Is There Benefit from Stenting on Cognitive Function in Intracranial Atherosclerosis?

Background: Revascularization of stenotic cerebral arteries is hypothesized to improve cognition by increasing cerebral perfusion. Aims: We compared cognition impairment among patients treated with percutaneous angioplasty and stenting (PTAS) and aggressive medical management (AMM) versus AMM alone in the Stenting versus Aggressive Medical Therapy for Intracranial Arterial Stenosis (SAMMPRIS) Trial. Methods: In SAMMPRIS, 451 patients with recent transient ischemic attack or stroke attributed to 70-99% intracranial stenosis were randomized to PTAS plus AMM or AMM alone. Patients who had stroke as the qualifying event with National Institutes of Health Stroke Scale indicating aphasia or neglect were excluded from these analyses. Patients with a cerebrovascular event (ischemic stroke, cerebral infarct with temporary signs or intracranial hemorrhage) during follow-up were excluded from follow-up visit analyses. The Montreal Cognitive Assessment (MoCA) score was used to assess cognition impairment at baseline, 4 months, 12 months and closeout. Cognitive impairment was defined as MoCA <26. Mean MoCA scores and the percentage of patients with cognitive impairment were compared between treatment groups at each time point using t tests and chi-square tests. Differences in MoCA mean at baseline and follow-up time points were compared using mixed model repeated measures ANOVA and Tukey-Kramer tests. Results: There were no significant differences between the treatment groups for mean MoCA at any time point. Mean MoCA scores improved in both groups. The percentage of patients with cognitive impairment in the AMM versus PTAS groups was not significantly different at any time point. Conclusions: Revascularization with PTAS showed no improvement in cognitive impairment over AMM alone among patients who did not have recurrent cerebrovascular events during follow-up.

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Abstract W P382: Cognitive Outcome in SAMMPRIS: Medical Therapy vs. Stenting

Stroke ◽

10.1161/str.46.suppl_1.wp382 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Alison P Smock ◽

Tanya N Turan ◽

George A Cotsonis ◽

Michael J Lynn ◽

Colin P Derdeyn ◽

...

Keyword(s):

Cognitive Impairment ◽

Repeated Measures ◽

Mixed Model ◽

Cerebral Arteries ◽

Cognitive Outcome ◽

Chi Square ◽

Treatment Groups ◽

Angioplasty And Stenting ◽

Time Point

Background: It has been hypothesized that revascularization of stenotic cerebral arteries may improve cognitive outcome by increasing cerebral perfusion. We sought to compare cognitive outcome in patients treated with percutaneous angioplasty and stenting (PTAS) and aggressive medical management (AMM) vs. AMM alone in the SAMMPRIS Trial. Methods: In SAMMPRIS, 451 patients with recent TIA or stroke attributed to 70%-99% intracranial stenosis were randomized to PTAS plus AMM or AMM alone. Patients with stroke as the qualifying event who had a NIHSS indicating aphasia or neglect were excluded from these analyses. Patients with any ischemic stroke, cerebral infarct with temporary signs (CITS), or ICH during follow-up were excluded from subsequent follow-up visit analyses. The Montreal Cognitive Assessment (MoCA) score was used to assess cognition at baseline, 4 months, 12 months, and closeout (mean 3.05 years in AMM group and 3.12 years in PTAS group). Cognitive impairment was defined as MoCA <26. Mean MoCA scores and the percentage of patients with cognitive impairment were compared between treatment groups at each time point using t-tests and Chi-square tests. Differences in MoCA means from baseline to follow-up time points were compared using mixed model repeated measures ANOVA and Tukey-Kramer tests. Results: As shown in the Figure, there were no significant differences between the treatment groups for mean MoCA at any time point. There were significant improvements in mean MoCA from baseline to 4 months, 12 months, and closeout in both groups. The percentage of patients with cognitive impairment in the AMM vs. PTAS groups were not significantly different at baseline (53 vs. 56%), 4 months (38 vs. 44%), 12 months (42 vs. 40%), and closeout (43 vs. 39%). Conclusions: Revascularization did not provide any additional cognitive benefit over AMM alone in SAMMPRIS even after excluding patients who had cerebral infarction or ICH during follow-up.

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Long-term seizure outcomes after pediatric temporal lobectomy: does brain MRI lesion matter?

