcast reviews current articles to help you stay up to date with research that you can use in your addiction medicine practice. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dan Jones, retired EPS member (spent time with the gang's unit and homicide team), chair of justice studies, NorQuest College Learn more about your ad choices. Visit megaphone.fm/adchoices

Contact Welcomed HereMOD episodes have no shelf-life or expiration date.  Our focus is principled so each episode reflects the immediate peace and stability of our Ever-Present Knowing Awareness that clarifies conflicted impressions manifest by the instability and hyper-reactivity of obsessive thoughts purely induced, “imagined reality”.While the Absolute nature of Life is an unadulterated gift - we earn our human experience. Good or bad, like it or not, it is how and what we think of Life, Reality, and Truth that complicate all the consequential forms of conflicted dysfunctional incapacities incorrectly blamed on life and human nature. It is not Life that is impossible, hard, or a struggle but imagining that our thoughts about it are omnipotent and as a result unchangeable. This addictive mental trend has the world of things and people seem in chronic need of change while we choose to inflict others with our thoughts to pretend we are not capable of causing such conflicts. This induced form of insanity once seen clearly is laughable. The only thoughts induced insanity seemingly overlook are the mistaken beliefs of their perpetrator. Acting like we're in a coma to maintain unnatural conditions does not affect our essence but causes over-dramatic mental and inter-reactive consequences. We choose how and what we think - and this news is good or bad dependent on how accurately, or honestly, our choices are conceded.  We Know We Know. We Are Aware We Are Aware. We Are as We Are. Reality is unlimited and never changes. The idea that how and what we think creates reality suggests otherwise. Acting on backward thoughts leads to behaviors that are out of order reflecting a reversal of our natural fortune. Anxious, nervous and systemic disorders reflect this impossible attempt to reverse the Law and order of the universe. Dis-ease is the lack of ease created and maintained by such twisted mental acrobatics. Stress and Anxiety inhibit healing and so contribute to any ailments. Mentality is a bodily function. Mental disease is a physcial ailment leading to others as long as it is improperly diagnosed - any treatment will perpetuate its contagion. Principles affirm our indivisible nature. Sharing principles affirms and confirms our indivisibility as our nature. Inspiration is natural while desperation, depression, degradation and acting oblivious to what is obvious is a choice. Absolute Intelligence, Peace and Silence is Nature's nature since It does not change. The nature of nature is naturally our nature. Ignoring what is happening, acting as though it shouldn't be or isn't happening, produces the unintelligible jibbersh of ignorance - not reality.

COMPUTER

No guest this week, just a lot of news to talk about. Like what games does CMON have left? And why is Asmodee hiring their crowdfunding “expert”? Even I can read the tea leaves on why thats a bad idea. Also, would you pay $165 for a Magic the Gathering event? I don't think I would.

