Methods and Results—This retrospective cohort study of 695 patients enrolled at a university hospital-based anticoagulation clinic includes patients who received anticoagulation with warfarin or warfarin and aspirin between June 1, 2007 and September 30, 2008. All patients were ≥45 years old, had AF as the indication for anticoagulation, and did not have mechanical heart valves. Hemorrhages were classified as major if they caused death, involved critical sites, or required hospitalization with transfusion of ≥2 units of blood. All other bleeds were classified as minor. Of the 695 patients 307(44.2%) received combination therapy. Hemorrhage rates in the warfarin and the combination cohorts were 5.2% and 7.0% per 100-people years (p=0.29), respectively. There were 17 (3.4%) patients with major hemorrhages in the warfarin only group and 9 (2.8%) in the combination group (p=0.62). On average, patients on combination therapy had lower international normalized ratio (INR) values circa presentation (4.27 vs 3.13 p=0.049). In either group, any history of hemorrhage was associated with a 3.8 (95% CI, 1.79-8.13) times higher risk of hemorrhaging compared to patients without such a history.

Conclusions—This study highlights the high incidence of combination therapy and suggests that patients on combination therapy may bleed at lower INR levels. However, hemorrhagic outcomes did not differ significantly.

A prospective study geared at improving predictive value of olfactory testing with a battery of psychological tests enrolled 45 PD patients and 44 controls. Of the PD patients, 9 had bilateral STN (subthalamic nucleus) DBS and 36 were medically treated. Subset analysis of PD patients with and without DBS placement revealed no difference in apathy or depression. DBS patients had better olfaction on UPSIT (Univ of Pennsylvania Smell Identification Test) (p<0.05). No differ-ence was noted in disease severity, gender, smoking status, medica-tion dosing, use of dopamine agonists, or maximal olfactory sulcus depth on MRI. DBS patients were significantly younger, however inter-group differences in UPSIT scores exceeded those seen in our control cohort with similar ages.

This study provides further data that DBS patients have improved ol-faction. It also provides preliminary evidence that DBS with medica-tion improves dysosmia to a greater extent than medication alone. This may result from indirect stimulation of olfactory processing cen-ters or changes in olfactory circuitry metabolism.

Methods We designed a 5-question sleep quality survey to be filled out by each patient seen in our outpatient neurology clinics. The forms were collected for entry and analysis on an Excel spreadsheet program. A response of 2 or 3 (moderate or high chance of having a symptom) for each of the questions 1-4 and a “yes” for question 5 were considered significant symptomology. We compared the incidence of sleep problems between the general clinic and the multiple sclerosis (MS) clinic.

Results Surveys from 1008 patients were analyzed. A large majority (78%) of the neurology patients seen in our clinics was found to have at least one significant sleep related symptom. Most of these patients were not referred for further diagnostic testing by polysomnography (PSG) or for formal evaluation by a sleep clinic.

Conclusions Our data support a well-known notion that neurological patients have a high prevalence of symptoms related to sleep disorders. As neurologists, we ought to include sleep as one of the functions of the brain, and we need to be more diligent in the diagnosis of sleep disorders in our patients. Our future goals include verification of our data with objective evidence from PSG results or formal sleep evaluations.