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.4.peds18677 ◽

2019 ◽

Vol 24 (2) ◽

pp. 200-208

Author(s):

Ravindra Arya ◽

Francesco T. Mangano ◽

Paul S. Horn ◽

Sabrina K. Kaul ◽

Serena K. Kaul ◽

...

Keyword(s):

Repeated Measures ◽

Mixed Model ◽

Linear Mixed Model ◽

Hippocampal Sclerosis ◽

Brain Mri ◽

Temporal Lobectomy ◽

Seizure Freedom ◽

Seizure Onset

OBJECTIVEThere is emerging data that adults with temporal lobe epilepsy (TLE) without a discrete lesion on brain MRI have surgical outcomes comparable to those with hippocampal sclerosis (HS). However, pediatric TLE is different from its adult counterpart. In this study, the authors investigated if the presence of a potentially epileptogenic lesion on presurgical brain MRI influences the long-term seizure outcomes after pediatric temporal lobectomy.METHODSChildren who underwent temporal lobectomy between 2007 and 2015 and had at least 1 year of seizure outcomes data were identified. These were classified into lesional and MRI-negative groups based on whether an epilepsy-protocol brain MRI showed a lesion sufficiently specific to guide surgical decisions. These patients were also categorized into pure TLE and temporal plus epilepsies based on the neurophysiological localization of the seizure-onset zone. Seizure outcomes at each follow-up visit were incorporated into a repeated-measures generalized linear mixed model (GLMM) with MRI status as a grouping variable. Clinical variables were incorporated into GLMM as covariates.RESULTSOne hundred nine patients (44 females) were included, aged 5 to 21 years, and were classified as lesional (73%), MRI negative (27%), pure TLE (56%), and temporal plus (44%). After a mean follow-up of 3.2 years (range 1.2–8.8 years), 66% of the patients were seizure free for ≥ 1 year at last follow-up. GLMM analysis revealed that lesional patients were more likely to be seizure free over the long term compared to MRI-negative patients for the overall cohort (OR 2.58, p < 0.0001) and for temporal plus epilepsies (OR 1.85, p = 0.0052). The effect of MRI lesion was not significant for pure TLE (OR 2.64, p = 0.0635). Concordance of ictal electroencephalography (OR 3.46, p < 0.0001), magnetoencephalography (OR 4.26, p < 0.0001), and later age of seizure onset (OR 1.05, p = 0.0091) were associated with a higher likelihood of seizure freedom. The most common histological findings included cortical dysplasia types 1B and 2A, HS (40% with dual pathology), and tuberous sclerosis.CONCLUSIONSA lesion on presurgical brain MRI is an important determinant of long-term seizure freedom after pediatric temporal lobectomy. Pediatric TLE is heterogeneous regarding etiologies and organization of seizure-onset zones with many patients qualifying for temporal plus nosology. The presence of an MRI lesion determined seizure outcomes in patients with temporal plus epilepsies. However, pure TLE had comparable surgical seizure outcomes for lesional and MRI-negative groups.

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AB0369 EFFICACY AND SAFETY OF RITUXIMAB ORIGINATOR AND BIOSIMILAR IN PRIMARY SJÖGREN’S SYNDROME IN A REAL-LIFE SETTING

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6608 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1485.3-1485

Author(s):

F. Carubbi ◽

A. Alunno ◽

P. Cipriani ◽

V. Pavlych ◽

C. DI Muzio ◽

...

Keyword(s):