Welcome or welcome back to Authentically ADHD, the podcast where we embrace the chaos and magic of the ADHD brain. Im carmen and today we're diving into a topic that's as complex as my filing system (which is to say, very): ADHD and its common co-occurring mood and learning disorders. Fasten your seatbelts (and if you're like me, try not to get distracted by the shiny window view) – we're talking anxiety, depression, OCD, dyslexia, dyscalculia, and bipolar disorder, all hanging out with ADHD.Why cover this? Because ADHD rarely rides solo. In fact, research compiled by Dr. Russell Barkley finds that over 80% of children and adults with ADHD have at least one other psychiatric disorder, and more than half have two or more coexisting conditions. Two-thirds of folks with ADHD have at least one coexisting condition, and often the classic ADHD symptoms (you know, fidgeting, daydreaming, “Did I leave the stove on?” moments) can overshadow those other disorders. It's like ADHD is the friend who talks so loud at the party that you don't notice the quieter buddies (like anxiety or dyslexia) tagging along in the background.But we're going to notice them today. With a blend of humor, sass, and solid neuroscience (yes, we can be funny and scientific – ask me how I know!), we'll explore how each of these conditions shows up alongside ADHD. We'll talk about how they can be misdiagnosed or missed entirely, and—most importantly—we'll dish out strategies to tell them apart and tackle both. Knowledge is power and self-awareness is the key, especially when it comes to untangling ADHD's web of quirks and comrades in chaos. So, let's get into it!ADHD and Anxiety: Double Trouble in OverdriveLet's start with anxiety, ADHD's frequent (and frantic) companion. Ever had your brain ping-pong between “I can't focus on this work” and “I'm so worried I'll mess it up”? That's ADHD and anxiety playing tango in your head. It's a double whammy: ADHD makes it hard to concentrate, and anxiety cranks up the worry about consequences. As one study notes, about 2 in 5 children with ADHD have significant problems with anxiety, and over half of adults with ADHD do as well. In other words, if you have ADHD and feel like a nervous wreck half the time, you're not alone – you're in very good (and jittery) company.ADHD and anxiety can look a lot alike on the surface. Both can make you restless, unfocused, and irritable. I mean, is it ADHD distractibility or am I just too busy worrying about everything to pay attention? (Hint: it can be both.) Especially for women, ADHD is often overlooked and mislabeled as anxiety. Picture a girl who can't concentrate in class: if she's constantly daydreaming and fidgety, one teacher calls it ADHD. Another sees a quiet, overwhelmed student and calls it anxiety. Same behavior, different labels. Women in particular have had their ADHD misdiagnosed as anxiety or mood issues for years, partly because anxious females tend to internalize symptoms (less hyperactive, more “worrier”), and that masks the ADHD beneath.So how do we tell ADHD and anxiety apart? One clue is where the distraction comes from. ADHD is like having 100 TV channels in your brain and someone else is holding the remote – your attention just flips on its own. Anxiety, on the other hand, is like one channel stuck on a horror movie; you can't focus on other things because a worry (or ten) is running on repeat. An adult with ADHD might forget a work deadline because, well, ADHD. An adult with anxiety might miss the deadline because they were paralyzed worrying about being perfect. Both end up missing the deadline (relatable – ask me how I know), but for different reasons.Neuroscience is starting to unravel this knot. There's evidence of a genetic link between ADHD and anxiety – the two often run in the family together. In brain studies, both conditions involve irregularities in the prefrontal cortex (the brain's command center for focus and planning) and the limbic system (emotion center). Essentially, if your brain were a car, ADHD means the brakes (inhibition) are a bit loose, and anxiety means the alarm system is hyper-sensitive. Combine loose brakes with a blaring alarm and you get… well, us. Fun times, right?Here's an interesting tidbit: Females with ADHD are more likely to report anxiety than males. Some experts think this is partly due to underdiagnosed ADHD – many girls grew up being told they were just “worrywarts” when in fact ADHD was lurking underneath, making everyday life more overwhelming and thus feeding anxiety. As Dr. Thomas Brown (a top ADHD expert) points out, emotional regulation difficulties (like chronic stress or worry) are characteristic of ADHD, even though they're not in the official DSM checklist. Our ADHD brains can amplify emotions – so a normal worry for someone else becomes a five-alarm fire for us.Now, action time: How do we manage this dynamic duo? The first step is getting the right diagnosis. A clinician should untangle whether symptoms like trouble concentrating are from anxiety, ADHD, or both. They might ask: Have you always had concentration issues (pointing to ADHD), or did they start when your anxiety kicked into high gear? Also, consider context – ADHD symptoms occur in most settings (school, work, home), while pure anxiety might spike in specific situations (say, social anxiety in crowds, or panic attacks only under stress).Treatment has to tackle both. Therapy – especially Cognitive Behavioral Therapy (CBT) – is a rockstar here. CBT can teach you skills to manage worry (hello, deep breathing and logical rebuttals to “what if” thoughts) and also help with ADHD organization hacks (like breaking tasks down, creating routines). Many find that medication is needed for one or both conditions. Stimulant meds (like methylphenidate or amphetamines) treat ADHD, but in someone with severe anxiety, a stimulant alone can sometimes ramp up the jitters. In fact, children (and adults) with ADHD + anxiety often don't respond as well to ADHD meds unless the anxiety is also addressed. Doctors might add an SSRI or other anti-anxiety medication to the mix, or choose a non-stimulant ADHD med if stimulants prove too anxiety-provoking.Let me share a quick personal strategy (with a dash of humor): I have ADHD and anxiety, so my brain is basically an internet browser with 50 tabs open – and 10 of them are frozen on a spinning “wheel of doom” (those are the anxieties). One practical tip that helps me distinguish the two is to write down my racing thoughts. If I see worries like “I'll probably get fired for sending that email typo” dominating the page, I know anxiety is flaring. If the page is blank because I got distracted after one sentence... well, hello ADHD! This silly little exercise helps me decide: do I need to do some calming techniques, or do I need to buckle down and use an ADHD strategy like the Pomodoro method? Try it out: Knowledge is power, and self-awareness is the key.Quick Tips – ADHD vs Anxiety: When in doubt, ask what's driving the chaos.* Content of Thoughts: Racing mind full of specific worries (anxiety) vs. racing mind full of everything except what you want to focus on (ADHD).* Physical Symptoms: Anxiety often brings friends like sweaty palms, racing heart, and tummy trouble. ADHD's restlessness isn't usually accompanied by fear, just boredom or impulsivity.* Treatment Approaches: For co-occurring cases, consider therapy and possibly a combo of medications. Experts often treat the most impairing symptom first – if panic attacks keep you homebound, address that alongside ADHD. Conversely, untreated ADHD can actually fuel anxiety (ever notice how missing deadlines and forgetfulness make you more anxious? Ask me how I know!). A balanced plan might be, say, stimulant medication + talk therapy for anxiety, or an SSRI combined with ADHD coaching. Work closely with a professional to fine-tune this.Alright, take a breath (seriously, if you've been holding it – breathing is good!). We've tackled anxiety; now let's talk about the dark cloud that can sometimes follow ADHD: depression.ADHD and Depression: When the Chaos Brings a CloudADHD is often associated with being energetic, spontaneous, even optimistic (“Sure, I can start a new project at 2 AM!”). So why do so many of us also struggle with depression? The reality is, living with unmanaged ADHD can be tough. Imagine years of what Dr. Russell Barkley calls “developmental delay” in executive function – always feeling one step behind in managing life, despite trying so hard. It's no surprise that about 1 in 5 kids with ADHD also has a diagnosable depression, and studies show anywhere from 8% to 55% of adults with ADHD have experienced a depressive disorder in their lifetime. (Yes, that range is huge – it depends how you define “depression” – but even on the low end it's a lot.) Dr. Barkley himself notes that roughly 25% of people with ADHD will develop significant depression by adulthood. In short, ADHD can come with a case of the blues (not the fun rhythm-and-blues kind, unfortunately).So what does ADHD + depression look like? Picture this: You've got a pile of unfinished projects, bills, laundry – the ADHD “trail of crumbs.” Initially, you shrug it off or maybe crack a joke (“organizational skills, who's she?”). But over time, the failures and frustrations can chip away at your self-esteem. You start feeling helpless or hopeless: “Why bother trying if I'm just going to screw it up or forget again?” That right there is the voice of depression sneaking in. ADHD's impulsivity might also lead to regrettable decisions or conflicts that you later brood over, another pathway to depressed mood.In fact, the Attention Deficit Disorder Association points out that ADHD's impact on our lives – trouble with self-esteem, work or school difficulties, and strained relationships – can contribute to depression. It's like a one-two punch: ADHD creates problems; those problems make you sad or defeated, which then makes it even harder to deal with ADHD. Fun cycle, huh?Now, depression itself can mask as ADHD in some cases, especially in adults. Poor concentration, low motivation, fatigue, social withdrawal – these can appear in major depression and look a lot like ADHD symptoms. If an adult walks into a doctor's office saying “I can't focus and I'm procrastinating a ton,” a cursory eval might yield an ADHD diagnosis. But if that focus problem started only after they, say, lost a loved one or fell into a deep funk, and they also feel worthless or have big sleep/appetite changes, depression may be the primary culprit. On the flip side, a person with lifelong ADHD might be misdiagnosed as just depressed, because they seem down or overwhelmed. As always, timeline is key: ADHD usually starts early (childhood), whereas depression often has a more defined onset. Also, ask: Is the inability to focus present even when life's going okay? If yes, ADHD is likely in the mix. If the focus issues wax and wane with mood, depression might be the driver.There's also a nuance: ADHD mood issues vs. clinical depression. People with ADHD can have intense emotions and feel demoralized after a bad day, but often these feelings can lift if something positive happens (say, an exciting new interest appears – suddenly we have energy!). Clinical depression is more persistent – even good news might not cheer you up much. As Dr. Thomas Brown emphasizes, ADHD includes difficulty regulating emotion; an ADHD-er might feel sudden anger or sadness that's intense but then dissipates . By contrast, depression is a consistent low mood or loss of pleasure in things over weeks or months. Knowing this difference can be huge in sorting out what's going on.Now, how do we deal with this combo? The good news: many treatments for depression also help ADHD and vice versa. Therapy is a prime example. Cognitive Behavioral Therapy and related approaches can address negative thought patterns (“I'm just a failure”) and also help with practical skills for ADHD (like scheduling, or as I call it, tricking my brain into doing stuff on time). There are even specialized therapies for adults with ADHD that blend mood and attention strategies. On the medication front, sometimes a single med can pull double duty. One interesting option is bupropion (Wellbutrin) – an antidepressant that affects dopamine and norepinephrine, which can improve both depression and ADHD symptoms in some people. There's also evidence that stimulant medications plus an antidepressant can be a powerful combo: stimulants to improve concentration and energy, antidepressant to lift mood. Psychiatrists will tailor this to the individual – for instance, if someone is severely depressed (can't get out of bed), treating depression first may be priority. If the depression seems secondary to ADHD struggles, improving the ADHD could automatically boost mood. Often, it's a balancing act of treating both concurrently – maybe starting an antidepressant and an ADHD med around the same time, or ensuring therapy covers both bases.Let's not forget lifestyle: exercise, sleep, nutrition – these affect both ADHD and mood. Regular exercise, for example, can increase BDNF (a brain growth factor) and neurotransmitters that help both attention and mood. Personally, I found that when I (finally) started a simple exercise routine, my mood swings evened out a bit and my brain felt a tad less foggy. (Of course, starting that routine required overcoming my ADHD inertia – ask me how I know that took a few tries... or twenty.)Quick Tips – ADHD vs Depression:* Check Your Joy Meter: With ADHD alone, you can still feel happy/excited when something engaging happens (ADHD folks light up for interesting tasks!). With depression, even things you normally love barely register. If your favorite hobbies no longer spark any joy, that's a red flag for depression.* All in Your Head? ADHD negative thoughts sound like “Ugh, I forgot again, I need a better system.” Depression thoughts sound like “I forgot again because I'm useless and nothing will ever change.” Listen to that self-talk; depression is a sneaky bully.* Professional Help: A thorough evaluation can include psychological tests or questionnaires to measure attention and mood separately. For treatment, consider a combined approach: therapy (like CBT or coaching) plus meds as needed. According to research, a mix of stimulant medication and therapy (especially CBT) can help treat both conditions. And remember, addressing one can often relieve the other: improve your ADHD coping skills, and you might start seeing hope instead of disappointment (boosting mood); treat your depression, and suddenly you have the energy to tackle that ADHD to-do list.Before we move on, one more important note: if you ever have thoughts of self-harm or suicide, please reach out to a professional immediately. Depression is serious, and when compounded with ADHD impulsivity, it can be dangerous. There is help, and you're not alone – so many of us have been in that dark place, and it can get better with the right support. Knowledge is power and self-awareness is the key, yes, but sometimes you also need a good therapist, maybe a support group, and possibly medication to truly turn things around. There's no shame in that game.Alright, deep breath. It's getting a bit heavy in here, so let's pivot to something different: a condition that seems like the opposite of ADHD in some ways, yet can co-occur – OCD. And don't worry, we'll crank the sass back up a notch.ADHD and OCD: The Odd Couple of AttentionWhen you think of Obsessive-Compulsive Disorder (OCD), you might picture someone extremely organized, checking the stove 10 times, everything neat and controlled. When you think ADHD… well, “organized” isn't the first word that comes to mind, right?

Ros Deegan is an industry leader and the CEO of OMass Therapeutics, an Oxford-based biotechnology company discovering medicines against highly-validated target ecosystems, such as membrane proteins or intracellular complexes.  OMass's MC2 program targeting Congenital Adrenal Hyperplasia, or CAH, is set to enter the clinic this year and in our interview today she walks me through how the company is preparing for their trials, how their approach differs to existing treatment options, and the impact on patient lives they hope to have. A leader in the UK biopharma industry, she also explains the strengths of the UK industry and how it can maintain an edge in the face of competition from Europe and the US.01:07   Meet Ros Deegan02:36   Cambridge and INSEAD04:24   Building industry experience05:16   Biotech in the US vs Biotech in the UK06:19   OMass: mission and ambition07:16   Funding the mission08:18   The importance of partnerships09:17   Industry and government10:37   OMass and CAH13:11   The differentiator for patient outcomes14:49   Into the clinic in 202516:31   CAH patients and patient groups19:29   The importance of hiring the right people20:55   The Oxford ‘brand' in biotechnology22:17   Preparing for the clinic23:43   Regulation and manufacturing26:17   Partnering with top pharma27:35   The importance of building value28:41   How the UK can compete on a global scale30:39   What's next for OMass32:59   The future of targeting rare diseaseInterested in being a sponsor of an episode of our podcast? Discover how you can get involved here! Stay updated by subscribing to our newsletterTo dive deeper into the topic: 10 biotech companies making a difference in rare diseasesRare Disease Day: seven drugs awaiting approval in 2025

[Rerun] Dr Kirk Honda talks with Dr Jennifer Sampson about hoarding disorder.This episode is sponsored by BetterHelp. Give online therapy a try at betterhelp.com/KIRK to get 10% off your first month.Become a member: https://www.youtube.com/channel/UCOUZWV1DRtHtpP2H48S7iiw/joinBecome a patron: https://www.patreon.com/PsychologyInSeattleEmail: https://www.psychologyinseattle.com/contactWebsite: https://www.psychologyinseattle.comMerch: https://psychologyinseattle-shop.fourthwall.com/Instagram: https://www.instagram.com/psychologyinseattle/Facebook Official Page: https://www.facebook.com/PsychologyInSeattle/TikTok: https://www.tiktok.com/@kirk.hondaJanuary 25, 2016The Psychology In Seattle Podcast ®Trigger Warning: This episode may include topics such as assault, trauma, and discrimination. If necessary, listeners are encouraged to refrain from listening and care for their safety and well-being.Disclaimer: The content provided is for educational, informational, and entertainment purposes only. Nothing here constitutes personal or professional consultation, therapy, diagnosis, or creates a counselor-client relationship. Topics discussed may generate differing points of view. If you participate (by being a guest, submitting a question, or commenting) you must do so with the knowledge that we cannot control reactions or responses from others, which may not agree with you or feel unfair. Your participation on this site is at your own risk, accepting full responsibility for any liability or harm that may result. Anything you write here may be used for discussion or endorsement of the podcast. Opinions and views expressed by the host and guest hosts are personal views. Although, we take precautions and fact check, they should not be considered facts and the opinions may change. Opinions posted by participants (such as comments) are not those of the hosts. Readers should not rely on any information found here and should perform due diligence before taking any action. For a more extensive description of factors for you to consider, please see www.psychologyinseattle.com

