Seth A. Margolis

Subjective cognitive complaints (SCCs) are common in Parkinson's disease (PD), yet the relationship among nonmotor symptoms remains understudied in early-stage, treatment-naïve populations. We examined interrelationships among SCCs, mood symptoms, and cognition in early-stage, treatment-naïve PD. We hypothesized that SCCs would relate to executive functioning and processing speed, and these relationships would be moderated by mood. Cross-sectional baseline data analyzed 250 individuals (169 men, 81 women; aged 50-84 years) in the Parkinson's Progression Markers Initiative. Moreover, t tests and Pearson correlations assessed associations among SCC group status, mood symptoms, and cognition. Ordinary least squares regression evaluated whether mood moderated the relationship between SCC group status and cognition. Participants in the higher SCC group were more likely to demonstrate processing speed impairment (14% vs. 5.3%, p = .02). Those in the higher SCC group exhibited poorer memory (p = .035, d = .41) and processing speed (p = .001, d = .21) and reported more depression symptoms (d = .84) and state (d = .72) and trait anxiety (ps < .001, d = .85). A significant interaction revealed that individuals in the higher SCC group with elevated state anxiety demonstrated worse memory (ps < .05). No other mood moderation effects were found. In early-stage, treatment-naïve PD, more SCCs corresponded with worse mood symptoms and worse processing speed and memory. Memory performance was worse when both higher SCCs and elevated state anxiety are present, but mood did not moderate higher SCCs' relationship with other domains. SCCs may be early indication of neurocognitive vulnerability. Longitudinal research is warranted to determine how mood symptoms impact SCCs' utility for predicting cognitive decline. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Increasingly, it has been recognized that non‐seizure‐related factors influence how people with epilepsy perform on neuropsychological tests. Therefore, neuropsychologists need to recognize the constellation of factors that can contribute to the neurocognitive presentation of a person with epilepsy and consider these factors in the interpretation of their assessment results. In this paper, we highlight common scenarios prompting the need to account for such factors when conducting and interpreting neuropsychological assessments. To illustrate these complexities, a case study is presented of a woman with early onset epilepsy complicated by a traumatic brain injury in adulthood who was a candidate for epilepsy surgery. A discussion of the need to consider neurodevelopmental, psychiatric, and psychosocial factors in conducting an assessment and arriving at a sound interpretation of results is presented. Clinical take‐away points are offered for guidance in undertaking such assessments.

Objective: Older adults with cognitive impairment are at risk of medication-taking errors. This study assessed the impact of providing medication adherence feedback to cognitively impaired older adults. Methods: Forty participants with mild cognitive impairment or mild dementia had their medication adherence electronically monitored for 8 weeks. They were provided with verbal and visual feedback about their adherence results. Initial participant reactions were elicited using a Motivational Interviewing approach, and self-reported behavior changes were assessed during a follow-up interview. Quantitative analyses assessed relationships among electronically monitored and self-rated adherence, initial reactions to adherence feedback, and subsequently reported medication self-management changes. Thematic analysis determined facilitators and barriers to making self-management changes. Results: Although self-rated adherence was high, electronic monitoring revealed that 20% of the sample had suboptimal adherence (took the recommended dose on <80% of monitored days). Fifty-three percent of the sample reported feeling surprised by their adherence results, and 45% endorsed initial motivation to change self-management behaviors. Motivated participants demonstrated worse electronically monitored adherence than unmotivated peers, and those who were surprised by their medication-taking errors expressed greater initial motivation to change. At follow-up, 50% reported having made changes, and 82.4% of them indicated that this study played a role. Facilitators of making changes included awareness of medication-taking errors and cognitive impairment, whereas barriers included lack of perceived difficulty/need. Conclusions: Adherence monitoring with feedback is feasible and impactful in cognitively impaired older adults. Increasing awareness of medication-taking errors fosters motivation to improve medication self-management and results in participant-reported behavior change.

In this prospective observational cohort study, we provide preliminary findings from a same-day multidisciplinary fast-tracked normal pressure hydrocephalus (NPH) clinic; incorporating the expertise of movement disorders neurologists, emphasizing the clinical characteristics, consensus classification, and management of patients referred for suspected NPH. We evaluated 111 patients (male/female: 67/44) from April 2022 to May 2023. Based on the multidisciplinary team consensus, 52 (46.8%) were classified as “probable” idiopathic NPH (iNPH), 14 (12.6%) as “possible” NPH, 42 (37.8%) as “unlikely” NPH, and three (2.7%) as secondary NPH. While parkinsonian syndromes were recognized in 19.2% of “probable” iNPH patients (vs. 7.1% in “possible” and 26.2% in “unlikely” NPH), no significant group differences were noted in the scores of the UPDRS-III scale. Degenerative spine pathologies were prevalent across all NPH categories, affecting at least 50% of patients. In the “probable” iNPH group, 78.8% received programmable ventriculoperitoneal shunts, with clinical improvement identified in 87.8% at 12-month follow-up. Our findings underscore the high prevalence of overlapping and competing movement and spinal disorders in patients with suspected NPH. Further, our novel approach, incorporating movement disorder neurologists in NPH multidisciplinary evaluation, improved diagnostic precision and streamlined personalized plans, including further neurological workups, necessary spinal interventions, and medical management or rehabilitation.

Nonbenzodiazepine hypnotics (“Z-drugs”) are prescribed for insomnia but might increase the risk of motor vehicle crash (MVC) among older adults through prolonged drowsiness and delayed reaction times. We estimated the effect of initiating Z-drug treatment on the 12-week risk of MVC in a sequential target trial emulation. After linking New Jersey driver licensing and police-reported MVC data to Medicare claims, we emulated a new target trial each week (July 1, 2007, to October 7, 2017) in which Medicare fee-for-service beneficiaries were classified as Z-drug-treated or untreated at baseline and followed for an MVC. We used inverse probability of treatment and censoring-weighted pooled logistic regression models to estimate risk ratios (RRs) and risk differences with 95% bootstrap confidence limits (CLs). There were 257 554 person-trials, of which 103 371 were Z-drug-treated and 154 183 untreated, giving rise to 976 and 1249 MVCs, respectively. The intention-to-treat RR was 1.06 (95% CL, 0.95-1.16). For the per-protocol estimand, there were 800 MVCs and 1241 MVCs among treated and untreated person-trials, respectively, suggesting a reduced MVC risk (RR, 0.83; 95% CL, 0.74-0.92) with sustained Z-drug treatment. Z-drugs should be prescribed to older patients judiciously but not withheld entirely over concerns about MVC risk. This article is part of a Special Collection on Pharmacoepidemiology.