Disease Activity ◽

Real Life ◽

Primary Sjögren’S Syndrome ◽

Efficacy And Safety ◽

Research Support ◽

Treatment Groups ◽

Real Life Setting ◽

Patient Reported ◽

Time Point

Background:Over the last 2 decades rituximab (RTX) has been widely used, albeit off-label, in primary Sjögren’s syndrome (pSS). Several studies reported that B-lymphocyte depletion with RTX is effective in this disease not only by reducing disease activity but also by affecting the inflammation and the lymphoid organization that occur in target tissues. With the recent release of several RTX biosimilars (bRTX) on the market, the demonstration of their interchangeability with RTX originator (oRTX) is required.Objectives:To compare efficacy and safety of oRTX and bRTX in pSS patients in a real-life setting.Methods:Clinical records of pSS patients referring to a tertiary rheumatology clinic were retrospectively evaluated. Patients having received at least 2 courses of either oRTX or bRTX (1000 mg IV infusion, repeated after 2 weeks -1 course- and the course repeated after 24 weeks) with complete data at baseline and after 3, 6, 9 and 12 months of treatment were enrolled. Disease activity was assessed with the EULAR SS disease activity index (ESSDAI) and its clinical version without the biological domain (ClinESSDAI). Patient-reported symptoms were assessed with the EULAR SS Patient Reported Index (ESSPRI).Results:Seven patients that received oRTX and 7 patients that received bRTX were enrolled. Baseline clinical features, including ESSDAI and ESSPRI were similar in the 2 treatment groups. Both compounds significantly reduced ESSDAI and ESSPRI as early as 3 months and no difference between the groups was observed at any time point (Figure 1). Of interest, ESSDAI slowly decreased until month 6 when the most pronounced reduction was observed. Conversely, ESSPRI dropped to its lowest values already at month 3. With regard to safety, at 12 months of follow-up no adverse event was observed in any of the treatment groups.Conclusion:At 12 months of follow-up, oRTX and bRTX display similar efficacy and safety profiles. The improvement of patient reported outcomes is faster than the improvement of disease activity with both compounds. Our data support interchangeability of oRTX and bRTX in pSS.References:[1]Carubbi F et al. Arthritis Res Ther. 2013;15(5):R172[2]Carubbi F et al. Lupus. 2014;23(13):1337-49Figure 1 ESSDAI and ESSPRI values at every time point in the 2 treatment groups. Asterisks indicate p values <0.05 compared to the other treatment group at the same time pointDisclosure of Interests:Francesco Carubbi Speakers bureau: Francesco Carubbi received speaker honoraria from Abbvie and Celgene outside this work., Alessia Alunno: None declared, Paola Cipriani Grant/research support from: Actelion, Pfizer, Speakers bureau: Actelion, Pfizer, Viktoriya Pavlych: None declared, claudia di muzio: None declared, Roberto Gerli: None declared, Roberto Giacomelli Grant/research support from: Actelion, Pfizer, Speakers bureau: Abbvie, Roche, Actelion, BMS, MSD, Ely Lilly, SOBI, Pfizer

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Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: a 6-year follow-up study

Psychological Medicine ◽

10.1017/s0033291712001948 ◽

2012 ◽

Vol 43 (6) ◽

pp. 1187-1196 ◽

Cited By ~ 83

Author(s):

E. Mora ◽

M. J. Portella ◽

I. Forcada ◽

E. Vieta ◽

M. Mur

Keyword(s):

Cognitive Impairment ◽

Processing Speed ◽

Verbal Memory ◽

Psychosocial Functioning ◽

Repeated Measures ◽

Rating Scale ◽

Psychosocial Adaptation ◽

Analysis Of Covariance ◽

Bipolar Patients

BackgroundPrevious cross-sectional studies report that cognitive impairment is associated with poor psychosocial functioning in euthymic bipolar patients. There is a lack of long-term studies to determine the course of cognitive impairment and its impact on functional outcome.MethodA total of 54 subjects were assessed at baseline and 6 years later; 28 had DSM-IV TR bipolar I or II disorder (recruited, at baseline, from a Lithium Clinic Program) and 26 were healthy matched controls. They were all assessed with a cognitive battery tapping into the main cognitive domains (executive function, attention, processing speed, verbal memory and visual memory) twice over a 6-year follow-up period. All patients were euthymic (Hamilton Rating Scale for Depression score lower than 8 and Young mania rating scale score lower than 6) for at least 3 months before both evaluations. At the end of follow-up, psychosocial functioning was also evaluated by means of the Functioning Assessment Short Test.ResultsRepeated-measures multivariate analysis of covariance showed that there were main effects of group in the executive domain, in the inhibition domain, in the processing speed domain, and in the verbal memory domain (p<0.04). Among the clinical factors, only longer illness duration was significantly related to slow processing (p=0.01), whereas strong relationships were observed between impoverished cognition along time and poorer psychosocial functioning (p<0.05).ConclusionsExecutive functioning, inhibition, processing speed and verbal memory were impaired in euthymic bipolar out-patients. Although cognitive deficits remained stable on average throughout the follow-up, they had enduring negative effects on psychosocial adaptation of patients.

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Development of white matter fibre density and morphology over childhood: a longitudinal fixel-based analysis

10.1101/342097 ◽

2018 ◽

Cited By ~ 1

Author(s):

Sila Genc ◽

Robert E Smith ◽

Charles B Malpas ◽

Vicki Anderson ◽

Jan M Nicholson ◽

...