In this episode, we explore methadone maintenance therapy for opioid use disorder, covering dosing strategies, recent regulatory changes, and safety considerations. Why do so many patients fail on methadone despite its proven effectiveness, and how can proper dosing make the difference between recovery and relapse? Faculty: Smita Das, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 1 CME: Pharmacologic Management of Opioid Use Disorder Methadone for Managing OUD

Recorded 2025-07-10 02:58:08

I spoke to Dutch defence journalist and Russia expert Steven Derix about an important new revelation of Russia's use of chemical weapons in the war in Ukraine, happening as part of direct orders and thousands of times. You can find the original report herehttps://www.nrc.nl/nieuws/2025/07/04/nederlandse-inlichtingendiensten-russen-zetten-in-oekraine-op-grote-schaal-chemische-wapens-in-a4899319Check out our Bookshop.org affiliate site behindthelines and please sign up for my substack at arthursnell.substack.com and/or follow me on Bluesky@snellarthur.bsky.social. You can sometimes find me on other podcasts - most often Disorder which I am involved with in partnership with RUSI, the Royal United Services Institute, the world's oldest think tank. Hosted on Acast. See acast.com/privacy for more information.

Learn the warning signs of AUD, from drinking more than intended to neglecting responsibilities. This medical condition exists on a spectrum from mild to severe, but treatment works at any stage—despite the stigma that prevents many from seeking help. Learn more at https://sayarc.com Addiction Resource Center LLC. City: Yuba City Address: 1002 Live Oak Blvd. Website: https://sayarc.com

Bill O'Reilly reacts to a viral video of good samaritans saving a woman on a New York subway from a crazed maniac, and New York releasing the criminal. Learn more about your ad choices. Visit megaphone.fm/adchoices

 Normal pressure hydrocephalus (NPH) is a clinical syndrome of gait abnormality, cognitive impairment, and urinary incontinence. Evaluation of CSF dynamics, patterns of fludeoxyglucose (FDG) uptake, and patterns of brain stiffness may aid in the evaluation of challenging cases that lack typical clinical and structural radiographic features. In this episode, Katie Grouse, MD, FAAN, speaks with Aaron Switzer, MD, MSc, author of the article “Radiographic Evaluation of Normal Pressure Hydrocephalus” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Switzer is a clinical assistant professor of neurology in the department of clinical neurosciences at the University of Calgary in Calgary, Alberta, Canada. Additional Resources Read the article: Radiographic Evaluation of Normal Pressure Hydrocephalus Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Aaron Switzer about his article on radiographic evaluation of normal pressure hydrocephalus, which he wrote with Dr Patrice Cogswell. This article appears in the June 2025 Continuum issue on disorders of CSF dynamics. Welcome to the podcast, and please introduce yourself to our audience. Dr. Switzer: Thanks so much for having me, Katie. I'm a neurologist that's working up in Calgary, Alberta, Canada, and I have a special interest in normal pressure hydrocephalus. So, I'm very happy to be here today to talk about the radiographic evaluation of NPH. Dr Grouse: I'm so excited to have you here today. It was really wonderful to read your article. I learned a lot on a topic that is not something that I frequently evaluate in my clinic. So, it's really just a pleasure to have you here to talk about this topic. So, I'd love to start by asking, what is the key message that you hope for neurologists who read your article to take away from it? Dr. Switzer: The diagnosis of NPH can be very difficult, just given the clinical heterogeneity in terms of how people present and what their images look like. And so, I'd like readers to know that detailed review of the patient's imaging can be very helpful to identify those that will clinically improve with shunt surgery. Dr Grouse: There's another really great article in this edition of Continuum that does a really great job delving into the clinical history and exam findings of NPH. So, I don't want to get into that topic necessarily today. However, I'd love to hear how you approach a case of a hypothetical patient, say, where you're suspicious of NPH based on the history and exam. I'd love to talk over how you approach the imaging findings when you obtain an MRI of the brain, as well as any follow-up imaging or testing that you generally recommend. Dr. Switzer: So, I break my approach down into three parts. First, I want to try to identify ventriculomegaly and any signs that would support that, and specifically those that are found in NPH. Secondly, I want to look for any alternative pathology or evidence of alternative pathology to explain the patient's symptoms. And then also evaluate any contraindications for shunt surgery. For the first one, usually I start with measuring Evans index to make sure that it's elevated, but then I want to measure one of the other four measurements that are described in the article, such as posterior colossal angle zed-Evans index---or z-Evans index for the American listeners---to see if there's any other features that can support normal pressure hydrocephalus. It's very important to identify whether there are features of disproportionately enlarged subarachnoid space hydrocephalus, or DESH, which can help identify patients who may respond to shunt surgery. And then if it's really a cloudy clinical picture, it's complicated, it's difficult to know, I would usually go through the full evaluation of the iNPH radscale to calculate a score in order to determine the likelihood that this patient has NPH. So, the second part of my evaluation is to rule out evidence of any alternative pathology to suggest another cause for the patient's symptoms, such as neurodegeneration or cerebrovascular disease. And then the third part of my evaluation is to look for any potential contraindications for shunt surgery, the main one being cerebral microbleed count, as a very high count has been associated with the hemorrhagic complications following shunt surgery. Dr Grouse: You mentioned about your use of the various scales to calculate for NPH, and your article does a great job laying them out and where they can be helpful. Are there any of these scales that can be reasonably relied on to predict the presence of NPH and responsiveness to shunt placement? Dr. Switzer: I think the first thing to acknowledge is that predicting shunt response is still a big problem that is not fully solved in NPH. So, there is not one single imaging feature, or even combination of imaging features, that can reliably predict shunt response. But in my view and in my practice, it's identifying DESH, I think, is really important---so, the disproportionately enlarged subarachnoid space hydrocephalus---as well as measuring the posterior colossal angle. I find those two features to be the most specific. Dr Grouse: Now you mentioned the concept of the NPH subtypes, and while this may be something that many of our listeners are familiar with, I suspect that, like myself when I was reading this article, there are many who maybe have not been keeping up to date on these various subtypes. Could you briefly tell us more about these NPH subtypes? Dr. Switzer: Sure. The Japanese guidelines for NPH have subdivided NPH into three different main categories. So that would be idiopathic, delayed onset congenital, and secondary normal pressure hydrocephalus. And so, I think the first to talk about would be the secondary NPH. We're probably all more familiar with that. That's any sort of pathology that could lead to disruption in CSF dynamics. These are things like, you know, a slow-growing tumor that is obstructing CSF flow or a widespread meningeal process that's reducing absorption of CSF, for instance. So, identifying these can be important because it may offer an alternative treatment for what you're seeing in the patient. The second important one is delayed onset congenital. And when you see an image of one of these subtypes, it's going to be pretty different than the NPH because the ventricles are going to be much larger, the sulcal enfacement is going to be more diffuse. Clinically, you may see that the patients have a higher head circumference. So, the second subtype to know about would be the delayed onset congenital normal pressure hydrocephalus. And when you see an image of one of these subtypes, it's going to be a little different than the imaging of NPH because the ventricles are going to be much larger, the sulcal enfacement is going to be more diffuse. And there are two specific subtypes that I'd like you to know about. The first would be long-standing overt ventriculomegaly of adulthood, or LOVA. And the second would be panventriculomegaly with a wide foramen of magendie and large discernomagna, which is quite a mouthful, so we just call it PAVUM. The importance of identifying these subtypes is that they may be amenable to different types of treatment. For instance, LOVA can be associated with aqueductal stenosis. So, these patients can get better when you treat them with an endoscopic third ventriculostomy, and then you don't need to move ahead with a shunt surgery. And then finally with idiopathic, that's mainly what we're talking about in this article with all of the imaging features. I think the important part about this is that you can have the features of DESH, or you can not have the features of DESH. The way to really define that would be how the patient would respond to a large-volume tap or a lumbar drain in order to define whether they have this idiopathic NPH. Dr Grouse: That's really helpful. And for those of our listeners who are so inclined, there is a wonderful diagram that lays out all these subtypes that you can take a look at. I encourage you to familiarize yourself with these different subtypes. Now it was really interesting to read in your article about some of the older techniques that we used quite some time ago for diagnosing normal pressure hydrocephalus that thankfully we're no longer using, including isotope encephalography and radionuclide cisternography. It certainly made me grateful for how we've come in our diagnostic tools for NPH. What do you think the biggest breakthrough in diagnostic tools that are now clinically available are? Dr. Switzer: You know, definitely the advent of structural imaging was very important for the evaluation of NPH, and specifically the identification of disproportionately enlarged subarachnoid space hydrocephalus, or DESH, in the late nineties has been very helpful for increasing the specificity of diagnosis in NPH. But some of the newer technologies that have become available would be phase-contrast MRI to measure the CSF flow rate through the aqueduct has been very helpful, as well as high spatial resolution T2 imaging to actually image the ventricular system and look for any evidence of expansion of the ventricles or obstruction of CSF flow. Dr Grouse: Regarding the scales that you had referenced earlier, do you think that we can look forward to more of these scales being automatically calculated and reported by various software techniques and radiographic interpretation techniques that are available or going to be available? Dr. Switzer: Definitely yes. And some of these techniques are already in development and used in research settings, and most of them are directed towards automatically detecting the features of DESH. So, that's the high convexity tight sulci, the focally enlarged sulci, and the enlarged Sylvian fissures. And separating the CSF from the brain tissue can help you determine where CSF flow is abnormal throughout the brain and give you a more accurate picture of CSF dynamics. And this, of course, is all automated. So, I do think that's something to keep an eye out for in the future. Dr Grouse: I wanted to ask a little more about the CSF flow dynamics, which I think may be new to a lot of our listeners, or certainly something that we've only more recently become familiar with. Can you tell us more about these advances and how we can apply this information to our evaluations for NPH? Dr. Switzer: So currently, only the two-dimensional phase contrast MRI technique is available on a clinical basis in most centers. This will measure the actual flow rate through the cerebral aqueduct. And so, in NPH, this can be elevated. So that can be a good supporting marker for NPH. In the future, we can look forward to other techniques that will actually look at three-dimensional or volume changes over time and this could give us a more accurate picture of aberrations and CSF dynamics. Dr Grouse: Well, definitely something to look forward to. And on the topic of other sort of more cutting-edge or, I think, less commonly-used technologies, you also mentioned some other imaging modalities, including diffusion imaging, intrathecal gadolinium imaging, nuclear medicine studies, MR elastography, for example. Are any of these modalities particularly promising for NPH evaluations, in your opinion? Do you think any of these will become more popularly used? Dr. Switzer: Yes, I think that diffusion tract imaging and MR elastography are probably the ones to keep your eye out for. They're a little more widely applicable because you just need an MR scanner to acquire the images. It's not invasive like the other techniques mentioned. So, I think it's going to be a lot easier to implement into clinical practice on a wide scale. So, those would be the ones that I would look out for in the future. Dr Grouse: Well, that's really exciting to hear about some of these techniques that are coming that may help us even more with our evaluation. Now on that note, I want to talk a little bit more about how we approach the evaluation and, in your opinion, some of the biggest pitfalls in the evaluation of NPH that you've found in your career. Dr. Switzer: I think there are three of note that I'd like to mention. The first would be overinterpreting the Evans index. So, just because an image shows that there's an elevated Evans index does not necessarily mean that NPH is present. So that's where looking for other corroborating evidence and looking for the clinical features is really important in the evaluation. Second would be misidentifying the focally enlarged sulci as atrophy because when you're looking at a brain with these blebs of CSF space in different parts of the brain, you may want to associate that to neurodegeneration, but that's not necessarily the case. And there are ways to distinguish between the two, and I think that's another common pitfall. And then third would be in regards to the CSF flow rate through the aqueduct. And so, an elevated CSF flow is suggestive of NPH, but the absence of that does not necessarily rule NPH out. So that's another one to be mindful of. Dr Grouse: That's really helpful. And then on the flip side, any tips or tricks or clinical pearls you can share with us that you found to be really helpful for the evaluation of NPH? Dr. Switzer: One thing that I found really helpful is to look for previous imaging, to look if there were features of NPH at that time, and if so, have they evolved over time; because we know that in idiopathic normal pressure hydrocephalus, especially in the dash phenotype, the ventricles can become larger and the effacement of the sulci at the convexity can become more striking over time. And this could be a helpful tool to identify how long that's been there and if it fits with the clinical history. So that's something that I find very helpful. Dr Grouse: Absolutely. When I read that point in your article, I thought that was really helpful and, in fact, I'm guessing something that a lot of us probably aren't doing. And yet many of our patients for one reason or other, probably have had imaging five, ten years prior to their time of evaluation that could be really helpful to look back at to see that evolution. Dr. Switzer: Yes, absolutely. Dr Grouse: It's been such a pleasure to read your article and talk with you about this today. Certainly a very important and helpful topic for, I'm sure, many of our listeners. Dr. Switzer: Thank you so much for having me. Dr Grouse: Again, today I've been interviewing Dr Aaron Switzer about his article on radiographic evaluation of normal pressure hydrocephalus, which he wrote with Dr Patrice Cogswell. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Claudio Milstein, PhD joins the podcast to discuss the concept of unified care in managing voice, swallowing, and upper airway disorders. Dr. Milstein explains the importance of interdisciplinary collaboration in optimizing patient outcomes and shares details about an exciting upcoming CME on unified care.

