Daily Archives: January 30, 2017

Further Details of the PART Hypothesis

Stylised Diagram of the Hippocampus - Frank Gaillard

Diagram showing Hippocampus, an area affected by Alzheimer’s Disease (credits Appendix A)

Crary and colleagues have written this 2014 paper on PART (Primary Age Related Tauopathy) (see also this paper by Crary). I’ve highlighted a few key points about the hypothesis from this paper

(1) The PART hypothesis is driven by pathological findings

(2) PART distinguishes between pathology and clinical manifestation

(3) Comorbid pathology presents a challenge when identifying ‘pure’ clinical correlates of PART

(4) Ambiguity in the hypothesis. PART has been described as:

(a) Distinct from Alzheimer’s Disease

(b) A subset of Alzheimer’s Disease cases

(c) An early stage of Alzheimer’s Disease (i.e. the Amyloid plaques may be expected to follow the appearance of the tangles)

(d) On a continuum with Alzheimer’s Disease

(5) PART also maps onto the pathology associated with several previous descriptors

(a) ‘Tangle Predominant Senile Dementia’

(b) ‘Tangle only Dementia’

(c) ‘Preferential Development of NFT without senile plaques’

(d) ‘Senile Dementia of the Neurofibrillary Tangle Type’

(6) TPSD (5a above) has previously been classed as a Frontotemporal Lobar Degeneration

The reader can see from the above that there are many possible variations of the hypothesis.

Appendix A – Credits

Picture by FG Designs. Creative Commons License.

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.

Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section.

Statisticians were Responsible for the Development of an International Classification of Diseases

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I wrote about the origins of the International Classification of Disease (ICD) in a previous post. The original classification described causes of deaths and was first presented and approved at the congress of the International Statistical Institute (ISI).

I checked out the schedule for the last conference of the ISI in Brazil in 2015 and was impressed by the breadth of topics (and intrigued by one topic – neurostatistics). It is particularly interesting to note that ICD which has led to the creation of diagnoses and influenced the lives of clinicians and patients alike was born in a statistical congress in 1893.

The mission statement of the International Statistical Institute is stated thus:

Founded in 1885, the International Statistical Institute (ISI) is among the oldest scientific societies. Its mission is to promote the understanding, development and good practice of statistics worldwide‘.

The society for advancing the study of a branch of mathematics has generated one of the most significant changes to clinical practice in the last few hundred years. I still don’t properly understand the details of how this was actualised but the longevity of ICD is testimony to the utility of a statistical (as well as clinical) underpinning.

I found it interesting that the statistical underpinnings are also referenced in the discussion of SNOMED-CT® by Schulz and colleagues

Health statistics over time should be affected as minimally as possible by changes in the underlying coding vocabulary. ICD has evolved for more than 120 years, which explains most of its structure, especially the single-hierarchy principle

Appendix A – Other Posts in the Series on Health Information Exchanges

A Literature Review of 40 years of SNOMED

Arizona Statewide Health Information Exchange

A History of The Health Information Exchange in Pennsylvania

The Arkansas Health Information Exchange – SHARE

The California Health Information Exchange – Cal Index

Creating a Health Information Exchange in Arizona

Health Information Exchanges

Health Information Exchanges and Chronic Conditions

HIPPA and Health Information Exchanges

ICD-11 and SNOMED CT®

ICD-SNOMED-CT® Harmonisation

Körner Data and SNOMED: A Snapshot from 1988

Mapping ICD 9 (or 10) to SNOMED CT®

Over 1 Million Relationships: SNOMED CT ®

Standardisation of Health Information Technology in New Zealand

Why Do We Need Electronic Record Systems to Talk to Each Other

Appendix B – Definition of Health Information Exchange

This is the definition of the Health Information Exchange that I use (Hersh et al, 2015)

Health information exchange (HIE), the electronic sharing of clinical information across the boundaries of health care organizations

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk.

Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section.