Keyword(s):

White Matter ◽

Cross Section ◽

Repeated Measures ◽

Pubertal Stage ◽

Full Spectrum ◽

Fibre Density ◽

Fibre Development ◽

Over Time ◽

Time Point

AbstractPurposeWhite matter fibre development in childhood involves dynamic changes to microstructural organisation driven by increasing axon diameter, density, and myelination. However, there is a lack of longitudinal studies that have quantified advanced diffusion metrics to identify regions of accelerated fibre maturation, particularly across the early pubertal period. We applied a novel longitudinal fixel-based analysis (FBA) framework, in order to estimate microscopic and macroscopic white matter changes over time.MethodsDiffusion-weighted imaging (DWI) data were acquired for 59 typically developing children (27 female) aged 9 – 13 years at two time-points approximately 16 months apart (time-point 1: 10.4 ± 0.4 years, time-point 2: 11.7 ± 0.5 years). Whole brain FBA was performed using the connectivity-based fixel enhancement method, to assess longitudinal changes in fibre microscopic density and macroscopic morphological measures, and how these changes are affected by sex, pubertal stage, and pubertal progression. Follow-up analyses were performed in sub-regions of the corpus callosum to confirm the main findings using a Bayesian repeated measures approach.ResultsThere was a statistically significant increase in fibre density over time localised to medial and posterior commissural and association fibres, including the forceps major and bilateral superior longitudinal fasciculus. Increases in fibre cross-section were substantially more widespread. The rate of fibre development was not associated with age or sex. In addition, there was no significant relationship between pubertal stage or progression and longitudinal fibre development over time. Follow-up Bayesian analyses were performed to confirm the findings, which supported the null effect of the longitudinal pubertal comparison.ConclusionUsing a novel longitudinal fixel-based analysis framework, we demonstrate that white matter fibre density and fibre cross-section increased within a 16-month scan rescan period in specific regions. The observed increases might reflect increasing axonal diameter or axon count. Pubertal stage or progression did not influence the rate of fibre development in the early stages of puberty. Future work should focus on quantifying these measures across a wider age range to capture the full spectrum of fibre development across the pubertal period.

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The Effectiveness of the Dealing with Homophobia Psycho-Education Program on Psychological Counselor Candidates

Higher Education Studies ◽

10.5539/hes.v10n3p1 ◽

2020 ◽

Vol 10 (3) ◽

pp. 1

Author(s):

Meryem Vural-Batık

Keyword(s):

Education Program ◽

Repeated Measures ◽

Mixed Model ◽

Control Group ◽

Post Test ◽

Quasi Experimental ◽

And Control ◽

Quantitative And Qualitative Methods ◽

Experimental Group

The aim of this research is to investigate the effect of the Dealing with Homophobia Psycho-Education Program on homophobia levels of psychological counselor candidates. This research was conducted with a mixed model and utilized quantitative and qualitative methods. 2 (experimental and control groups) x 3 (pre-test, post-test, follow-up) research design which is a type of quasi-experimental design was used and content analysis was applied to the data obtained via interviews. The study was conducted with a total of 24 psychological counselor candidates, 12 in the experimental group and, 12 in the control group. The Homophobia Scale was used to determine the homophobia levels of psychological counselor candidates. The Dealing with Homophobia Psycho-Education Program was developed by the researcher. In order to determine the effectiveness of the program, The Two-Way Analysis of Variance with Repeated Measures was used. As a result of the research, it was determined that the Dealing with Homophobia Psycho-Education Program is effective in decreasing the levels of homophobia of the psychological counselor candidates. Also, according to the participant's views, it was determined that the psycho-education program was effective in decreasing homophobia and caused changes in attitudes. The importance and necessity of using the program on psychological counselor education are discussed.

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83 The acute effects of feeding a grain-free diet with or without methionine, taurine or methyl donor/acceptor supplementation on plasma and whole blood amino acid concentrations in dogs

Journal of Animal Science ◽

10.1093/jas/skaa278.112 ◽

2020 ◽

Vol 98 (Supplement_4) ◽

pp. 62-62

Author(s):

Sydney Banton ◽

Julia G Pezzali ◽

Renan Antunes Donadelli ◽

Marica Bakovic ◽

Katharine M Wood ◽

...