Send us a textScott and John hang with Troll for Trout (and many others) bassist and friend of the NMD Podcast, John Connors,  for a round of "Pick 5". Youtube: https://www.youtube.com/@narcissisticmusicdisorderJoin us on Facebook at NMD podcast group.nmdpodcast@gmail.com to contact us.Tell your friends!!Be sure to Like and Subscribe. Thanks for listening!

The verdict is in and let's be honest, the justice system is a hot mess. Also, we are tired of the N-Word Pass!! Huge shoutout to Chris Laflare and from Was It Good Though Podcast, Jazz and Jason for joining us. Become a Habitual Ish Talker and follow us on The App Formally Known As Twitter: twitter.com/TalkinIsh_PodJoin in on the conversation! E-Mail us at ⁠talkinishpod@gmail.com⁠Listen to the audio version: https://linktr.ee/TalkinIshPod00:00​​​ - Intro/Idle Chit Chat08:50 - Viewer Comments 26:24 - RTD 1: Diddy and the Verdict of Discontent 1:17:11 - RTD 2: Can We Stop With Giving The N-Word Pass?!2:09:46 - Wrap It Up, YO!!! (Closing)

Welcome to Part 3 of my mini-series answering your burning questions! Today, we're diving into the topic of verbal imitation.When it comes to verbal imitation and echoic goals, context is everything. These goals must be functional and meaningful to the individual child in order to support communication development.As an SLP collaborating with a BCBA, and vice versa, rely on assessment tools and an SLP's robust training in speech to identify and shape functional goals. It's crucial that we plan and program with intention—otherwise, we risk discouraging a child from verbalizingThe key? Collaborate early and often. Assess together. Plan together. Use resources like the Autism IEP Goal Bank (don't miss the freebie!). Then, have the SLP on the team focus on those targeted words and move into collaboratively supporting generalization into the natural environment for a robust bank of words.Looking ahead to 2026, we're excited to explore communication disorders more deeply over at ABA Speech Connection. Stay tuned—because sometimes, you don't know what you don't know. #autism #speechtherapy What's Inside:Summer mini-seriesStrategy to work collaboratively as BCBA and SLPsVerbal imitation goals Communication developmentMentioned In This Episode:Verbal Imitation Guide (Hack #19) Join our ethics course Speech Membership - ABA Speech  ABA Speech: Home

Today on Grounded: The Vestibular Podcast, we are talking all about CGRP medications. These are a class of drugs used to manage migraine attacks. Interestingly, people with migraine have a higher level of CGRP during migraine attacks, but also have a harder time breaking them down for whatever reason. In this episode, we'll dig into: What CGRP medications are How CGRP medications work Generic names of CGRP medications How effective CGRPs are How CGRPs interact with Botox Will insurance cover CGRP medications What step therapy is and how to navigate it If a multi-pronged approach is still worth it Whether you're newly diagnosed, still searching for answers, or supporting someone with VM, this episode was created as a resource for you. Tune in and discover if we're fans of CGRPs over here… or not—and everything you need to know about these medications. Links/Resources Mentioned: Vestibular Group Fit (code GROUNDED at checkout!)  More Links/Resources: ⁠The 4 Steps to Managing Vestibular Migraine ⁠The PPPD Management Masterclass⁠ ⁠What your Partner Should Know About Living with Dizziness⁠ ⁠The FREE Mini VGFit Workout⁠ ⁠The FREE POTS - safe Workouts⁠ ⁠Vestibular Group Fit (code GROUNDED at checkout for 15% off your first subscription cycle!) ⁠ Connect with Dr. Madison: ⁠@⁠⁠TheVertigoDoctor ⁠ ⁠@TheOakMethod⁠ ⁠@VestibularGroupFit⁠ Connect with Dr. Jenna @dizzy.rehab.therapist  Work with Dr. Madison 1:1, Vestibular Rehabilitation Therapy Vestibular Group Fit Small Group Coaching (offered throughout the year, sign up for our email list to learn when!) Why The Oak Method? Learn about it here! Love what you heard? Reviews really help us out! Please consider leaving one for us.  This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here. ————————————— vestibular migraine, VM, CGRP medications, CGRPs for migraine, calcitonin gene-related peptides, migraine disorder, migraine attacks, preventative CGRP, acute CGRP, Aimovig, Ajovy, CGRP injections, Vyepti, Ubrelvy, oral CGRP, are CGRPs covered by insurance, step therapy, comprehensive migraine treatment

In his roll as UK Foreign Secretary, David Lammy has often talked of his concept of progressive realism, but what does that mean? And how has that impacted British foreign policy over the past 12 months? In this episode of Disorder, Alex Hall Hall and Arthur Snell delve into the complexities of British diplomacy over the past year – offering a grade point for each area of British foreign policy. They assess the UK's relationships with the US and EU, the implications of NATO and defense strategies, their dealings with Ukraine amidst the ongoing conflict with Russia and the government's response to the humanitarian crisis in the Middle East.  To close – and Order the Disorder – the pair express the need for a clearer vision in foreign policy, greater engagement with the Global South, and a clearer moral backbone from Starmer and co. Producer: George McDonagh Subscribe to our Substack - https://natoandtheged.substack.com/ Disorder on YouTube - https://www.youtube.com/@DisorderShow  Show Notes Links: Read ‘Keir Starmer Has Missed His Chance to Make a Bold Break With the Past on Foreign Policy' by Alex Hall Hall: https://bylinetimes.com/2025/06/27/labour-foreign-policy-report-card/  Learn more about your ad choices. Visit megaphone.fm/adchoices

Could anxiety just be energy misinterpreted? Kate Mason sits down with clinical hypnotherapist and bestselling author Jake Yanitz Rubin to explore a radically new understanding of anxiety—not as a mental illness, but as a misunderstood part of the human experience. They dive deep into how reframing anxiety as energy can unlock personal growth, self-awareness, and even spiritual awakening. Jake shares powerful insights from his book From Anxiety to Awakening, practical mindset shifts, and life-changing tools rooted in psychology, ancient philosophy, and consciousness work. Listen For05:02 Panic, Purpose, and the Pivot Within10:12 What's Really Happening in Hypnosis?14:59 Anxiety Isn't a Disorder It's Energy19:08 You Are Not Your Thoughts26:50 The Present Moment is All There Is36:37 Be Your Own Frequency Live by Your Truth Leave a rating/review for this podcast with one click Connect with guest: Jake Yanitz Rubin, Author | Transformational Mentor | Spiritual Teacher | Clinical Hypnotherapist | 25+ Years Guiding Personal AwakeningWebsite | From Anxiety to Awakening Book | LinkedIn| InstagramContact Kate:Email | Website | Kate's Book on Amazon | LinkedIn | Facebook | X

Today I'm happy to chat with our patient Leslie who shares her successful journey with histamine intolerance healing. We'll go through how SIBO led to her histamine issues, the connection to low vagus nerve tone, as well as the low histamine diet and treatments such as dao enzymes. Tune in to learn how you can reduce histamine in the body naturally.    Start healing with us! Learn more about our virtual clinic:  https://drruscio.com/virtual-clinic/ Histamine Intolerance and Diet Guide: https://drruscio.com/guides/get-histamine-intolerance-guide/  

ADHD isn't a defect— it's a brilliant survival strategy.Heather McKean and co-host Kent dive into the neuroscience (dopamine, DMN, hyper-vigilance), childhood ACEs, and school-system pressures that wire an “ADHD brain.” Then they show how Mind Change tools re-route those patterns—no shame, no labels.Inside this conversationWhy a hyperactive brain is often a hyper-vigilant brainDopamine “hunger” vs. true connectionHow compliance-based classrooms amplify symptomsRewiring steps that turn coping skills into super-powersHit ▶︎ to rethink everything you were told about ADHD—and grab the free resources at mindchange.com.Support this podcast at — https://redcircle.com/the-mind-change-podcast/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Dr. Wendy is talking to Dr. Eva Ritvo about AI and mental health. We are also talking to Dr. Timothy Fong about cannabis use disorder and what we can do. It's all on KFIAM-640!

In this episode, host Alyssa Watson, DVM, is joined by John M. Thomason, DVM, MS, DACVIM (SAIM), to talk about his recent Clinician's Brief article, “Top 4 Primary Immune-Mediated Disorders in Dogs.” In part 1 of this 2-part conversation, Dr. Thomason focuses on the diagnosis and management of IMHA and IMTP. You'll hear vital details for both conditions including the right way to handle blood smears and slide agglutination, which IMHA cases are hypercoagulable (spoiler: all of them), and if vincristine actually helps in IMTP (spoiler again: it does).Resources:https://www.cliniciansbrief.com/article/anemia-thrombocytopenia-immune-disorder-dogshttps://www.zoetisus.com/products/dogs/librelaContact:podcast@instinct.vetWhere To Find Us:Website: CliniciansBrief.com/PodcastsYouTube: Youtube.com/@clinicians_briefFacebook: Facebook.com/CliniciansBriefLinkedIn: LinkedIn.com/showcase/CliniciansBrief/Instagram: @Clinicians.BriefX: @CliniciansBriefThe Team:Alyssa Watson, DVM - HostAlexis Ussery - Producer & Multimedia Specialist

Is it healthy to dwell in the past? Before the turn of the last century, nostalgia was still considered by some mental health professionals as a psychological disorder. So then…why have numerous storied food and beverage CPG brands more recently leaned on their decades of history to redesign packaging with elements of their past? Obviously, the understanding of nostalgia evolved over time…now being viewed less as a disorder and more as a natural human emotion. But with nostalgia being perhaps the most active and useful during uncomfortable (or transitionary) states, it's no wonder why many legacy CPG brands have recently leveraged it when seeking to elevate connectedness towards a simpler era of life. Yet, deploying a “blast from the past” strategy isn't universally impactful, and I believe today's consumers are typically more engaged by the future that brand is creating compared to what happened in the past.

Dr. Timothy Fong is a Professor of Psychiatry at the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA. He is board certified in adult and addiction psychiatry.Dr. Fong is also a member of the Steering Committee of the UCLA Center for Cannabis andCannabinoids whose mission is to address the most pressing questions related to the impact ofcannabis legalization through rigorous scientific study and discourse across disciplines.Take a listen to his take on usage.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/GWQ865. CME/MOC/AAPA/IPCE credit will be available until June 29, 2026.Cracking the Code of GBA1-Associated Parkinson's Disease and Lysosomal Storage Disorders: Transforming Diagnosis and Management In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Gaucher Community Alliance. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/GWQ865. CME/MOC/AAPA/IPCE credit will be available until June 29, 2026.Cracking the Code of GBA1-Associated Parkinson's Disease and Lysosomal Storage Disorders: Transforming Diagnosis and Management In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Gaucher Community Alliance. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/GWQ865. CME/MOC/AAPA/IPCE credit will be available until June 29, 2026.Cracking the Code of GBA1-Associated Parkinson's Disease and Lysosomal Storage Disorders: Transforming Diagnosis and Management In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Gaucher Community Alliance. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/GWQ865. CME/MOC/AAPA/IPCE credit will be available until June 29, 2026.Cracking the Code of GBA1-Associated Parkinson's Disease and Lysosomal Storage Disorders: Transforming Diagnosis and Management In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Gaucher Community Alliance. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/GWQ865. CME/MOC/AAPA/IPCE credit will be available until June 29, 2026.Cracking the Code of GBA1-Associated Parkinson's Disease and Lysosomal Storage Disorders: Transforming Diagnosis and Management In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Gaucher Community Alliance. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/GWQ865. CME/MOC/AAPA/IPCE credit will be available until June 29, 2026.Cracking the Code of GBA1-Associated Parkinson's Disease and Lysosomal Storage Disorders: Transforming Diagnosis and Management In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Gaucher Community Alliance. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/GWQ865. CME/MOC/AAPA/IPCE credit will be available until June 29, 2026.Cracking the Code of GBA1-Associated Parkinson's Disease and Lysosomal Storage Disorders: Transforming Diagnosis and Management In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Gaucher Community Alliance. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

A new study published recently as the cover of Aging Volume 17, Issue 6, describes a new method to estimate how fast the brain is aging. By analyzing lipids, or fat molecules, in brain tissue, researchers from the National University of Singapore and Hanze University of Applied Sciences created a biological “clock” called DoliClock. This innovation highlights how conditions such as autism, schizophrenia, and Down syndrome are associated with accelerated brain aging. Understanding Brain Aging As people grow older, their brains naturally change. However, in many neurological disorders, these changes seem to appear earlier and progress more rapidly. Disorders like autism, schizophrenia, and Down syndrome reduce quality of life and contribute to premature death. Scientists have long searched for better ways to measure biological age in the brain to understand these processes and develop strategies to slow them down. Most existing methods for estimating biological age rely on genetic markers, such as DNA methylation, which are chemical modifications of DNA. While useful, these approaches may not fully capture the complexity of aging, especially in the brain. Lipids, which are essential components of brain cells and play important roles in energy storage and signaling, offer another perspective. Full blog - https://aging-us.org/2025/07/doliclock-a-lipid-based-clock-for-measuring-brain-aging/ Paper DOI - https://doi.org/10.18632/aging.206266 Corresponding author - Brian K. Kennedy - bkennedy@nus.edu.sg Video short - https://www.youtube.com/watch?v=-FEiyj9PjBE Sign up for free Altmetric alerts about this article - https://aging.altmetric.com/details/email_updates?id=10.18632%2Faging.206266 Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts Keywords - aging, aging clock, down syndrome, autism, schizophrenia, dolichol To learn more about the journal, please visit our website at https://www.Aging-US.com​​ and connect with us: Facebook - https://www.facebook.com/AgingUS/ X - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Bluesky - https://bsky.app/profile/aging-us.bsky.social Pinterest - https://www.pinterest.com/AgingUS/ Spotify - https://open.spotify.com/show/1X4HQQgegjReaf6Mozn6Mc MEDIA@IMPACTJOURNALS.COM

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/MOC/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/GWQ865. CME/MOC/AAPA/IPCE credit will be available until June 29, 2026.Cracking the Code of GBA1-Associated Parkinson's Disease and Lysosomal Storage Disorders: Transforming Diagnosis and Management In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and Gaucher Community Alliance. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Lilly.Disclosure information is available at the beginning of the video presentation.