Keyword(s):

Whole Blood ◽

Repeated Measures ◽

Latin Square ◽

Acute Effects ◽

Treatment Groups ◽

Time Points ◽

Postprandial Response ◽

Donor Acceptor ◽

Amino Acid Concentrations ◽

Time Point

Abstract Grain-free pet foods have been sold for over a decade and comprise more than 40% of dog and cat diets sold today. Grain-free diets replace grain ingredients with pulse ingredients, which are high in lysine but low in methionine and cysteine, the precursor amino acids to taurine synthesis in the dog. The objective of this study was to evaluate the postprandial response of plasma methionine and taurine and whole blood taurine concentrations of dogs fed a grain-free diet without supplementation (CON) or with methionine (MET), taurine (TAU) or creatine, carnitine and choline (CCC) supplementation. Eight Beagles were pair housed and fed one of the four experimental diets for seven days in a 4x4 Latin Square Design. On the morning of d 7, cephalic catheters were placed and one fasted sample (0 min) and nine post-meal blood samples (15, 30, 60, 90, 120, 180, 240, 300 and 360 min) were collected. Data were analyzed as repeated measures using the PROC GLIMMIX function in SAS (Version 9.4). Dogs supplemented with MET had significantly higher plasma methionine concentrations from 30 to 360 minutes post-meal compared to dogs on CON, TAU and CCC treatments (P < 0.05). However, no differences were observed in plasma methionine concentrations between CON, TAU and CCC treatments at any time point (P > 0.05). Plasma taurine concentrations were significantly higher across time points in all treatment groups compared to CON (P < 0.05). Whole blood taurine concentrations tended to be higher across time points in MET and TAU treatment groups compared to CCC (P = 0.0513). Overall, MET, TAU and CCC supplementation increased plasma taurine concentrations compared to CON, but only MET supplementation increased plasma methionine concentrations from 30 to 360 minutes post-meal.

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Changes in fruit, vegetable and fish consumption after statutory retirement: a prospective cohort study

British Journal Of Nutrition ◽

10.1017/s0007114520000136 ◽

2020 ◽

Vol 123 (12) ◽

pp. 1390-1395

Author(s):

Kirsi Ali-Kovero ◽

Olli Pietiläinen ◽

Elina Mauramo ◽

Sauli Jäppinen ◽

Ossi Rahkonen ◽

...

Keyword(s):

Fish Consumption ◽

Repeated Measures ◽

Food Habits ◽

Employment Status ◽

Mixed Model ◽

Negative Binomial ◽

Vegetable Consumption ◽

Healthy Food ◽

Health Study

AbstractRetirement is a major life transition affecting health and health behaviour, but evidence on how this transition contributes to changes in healthy food habits is scarce. We examined whether the consumption of fruit and vegetables as well as fish changes after transition into statutory retirement. The data were derived from the prospective Helsinki Health Study. At phase 1 in 2000–2002, all participants were 40- to 60-year-old employees of the City of Helsinki, Finland (n 8960, response rate 67 %). Follow-up surveys were conducted in 2007, 2012 and 2017 (response rates 79–83 %). Using the four phases, we formed three nested cohorts in which the participants either continued working or moved to statutory retirement. The final analytical sample consisted of 6887 participants (14 357 observations). Frequency of fruit, vegetable and fish consumption was calculated from a twenty-two-item FFQ. Analyses of repeated measures of food consumption before and after retirement transition were conducted with a negative binomial mixed model, adjusting for age, marital status, limiting long-standing illness and household income. During the follow-up, altogether 3526 participants retired. Transition to retirement was associated with a decrease in vegetable consumption among women and, contrarily, with an increase in fruit consumption among men (P < 0·05 for interaction between time and employment status). Fish consumption did not differ by the change in employment status. Statutory retirement can have mixed effects on healthy food habits, and these can differ between food groups and sex. Healthy food habits should be promoted among employees transitioning to retirement.

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PROMs and PREMs in Dutch integrated head and neck cancer care.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.6570 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 6570-6570

Author(s):

Rosella Hermens ◽

Lydia Francisca Jacoba van Overveld ◽

Robert P. Takes ◽

Jozé C.C. Braspenning ◽

Ludi E Smeele ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Mixed Model ◽

Mixed Model Analysis ◽

Treatment Groups ◽

Patient Reported ◽

Over Time ◽

Domain Scores

6570 Background: Providing patient-centred care is an essential component of high quality integrated care. A method to get insight in patients perspectives about the quality of health care they received, is measuring Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs). We aimed to determine the outcomes of, and differences between PROs and PREs over time and between treatment groups for patients with head and neck cancer (HNC). Methods: Patientswere recruited from nine hospitals participating in the DHNA. Validated questionnaires were distributed at baseline, 3, 6 and 12 months follow-up. Included PROMs were EuroQol 5 Dimension 3 Level (EQ-5D-3L), EORTC QLQ-C30 and -H&N35. Included PREMs, Consumer Quality index for Oncologic care (CQO) and Radiotherapeutic care (CQR), have similar domains with different questions. With descriptive analysis, ANOVA and mixed model analysis, differences over time and between treatment groups were analyzed. Results: Questionnaires were filled in by 426 patients. Pain decreased significantly at 6 and 12 months follow-up (14 and 21 points on a scale of 0-100) and dry mouth increased significantly at 3, 6 and 12 months follow-up compared to baseline (35, 27 and 20 points). Sticky Salvia, problems with social eating and sense problems increased at 3 and 6 months follow-up, but were similar to the baseline score at 12 months follow-up. Pain and sticky saliva differed between radiotherapy and chemoradiotherapy or surgery and radiotherapy respectively (p≤0.05). Regarding the CQO domain scores, all treatment groups differed significantly from each other (p≤0.05), especially for the domain Personal input. There was no difference regarding the CQR domain scores. Recognizing the emotional side of HNC and guidance after the treatment scored low in patients. Conclusions: This study gives clues to improve healthcare according the experiences of the patient and we can predict more carefully the outcomes of the patients with different treatment types. PROMs according to the ICHOM criteria and PREMs are promising for measuring and improving quality and personalization of HNC care. However, recognizing the emotional side of HNC and intensifying guidance after the treatment period needs improvement.

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NCOG-12. COGNITIVE FUNCTION (CF) & QUALITY OF LIFE (QOL) IN PATIENTS TREATED WITH PROCARBAZINE, CCNU, & VINCRISTINE (PCV) + RADIOTHERAPY (RT) VS. RT FOR ANAPLASTIC OLIGODENDROGLIOMA (AO) ON NRG RTOG TRIAL 9402

Neuro-Oncology ◽

10.1093/neuonc/noab196.603 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi154-vi154

Author(s):

Laura Donovan ◽

Minhee Won ◽

J Gregory Cairncross ◽

Fabio Iwamoto ◽

Jan Buckner ◽

...

Keyword(s):

Quality Of Life ◽

Treatment Groups ◽

Younger Age ◽

Baseline Characteristics ◽

The Impact ◽

Over Time ◽

Time Point

Abstract BACKGROUND PCV+RT substantially prolongs survival in AO patients, but long-term CF and QOL implications are unclear. We compared CF and QOL by treatment arm in RTOG 9402 participants and evaluated the impact that baseline characteristics had on CF, QOL, and survival. METHODS CF and QOL were evaluated using the Mini Mental State Exam (MMSE) and Brain-Quality of Life (B-QOL) scale at baseline and annually. Scores were analyzed between treatment arms at each time point for patients with ≥ 10 years of follow-up data. Shared parameter models evaluated MMSE and B-QOL scores and survival for all patients. RESULTS 42/148 (28.4%) participants in PCV+RT and 20/143 (14%) in RT alone arms survived ≥ 10 years. 35/42 and 39/42 (PCV+RT) and 18/20 and 17/20 (RT) participants completed baseline B-QOL and MMSE assessments, respectively. B-QOL scores did not differ between treatment groups at any time-point. Among 16 patients (10 PCV+RT, 6 RT) who completed year 10 MMSE evaluations, mean MMSE score at 10 years was higher in the RT arm (29.83 [95% CI 22.1, 30.0] vs. 26.50 [95% CI 29.4, 30.0], P= 0.04). Change in MMSE and B-QOL scores from baseline did not differ significantly between treatment groups at any time. In shared parameter models including all patients with baseline assessments, MMSE and B-QOL scores decreased over time (MMSE P= 0.0189, B-QOL P= 0.0005), but this did not differ by treatment group (MMSE P= 0.5727, B-QOL P= 0.3592). Younger age and higher KPS predicted better scores (MMSE P < 0.0001, P = 0.0002; B-QOL P = 0.0043, P = 0.0007). PCV+RT predicted better survival in both models. CONCLUSIONS PCV+RT improves survival in AO. Shared parameter models show decrease in MMSE and B-QOL over time. However, relative to RT alone, the addition of PCV did not impact change in CF and QOL over time.

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