We hear much in Unity about Divine Order, which simply means Spirit guides your lives and circumstances by Her orderly process. Did you know God also guides you through disorder, stressful times when challenges abound. Can you allow yourself to be subject to divine guidance during those inevitable times of chaos and disorder? Let's talk about this on Sunday.

I see a lot of health educators throw their weight around saying that they have more then a few decades of experience working one on one with clients, and then selling you the idea that acting based on your symptoms is just mimicking the allopathic pharma way of thinking. But what if we acknowledged our symptoms and used them as guiding lights instead of lab tests? Or you could do both. Natasha Snoeijer focuses on thyroid, hormone and metabolic optimization. She joins me to bring that "what about both?" energy to the health discussion. What if high dose supplementation can create long term healing? One vitamin did that for her. She shares her thoughts on the sugar diet, how to use your bowel movements to assess your health status, how to supplement thyroid properly, why she isn't a fan of hair tissue mineral analysis tests and what she likes instead, why candida cleanses don't work, and lots more. Work with Natasha: https://www.natashabwellness.com My website: www.matt-blackburn.com Mitolife products: www.mitolife.co Music by Nicholas Jimenez: https://spoti.fi/4cte2nD

Mix up a mocktail and settle in for another addition to our ADHD & addiction series.   This episode, we're on a mission to bring back fun, lighthearted conspiracy theories before diving into the Meat, where Kristin is teaching us about Alcohol Use Disorder (AUD).    She's covering the diagnostic criteria for AUD, how alcohol affects the brain and body, why ADHDers are especially drawn to it, and some judgment-free suggestions for reducing your use.  Resources: Alcohol Use Disorder: Screening, Evaluation, and Management - StatPearls - NCBI Bookshelf Alcohol use disorders and ADHD - ScienceDirect Increased Sensitivity to the Disinhibiting Effects of Alcohol in Adults with ADHD - PMC ADHD and Alcohol Use: What's the Link? | Psych Central ADHD & Alcohol: Exploring the Connection and Overcoming Challenges The Clinically Meaningful Link Between Alcohol Use and Attention Deficit Hyperactivity Disorder - PMC Alcohol Use Disorder: A Comparison Between DSM–IV and DSM–5 | National Institute on Alcohol Abuse and Alcoholism (NIAAA) Effects of Alcohol on the Brain, Animation, Professional version. Alcohol and Neurotransmitter Interactions - PMC Associations between childhood ADHD, gender, and adolescent alcohol and marijuana involvement: A causally informative design. - Abstract - Europe PMC Faye Lawrence - ADHD, Grey Area Drinker & Behaviour Change Coach Atomoxetine treatment of adults with ADHD and comorbid alcohol use disorders - ScienceDirect Common Nightingale - YouTube

Visit Project Mindfully Outdoors to learn more Save 15% on all your 1st aid needs at My Medic.com by using Promo Code PROJECTOUTDOORS15 In this captivating episode of Mindful Trails, we embark on an epic journey to tackle a growing concern in our fast-paced world: Nature Deficiency Disorder (NDD). While not a clinically recognized ailment, NDD reflects our disconnection from the natural environment, leading to a host of physical and mental health challenges. Join us as we delve into the signs and symptoms of this modern malaise—like increased anxiety, lethargy, and diminished creativity—and discover practical strategies to reclaim your bond with nature. From daily outdoor activities to nurturing green spaces at home, we'll explore actionable tips that can transform your life. Learn how to harness technology to deepen your connection with the environment and why advocating for local green spaces is vital for our well-being. Whether you're seeking solace in your backyard or yearning for grand adventures in the wild, this episode is your call to action. Let the great outdoors rejuvenate your spirit, enhance your creativity, and restore balance in your life. Tune in, breathe deeply, and step into the wilderness—your journey to a healthier, more mindful existence begins now!

Visit Project Mindfully Outdoors to learn more Save 15% on all your 1st aid needs at My Medic.com by using Promo Code PROJECTOUTDOORS15 In this captivating episode of Mindful Trails, we embark on an epic journey to tackle a growing concern in our fast-paced world: Nature Deficiency Disorder (NDD). While not a clinically recognized ailment, NDD reflects our disconnection from the natural environment, leading to a host of physical and mental health challenges. Join us as we delve into the signs and symptoms of this modern malaise—like increased anxiety, lethargy, and diminished creativity—and discover practical strategies to reclaim your bond with nature. From daily outdoor activities to nurturing green spaces at home, we'll explore actionable tips that can transform your life. Learn how to harness technology to deepen your connection with the environment and why advocating for local green spaces is vital for our well-being. Whether you're seeking solace in your backyard or yearning for grand adventures in the wild, this episode is your call to action. Let the great outdoors rejuvenate your spirit, enhance your creativity, and restore balance in your life. Tune in, breathe deeply, and step into the wilderness—your journey to a healthier, more mindful existence begins now!

Psychiatrist Carolyn Rodriguez studies hoarding disorder and says that all of us have attachments to our possessions. But for many, these attachments can disrupt daily life and even pose health risks. For those with loved ones who struggle with hoarding disorder, she says treatments exist, including cognitive behavioral therapy (CBT). Lately, she's been studying how virtual reality can augment CBT through virtual discarding practice and ways brain stimulation may improve symptoms. But, Rodriguez says, never underestimate the value of empathy for those in need of help, as she tells host Russ Altman on this episode of Stanford Engineering's The Future of Everything podcast.Have a question for Russ? Send it our way in writing or via voice memo, and it might be featured on an upcoming episode. Please introduce yourself, let us know where you're listening from, and share your question. You can send questions to thefutureofeverything@stanford.edu.Episode Reference Links:Stanford Profile: Carolyn RodriguezConnect With Us:Episode Transcripts >>> The Future of Everything WebsiteConnect with Russ >>> Threads / Bluesky / MastodonConnect with School of Engineering >>> Twitter/X / Instagram / LinkedIn / FacebookChapters:(00:00:00) IntroductionRuss Altman introduces Carolyn Rodriguez, a professor of psychiatry and behavioral science at Stanford University.(00:02:47) Motivation to Study Hoarding DisorderWhy Carolyn chose to focus her research on hoarding disorder.(00:03:44) Collecting Versus HoardingDistinguishing between normal behavior and clinically significant hoarding.(00:05:47) Prevalence of Hoarding DisorderThe universality and pervasiveness of hoarding disorder.(00:07:11) The Brain Science Behind HoardingEarly neuroscience findings on attachment and discarding behavior.(00:08:47) Dopamine and Excessive AcquisitionThe connection between hoarding and potential dopamine reward pathways.(00:09:55) Risk Factors and Cognitive ChallengesPersonality traits, genetics, and processing difficulties involved in hoarding.(00:11:14) Gender Differences and Insight IssuesGender prevalence in treatment-seeking and the concept of anosognosia.(00:12:35) The “Why” Behind HoardingHow motivations and emotional attachments influence behavior.(00:13:50) Onset and Progression of DisorderTypical onset age, aging effects, and early warning signs.(00:15:05) Historical References to HoardingAccounts from ancient literature of hoarding-like behavior(00:17:16) Attachment to ObjectsThe emotional, aesthetic, and identity-based reasons people retain objects.(00:20:45) Current Treatment OptionsThe treatment landscape, including lack of medications and focus on CBT.(00:22:30) Chronic Nature of Hoarding DisorderFraming hoarding as a long-term condition with hopeful outcomes.(00:23:08) Virtual Reality for TreatmentA study on using VR to safely practice letting go of personal items.(00:25:58) Neuromodulation ResearchUsing non-invasive brain stimulation to reduce acquisition urges.(00:27:00) Advice for Individuals and FamiliesThe importance of empathy and self-care for individuals and caregivers.(00:28:47) Conclusion Connect With Us:Episode Transcripts >>> The Future of Everything WebsiteConnect with Russ >>> Threads / Bluesky / MastodonConnect with School of Engineering >>>Twitter/X / Instagram / LinkedIn / Facebook

Recorded 2025-07-03 02:59:08

REGIME CHANGE AND DISORDER. GREGORY COPLEY, DEFENSE & FOREIGN AFFAIRS 1870 SIEGE OF PARIS

This week we go in on one of our favorite albums, Vision of Disorder's self-titled major label debut. And to do this, we reached out to our Long Island correspondents Rob and Corey who were at ground zero when this band became a thing. We go down some great LIHC rabbit holes, and cover a ton of ground...cheers! Instagram: Email:  Voicemail:  267-297-4627 Twitter: Facebook Group: Tim Twitter:  Jay Twitter:  Youtube Channel: Spotify Playlists:  Merch Store:

Normal pressure hydrocephalus (NPH) is a clinical syndrome characterized by the triad of gait apraxia, cognitive impairment, and bladder dysfunction in the radiographic context of ventriculomegaly and normal intracranial pressure. Accurate diagnosis requires consideration of clinical and imaging signs, complemented by tests to exclude common mimics. In this episode, Lyell Jones, MD, FAAN speaks with Abhay R. Moghekar, MBBS, author of the article “Clinical Features and Diagnosis of Normal Pressure Hydrocephalus” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Moghekar is an associate professor of neurology at Johns Hopkins University School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Clinical Features and Diagnosis of Normal Pressure Hydrocephalus Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Abhay Moghekar, who recently authored an article on the clinical features and diagnosis of normal pressure hydrocephalus for our first-ever issue of Continuum dedicated to disorders of CSF dynamics. Dr Moghekar is an associate professor of neurology and the research director of the Cerebrospinal Fluid Center at Johns Hopkins University in Baltimore, Maryland. Dr Moghekar, welcome, and thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Moghekar: Thank you, Dr Jones. I'm Abhay Moghekar. I'm a neurologist at Hopkins, and I specialize in seeing patients with CSF disorders, of which normal pressure hydrocephalus happens to be the most common. Dr Jones: And let's get right to it. I think most of our listeners who are neurologists in practice have encountered normal pressure hydrocephalus, or NPH; and it's a challenging disorder for all the reasons that you outline in your really outstanding article. If you were going to think of one single most important message to our listeners about recognizing patients with NPH, what would that be? Dr Moghekar: I think I would say there are two important messages. One is that the triad is not sufficient to make the diagnosis, and the triad is not necessary to make the diagnosis. You know these three elements of the triad: cognitive problems, gait problems, bladder control problems are so common in the elderly that if you pick 10 people out in the community that have this triad, it's unlikely that even one of them has true NPH. On the other hand, you don't need all three elements of the triad to make the diagnosis because the order of symptoms matters. Often patients develop gait dysfunction first, then cognitive dysfunction, and then urinary incontinence. If you wait for all three elements of the triad to be present, it may be too late to offer them any clear benefit. And hence, you know, it's neither sufficient nor necessary to make the diagnosis. Dr Jones: That's a really great point. I think most of our listeners are familiar with the fact that, you know, we're taught these classic triads or pentads or whatever, and they're rarely all present. In a way, it's maybe a useful prompt, but it could be distracting or misleading, even in a way, in terms of recognizing the patient. So what clues do you use, Dr Moghekar, to really think that a patient may have NPH? Dr Moghekar: So, there are two important aspects about gait dysfunction. Say somebody comes in with all three elements of the triad. You want to know two things. Which came first? If gate impairment precedes cognitive impairment, it's still very likely that NPH is in the differential. And of the two, which are more- relatively more affected? So, if somebody has very severe dementia and they have a little bit of gait problems, NPH is not as likely. So, is gait affected earlier than cognitive dysfunction, and is it affected to a more severe degree than cognitive dysfunction? And those two things clue me in to the possibility of NPH. You still obviously need to get imaging to make sure that they have large ventricles. One of the problems with imaging is large ventricles are present in so many different patients. Normal aging causes large ventricles. Obviously, many neurodegenerative disorders because of cerebral atrophy will cause large ventricles. And there's an often-used metric called as the events index, which is the ratio of the bitemporal horns- of the frontal horns of the lateral ventricles compared to the maximum diameter of the skull at that level. And if that ratio is more than 0.3, it's often used as a de facto measure of ventriculomegaly. What we've increasingly realized is that this ratio changes with age. And there's an excellent study that used the ADNI database that looked at how this ratio changes by age and sex. So, in fact, we now know that an 85-year-old woman who has an events index of 0.37 which would be considered ventriculomegaly is actually normal for age and sex. So, we need to start adopting these more modern age- and sex-appropriate age cutoffs of ventriculomegaly so as not to overcall everybody with big ventricles as having possible NPH. Dr Jones: That's very helpful. And I do want to come back to this challenge that we've seen in our field of overdiagnosis and underdiagnosis. But I think most of us are familiar with the concept of how hydrocephalus could cause neurologic deficits. But what's the latest on the mechanism of NPH? Why do some patients get this and others don't? Dr Moghekar: Very good question. I don't think we know for sure. And it for a long time we thought it was a plumbing issue. Right? And that's why shunts work. People thought it was impaired CSF absorption, but multiple studies have shown that not to be true. It's likely a combination of impaired cerebral blood flow, biomechanical factors like compliance, and even congenital factors that play a role in the pathogenesis of NPH. And yes, while putting in shunts likely drains CSF, putting in a shunt also definitely changes the compliance of the brain and affects blood flow to the subcortical regions of the brain. So, there are likely multiple mechanisms by which shunts benefit, and hence it's very likely that there's no single explanation for the pathogenesis of NPH. Dr Jones: We explored this in a recent Continuum issue on dementia. Many patients who have cognitive impairment have co-pathologies, multiple different causes. I was interested to read in your article about the genetic risk profile for NPH. It's not something I'd ever really considered in a disorder that is predominantly seen in older patients. Tell us a little more about those genetic risks. Dr Moghekar: Yeah, everyone is aware of the role genetics plays in congenital hydrocephalus, but until recently we were not aware that certain genetic factors may also be relevant to adult-onset normal pressure hydrocephalus. We've suspected this for a long time because nearly half of our patients who come to us to see us in clinic with NPH have head circumferences that are more than 90th percentile for height. And you know, that clearly indicates that this started shortly at the time after birth or soon afterwards. So, we've suspected for a long time that genetic factors play a role, but for a long time there were not enough large studies or well-conducted studies. But recently studies out of Japan and the US have shown mutations in genes like CF43 and CWH43 are disproportionately increased in patients with NPH. So, we are discovering increasingly that there are genetic factors that underlie even adult onset in patients. There are many more waiting to be discovered. Dr Jones: Really fascinating. And obviously getting more insight into the risk and mechanisms would be helpful in identifying these patients potentially earlier. And another thing that I learned in your article that I thought was really interesting, and maybe you can tell us more about it, is the association between normal pressure hydrocephalus and the observation of cervical spinal stenosis, many of whom require decompression. What's behind that association, do you think? Dr Moghekar: That's a very interesting study that was actually done at your institution, at Mayo Clinic, that showed this association. You know, as we all get older, you know, the incidence of cervical stenosis due to osteoarthritis goes up, but the incidence of significant, clinically significant cervical stenosis in the NPH population was much higher than what we would have expected. Whether this is merely an association in a vulnerable population or is it actually causal is not known and will need further study. Dr Jones: It's interesting to speculate, does that stenosis affect the flow of CSF and somehow predispose to a- again, maybe a partial degree for some patients? Dr Moghekar: Yeah, which goes back to the possible hydrodynamic theory of normal pressure hydrocephalus; you know, if it's obstructing normal CSF flow, you know, are the hydrodynamics affected in the brain that in turn could lead to the development of hydrocephalus. Dr Jones: One of the things I really enjoyed about your article, Abhay, was the very strong clinical focus, right? We can't just take an isolated biomarker or radiographic feature and rely on that, right? We really do need to have clinical suspicion, clinical judgment. And I think most of our listeners who've been in practice are familiar with the use and the importance of the large-volume lumbar puncture to determine who may have, and by exclusion not have, NPH, and then who might respond to CSF diversion. And I think those of us who have been in this situation are also familiar with the scenario where you think someone may have NPH and you do a large-volume lumbar puncture and they feel better, but you can't objectively see a difference. How do you make that test useful and objective in your practice? What do you do? Dr Moghekar: Yeah, it's a huge challenge in getting this objective assessment done carefully because you have to remember, you know, subconsciously you're telling the patients, I think you have NPH. I'm going to do this spinal tap, and if you walk better afterwards, you're going to get a shunt and you're going to be cured. And you can imagine the huge placebo response that can elicit in our subjects. So, we always like to see, definitely, did the patient subjectively feel better? Because yes, that's an important metric to consider because we want them to feel better. But we also wanted to be grounded in objective truths. And for that, we need to do different tests of speed, balance and endurance. Not everyone has the resources to do this, but I think it's important to test different domains. Just like for cognition, you know, we just don't test memory, right? We test executive function, language, visuospatial function. Similarly, walking is not just walking, right? It's gait speed, it's balance, and it's endurance. So, you need to ideally test at least most of these different domains for gait and you need to have some kind of clear criteria as to how are you going to define improvement. You know, is a 5% improvement, is a 10% improvement in gait, enough? Is 20%? Where is that cutoff? And as a field, we've not done a great job of coming up with standardized criteria for this. And it varies currently, the practice varies quite significantly from center to center at the current time. Dr Jones: So, one of the nice things you had in your article was helpful tips to be objective if you're in a lower-resource setting. For you, this isn't a common scenario that someone encounters in their practice as opposed to a center that maybe does a large volume of these. What are some relatively straightforward objective measures that a neurologist or someone else might use to determine if someone is improving after a large-volume LP? Dr Moghekar: Yeah, excellent question, Dr Jones, and very practically relevant too. So, you need to at least assess two of the domains that are most affected. One is speed and one is balance. You know, these patients fall ultimately, right, if you don't treat them correctly. In terms of speed, there are two very simple tests that anybody can do within a couple of minutes. One is the timed “up-and-go” test. It's a test that's even recommended by the CDC. It correlates very well with faults and disability and it can be done in any clinic. You just need about ten feet of space and a chair and a stopwatch, and it takes about a minute or slightly more to do that test. And there are objective age-associated norms for the timed up-and-go test, so it's easy to know if your patient is normal or not. The same thing goes for the 10-meter walk test. You do need a slightly longer walkway, but it's a fairly easy and well-standardized test. So, you can do one of those two; you don't need to do both of them. And for balance, you can do the 30-second “sit-to-stand”; and it's literally, again, 30 seconds. You need a chair, and you need somebody to watch the patient and see how many times they can sit up and stand up from a seated position. Then again, good normative data for that. If you want to be a little more sophisticated, you can do the 4-stage balance test. So, I think these are tests that don't add too much time to your daily assessment and can be done with even trained medical assistants in any clinic. And you don't need a trained physical therapist to do these assessments. Dr Jones: Very practical. And again, something that is pretty easily deployed, something we do before and then after the LP. I did see you mentioned in your article the dual timed up-and-go test where it's a simultaneous gait and executive function test. And I've got to be honest with you, Dr Moghekar, I was a little worried if I would pass that test, but that may be beyond the scope of our time today. Actually, how do you do that? How do you do the simultaneous cognitive assessment? Dr Moghekar: So, we asked them to count back from 100, subtracting 3. And we do it particularly in patients who are mildly impaired right? So, if they're already walking really good, but then you give them a cognitive stressor, you know, that will slow them down. So, we reserve it for patients who are high-performing. Dr Jones: That's fantastic. I'm probably aging myself a little here. I have noticed in my career, a little bit of a pendulum swing in terms of the recognition or acceptance of the prevalence of normal pressure hydrocephalus. I recall when I was a resident, many, many people that we saw in clinic had normal pressure hydrocephalus. Then it seemed for a while that it really faded into the background and was much less discussed and much less recognized and diagnosed, and less treated. And now that pendulum seems to have swung back the other way. What's behind that from your perspective? Dr Moghekar: It's an interesting backstory to all of this. When the first article about NPH was published in the Newman Journal of Medicine, it was actually a combined article with both neurologists and neurosurgeons on it. They did describe it as a treatable dementia. And what that did is it opened up the floodgates so that everybody with any kind of dementia started getting shunts left, right, and center. And back then, shunts were not programmable. There were no antibiotic impregnated catheters. So, the incidence of subdural hematomas and shunt-related infections was very high. In fact, one of our esteemed neurologists back then, Houston Merritt, wrote a scathing editorial that Victor and Adam should lose their professorships for writing such an article because the outcomes of these patients were so bad. So, for a very long period of time, neurologists stopped seeing these patients and stopped believing in NPH as a separate entity. And it became the domain of neurosurgeons for over two or three decades, until more recently when randomized trials started being done early on out of Europe. And now there's a big NIH study going on in the US, and these studies showed, in fact, that NPH exists as a true, distinct entity. And finally, neurologists have started getting more interested in the science and understanding the pathophysiology and taking care of these patients compared to the past. Dr Jones: That's really helpful context. And I guess that maybe isn't rare when you have a disorder that doesn't have a simple, straightforward biomarker and is complex in terms of the tests you need to do to support the diagnosis, and the treatment itself is somewhat invasive. So, when you talk to your patients, Dr Moghekar, and you've established the diagnosis and have recommended them for CSF diversion, what do you tell them? And the reason I ask is that you mentioned before we started recording, you had a patient who had a shunt placed and responded well, but continued to respond over time. Tell us a little bit more about what our patients can expect if they do have CSF diversion? Dr Moghekar: When we do the spinal tap and they meet our criteria for improvement and they go on to have a shunt, we tell them that we expect gait improvement definitely, but cognitive improvement may not happen in everyone depending on what time, you know, they showed up for their assessment and intervention. But we definitely expect gait improvement. And we tell them that the minimum gait improvement we can expect is the same degree of improvement they had after their large-volume lumbar puncture, but it can be even more. And as the brain remodels, as the hydrodynamics adapt to these shunts… so, we have patients who continue to improve one year, two years, and even three years into the course of the intervention. So, we're, you know, hopeful. At the same time, we want to be realistic. This is the same population that's at risk for developing neurodegenerative disorders related to aging. So not a small fraction of our patients will also have Alzheimer's disease, for example, or go on to develop Lewy body dementia. And it's the role of the neurologist to pick up on these comorbid conditions. And that's why it's important for us to keep following these patients and not leave them just to the neurosurgeon to follow up. Dr Jones: And what a great note to end on, Dr Moghekar. And again, I want to thank you for joining us, and thank you for such a wonderful discussion and such a fantastic article on the clinical diagnosis of normal pressure hydrocephalus. I learned a lot reading the article, and I learned a lot more today just in the conversation with you. So, thank you for being with us. Dr Moghekar: Happy to do that, Dr Jones. It was a pleasure. Dr Jones: Again, we've been speaking with Dr Abhay Moghekar, author of a wonderful article on the clinical features and diagnosis of NPH in Continuum's first-ever issue dedicated to disorders of CSF dynamics. Please check it out. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

On this Out of the Loop, Jason Pack helps us understand what the conflict between Iran and Israel signifies, and where we can expect it to go from here.Welcome to what we're calling our "Out of the Loop" episodes, where we dig a little deeper into fascinating current events that may only register as a blip on the media's news cycle and have conversations with the people who find themselves immersed in them. Disorder podcast host Jason Pack is here to help us make sense of the recent escalation in conflict between Iran and Israel — how we got here, the dangers and opportunities of the moment, and what we need from world leadership to keep the problem contained.Full show notes and resources can be found here: jordanharbinger.com/1177On This Episode of Out of the Loop:Israel launched surprise attacks on Iran's nuclear program and leadership, setting back its nuclear capabilities by months to years while demonstrating complete intelligence penetration.The US brokered a ceasefire between Iran and Israel, but this only addresses symptoms — the underlying regional conflicts and proxy wars remain unresolved.Iran announced it's accelerating its nuclear program in response to the attacks, following the "Libya lesson" that nuclear weapons provide protection from regime change.The current moment presents a unique opportunity for comprehensive Middle East peace due to weakened Iranian proxies and shifting regional power dynamics.Success requires multilateral diplomacy involving Qatar, Europe, Gulf states, and addressing root causes — not just ceasefire management but genuine conflict resolution through shared interests.And much more!Connect with Jordan on Twitter, on Instagram, and on YouTube. If you have something you'd like us to tackle here on an Out of the Loop episode, drop Jordan a line at jordan@jordanharbinger.com and let him know!Connect with Jason Pack on Twitter or on LinkedIn, and be sure to subscribe to his newsletter and check out his Disorder podcast!And if you're still game to support us, please leave a review here — even one sentence helps! Sign up for Six-Minute Networking — our free networking and relationship development mini course — at jordanharbinger.com/course!Subscribe to our once-a-week Wee Bit Wiser newsletter today and start filling your Wednesdays with wisdom!Do you even Reddit, bro? Join us at r/JordanHarbinger!This Episode Is Brought To You By Our Fine Sponsors:Boulevard: 10% off first year: joinblvd.com/jordanIDEO U: 15% off: ideou.com/jordanOpenPhone: 20% off 1st 6 months: openphone.com/jordanAirbnb: airbnb.com/hostHomes.com: Find your home: homes.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

If you've ever felt like you're moving through life with your head wrapped in cotton—unable to think clearly, focus, or find the right words—you're not alone. In this episode of Grounded: The Vestibular Podcast, we dive into one of the most frustrating and misunderstood symptoms of vestibular disorders: brain fog. We explore what brain fog really is, how it's connected to conditions like vestibular migraine, PPPD, and inner ear dysfunction, and why it's more than just “being tired.” You'll learn about the neurological and physiological causes behind this cognitive cloudiness—from sensory overload and poor vestibular compensation to medication side effects and chronic stress. But we won't leave you hanging in the haze. We're also sharing 10 practical strategies to help lift the fog and reclaim mental clarity—ranging from diet and hydration tips to pacing, vestibular rehab, and cognitive tools that actually work. Whether you're newly diagnosed or years into your vestibular journey, this episode is here to remind you: you're not broken, and you're not alone. Tune in for science, support, and strategies that ground you. Links/Resources Mentioned: Vestibular Group Fit (code GROUNDED at checkout!)  More Links/Resources: ⁠The 4 Steps to Managing Vestibular Migraine ⁠The PPPD Management Masterclass⁠ ⁠What your Partner Should Know About Living with Dizziness⁠ ⁠The FREE Mini VGFit Workout⁠ ⁠The FREE POTS - safe Workouts⁠ ⁠Vestibular Group Fit (code GROUNDED at checkout for 15% off your first subscription cycle!) ⁠ Connect with Dr. Madison: ⁠@⁠⁠TheVertigoDoctor ⁠ ⁠@TheOakMethod⁠ ⁠@VestibularGroupFit⁠ Connect with Dr. Jenna @dizzy.rehab.therapist  Work with Dr. Madison 1:1, Vestibular Rehabilitation Therapy Vestibular Group Fit Small Group Coaching (offered throughout the year, sign up for our email list to learn when!) Why The Oak Method? Learn about it here! Love what you heard? Reviews really help us out! Please consider leaving one for us.  This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here.

This conversation explores the complexities of addiction treatment through the perspectives of two professionals, Heather and Josh, who share their personal journeys and insights into the stigma, politics, and treatment approaches surrounding addiction. They discuss the importance of understanding the underlying causes of addiction, the role of choice, and the need for comprehensive education and support systems to effectively address addiction in society.   Know more about Josh & Heather's work: Addiction2recovery Podcast Book "Trauma's Worth" by Heather Bell   Know more about Sathiya's work: JOIN DEEP CLEAN INNER CIRCLE Got a Question? Submit It Anonymously Through This Form Get A Free Copy of The Last Relapse, A Blueprint For Recovery Watch Sathiya on Youtube For More Content Like This   Chapters: (00:00) Introduction to Addiction Medicine (01:53) The Journey into Addiction Treatment (10:11) Personal Stories of Addiction and Recovery (14:00) The Stigma Surrounding Addiction (23:05) Is Addiction a Choice? (29:46) Predictors of Addiction (37:15) The Role of Support Systems (46:29) Addressing Co-occurring Disorders (54:44) The Future of Addiction Treatment (1:00:50) Conclusion and Resources